Monday, November 19, 2012

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.)
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”.

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