What killed Prince Albert?

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Prince Albert of Saxe-Coburg-Gotha was a lifelong martyr to his weak constitution, so much so that it turned him into a hypochondriac who always became extremely depressed when ill. Up till the age of 10, Albert suffered repeated attacks of croup brought on by the slightest cold. Baron Stockmar, his trusted German advisor – himself a qualified physician – noticed that Albert always had a tendency to tire easily after exercise and on such occasions was “apt to look pale and exhausted”. Stockmar took note especially of the prince’s “delicate stomach”; when Albert was in his late teens Stockmar worried that his physical condition “cannot be called strong”. Albert suffered from “fits of somnolence” well into adult life; even Victoria wrote how, on his first visit to England in 1836, Albert fell asleep at table at dinner and didn’t share her stamina for staying up late.

From childhood, Albert had always reacted badly to the common cold and feverish chills. He was forever going down with sore throats and swollen glands. He was also plagued by anaemia and nosebleeds; toothache and inflamed gums – all of which persisted into adulthood. There were bouts of dizziness and fainting too, and whenever he travelled by ship he succumbed to terrible seasickness. Such was the depth of his concern, that Stockmar had no confidence at all in Albert's ability to fight off severe illness; as early as 1844, when Albert was only 25, Stockmar presciently confided in a friend at the British court that “if ever he falls sick of a low fever you will lose him”.

From his late teens Albert had also complained of attacks of “rheumatism” – a significant symptom when it comes to making some kind of diagnosis of his condition (and which we will return to later). His suffering was made worse by his preternaturally robust wife’s obsession with fresh air. Victoria was intolerant of the heat and utterly impervious to the cold; she insisted on having the windows of her homes open, even in winter, with no room heated above 68 degrees. And so, like everyone else in the royal household, Albert was forced to endure extremes of cold in the underheated royal residences: at Windsor he would often get up as early as 6am to deal with the queen’s dispatch boxes and in winter was often seen wrapped in a rug, trying to warm his hands over his reading lamp. So cold was he that he took to wearing a fur-lined coat indoors and a wig to keep his balding head warm.

It was, however, his gut that preoccupied Albert the most, for this was where stress most took its toll on him. Victoria herself noted that whenever her husband was worried it would “affect his poor dear stomach”. Albert once complained that “the weak stomach with which [he] came into the world” he would “take with him to his grave”. Despite knowing this, he did himself no favours: he was always in a hurry, eating his meals fast and always rushing off to the next meeting. His frequent bouts of ill health often resulted in a loss of appetite, and yet he had a tendency to corpulence and bloating. Victoria noticed his flabbiness when she first met him in 1836 and by his early thirties many remarked on how Albert was putting on weight and ageing prematurely. As one observer remarked, he had the “sedentary air of an older man”.

Escalating physical and mental strain

But it isn’t just his physical health that we need to examine; Albert’s psychological makeup impinged directly on his wellbeing. His whole life was driven by an overriding if not slavish sense of duty. He was a perfectionist who was rarely able to truly relax, laugh and unwind. The Balmoral estate in Aberdeenshire was the only place where he enjoyed any real respite from his commitments and a degree of leisure time. This inability to let go was compounded by the fact that he rarely gave vent to anger and internalised his feelings. But worse, and most significant in terms of the inordinate amount of mental strain placed upon him, Prince Albert concealed how ill he often felt from his wife, being acutely aware of her extreme dependency on him and how badly she responded when he was ill.

Queen Victoria was a very loving and demonstrative wife but also very highly strung. Albert was inevitably first in the firing line of the unpredictable turmoil of her volatile nature and her bouts of PMT and post-natal depression. The physical consequences of so much strain were clear to see as he juggled endless problems and worries about his work, children, and a succession of political and governmental crises.

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During the 1850s one can observe a clear and accumulating pattern of escalating physical and mental strain, beginning with frequent bouts of insomnia in the run up to the opening of the Great Exhibition in May 1851. Albert admitted at the time that he felt “more dead than alive from overwork”.

Two years later, in June 1853, he fell gravely ill with measles, caught from one of the children. He was pitifully weak and his recovery was very slow – he remained listless and depressed for weeks afterwards. (It has been suggested that perhaps he had suffered complications such as encephalitis [inflammation of the brain].) During the Crimean War of 1854–6 Albert was the target of vicious and unjust accusations of being a traitor and a Russian spy. Once again the stress affected him physically, provoking attacks of severe rheumatism, exhaustion and fever.

By 1855, illness brought on by overwork was an almost permanent fixture in Albert’s life. Two years later he admitted that “I never remember having so much work to do as I have had lately”. The demands on him were now intolerable and it was grinding him down not just physically but also spiritually. Illness always lowered Albert’s spirits and brought on a heightened sense of fatalism. His wife’s response was generally ruthlessly dismissive; Albert always made such a drama of being ill, in Victoria’s view.

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But Albert warned his wife that he did not have her tenacity, nor her zest for life – and the last two years of his life saw a dramatic and rapid decline in his health. He never felt well any more, but continued to push himself relentlessly, obsessively. “I know that I dare not stop for a moment to relax,” he said. “Like the hawk, I must not sleep, but be forever on the watch.”

By the late 1850s the tenuous balance of Prince Albert’s health was punctuated by clear and recurring symptoms that increasingly took the form of feverishness, stomach cramps and attacks of diarrhoea. By 1861 his ill health had brought him so low and demoralised that it is likely he was also suffering from clinical depression.

But what was causing these marked and increasingly severe gastric attacks? When researching my book Magnificent Obsession I compiled a detailed medical case-history for Prince Albert (there being of course no convenient file on the subject in the Royal Archives) based on a close examination of comments in Albert’s own correspondence, the queen’s letters and journals, and the observations of people close to Albert in the royal entourage. I submitted my notes to experts in the field of gastroenteric and infectious diseases. They concurred with my thesis that Albert did not fall sick with typhoid fever in November 1861 – as it is often reported – but that he had clearly been suffering from a longstanding gastrointestinal complaint. Nor did his symptoms indicate bowel or colon cancer, as some have suggested.

A final flare up of a chronic illness?

All the medical evidence, such as survives (and Queen Victoria refused to allow a post-mortem that might have shed crucial light on Albert’s condition), points to him having succumbed to a final and severe flare up of Crohn’s Disease, a chronic inflammatory condition of the intestine, characterised by severe abdominal pain, mouth ulcers, fever, diarrhoea and arthropathy – all of which he had been suffering from for some time. This condition manifests itself in chronic problems in the gut that can go into periods of remission and then be triggered by periods of stress. The only other possible diagnosis suggested to me was abdominal tuberculosis, which is almost indistinguishable from Crohn’s. All the stresses of 1861 – from the death of Victoria’s mother in March prompting the queen’s collapse into hysterical grief; to anxiety about Bertie’s sexual escapades with Nellie Clifden at the Curragh; to the death of his cousin, the young and promising King Pedro of Portugal; to the final diplomatic nightmare of the Trent Crisis with America in November – had combined to aggravate Albert’s condition. It had flared up with a vengeance, causing a stricturing of the bowel that was probably complicated by an intra-abdominal abscess that perforated, leading to septicaemia.

Crohn’s Disease was, of course, unknown at the time: the basic symptoms of it as a type of ulcerative colitis were first described in 1904 and 1913, but it was not until 1932 that Burrill Crohn and his colleagues defined its nature more fully and the condition was given its present name.

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Within the limited capabilities of allopathic medicine of the time, the royal doctors could have diagnosed Albert’s condition as one of many kinds of ‘low fever’. In fact, they were at a loss to provide a definitive diagnosis; typhoid fever seemed to fit the bill, though the dreaded words remained unspoken at Windsor, for typhoid fever was considered ‘a poor man’s disease’ and it was decidedly unbecoming for a Prince Consort of the realm to go down with it. Without the doctors’ formal confirmation typhoid fever was, nevertheless, soon widely transmitted as the assumed cause of Albert’s death – and worse, with many publications (even now) confusing typhoid (a water born disease) with typhus (which is transmitted by fleas and lice).

The public accepted this conclusion without question, despite it soon being made abundantly clear in a press announcement that there was no prevalence of the sickness in Windsor or at the castle at that time. In fact, the very same month that Albert died, the medical journal The Lancet accurately suggested what now seems to have been the trigger of Albert’s final, fatal decline: “There was enough of suddenness in the immediate termination of the disease to raise the question whether it might not have been due to ulcerative perforation of the bowel”, and this had led to septicaemia. In the event, however, it was the onset of pneumonia in the final couple of days that actually killed Prince Albert on 14 December 1861. If it had not, the septicaemia would have done for him soon after.

A full and detailed description and analysis of all the evidence relating to Prince Albert’s condition can be found in the Appendix to Helen Rappaport’s book Magnificent Obsession: Victoria, Albert and the Death that Changed the Monarchy (Hutchinson 2011).