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For the want of an heir: the obstetrical history of Queen Anne.

Queen Anne had 17 recorded pregnancies but failed to leave an heir to the throne, and the succession passed to the Elector of Hanover, who became George I of England. Anne's disastrous obstetrical history was dynastically important and this has added interest to the purely medical aspects. Ever since her death there has been speculation on her recurrent fetal loss, and recent discoveries now enable us to give a coherent scientific explanation, linking this loss with her other illnesses. Anne's early medical history was marked by only a "defluxion" of the eyes, a constant watering for which she visited a French oculist at the age of 4. This persisted all her life and gave her problems with reading, especially by candlelight. Stenosis of the nasolacrimal ducts seems a likely diagnosis. She had smallpox, fortunately a mild attack, and was troubled by blushing all her life, which may be more important. In 1683, aged 17, she married Prince George of Denmark, an arranged union with a Protestant prince which turned out happily for them both. George was a man of monumental dullness, distinguished only by his appetites for food and drink, his mild military ambitions, which were squashed by William of Orange when he became king, and his asthma. One wag said that his heavy breathing was all that convinced people he was in fact alive. Anne's prompt first pregnancy ended with a stillborn daughter. Two daughters were born in 1685 and 1686 but died of smallpox in 1687. Three miscarriages followed, and in 1689 William Duke of Gloucester was born. He was always a weakly child, with a head too big for his body; he had difficulty in walking, running, and getting to his feet if he fell. He seems to have had some form of hydrocephalus, and the painting by Closterman in the National Portrait Gallery in London certainly suggests this, though presumably in suitably modified form. He was ofnormal intelligence, but died from a fever a few days after his 11th birthday in 1700. After Gloucester's birth there followed a daughter and a son who each lived less than a day. Anne then had a sequence of eight pregnancies, none of which resulted in a living child. The last of these was in 1700. One is recorded as a double gestation, a boy of 7 months' growth and another of 2 or 3 months, presumably a blighted twin. Anne succeeded to the throne on the death of William of Orange in 1702. George of Denmark died in 1708 and Anne in 1714 at the age of 49. The first stillbirth may or may not be important. The deaths of Anne's daughters from smallpox and her son's hydrocephalus and death from fever are unrelated to her own medical history. It is the 11 miscarriages and the two neonatal deaths that we must consider, and we must take into account the fact that her last 10 pregnancies did not produce a child who lived more than two hours.