An Event That Changed History
Princess Charlotte, the only legitimate granddaughter of George III, died five hours following childbirth, in November 1817. The baby also died. The obstetrician, Sir Richard Croft, committed suicide. Charlotte’s death changed history and led to the conception, birth, and reign of Queen Victoria. Princess Charlotte’s death has been widely reported as being due to postpartum haemorrhage, but a more recent analysis suggests that she died of pulmonary embolism (Friedman et al. Br J Obstet Gynaecol 1988;95:683–8).
Postpartum haemorrhage was the cause of death put forward in the first publication on the subject in modern times by Sir Eardley Holland in his seminal paper entitled ‘A triple obstetric tragedy’ (Holland. J Obstet Gynaecol Br Empire 1951;58:903–19). His conclusion was based on the description of the confinement found by the Croft family and donated to Sir Eardley. His contention was repeated by Sir John Dewhurst (Royal Confinements 1981;108–32). Among several more recent publications, Gillian Gill’s book, We Two, describing the life of Queen Victoria and Prince Albert, again offers haemorrhage as the cause of Charlotte’s death. The annotation in Wikipedia attributes Charlotte’s death to bleeding.
These accounts do not appreciate that pulmonary embolism was not recognised as a clinical or pathological diagnosis until 1846 when Rudolf Virchow described it (Virchow. Gesammelte Abhandlung Zur Wissenshaftichen Medicin 1856:227–380). A mandatory autopsy was performed and the lungs were ‘sliced’ but the pulmonary arteries were not examined by opening them. Death from postpartum haemorrhage is unlikely because all contemporary accounts, including the detailed description of her labour by her obstetricians, specifically state that there was no excessive external bleeding. The autopsy showed that the amount of blood clot found in the uterus above a persistent uterine constriction weighed ‘one pound and a half’. Because the volume of donated autologous blood admixed with citrate is greater than with normal blood, fresh blood was obtained from a healthy donor, weighed and allowed to coagulate. I found that one pound of blood clot would be derived from one pint of blood. This means that the blood clot found at autopsy would have been derived from 1.5 pints of fresh blood, unlikely to have caused death in an otherwise healthy young woman.
The description of the terminal events of the princess’s life by the physicians present at the delivery, all describe a respiratory death. In 1915, Dr R. Hingston Fox (Letter, The Lancet, 24 November 1917:804), first suggested that the Princess died of pulmonary embolism. The Princess’s 24‐hour second stage of labour was a sufficient cause of pelvic venous thrombosis leading to pulmonary embolism, and for the sake of historical accuracy, accounts of her death should include this possibility.
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