Sweating Bullets: A Story of Ann Boleyn 4/4

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! Here are Part I,  Part II and Part III.

Welcome back, JoAnn!

Part IV:  The cold hard facts.
 

Influenza has been around since at least Hippocrates’ time.  It is thought of today mostly as a nuisance that can be sanitized or vaccinated away.  This testifies to a short collective memory when the story of the Spanish Flu pandemic of 1918 is considered. 

Within 25 weeks of the beginning of the Spanish Flu pandemic, an estimated 25 million people died worldwide.  When the pandemic finally ended in 1920, as many as 50 million people had died.  In an era when supportive care for influenza symptoms such as fever was better understood than it was in Tudor times, the mortality rate for Spanish Flu was still around 10%.



Ann Boleyn

It doesn’t take much math to figure out that as many as 500 million people developed Spanish Flu between 1918 and 1920.  It was an era when people knew a lot more about disease transmission than they did when Anne Boleyn retreated to Hever.  As a result, many a large public gathering was cancelled for preventive purposes during the Spanish Flu pandemic, and people around the world wore surgical-type face masks when in public.  These efforts were unavailing against the spread of the infection; Spanish Flu was as mysterious and maddening as Anne Boleyn herself.

Many believe nowadays that Spanish Flu was an avian virus, akin to the modern H1N1 or bird flu virus which is originates in, and is spread by, infected poultry.

Anne Boleyn is unlikely to have personally prepared poultry for consumption.  She did, however, feast in the Tudor court where feathered fare ranging from swallows to game birds to swans were prepared by the help and consumed by ‘the quality’ with gusto.  The Tudor court was also a home to falcons which were used by both men and women for hunting for sport.  Anne Boleyn’s family crest actually features a falcon.  Parrots and parakeets, novelty birds from the New World, were also present at the Tudor court as pets.  Henry VIII himself was said to have an African Grey Parrot which could mimic calls to boatsmen on the Thames, leading more than one of them on a fool’s errand.  Another tale says that when the parrot fell into the Thames on one occasion, it was recognized and rescued only because it started to scream ‘boat!’ as it fell into the river.

The Sweat and the Spanish Flu do not have only a surprising causation in common.   Both claimed, for the most part, a surprising set of victims.  

The Sweat did not prey on vulnerable folk such as the weak, the very young, and the very old.  According to Caius, “They which had this sweat sore with peril of death were either men of wealth, ease or welfare, or of the poorer sort, such as were idle persons, good ale drinkers and taverne haunters.”  Contemporary sources also tell us that men were disproportionately affected; “mortalitie fell chieflie or rather upon men, and those of the best age as between thirtie and fortie years. Few women, nor children, nor old men died thereof”.

The Spanish Flu likewise claimed the least likely as its victims, with many heretofore healthy young adults succumbing.  The Spanish Flu pandemic started, in fact, in an army base in Kansas, claiming the lives of robust young World War I soldiers while their physicians looked on, helpless. It is thought today that this was due to a phenomenon known as cytokine storm, a scenario in which a healthy immune system is actually a liability. 

If a virus such as bird flu enters the body through inhalation, the infection will center in the lungs.  It is normal for the body to fight infection in the lungs with inflammatory responses that are familiar:   increased circulation to the area, mucus production, coughing, fever to ‘burn out’ the infection, etc. In a cytokine storm, too much of all of these symptoms creates as much of a problem, if not more of a problem, than the infectious agent itself.  Soldiers with Spanish Flu were drowned by copious blood and fluids produced by their own lungs, possibly as a result of this phenomenon.  Perhaps a similar phenomenon caused the profuse, and often deadly, heat and perspiration of Tudor-era Sweat sufferers.

The Sweat, and the Spanish Flu, were both maddening, mysterious forces, capable of bringing about a strong man’s downfall, and yet as elusive and as hard to contain as a bird in flight.  The association with Henry VIII and Anne Boleyn, surely, is fitting.
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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 Ann Boleyn 3/4

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! Here are Part I and Part II.

Welcome back, JoAnn!

Part III:  The cold hard facts.

In the Latin that united the cosmopolitan Renaissance medical world, the Sweating Sickness was called ‘sudor anglicus’, or The English Sweat.  Some Brits thought it an imported commodity, courtesy of the mercenaries from continental Europe who helped Henry VII, the first Tudor king, to win his throne.  In the sickness’ last rampage, it spread eastward through northern Europe as far as Russia, but largely spared Scotland, Ireland, and the more southern portions of Europe.

Much of Europe thought England in Tudor times a bit behind when it came to cleanliness and hygiene practices.  Erasmus described floors “covered with rushes, occasionally renewed, but so imperfectly that the bottom layer is left undisturbed, sometimes for twenty years, harbouring expectoration, vomiting, the leakage of dogs and men, ale droppings, scraps of fish, and other abominations not fit to be mentioned. Whenever the weather changes a vapour is exhaled, which I consider very detrimental to health.” The grasses and straw which comprised rushes, and which were also used to fill mattresses and cushions, were often infested with critters such as lice and bedbugs.  This perception played a large part in two of modern sciences’ earliest hypotheses about causes of The Sweat:  potties and pests.
 

Early epidemiologists associated The Sweat with Typhoid Fever.  Salmonella typhi spreads through contaminated food or water by what is known as the fecal-oral route and is strongly associated with poor sanitation and waste disposal.  This ailment probably killed such prominent Brits as Prince Albert, as well as several of the literary Brontes.  Typhoid fever has, however, a marked gastroenterological component.  Such symptoms are largely absent, or not emphasized, in contemporary descriptions of The Sweat.

Relapsing Fever, caused by louse-borne Borrelia recurrentis, is another Sweat contender.  It originated in the warmer parts of the world, including parts of Africa and South and Central America.  In the early Renaissance era, European exploration of these areas was just beginning. The plants, animals, and people that Europe’s explorers brought back home to the Old World could have been inadvertent Borrelia vectors.  Most of these early explorations, however, originated out of, and returned to, Southern European countries which were largely, unlike England, Sweat-spared.
Relapsing and Typhoid Fevers are caused by bacteria.

Bacteria were understood long before the discovery of viruses, which occurred around the turn of the 20thcentury.  Still more advanced 21stcentury knowledge about microbes provides a most convincing possibility for categorizing The Sweat:  influenza.

We’ll discuss the possibility of Sweating Sickness being viral in nature next post.
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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 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”.