An Israeli medical researcher has helped shed new light on a mystery that has endured for nearly 340 years: what killed Queen Christina of Sweden, one of 17th-century Europe’s most unusual monarchs.
Prof. Zaid Abassi of the Technion’s Ruth and Bruce Rappaport Faculty of Medicine and Rambam Health Care Campus, together with Prof. Rolf Barth of Ohio State University and Prof. L. Maximilian Buja of the University of Texas, reexamined historical records, symptoms documented during Christina’s lifetime and findings from her postmortem examination.
Queen Christina of Sweden
(Photo: Shutterstock)
Their conclusion: Christina most likely suffered from undiagnosed diabetes, which may have contributed to a chronic wound and bacterial infection in her right leg. The infection probably spread through her body, causing sepsis and ultimately her death at age 62.
The researchers caution that diagnosing a person who died centuries ago can never be definitive because the surviving medical evidence is incomplete.
An Israeli doctor joins a centuries-old investigation
The project began during a chance hallway conversation while Abassi was on sabbatical in Ohio State University’s pathology department.
Abassi and Barth, both physicians with an interest in history, began discussing Christina’s unexplained death. The conversation grew into a medical detective investigation that led them through centuries-old records and an autopsy report that had resurfaced in a private archive in Vienna.
“Following that conversation, I began digging through historical records and old autopsy reports, one of which unexpectedly surfaced in a private archive in Vienna,” Abassi said.
The researchers found that Christina had suffered from extreme thirst, excessive urination, weight loss and chronic wounds on her legs, symptoms they say are consistent with diabetes.
“Based on a professional analysis of all the records and clinical symptoms, which included extreme thirst, excessive urination, weight loss and chronic leg wounds, we were able to define the cause of Queen Christina’s death: undiagnosed diabetes accompanied by a chronic bacterial infection in the limb,” Abassi said.
Historical records suggest some of the symptoms had appeared years before Christina’s death. She reportedly suffered from thirst and weight loss from her 40s, while extreme thirst and frequent urination were documented during her final months.
Doctors in the 17th century, however, did not understand diabetes as a disease that could be diagnosed in the modern sense. Physicians knew that some people experienced excessive urination and urine with a sweet taste, but they did not have the diagnostic tools available today.
“Diabetes was not yet recognized as a diagnostic entity in the 17th century,” Abassi said. “Our diagnosis sheds light on the cause of her death and complements the findings of our predecessors, who correctly argued that she died from an infection.”
The wound that would not heal
Christina’s health deteriorated sharply in early 1689.
In February, a persistent wound reappeared on her right leg along with a red skin lesion diagnosed as erysipelas. By mid-April she was suffering from fever and repeated episodes of unconsciousness. She died on April 19, 1689.
Three days later, an autopsy was performed at Rome’s Riario Palace by court physician Alessio Spalla. Such examinations were relatively unusual in the 17th century, but the autopsy did not provide a clear explanation for Christina’s death at the time.
The three-day delay complicated later interpretation because the body had already undergone significant autolysis, the natural breakdown of cells and tissues after death. The researchers note that some changes may also have resulted from sepsis.
Apart from a single gallstone, the internal organs showed no obvious abnormality that could explain her death.
The strongest clue was in the leg.
Spalla recorded a recurring red lesion on Christina’s right leg diagnosed as erysipelas, a bacterial skin infection. Although the condition had been recognized by name for centuries, its bacterial cause was not identified until the late 19th century.
Untreated, erysipelas can spread and cause sepsis. By combining the recurring wound, the historical diagnosis and Christina’s rapid decline, the researchers concluded that sepsis from the leg infection was the most likely immediate cause of death.
They could not determine which bacterium was responsible.
A queen who defied convention
Christina was born in 1626, the only surviving child of King Gustav II Adolf. After her father was killed during the Thirty Years’ War, she inherited the Swedish throne at age six and began ruling in her own right at 18.
She became known as one of the most intellectually curious monarchs of her era, studying several languages, including Hebrew and Arabic, and maintaining relationships with leading thinkers such as René Descartes.
Her reign became increasingly controversial as she moved away from Lutheranism and toward Catholicism.
In 1654, Christina abdicated, left Sweden disguised as a man and eventually settled in Rome, where she became closely involved in the city’s aristocratic and intellectual life and received support from several popes. She was also known for intervening on behalf of Rome’s Jewish community.
Her upbringing, clothing, refusal to marry and behavior fueled centuries of speculation about her sex and sexuality. The researchers stress that much of that speculation rests on incomplete evidence and later interpretations shaped by eras with very different understandings of sex and gender.
After her death, Christina was buried in St. Peter’s Basilica, one of the relatively few women granted burial at the Vatican.
Her remains solved another mystery
In 1965, more than 250 years after Christina’s death, her remains were exhumed and examined using modern medical and anthropological methods.
Researchers carefully measured her skeleton but could not conclusively determine which illnesses she had suffered during her lifetime.
The examination did, however, establish that Christina had scoliosis and addressed another long-running question surrounding her: measurements of her pelvis and shoulders showed that the skeleton was female.
The new study now adds a medical explanation for her final illness.
“This research, combining pathology, physiology and medical archaeology, proves that even after hundreds of years, modern science can shed light on the lives and deaths of historical figures and solve mysteries sealed between the pages of history,” Abassi said.
The study was published in the medical-history section of the Swedish journal Läkartidningen. Its authors nevertheless emphasize that any retrospective diagnosis of a person who died centuries ago must remain cautious because the available medical evidence is necessarily incomplete.