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

The history of antiphospholipid syndrome

Antiphospholipid Syndrome (APS) is an autoimmune disease which was defined in the early 1980s. The principal features include thromboembolic events and/or pregnancy losses in association with antiphospholipid antibodies (aPL). As an historical note, the full-blown picture of the syndrome resembles the illness suffered by Anne Stuart, Queen of England in the XVIII century, whose repeated miscarriages caused the end of the royal Stuart line and the Hanoverian succession. The identification of aPL started in the early XX century and was linked to the introduction of the serological test for the diagnosis of syphilis. This involves a reaction between an antibody (reagin) and a phospholipid antigen derived from bovine heart (cardiolipin). Later on, it was observed that not all subjects with a positive test had syphilis, and that the so called "false positive reaction" was often reported in patients with systemic lupus erythematosus. Different tests for the identification of aPL were subsequently developed: first lupus anticoagulant (1971) and then immunoassays for anticardiolipin (1983) and anti-beta2 glycoprotein I (1990) antibodies. In the same period the association between the presence of circulating aPL and thrombotic and obstetric events was established, both in patients with autoimmune diseases and in otherwise healthy subjects, leading to the identification of APS as a distinct autoimmune disease. This has allowed better diagnosis and more targeted treatment for many patients.

Queen Anne (1665-1714) and her health

The contemporary records of Queen Anne's health and disease are reviewed, including the strange diagnoses made and the treatments prescribed. A correct diagnosis is suggested.

'To[o] much eating stifles the child': fat bodies and reproduction in early modern England

This article examines associations between fat bodies and reproductive dysfunction that were prevalent in medical, midwifery and other literature in early modern England. In a period when fertility and successful reproduction were regarded as hugely important for social, economic and political stability such associations further contributed to negative attitudes towards fat bodies that were fuelled by connection with the vices of sloth and gluttony. Fat bodies were categorized as inherently, constitutionally, less sexual and reproductively successful. Consequently they were perceived as unhealthy and unfit for their primary purpose once they had reached sexual maturity: marriage and the production of children.

Contrasting selected reproductive challenges of today with those of antiquity--the past is prologue

Viewing human history through a medical lens provides a renewed appreciation for today's vexing reproductive challenges, as some modern dilemmas are actually continuations of similar challenges experienced long ago. Certainly there are many examples of assisted fertility therapy that were entirely theoretical only a generation ago, but have become commonplace in modern practice and society. In particular posthumous birth and infertility have, over time, been the focus of compelling social interest, occasionally even impacting national security and dynastic succession. While the concepts have remained static, the tools available to extend and improve reproductive success have changed radically. Appropriately regarded as confidential and private, an individual's reproductive details are typically impervious to formal study. Yet, archival sources including ancient literature and formal court records can occasionally provide evidence of otherwise deeply personal concerns of a different era. Our assessment finds the issues, worries, and desires of patients of antiquity to align closely with contemporary reproductive challenges. Because children and family have always been central to the human experience, the consequences of reproduction (or the lack thereof) can make substantial imprints upon the cultural, economic, and political landscape-irrespective of civilization or century. In this article, selected motifs are described in a broad historical context to illustrate how challenges of human reproduction have remained essentially unchanged, despite a vast accumulation of knowledge made possible by gains in reproductive science and technology. Plus ça change, plus c'est la même chose. -Jean-Baptiste Alphonse Karr (1808-1890).

William Henry, Duke of Gloucester (1689-1700), son of Queen Anne (1665-1714), could have ruled Great Britain

Hope for continuation of the Stuart dynasty in Britain ended with the death, from pneumonia in 1700, of the 11-year-old son of Princess Anne and Prince George, William Henry Duke of Gloucester. Considered by some to have been physically and mentally unfit to reign, careful examination of primary source materials shows him to have been a bright and interesting boy with mild hydrocephalus. Had he lived, he could have ruled.

A study of 100 high risk lupus pregnancies

Certain subgroups of lupus patients and those with circulating antiphospholipid antibodies (aPL) in particular, suffer a high rate of fetal loss. Over the past 4 years, we have prospectively studied 100 pregnancies in patients with systemic lupus erythematosus (SLE) and primary antiphospholipid syndrome. In addition to conventional methods of monitoring SLE and fetal development, we have also used Doppler flow assessment of placental perfusion from the 14th wk of pregnancy onward. Patients with the antiphospholipid syndrome and previous history of thrombotic events were treated with daily heparin (10,000 IU) and low-dose aspirin (75 mg). Those without a history of thrombosis were treated with low-dose prednisolone, azathioprine, or hydroxychloroquine. Pregnancy loss was reduced from 81.3% in 101 previous pregnancies to 36.8% in 100 pregnancies managed by us. None of the patients who received hydroxychloroquine throughout the pregnancy presented fetal malformations. Careful management and close monitoring of the lupus pregnancy has substantially improved fetal outcome.