Here's a fun fact for you: George II, the king of Great Britain from 1727 to 1760, was
the last British monarch to take part in a battle.
Rather than die on the battlefield, though, George died an aged man of 76, after suffering
an aortic dissection while trying to pass a bowel movement.
Not exactly the stuff of legend.
An aortic dissection is when the body's main artery, the aorta, tears its inner walls,
potentially leading to a full split of the artery.
Its symptoms are similar to other cardiac crises and include chest pain, sudden stomach
pain, a loss of consciousness, and symptoms that may appear to resemble those of a stroke.
Aortic dissection, while relatively rare, is often fatal and requires open-heart surgery.
In King George's day, it was pretty much a death sentence.
However, there are other theories regarding the sudden death of King George.
For example, some have argued that the immediate cause was actually a right ventricular rupture
caused by heart disease.
The notion that the aortic dissection killed him stems from his autopsy report, which makes
for some pretty grisly reading.
According to the king's autopsy, on the day of his death, George II woke up at 6 a.m.,
drank some hot chocolate, and went into his water closet in his home at Kensington Palace.
Soon, the king's attendant heard a noise from within the bathroom and ran in, finding the
king collapsed on the floor.
The personal physician of the king, Frank Nicholls, performed the autopsy, which was
a vital process in ensuring that the king hadn't died under suspicious circumstances.
Nicholls began by dissecting the king's abdomen, then moved to his brain, and finally his chest.
According to the autopsy report, he found that the membrane surrounding the heart was
"distended with a quantity of coagulated blood" — a recognizable sign of aortic dissection.
This was actually the first recognizable record of aortic dissection by a medical expert,
and the picture painted in the report was a dire one.
Nicholls wrote:
"The whole heart was so compressed as to prevent any blood contained in the veins from being
forced into the auricles; therefore the ventricles were found absolutely void of blood."
The autopsy's conclusion was even grimmer, confirming that the king had died "while straining
on the toilet."
The term "aortic dissection" itself wasn't used in the report, because it wouldn't be
coined until 1802.
Still, the king's death is widely known today as a famous example of this fatal condition.
However, some have argued that, although an aortic dissection did occur, it was not the
primary cause of King George II's death.
For one, though the report noted an inner tear on the aorta, the aorta didn't actually
rupture.
The blood instead pooled under the outer layer of the aorta, and the right ventricle ruptured.
This points to a sudden pulmonary event being the immediate cause of death, such as a large
pulmonary embolism.
In his autopsy report, Nicholls wrote that the king had heart problems in his old age:
"His Majesty had, for some years, complained of frequent distresses and sinkings about
the region of the heart.
[His] pulse was, of late years, observed to fall very much upon bleeding."
It's certainly possible that the king may have had coronary artery disease, though the
other findings in the autopsy were not particularly notable.
There were hydatid cysts around his kidneys, which, the autopsy notes, may have "eventually
proved fatal," but they were still small and likely didn't play a role in the king's death.
His brain and lungs looked normal too, according to Nicholl's notes.
George's son, Frederick, had died before George II, so the king was succeeded by his grandson,
George III — the man who infamously lost the U.S. War of Independence and suffered
a mysterious and debilitating mental illness.
"I believe we too can make Britain great — you as the prince regent, and I as King Penguin!"
For his part, Nicholls did not attend to George III.
Instead, the physician moved with his family to Oxford and later retired in Epsom, where
he died in 1778 at the age of 80.
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