Sweating Bullets: A Story of Ann Boleyn 2/4

I am so honored to have JoAnn Spears back at Redwood’s Medical Edge. Her posts about the ailments of long lost monarchs are hugely popular and entertaining as well.

This four part Monday series focuses on Ann Boleyn and the mysterious sweating sickness that had a 70% mortality rate! You can find Part I here.

Welcome back, JoAnn!

Part 2:  Running hot and cold.

Anne Boleyn retreated to Hever when an unidentified lady-in-waiting of hers contracted The Sweat in June, 1528. Butts, however, is reported to have treated Anne herself for the ailment when he was dispatched to Hever.

Butts would have been under tremendous pressure, certainly, to pull his patient through, or suffer the ire of the infatuated Henry VIII.  The prospect of that must have loomed large for poor Dr. Butts.  Since Anne Boleyn was stricken during one of the midcourse outbreaks of the disease, it would likely have been established by then that mortality rates were high with this condition–as high as 70%–even in heretofore healthy individuals.

Pressure aside, Butts would have been faced with a patient who was enduring, had endured, or was about to endure a grueling progression of symptoms.  The acute trajectory of The Sweat was rapid.  From time of onset, death or a turning point toward survival typically occurred within 24 hours or, as Caius would have it, ‘one natural day’. 

Anne may have gone through the prodromal symptoms of violent chills and a feeling of doom before Butts got to her.  It’s possible that he arrived in time to see Anne through the second phase of the illness, characterized by severe cephalgia (aching and pain in the head and neck), diffuse myalgia (pain in the limbs), and prostration.  Even if he missed these prodromals, perhaps Butts was present for the eponymous symptoms that would have followed.

Caius relates that several hours after the initial vague symptoms of The Sweat set in, more telling symptoms followed.  He speaks of the “fight, trauaile (travail), and laboure of nature againste the infection receyued (received) in the spirites, whervpon (whereupon) by chaunce foloweth a Sweate’. 

As described by Caius, profuse and copious sweating and ‘heat’ were the manifestations of the fight of the patient’s constitution against the depredations of The Sweat. Caius, and poor Dr. Butts, practiced medicine in an era in which temperature, blood pressure, and electrolytes could not be accurately measured.  It seems likely though, that high fevers and autonomic instability were part and parcel of the acute phase of The Sweat.  This phase of symptoms would be followed by cardiopulmonary symptoms, according to Caius:  heart palpitations and chest pain, labored breathing, and an overall feeling of heaviness. Gastrointestinal symptoms such as nausea and ‘wind’ might also occur.  Eventually, exhaustion and a desire to sleep set in.

Anne Boleyn survived her experience with The Sweat and eventually went on to marry Henry VIII and give birth to his daughter, Elizabeth I.  Given Anne’s mercurial ways, it’s not surprising that there are some who say that she never had The Sweat at all.  Could it be that she merely used the circumstances that prevailed in the summer of 1528 to manipulate the besotted Henry VIII and advance her own agenda?  This scenario is certainly not outside of the realm of possibility. 

The Sweat was contemporaneous with the Tudor dynasty through the reign of Mary I, known as ‘Bloody Mary’.  The Sweat bowed off the Tudor stage in time to spare the subjects of the last of the Tudors–Anne Boleyn’s daughter, the glorious Elizabeth I– from its ravages.

(An interesting side-note to the story of Dr. Butts is the fact that his daughter, Anne, married Sir Nicholas Bacon.  Historical rumor and conspiracy theory have it that two scions of the Nicholas Bacon family, Anthony and the legendary genius Sir Francis Bacon, may actually have been the illegitimate children of Elizabeth I, and therefore the grandchildren of Anne Boleyn.)
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JoAnn Spears is a registered nurse with Master’s Degrees in Nursing and Public Administration. Her first novel, Six of One, JoAnn brings a nurse’s gallows sense of humor to an unlikely place: the story of the six wives of Henry VIII. Six of One was begun in JoAnn’s native New Jersey. It was wrapped up in the Smoky Mountains of Northeast Tennessee, where she is pursuing a second career as a writer. She has, however, obtained a Tennessee nursing license because a) you never stop being a nurse and b) her son Bill says “don’t quit your day job”.

Sweating Bullets: A Story of Anne Boleyn 1/4

I am so honored to have JoAnn Spears back at Redwood’s Medical Edge. Her posts about the ailments of long lost monarchs are hugely popular and entertaining as well.

This four part Monday series focuses on Ann Boleyn and the mysterious sweating sickness that had a 70% mortality rate!

Welcome back, JoAnn!

Part I:  Working up a sweat, bugs indeterminate, and a man named Butts.

The courtship of Anne Boleyn and Henry VIII is the stuff of legend.  Tudor history buffs and Anne Boleyn fans alike will already know that Anne Boleyn was the first and foremost proponent of ‘if you like it… put a ring around it’.  By 1528, after about two years of courtship, Henry had yet to do so.  Anne parried with a retreat from Henry’s court to her family’s country home at Hever.  Romantically enough, she was suffering from, or at risk of contracting, a catching ailment.  There was a real chance she could die from it.  More romantically still, she hastened away to protect Henry from the contagion. 
Dr. William Butts

On a less romantic note, Henry himself did not follow Anne to Hever.  His devotion only stretched to his sending, in his stead, his second-best physician.  Less romantically still, that physician was called Butts, and the disease he was to treat Anne Boleyn for was known as ‘The Sweat’.

Life-threatening plagues and infectious diseases were a feature of life in Europe during the Middle Ages and the Renaissance.  Some of these illnesses are fairly well understood retrospectively.  For example, a good deal is known today about the causation, mode of transmission, treatment, and natural course of Yersinia pestis, or Plague.  The Sweat, however, remains, like its star sufferer, something of an enigma.


The Sweat debuted in England around the same time that the Tudor dynasty did, in 1485.  It recurred in 1508, 1517, 1528 and 1551; as far as we know, it did not recur thereafter. Each of these outbreaks began in England, and four of them had little or no spread outside of the British Isles.  The fourth, the outbreak of 1528, made its way across much of northern and eastern Europe. 

Two Tudor physicians, Thomas Forestier and John Caius, are the sources of much of the extant medical information about The Sweat.  The accounts these two physicians give of the condition are like bookends to its history.  Forestier speaks from the perspective of the first outbreak of The Sweat, in 1485.  He isolates The Sweat from other pestilences and poxes of the time by identifying the primary way in which it was unlike them; the absence of rash, pustule, buboe, or other manifestation on the skin.   “The exterior is calm in this fever”, Forestier explained, “and the interior excited.” 

John Caius authored “A boke or counseill against the disease commonly called the sweate or sweatyng sicknesse” in 1552, after the last outbreak of The Sweat.  He felt confident enough in his experience and findings to subtitle the work “uery (very) necessary for everye personne and much requisite to be had in the hands of al (all) sortes, for their better instruction, preparation and defence, against the soubdein (sudden) comyng, and fearful assaultyng of the same disease”.

Prominent as Forestier and Caius were as practitioners, they do not have the same Tudor cache as the man who was on the job when Anne Boleyn commenced The Sweat:  Dr. William Butts.  Other than his Sweating-Sickness association with Boleyn, little is known about the man.  Just what would the second-best Butts encounter when he arrived at Hever to tend his King’s lady love?  It’s difficult to tell the exact point in Anne Boleyn’s Sweat trajectory at which Butts came into the picture.

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JoAnn Spears is a registered nurse with Master’s Degrees in Nursing and Public Administration. Her first novel, Six of One, JoAnn brings a nurse’s gallows sense of humor to an unlikely place: the story of the six wives of Henry VIII. Six of One was begun in JoAnn’s native New Jersey. It was wrapped up in the Smoky Mountains of Northeast Tennessee, where she is pursuing a second career as a writer. She has, however, obtained a Tennessee nursing license because a) you never stop being a nurse and b) her son Bill says “don’t quit your day job”.

A Sad Story of Royal Obstetrics: Part 4/4

Today, JoAnn Spears concludes her fascinating observations on Queen Anne’s obstetrical history. I know that I sure learned a lot. You can find the previous installments of this series by following the links: Part I, Part II, and Part III.
 
Thank you JoAnn for such a wonderful look into this woman’s life.


Part Four: Was Diabetes the Cause?

Diabetes may be the most likely culprit in Queen Anne’s story. Her first three pregnancies went to term, and resulted in two healthy children. Statistically and fertilely, Anne, at that point, was par for the 17th century reproductive course. From there, though, things went terribly wrong.

The beginning of this downhill descent, 1687-88, coincided with the death of two of Anne’s daughters from smallpox. It also coincided with her father’s ascent to the throne and his loss of it during the Glorious Revolution. The familial loyalties and betrayals involved in this were deep and complex, and Anne was not a deep or a complex person. The compound stress must have been enormous. She was eating, and probably drinking, heavily. Might Anne have developed diabetes around the time of, or during, her 4thor 5th pregnancy?  Anne’s lifestyle was characterized by overindulgence. She was not very active; her preferred recreation was playing cards. She would certainly be at greater risk than most for developing diabetes during a pregnancy, and unconsciously fueling the diabetic trajectory with her personal habits.

Uncontrolled diabetes is associated with a host of poor fetal and neonatal outcomes. Unusually low or high birth weight, premature birth, cardiac or skeletal anomalies, neurological problems, cerebral palsy, lung immaturity with RDS (respiratory distress syndrome), and even intrauterine death are some of the sad set of possibilities that Anne may have run the gamut of. Unfortunately, medical descriptions of the babies Anne lost or miscarried are sadly lacking.

Diabetes is a progressive condition. Anne became increasingly obese and debilitated as she aged, bringing to mind her distant relative Henry VIII. Both Henry and Anne had pains in their lower extremities that prevented them from moving about well. This may have been peripheral neuropathy associated with diabetes in both of their cases. Anne and Henry also had chronic, non-healing leg ulcers, another diabetes symptom, in common.

As his desperate attempts to father sons were ended by his declining physical condition, the morbidly obese Henry VIII had lifts and other machinery devised to move his unwieldy body around. It’s said that Queen Anne had this machinery refitted for her own use as her own health began to fail. If it’s true, it’s an ironic footnote to the two saddest stories of infertility in English history.
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JoAnn Spears is a registered nurse with Master’s Degrees in Nursing and Public Administration. Her first novel, Six of One, JoAnn brings a nurse’s gallows sense of humor to an unlikely place: the story of the six wives of Henry VIII. Six of One was begun in JoAnn’s native New Jersey. It was wrapped up in the Smoky Mountains of Northeast Tennessee, where she is pursuing a second career as a writer. She has, however, obtained a Tennessee nursing license because a) you never stop being a nurse and b) her son Bill says “don’t quit your day job”.

Winner!!– And Up and Coming

Hello Redwood’s Fans!

Are you getting geared up to enjoy some Halloween Spooky FUN?!?

I just started watching the last season of Dexter as a treat for finishing the rough draft of my third novel, Peril,— now its official title. I know– strange way to celebrate but I am a suspense novelist so it really is a treat. Peril will release next year about this time. So crazy to be finishing books that won’t be seen for what seems like soooo long but the time does go by quickly– at least for the author.

Congratulations, Heather! You won Michael King’s book, A Thousand Sleepless Nights! I’ll be e-mailing you.

But don’t despair if you didn’t win– I’ve got another great giveaway this week. Details below.

For you this week:


Monday: JoAnn Spears concludes her series on Queen Anne’s obstetrical history. This has been super fascinating where JoAnn offers her nursing insight into historical monarchs. Queen Anne was very fertile but sadly, none of her children lived. I’ve linked the other parts here for you: Part I, Part II, Part III.

Wednesday and Friday: So excited to host author Peter Leavell. Peter was the winner of Christian Writers Guild’s Operation First Novel contest. He’s offering a chance to win his novel, Gideon’s Call, simply leave a comment with your e-mail address on either of his two posts. Must live in the USA. Winner announced here next Sunday.

Hope you all are fabulous. Stay safe carving those pumpkins.

Jordyn

A Sad Story Royal Obstetrics: Part 3/4

JoAnn Spears continues her series on Queen Anne’s very interesting obstetrical history. You can find Part I and Part II by following the links.

Part Three:  How could this happen?

One or more of the following conditions may have played a part in Anne’s hauntingly tragic obstetrical history.

Rhesus incompatibility occurs when an Rh positive baby is carried by an Rh negative mother.  The pattern with this condition, untreated, is one of normal initial pregnancy or pregnancies, followed by miscarriages and stillbirths in a progressive pattern. A normal later pregnancy, while statistically less likely than a problem one, could occur if an Rh negative child were conceived; perhaps young William of Gloucester was such a child.

Chronic Listeria infection is also congruent with Anne’s reproductive clinical picture. Listeria is associated with improperly handled cheeses and meats, and food safety in Anne’s day and age was sadly lacking. She ate, however, what everyone else at her court ate, in quality if not quantity. A coinciding rash of female infertility in the women of Anne’s court is not reported.

Cephaolpelvic disproportion occurs when a mother’s birth canal is too small to accommodate delivery of the largest part of the fetus, its head. Some believe that Anne’s anatomy may have had something to do with her troubles. A later Stuart descendant, the wildly popular Princess Charlotte, fell victim to this condition. She died after three days in unsuccessful labor with her first pregnancy.

Medical records from Queen Anne’s physicians are maddeningly vague. It is unclear if young William of Gloucester developed hydrocephalus shortly after his birth, or if he was born with an abnormally large head, or macrocephaly, to begin with. A spontaneous, unidentified congenital or genetic syndrome may have caused this symptom, and affected other of Anne’s babies. Interestingly, the hemophilia that the later Queen Victoria would introduce into Europe’s royal houses was probably caused by a spontaneous genetic aberration in Victoria.

Anne’s obstetrical history and her physical attributes, specifically her obesity and red, round face, are congruent with Cushing’s Syndrome, a hormonal imbalance. However, Cushing’s is associated with menstrual irregularities. One of the few clear, objective medical statements we have about Anne comes from a physician who commented that, even when she was in her 40s, her menstrual cycle was as regular as that of a twenty year old.

Systemic Lupus Erythematous, or SLE, was discussed in Part Two of this series. It can lead to issues with fetal health, but statistically not to the extent that this occurred with Anne. Flare ups of poor maternal health would be more expected.

Porphyria was the cause of the madness of the post-Anne monarch, King George. Certainly, the catch-all term ‘gout’ would have been used by Anne’s medical men for the painful symptoms of porphyria’s metabolic derangement. However, Anne’s symptoms seem to have been more of a chronic nature than those of poor King George, and she was not emotionally labile.
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JoAnn Spears is a registered nurse with Master’s Degrees in Nursing and Public Administration. Her first novel, Six of One, JoAnn brings a nurse’s gallows sense of humor to an unlikely place: the story of the six wives of Henry VIII. Six of One was begun in JoAnn’s native New Jersey. It was wrapped up in the Smoky Mountains of Northeast Tennessee, where she is pursuing a second career as a writer. She has, however, obtained a Tennessee nursing license because a) you never stop being a nurse and b) her son Bill says “don’t quit your day job”.
 

A Sad Story of Royal Obstetrics: Part 2/4

 
JoAnn Spears is doing a four part series on Queen Anne’s obstetrical history. It’s very fascinating. You can find Part I here. Part III here.


Part Two:  What happened to Queen Anne?

A health history marked by seventeen or eighteen pregnancies and no surviving children staggers the modern mind, but it is only one part of the medical history of Queen Anne the Good.
In terms of childhood health, Anne was probably like she was in so many other ways–middling. She survived smallpox. She suffered from some sort of eye ailment, described as a defluxation, or preponderance of tears. It sounds like a fairly minor problem, but apparently was concerning enough for the child to be sent to France for treatment at a time when travel could be dangerous.
The young adult Anne was healthy enough to marry at the usual age, and by all accounts thoroughly enjoyed conjugal relations. Married in 1683, she was pregnant pretty much annually until 1700.
Anne’s obstetrical history is variously reported. It appears her first child, a girl, was stillborn. Her next two children, daughters, were born healthy. Unfortunately, smallpox claimed both daughters within days of each other when they were tots.

Three unsuccessful pregnancies followed. Then, in 1689, William, Duke of Gloucester, was born, and survived.

Baby William, according to medical report and portraiture, had a large head. Possibly, he had hydrocephalus, or fluid in the skull. Nowadays, hydrocephalus can be effectively treated with surgical shunting, but that was not the case in Queen Anne’s day. Brain damage of some kind would be expected.
Some sources describe young William as delicate and backward; others describe him as quite a clever child. He clearly had difficulty with balance, walking, falling down, and getting up. This was attributed by his caregivers to his disproportionate head size. It is worth noting, however, that Anne’s grandfather, Charles I, walked at a very late age, and only after his weak and rickety legs had been braced.
William’s birth was followed by at least ten pregnancies (one with twins), all resulting in miscarriages or stillbirths. Sadly, William of Gloucester eventually died in adolescence of pneumonia, leaving Anne childless.
Around the time Anne’s pregnancies ceased, other physical infirmities began. Gout was one of them. Nowadays gout refers to a specific metabolic problem that affects particular joints. In Anne’s day, it was a catch-all term for pain. Her ‘gout’ sounds more to modern medicine like migratory arthritis or arthralgia, pain making its way all around the body, caused by an autoimmune condition such Systemic Lupus Erythematous (SLE). Anne is reported to have had the facial redness or rash associated with such disorders.
Anne’s was also morbidly obese. She liked her food and drink, and was aided and abetted in overindulgence by her like-minded husband. Her being nicknamed ‘Brandy Nan’ at a time when a degree of abstemiousness was expected in women hints at the possibility of actual alcohol abuse or alcoholism.
Anne’s weight and debility necessitated her being toted to her coronation in a litter in 1702. She was unable to walk much on her own.
Anne died in 1714, a martyr to her ill health. She had become so overweight that her coffin was described as almost square; it required fourteen men to carry it. A contemporary commented that no sufferer would covet their rest as much as Anne would.
Surely, Anne’s phantom children–possibly as many as twenty of them–were on her mind at the very end. What was it that had made her reproductive history go so very tragic?

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JoAnn Spears is a registered nurse with Master’s Degrees in Nursing and Public Administration. Her first novel, Six of One, JoAnn brings a nurse’s gallows sense of humor to an unlikely place: the story of the six wives of Henry VIII. Six of One was begun in JoAnn’s native New Jersey. It was wrapped up in the Smoky Mountains of Northeast Tennessee, where she is pursuing a second career as a writer. She has, however, obtained a Tennessee nursing license because a) you never stop being a nurse and b) her son Bill says “don’t quit your day job”.
 

A Sad Story of Royal Obstetrics: Part 1/4

I’m so pleased to host JoAnn Spears again. Her nursing musings on the medical ailments of some famous and not so famous royals has been a real crowd pleaser. In this series, she focuses on Queen Anne the Good and her very interesting obstetrical history. 
Personally, I found this fascinating.
Welcome back, JoAnn!

Part One: Who was the woman this happened to?

By the time Queen Anne the Good ascended the throne of Britain in 1702, she had been pregnant a remarkable seventeen or eighteen times. She died, twelve years later, childless. What was this remarkable woman’s story?

Part One: Who was the woman this happened to?
Henry VIII is the British monarch most associated with serious fertility issues. The failure of his first marriage to produce a surviving son led to the English Reformation, the execution of Ann Boleyn, and ultimately, six marriages. Henry in his youth was tall, healthy, vigorous, athletic and intelligent. In old age, he became markedly corpulent.
Queen Victoria is the monarch most associated with royal fecundity. Her nine pregnancies produced nine children and made her, through carefully orchestrated intermarriages, ‘The Grandmother of Europe’. Unfortunately, Victoria also appears to have been the point at which the hemophilia gene entered Europe’s royal houses. Victoria, like Henry VIII, was obese in later life.
Pretty much midway between these two extremes of royal fecundity, Britain was ruled by a queen named Anne, known as ‘the Good’. She is little remembered today. As a study in fertility and infertility, Ann deserves to be better remembered.

Ann was a Stuart, a descendant of the Tudors and of the romantic Mary Queen of Scots. Her father and mother were controversial figures. James II seems to have been always out of step. Anne’s mother, Ann Hyde, was a non-royal that James married, typically, against absolutely all advice. When Ann Hyde died–corpulent– in 1671, she had experienced eight pregnancies and left behind two living children.

The ‘good’ moniker is probably the best description of Anne as a child and young woman. In looks and intellect, it’s most likely that she was pretty average. She was a good and serious English Protestant. Her father, out of step as usual, was not. This political liability led to his losing his throne and to the reigns of Anne’s brother-in-law and sister, William and Mary. When Mary and then William died, childless, Anne ascended the throne.
At an appropriate age, Anne had married an appropriate young man: Prince George of Denmark, a cousin once removed. They were married for about twenty-five years and were a devoted couple. George seems to have been a lot like Anne, both unexceptional and unexceptionable. The wittier members of the English court found him boring, joking that the loud breathing caused by his asthma was the only way they had of knowing that he was actually alive.
Anne’s reign lasted from 1702 to 1714. It was notable for being the time when the two-party system emerged in British politics. It was also notable as a time when female friendships had more of an impact on government behind-the-throne than romantic alliances did. Anne’s friend Sarah Churchill, a distant relative of the modern Princess Diana, was a key political player of the day.
Anne’s obstetrical history was over and done with by the time she became Queen. The year 1700 had seen her final pregnancy. That pregnancy had been preceded by another sixteen or seventeen. The number of living children she had when she ascended the throne–sadly, and almost unbelievably to modern minds–was zero.

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JoAnn Spears is a registered nurse with Master’s Degrees in Nursing and Public Administration. Her first novel, Six of One, JoAnn brings a nurse’s gallows sense of humor to an unlikely place: the story of the six wives of Henry VIII. Six of One was begun in JoAnn’s native New Jersey. It was wrapped up in the Smoky Mountains of Northeast Tennessee, where she is pursuing a second career as a writer. She has, however, obtained a Tennessee nursing license because a) you never stop being a nurse and b) her son Bill says “don’t quit your day job”.