Elsevier

Cardiovascular Pathology

Volume 53, July–August 2021, 107340
Cardiovascular Pathology

The illness and death of King George VI of England: the pathologists' reassessment

https://doi.org/10.1016/j.carpath.2021.107340Get rights and content

Highlights

Abstract

The illness and death of King George VI has received renewed attention based on the events portrayed in the Netflix blockbuster series, The Crown. The King, a heavy smoker, underwent a left total pneumonectomy in September 1951 for what euphemistically was called "structural abnormalities" of his left lung, but what in reality was a carcinoma. His physicians withheld this diagnosis from him, the public, and the medical profession. The continuation of hemoptysis following surgery suggested that his cancer had spread to his right lung. Although he made a slow and uneventful recovery from his surgery, King George VI died suddenly and unexpectedly in his sleep on February 6, 1952, at the age of 56. Since the King had a history of peripheral vascular disease, it was assumed that the cause of death was a "coronary thrombosis." In this report, we explore the cardiovascular and oncologic findings relating to his illness and death and consider an alternative explanation for his demise, namely, that he may have died of complications from a carcinoma that had originated in his left lung and spread to his right lung, as evidenced by continued hemoptysis. We suggest that this possibly could have led to his sudden death due to either a pulmonary embolus or a massive intra-thoracic hemorrhage rather than a "coronary thrombosis."

Introduction

The first season of the Netflix blockbuster series, The Crown, begins with a dramatic portrayal in Episode 1 of the illness and, in Episode 2, the subsequent death of King George VI leading to the coronation of his daughter, Elizabeth, as Queen of the United Kingdom [1,2]. Albert Frederick Arthur George Windsor (called “Bertie” within the royal family) reluctantly ruled England as George VI for almost 16 years. This followed the abdication of his brother, Edward VIII in 1936 in order to marry the twice divorced American, Wallis Simpson. Edward subsequently lived the rest of his life in exile as the Duke of Windsor, and King George VI reigned until his death on February 6, 1952 at the age of 56. The official statement of King George VI's death was as follows:

"The King was found dead in bed at Sandringham House in Norfolk, on the morning of February 6. He had died from a coronary thrombosis – a blocking of blood flow to the heart – as a result of a blood clot in an artery – in his sleep. . . . The tea was never drunk: a blood clot had stilled George VI's valiant heart as he slept [3]."

But was this really the cause of death of King George VI? Since there was at that time a social stigma associated with the diagnosis of cancer, there was strong reason not to reveal that he had undergone a total left pneumonectomy for lung cancer in September of the previous year. His medical history is complex and not well documented and raises questions as to the nature of the acute event leading to his death that we will address in the following report.

Section snippets

Clinical history

George VI was a moderate drinker, but a heavy smoker, having begun as a teenager. Although it is impossible to determine precisely how heavy his cigarette smoking was, biographical descriptions [4,5] suggest that it is reasonable to estimate that his 40-year history of smoking possibly 2 packs of cigarettes per day would be equivalent conservatively to 80 pack-years. This would be an extraordinarily high number for someone who was only 56 years old at the time of his death. Furthermore, there

King George VI's cardiovascular disease

At issue are the extent, severity, and nature of King George VI's vascular disease. As previously described, he was a heavy smoker. In 1949, 2 years before developing lung cancer, he developed another smoking-related malady, namely, arterial insufficiency of his right lower extremity, as manifested by claudication [12]. To alleviate these symptoms, a lumbar sympathectomy was performed [6]. This procedure frequently was used at the time to improve arterial circulation to the lower limbs [13].

King George VI's lung cancer

King George VI, a heavy cigarette smoker with a possible 80-pack year history of cigarette smoking, developed a mass in his left lung that was identified by X-ray and chest tomography as cancer and which was easily reached by bronchoscopy and then biopsied. These features point to a centrally located bronchial tumor, most likely a squamous cell carcinoma [11,26]. His slow recovery and sudden death 4.5 months after his pneumonectomy raises the possibility that, although complete resection of the

Conclusions

Our interest in medical history is based on our belief that knowledge of major events and people that influenced the evolution of medical science and practice enriches and enhances the contemporary practice of medicine. This extends to the role of the autopsy in medicine[31,35]. Another interest is the elucidation of new information and insights into the deaths of historically noteworthy individuals [36,37]. It is in this vein that we have re-explored the death of King George VI, and we would

Acknowledgments

We could like to thank Mr. Pankaj Chandak, Transplant Surgery (Adult and Pediatric), Guys and Great Ormond Street Hospitals, London, England; Dr. Nahush Mokadam, Division of Cardiac Surgery, and Dr. Sergey Brodsky, Department of Pathology, The Ohio State University, Columbus, Ohio; and Dr. Christofer Barth, Director, Cardiac Surgery Intensive Care Unit, St. Luke's Hospital/Aurora Health Care, Milwaukee, Wisconsin for their insightful comments relating to the sudden death of King George VI.

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    This research received no specific grant support from funding agencies in the public, commercial, or not-for-profit sectors.

    The authors declare that there is no conflict of interest.

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    Both authors have contributed equally to the writing of this report.

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