It was Queen Victoria's darkest day. On December 21, 1861, her husband of 21 years, Prince Albert, died at the age of just 42. She never got over his death, and dressed in black for the rest of her life. On the death certificate, the registrar-general gave the cause of death as "typhoid fever: duration 21 days".
Typhoid is caused by the bacterium Salmonella typhi. It is spread by consuming food or water contaminated with the faeces of an infected person. The disease is therefore associated with poor sanitation and unhygienic preparation of food. 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.
The Great Stink
Only a few years before, during the hot summer of 1858, the sluicing of raw sewage into the Thames had reached crisis point, producing the "Great Stink". For all Victorians, even the aristocracy, typhoid was an ever-present menace that could kill up to a third of those infected. Death was usually a result of intestinal ulceration – if one of the ulcers perforated, peritonitis would follow, as happens in the case of a burst appendix.
Despite the daily reality of typhoid in the 1860s, a stunned public almost immediately began to express scepticism regarding the diagnosis, with letters appearing in The Lancet and the British Medical Journal. No autopsy was performed – whatever the uncertainty regarding the much respected Prince's tragically premature end, there were no suspicious circumstances and the curiosity-driven dissection of a royal corpse was regarded as a step too far.
The royal doctors also had to consider the effect further public discussion of the Prince's illness would have had on the distraught state of his widow, Queen Victoria, which later deepened into a lifelong state of mourning that today we might call clinical depression. As far as the royal medical team were concerned, it was case closed.
Recent biographies of Prince Albert have either tended to gloss over the exact cause of death as unimportant or actively dispute it. 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.
Certainly, Albert's health had been deteriorating intermittently for several years. Although he and his wife were almost purely constitutional monarchs in the modern sense, with the reins of government held firmly by the prime minister and the cabinet, Albert insisted on taking a very active role in decision-making.
Nineteenth-century deference to the aristocracy and the Prince Consort's assertive personality meant that he was rarely denied this privilege, and he frequently distressed himself acutely over matters well beyond his official job description. Nor did he use his dabbling in government as an excuse to avoid the ceremonial aspects of his role. Albert's life became a whirlwind of public engagements and private office work over long hours; he was a man driving himself to the brink.
Nevertheless, the typhoid fever diagnosis ought not to be completely discounted. The junior of the main pair of royal physicians was William Jenner, the world's acknowledged expert on typhoid fever. His theoretical superior, the 72-year-old Sir James Clark, had first become known as the doctor who treated the poet John Keats during his final illness in Rome 41 years previously. In 1861, however, Clark's contribution to Prince Albert's care went little beyond the reassurance provided by his eminent presence in the sickroom.
Instead, Jenner took the lead, basing his diagnosis of typhoid on previous observation of hundreds of cases. If anybody knew typhoid, Jenner did, and he saw the same pattern playing out in Albert.
Albert had been well and in relatively good spirits on the royal family's annual outing to Balmoral in late summer 1861, but after the holiday he returned to his old habits of obsessive working. Psychologically he was under great strain due to the recent deaths of three of his cousins in the Portuguese royal family, coincidentally also all from typhoid. The Queen noted his depression in her diary on November 12. One of his daughters also later recollected that he ate very little during this time.
On November 22, Albert had been soaked to the skin by a rainstorm on a morning visit to Sandhurst military academy. The following day, he began to complain of rheumatic pains and feeling very unwell.
But on November 25, instead of resting and recuperating, he went off to Cambridge to upbraid his eldest son, Albert Edward, the Prince of Wales, on his liaison with what Albert called a "low, common woman" – the actress Nellie Clifden, who had become the student prince's first mistress.
They went for a long walk, considerably lengthened by a wrong turning in the rain. Albert returned exhausted, once again soaked to the skin, and in his native German "recht elend" (quite miserable). Despite this extreme tiredness, Albert recorded in his diary that day that he had scarcely slept for a fortnight.
A few days later, at an Eton College parade on November 29, witnesses recorded that the Prince Consort looked very unwell and he complained to one of his daughters of "very heavy catarrh" and a headache as well as rheumatic pain. He later suffered from a violent coughing fit.
Jenner examined him that evening but did not initially suspect anything serious. The following day, Albert was back at his desk, but once again soon exhausted. From December 4, he began to go badly downhill, exhibiting signs of breathlessness with occasional vomiting and episodes of delirium. His insomnia continued and Jenner and Clark became, between themselves, increasingly worried, although the nervous Queen was kept reassured.
On December 7, Jenner noticed the characteristic pink-purple "rose spots" of typhoid on the Prince Consort's abdomen. The last piece of the jigsaw had slotted into place, and the diagnosis of typhoid was made.
There was a slight improvement from December 8-11, but on December 12 the fever, breathing difficulties and delirium returned with greater force and he coughed up a large quantity of mucus. On December 14, the fever intensified further, his hands and face began to darken (possibly a cyanosis from circulatory failure) and his breathing became more rapid. Just before 11pm, he died.
Can this have been a description of typhoid? The slow progress of the disease over three weeks is very characteristic. Likewise the sporadic delirium, rose spots, headache, coughing and progressive exhaustion are all typical symptoms.
Mid-19th century doctors had virtually no laboratory diagnostic resources and relied almost exclusively on observation of the patient. The first blood test for typhoid was not developed until 1896. In Albert's case, the key sign was the rose spot rash.
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. Where the other symptoms are diffuse and general, it is often the rash that clinches things.
But if we accept Jenner's observational experience and expertise in typhoid and agree with his diagnosis, the question then arises of when the Prince 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. 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. Albert was also eating virtually nothing at this time, also minimising the opportunities for typhoid transmission.
However, this critique fails to consider the issue of the incubation period of the disease. Typhoid has a clinical course of three to four weeks, but a wide incubation period of six to 30 days. To find the places where the Prince Consort was potentially infected, we need to look at his diary not in late November but from late October to mid-November.
The royal party left Edinburgh by train for London on October 23, having travelled the day before from Balmoral, where they had been since August 31. En route from Balmoral to Edinburgh, the only meal was a lunch taken at Stonehaven, on the coast near Aberdeen. In Edinburgh, all dining was at Holyrood Palace, where several eminent guests joined the royal party.
After that, Albert was based at Windsor until his death, the only trips of any distance being four to London on October 26, October 30, November 6 and November 11, and the visit to his son in Cambridge on November 25. It is possible that Albert was infected with typhoid during that Stonehaven lunch break, or perhaps on one of his London trips but that is, of course, purely speculative.
The London Morning Post, on December 18, 1861 recorded just 39 cases of typhoid fever in London in the previous month. The only mention of typhoid in the Press and Journal, the local newspaper in Stonehaven, in 1861 was to report the death of the Prince Consort. So further investigation of the possible incubation period does not lend any obvious support to the typhoid theory.
A third possibility remains. Albert may have had an illness that is still unknown today. 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.