Fans of ITV’s Victoria have delighted in the return of the costume drama for a second series.
The popularity of the show, starring Jenna Coleman as Queen Victoria and Tom Hughes as Prince Albert, has prompted a fresh debate over how the prince met his untimely end.
The Royal took his last breath at 10.50pm on the night of Saturday 14 December 1861 at Windsor Castle in the presence of the inconsolable wife and five of their nine children. He was just 42. Queen Victoria, who adored Albert, never recovered from his death and always wore black.
The official cause on his death certificate is ‘typhoid fever: duration 21 days’. Yet a stunned public were sceptical over the diagnosis, with letters appearing in The Lancet and the British Medical Journal.
His death prompted many to ask, how could a vigorous man have died without warning? Now an academic has looked closely at the reports of Albert’s symptoms.
Writing for The Conversation, Derek Gatherer, a lecturer in the division of biomedical and life sciences at Lancaster University, examines the key problem with the diagnosis: there were no cases of typhoid fever reported at any of the places Albert visited three weeks before his death.
An alternative theory is that Albert was suffering from a ‘modern’ condition not even known about then – Crohn’s disease – or even stomach cancer. Here Dr Gatherer outlines various theories.
ITV’s Victoria stars Jenna Coleman as Queen Victoria and Tom Hughes as Prince Albert
Queen Victoria, who adored Albert, never recovered from his death and always wore black
The case for typhoid
Grieving Victoria refused to allow a post-mortem to be carried out on her beloved husband.
And of course mid-19th century doctors had virtually no laboratory diagnostic resources and the first blood test for typhoid was not developed until 1896.
So doctors relied almost exclusively on observation of the patient. In Albert’s case, the key sign was a rose spot rash.
The official cause on the Prince’s death certificate is ‘typhoid fever: duration 21 days’
HOW TYPHOID SPREADS
Typhoid fever is caused by a type of bacteria called Salmonella typhi.
This isn’t the same bacteria that cause salmonella food poisoning, but the two are related.
The Salmonella typhi bacteria will be in the stools (poo) of an infected person after they’ve been to the toilet.
If they don’t wash their hands properly afterwards, they can contaminate any food they touch. Anyone else who eats this food may also become infected.
Less commonly, the Salmonella typhi bacteria can be passed out in an infected person’s urine.
Source: NHS Choices
In the last weeks of his life, Albert suffered from terrible muscular pains, insomnia, headaches and ‘very heavy catarrh’.
A visit to the new Royal Military Academy at Sandhurst in the pouring rain added to his woes, as did highly emotional a meeting at Cambridge two days later with his son, Bertie, the future King Edward V11, over his scandalous affair with a young actress, Nellie Clifden.
A few days later, at an Eton College parade on November 29, witnesses recorded that the Prince Consort looked very unwell.
It was on December 7 that a Royal physician noticed the characteristic pink-purple ‘rose spots’ of typhoid on the Prince Consort’s abdomen and made the diagnosis of typhoid fever.
There was a slight improvement in the following days, but on December 12 fever, breathing difficulties and delirium returned with greater force and he died two days later.
Can this have been a description of typhoid?
The disease was rife in Victorian times, especially among the poor as bad sanitation and hygiene were risk factors. But even Royalty were not immune and Albert’s cousins were said to have died from typhoid too.
‘The slow progress of the disease over three weeks is very characteristic,’ said Dr Gatherer.
‘Likewise the sporadic delirium, rose spots, headache, coughing and progressive exhaustion are all typical symptoms.’
Why are there doubts?
If Albert had typhoid, the question then arises of when and where he contracted it.
‘Biographers who disagree with the typhoid theory often point to the fact that December 1861 was a relatively quiet time for the disease,’ explained Dr Gatherer.
‘There were no cases reported in any of the locations where Albert was to be found in the three weeks or so before his death – neither in Windsor, Cambridge nor Sandhurst.
Critics of the typhoid theory say there were no reported cases anywhere Albert visited three weeks before death
‘Albert was also eating virtually nothing at this time, also minimising the opportunities for typhoid transmission.’
But this critique fails to consider the issue of the incubation period of the disease, he points out. Typhoid has a clinical course of three to four weeks, but a wide incubation period of six to 30 days.
After examining the Prince’s diary from a wider period – late October to mid-November – he notes that he made four trips to London, once via stopping for lunch in Stonehaven, on the coast near Aberdeen and a visit to his son in Cambridge.
There were no reports in the local papers of typhoid in Stonehaven or Cambridge and just 39 cases in London in November.
‘It is possible that Albert was infected on one of his London trips but that is, of course, purely speculative.
‘After that, Albert was based at Windsor until his death. So further investigation of the possible incubation period does not lend any obvious support to the typhoid theory.’
However, Dr Gatherer said the typhoid fever diagnosis ought not to be completely discounted.
‘The junior of the main pair of royal physicians [who diagnosed Albert] was William Jenner, the world’s acknowledged expert on typhoid fever. If anybody knew typhoid, Jenner did.
‘It is still a serious problem in many of the poorer parts of the world, but in the Victorian era, it could strike anyone, anywhere – even a prince.’
Did Albert die of Crohn’s?
‘One of the most favoured alternative theories is that Albert had stomach cancer (a disease that killed his mother at the age of 30), or perhaps Crohn’s disease,’ explained Dr Gatherer.
‘Certainly, Albert’s health had been deteriorating intermittently for several years.’
Indeed, historian Helen Rappaport, who has spent three years researching his death for her book, believes Albert actually succumbed to the very modern affliction.
Crohn’s is a serious – and sometimes fatal – form of inflammatory bowel disease that today affects one in 500 people.
Experts have proposed he actually succumbed to a more modern affliction – Crohn’s disease
While the exact cause is unknown, the condition is linked to a problem with the body’s immune system response.
Symptoms can come in waves and include debilitating and crampy abdominal pain, fever, fatigue, loss of appetite, chronic diarrhoea, liver inflammation and weight loss.
According to Helen, Albert had been chronically sick on and off all his adult life and suffered from long-standing gastric problems.
Rappaport took her findings, contained in a detailed 14-page medical dossier, to the John Radcliffe Hospital in Oxford where Dr Chris Conlon, consultant in infectious diseases including typhoid, and Dr Simon Travis, consultant in gastroenterology, examined them in detail.
Having looked at the evidence, both doctors dismissed typhoid fever and cancer as possible causes of death and concluded the evidence for Crohn’s looked very strong.
What are the other theories?
Dr Gatherer points out that a rash can be sign of many afflictions.
‘Infectious diseases often exhibit distinctive rashes or other skin lesion patterns – measles, chickenpox, smallpox, roseola, scarlet fever, syphilis, scabies, coxsackievirus, herpesvirus, Zika virus and papillomavirus as well as typhoid,’ he said.
He also says that another possibility remains.
‘Albert may have had an illness that is still unknown today,’ he added. ‘It is easy to be dismissive of the comparatively primitive medicine of the 1860s, but the medicine of our own age will be similarly dismissed 150 years from now.
‘We can be sure that there are some things we still do not fully understand, and perhaps Albert’s fatal decline is one of them.’