The Sickly Stuarts—the Medical Downfall of a Dynasty
Authors: Milo Keynes
Journal: Journal of the Royal Society of Medicine (2004)

In 1991 Frederick Holmes, now Emeritus Professor of Medicine at Kansas, took sabbatical leave and enrolled in a graduate course in Modern British History, beginning with a colloquium on the period from James I to Queen Anne. It gave him the idea for this book. Maintaining that there was what he calls a weak bridge between the Tudors and the Hanoverians, he attempts to show that the failure of the Stuart dynasty to last beyond 1714 was entirely due to ill-health and medical misadventure. He remarks that, if Cromwell had accepted the crown when it was offered to him, the dynasty would have come to an end after the rule of just two monarchs—though this would hardly then have been from medical downfall, given that the decapitation of Charles I was not truly a surgical procedure.

The book starts with a description of disease in the seventeenth century, followed by an assessment of the physicians who looked after the six Stuart monarchs and their families. The family name came from Henry Stuart. Lord Darnley, when he married Mary Queen of Scots, James VI was born 2 years later, but he was deserted by his mother before his first birthday and fostered after that. He became King of England in 1603 when he was 36 years old, and apparently died of a stroke in 1625. His weak legs remain unexplained, as do episodes of jaundice, but a shrunken kidney containing stones at post mortem explains the attacks of blood and gravel in his urine. From 1616 he was disabled from arthritis, and began showing a dementia 6 years before he died. The possibility of hyperparathyroidism has not been a speculation until this review.

The order in the chapter on the three children of James I who became adults does not make for easy medical history. They were Henry, Prince of Wales (1594-1612), who was intellectually remarkable and died of typhoid; Elizabeth, Queen of Bohemia (1596-1662), buried in Westminster Abbey on order of Charles II; and the unsatisfactory Charles I (1600-1649). The chapter starts with an account of the execution of Charles I, followed by the lives of Prince Henry and Elizabeth, before detailing the post mortem findings of Charles and those of Henry. It then discusses the childhood, the growing up, and the adult political failings of Charles, and ends by considering two of Elizabeth's children, Prince Rupert (1619-1682) and Sophia (1630-1714), who married the Protestant prince Ernst Augustus, later Elector of Hanover, and was mother of George I.

The devout Catholic Catherine of Braganza (1638-1703), the wife of the otherwise fertile Charles II, failed to become pregnant. Charles's death at 55 in 1685 may have been due to encephalopathy derived from his efforts to smelt and refine mercury in his laboratory—on the finding of raised levels of this metal in hair said to have come from his head.

In the Stuart family the deaths included one murder (Lord Darnley) besides the beheadings of Mary Queen of Scots and Charles I, and ten from uncertain causes. With some of the others there is inevitable speculation despite the surprising number of post mortem examinations. Historically, the poor health of a monarch may have had political importance, but it is the inability to produce a suitable heir that has been the usual cause for the end of a dynasty, as well as bad luck. Charles I (clearly more so) and James II were unsuitable in the way they dealt with Parliament, with both engendering a lessening power to the monarchy. However, James was deposed without losing his head—mainly because of his Roman Catholicism, a religion which he shared with the members of his second family, the Old and the Young Pretenders and Cardinal Henry Benedict, who died from uncertain causes aged 78, 68 and 82, and Louisa Mary, his daughter, who died from smallpox aged 20.

In exile after reigning for just 3 years, James set up his court in St Germain, near Paris, where he was buried in 1701 after a stroke at the age of 68. The elder of the two Protestant daughters of his first marriage, the childless Mary II, took the throne with William III in 1688 until her death from smallpox at the age of 32 in 1694. William died 8 years later, in 1702, from pneumonia after a fall from his horse, and was succeeded by Queen Anne. She died aged 49 in 1714, with only one of the five that survived childbirth from her seventeen pregnancies living beyond the age of 2 years. He was the hydrocephalic William, Duke of Gloucester, who died of pneumonia when aged 11. Anne's obstetrical calamities have been attributed to systemic lupus erythematosus, from the complications of which she may have died.

Professor Holmes's claim that the failure of the Stuart dynasty to last was entirely due to ill-health must be viewed with scepticism. It is also a bizarre view of history when he compares the Stuarts with the Bourbons and the Habsburgs, and then suggests that the countries of those other dynasties became more prosperous because of the longevity of their rulers. The book is nicely illustrated, and it is of interest to find out what happened to some of the less important Stuarts, such as the fourth son of Charles I, Henry, Duke of Gloucester (1620-1640), who died of smallpox. If he had survived, he might have been chosen to replace James II, as when he was pressed by their mother, Henrietta Maria, to become a Romanist, he was disowned by her on his refusal.