The London Prat

Queen Victoria's gene, a faith healer in the palace and a boy whose bruises were a state secret SPAŁA, POLAND, October 1912 - In a hunting lodge in the Polish forests, the eight-year-old heir to the Russian throne lay in bed, grey-faced, with a swelling in his groin so painful that he screamed for days. Bulletins were issued. Priests were summoned. A newspaper somewhere printed the first line of an obituary. The Tsarevich Alexei Nikolaevich had haemophilia, a condition that in 1912 was among the cruellest in medicine, and in Russia it was also a secret so closely guarded that most of the empire hadn't the faintest idea its future ruler was ill. How Queen Victoria Gave the Romanovs a Problem The story starts in England. Queen Victoria carried a mutation for haemophilia, and she passed it to at least two of her daughters and, through them, to the royal houses of Spain, Germany and Russia. Her granddaughter Alexandra, who married Tsar Nicholas II, was a carrier, and in 1904, after four daughters, she finally bore a son. Within weeks, the baby began to bleed from the navel and wouldn't stop. The article on haemophilia in European royalty traces the "royal disease" through the family trees of Europe, and it makes uncomfortable reading for anyone who believes in blue blood. What Was Actually Wrong With Alexei? For years historians debated which type of haemophilia he had. In 2009 a team of researchers analysed DNA from the remains of the Romanov family, discovered in the 1990s and 2000s, and identified a mutation in the gene for clotting factor IX. That means he had haemophilia B, sometimes called Christmas disease, a rarer cousin of the more common haemophilia A. In plain English, his blood lacked a protein needed to form clots. A fall, a knock or even a vigorous romp in the palace gardens could cause bleeding into his joints and muscles that wouldn't stop, and a bruise could turn into a medical emergency. What Modern Medicine Does for Haemophilia B Today, haemophilia is managed with regular injections of the missing clotting factor, which can be given at home from a young age. Patients who follow a prophylactic regime, with injections every few days, can lead almost entirely normal lives, play sport and travel. Newer drugs and gene therapies, which have been approved in recent years, aim to reduce or even remove the need for regular injections. The Haemophilia Society in the UK offers support to families, and a boy with Alexei's diagnosis born today would play football at school, with a care plan and a spare vial in his bag. The most traumatic thing in his day would be the school dinner. The Palace Where Nobody Could Say the Word The royal couple kept their son's condition a closely guarded secret. Public appearances were restricted, the press was told that the boy had minor illnesses, and members of the court were sworn to silence. A burly sailor named Andrei Derevenko was assigned to carry the boy when he couldn't walk. The Empress, desperate and exhausted, turned from doctor to doctor and, finally, to a Siberian holy man named Grigori Rasputin, whose apparent ability to calm the boy during his crises won her unshakeable devotion. You'll remember him from the previous chapter, and the way he ended up in the river. Here we see why the Tsarina defended him against everyone, including her own family. The Telegram From Siberia In the Spała crisis of 1912, the doctors told the Tsarina that the boy was dying. She wired Rasputin, who sent back a short telegram saying that the child wouldn't die, and that the doctors shouldn't be allowed to trouble him too much. The bleeding began to ease soon afterwards, and Alexei pulled through. Some historians have suggested that Rasputin's advice to stop the doctors may have saved him, since they had probably been giving him aspirin, a blood-thinner available since 1899, which would have made the bleeding worse. That's a theory, not a certainty, but it's a plausible one. If so, the miracle worker's greatest cure was telling the physicians to stop. A Modern Consultation Imagine the Tsarevich in a modern paediatric clinic. The haematologist explains the diagnosis, shows the nurse how to inject the factor, and hands over a patient card for emergencies. "He mustn't take aspirin," the doctor tells the Tsarina. "Or ibuprofen. Just paracetamol." The Tsarina nods, wide-eyed. "And who is Rasputin?" the doctor asks, reading her notes. "Nobody important," says the Tsarina, quickly. The palace sailor is given a different job, probably something with a mop. The court is told that the heir has a chronic condition, in the same way that the court of the day might be told about hay fever. The scandal evaporates. What Would Have Changed? A great deal, though not everything. A healthy, active Alexei would have reduced the pressure on his mother, and perhaps weakened Rasputin's grip on the court. The Tsarina might have taken a less obsessive interest in politics, and the scandal that undermined the monarchy might never have grown so toxic. But Russia's problems ran far deeper. The war, the food shortages, the military defeats and a stubborn autocracy were sufficient to bring down the dynasty. The Britannica biography of Rasputin makes the case that he was a symptom rather than a cause. The End of the Story It would be dishonest to treat this chapter as pure comedy, and the history here doesn't permit it. After the revolution, the Romanov family was held prisoner in Yekaterinburg, and on 17 July 1918 Alexei, aged thirteen, was killed with his parents and sisters by Bolshevik guards, along with the family doctor, Yevgeny Botkin, who had refused to leave them. No medicine could have prevented that. The boy whose every bruise had been a matter of state died, in the end, because of what he was born into. It's the one part of the story that a modern doctor couldn't fix. The Verdict: Treatable, Politically Fatal Modern medicine could have saved Alexei from haemophilia and given him a normal life. It couldn't have saved him from the revolution. If there's a lesson in the Romanov story, it's a rather dry one: when the heir to the throne has a medical problem, tell the doctors, tell them early, and don't put your faith in a man who works by telegram. And if you have a royal family, make sure at least one of them knows what a clotting factor is. Humorous Observations Queen Victoria was known as the "grandmother of Europe", and the title came with a hidden gene. The Tsarina hired a holy man to do what a haematologist could have done with a vial and a syringe. Rasputin's greatest medical advice was to stop the doctors, which is one of the few times in history that a fraud and an expert have agreed. A palace where you can't mention the heir's health is the only place in the world with a policy of complete clinical silence. The royal sailor who carried the boy was the original hospital porter, with better manners and a worse salary. Aspirin was the wonder drug of 1899 and the worst thing you could give a haemophiliac, which is a lesson for every optimist. A modern prescription card would have kept the Romanovs out of the history books as the world's most secretive family. The "royal disease" turned up in half the palaces of Europe, which is the only time in history that Queen Victoria's descendants all agreed on something.

Tag: Tsarevich Alexei death

Could Modern Doctors Have Saved Tsarevich Alexei? Haemophilia Is Now a Routine Injection, Not a Court Scandal

The London Prat

London Satire

bohiney.com

Encyclopedia of Satire

spintaxi.com