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Anne’s final pregnancy ended on January 25, 1700 with a stillbirth. She had been pregnant at least 17 times over as many years, and had miscarried or given birth to stillborn children at least 12 times. Of her five liveborn children, four died before the age of two.

Anne suffered from bouts of “gout” (pains in her limbs and eventually stomach and head) from at least 1698. Based on her foetal losses and physical symptoms, she may have had systemic lupus erythematosus, or antiphospholipid syndrome. Alternatively, pelvic inflammatory disease could explain why the onset of her symptoms roughly coincided with her penultimate pregnancy.

Other suggested causes of her failed pregnancies are listeriosis, diabetes, intrauterine growth retardation, and rhesus incompatibility. Rhesus incompatibility, however, generally worsens with successive pregnancies, and so does not fit the pattern of Anne’s pregnancies, as her only son to survive infancy, Prince William, Duke of Gloucester, was born after a series of stillbirths. Experts also believe syphilis, porphyria and pelvic deformation to be unlikely as the symptoms are incompatible with her medical history.

Anne’s gout rendered her lame for much of her later life. Around the court, she was carried in a sedan chair, or used a wheelchair. Around her estates, she used a one-horse chaise, which she drove herself “furiously like Jehu and a mighty hunter like Nimrod”. She gained weight as a result of her sedentary lifestyle; in Sarah’s words, “she grew exceeding gross and corpulent. There was something of majesty in her look, but mixed with a gloominess of soul”.

Anne’s sole surviving child, Prince William, Duke of Gloucester, died at age 11 on July 30, 1700. She and her husband were “overwhelmed with grief”. Anne ordered her household to observe a day of mourning every year on the anniversary of his death. With King William III childless and the Duke of Gloucester dead, Anne was the only person remaining in the line of succession established by the Bill of Rights 1689.

To address the succession crisis and preclude a Catholic restoration, the Parliament of England enacted the Act of Settlement 1701, which provided that, failing the issue of Anne and of William III by any future marriage, the Crown of England and Ireland would go to Sophia, Electress of Hanover, and her Protestant descendants.

Sophia was the granddaughter of James I-VI of England, Scotland and England through his daughter Elizabeth, who was the sister of Anne’s grandfather Charles I. Over 50 Catholics with stronger claims were excluded from the line of succession.

Anne’s father, the former King James II-VII, died in September 1701. His widow, Anne’s stepmother, the former queen, wrote to Anne to inform her that her father forgave her and to remind her of her promise to seek the restoration of his line, meaning her Catholic half-brother, James Francis, The Prince of Wales, but Anne had already acquiesced to the line of succession created by the Act of Settlement.