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”.