Princess Alexandra (Alix) of Denmark (1844-1925) was the wife of Edward the Prince of Wales (1841-1910) subsequently King Edward VII. In February 1867 she developed a severe and very painful arthritis of the right knee. Her illness is well described in Jane Ridley’s excellent biography of Edward, The Heir Apparent.

As Edward was a promiscuous husband, Ridley considers the possibility that Alix was suffering from a sexually transmitted disease. She considers syphilis as a possibility, but after some length dismisses this possibility. This conclusion is correct. Syphilis does not cause monoarticular arthritis. Ridley goes no further and says that the princess had a septic arthritis of unspecified etiology.

Why when she thinks a STD might be the cause of this illness and then never considers the most likely possibility suggests that either she had a weak medical consultant or more likely that she didn’t get any medical advice at all. While without bacterial confirmation, impossible in 1867, I can only speculate – the obvious culprit in a healthy young woman married to a sexually hyperactive husband is Neisseria gonorrhoea. A third year medical student would put gonorrhea at the top of his differential diagnosis when presented with Princess Alix’s medical history of this illness.

Alix was eight months pregnant when she developed this illness. After much suffering she spontaneously recovered. In the absence of antibiotics that was the only way she could recover. The medical confusion aside, Ms Ripley’s biography is an excellent survey of both the Victorian and Edwardian eras and is highly recommended.