Henry VIII's Health in a Nutshell

Henry VIII’s
Health
in a Nutshell

Copyright © 2015
MadeGlobal Publishing
Kindle Version

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Dedicated to Lewis Wayne Cornelius, my wonderful father and a brilliant physician

Cover:
Vintage Engraving of Henry VIII from 1855

Contents

Introduction

The worst legs in the world

A brief account of the king’s offspring

A tale of two Henrys: The king before and after 1531

Theories regarding Henry’s mental aberrations

Conclusion

Bibliography

List of illustrations

About the Author

Introduction

Henry VIII is one of England’s most well-known monarchs. Although he should be more justly famous for breaking England away from the Catholic church and creating the rough draft of the Church of England, it is the fact that he notoriously married six women and executed two of them during his desperate quest for a male heir that makes him stick in the public mind. Henry’s popularity had led to many depictions of him in visual media and written fiction, showing him as everything from an uncouth, fat tyrant eating a turkey leg to a sexy and sex-crazed hound. Notwithstanding the imagined versions of him, Henry was more than an obese, reproductively challenged, marriage monger. In reality, the youthful king was athletic, intelligent and kind. It was only after his marriages and attempts at securing a male heir had gone spectacularly awry and his health had likewise failed that Henry turned into a monster.

1. Figure 1 -
   Henry VIII from a vintage engraving from 1855
   

The oddities of Henry’s reign have inspired many people, laymen and historians alike, to postulate medical explanations for his reproductive tribulations and his disintegrating health, both physically and mentally. Some theories try to explain why the king developed ulcers on his upper legs and became nearly immobile in his middle age. Other theories try to understand why the king who was once noted for his scholarship and chivalry became “a psychotic, paranoid bully” in his middle age
¹
. A few theories try to formulate an answer for why Henry’s reproductive track record is marred by foetal loss and neonatal deaths, and even fewer serve as an umbrella explanation for all the king’s problems. His suspected ailments are legion, and harder to fit into a nutshell that one would expect.

One of the compounding factors about Henry’s health is comorbidity. Any patient can have multiple illnesses at the same time, and the king was no exception. Considering the constellation of symptoms that hounded Henry, it is almost certain that he had more than a single ailment or underlying health issue. These myriad problems often overlap so that it is impossible to tell where one begins and the other ends without modern diagnostic tools. Lacking his DNA for analysis, all that scholars can offer is educated guesses and reasonable hypothesizes based on clues winkled out of historical record.

The worst legs in the world

One of the most simple and direct issues regarding Henry’s health are the ulcerous legs that plagued him during the last third of his life. The suppurating lesions hurt as badly as they smelled. Henry must have hated them, not just because of the discomfort they caused him, but also because having weeping ulcers on his thighs was an assault on his vanity. Strong and unblemished legs were a necessity of male beauty in Henry’s era, and having his handsomeness blighted by oozing abscesses doubtlessly wounded his pride. As a young man Henry had been openly conceited, with good cause, about his muscular limbs, bragging to a foreign ambassador that he had a “good calf to his leg”. The sores must have been a constant reminder of the lost physique of his youth.

1. Figure 2 -
   Detail of Henry VIII’s legs from a portrait by the workshop of Hans Holbein the Younger
   

The theory that has the most medical and historical support is the premise that the king suffered from osteomyelitis
²
. Osteomyelitis is an infection of the bone, often caused by an injury. Henry probably injured the bones in his legs on one of the occasions when he fell off his horse while hunting or jousting. Even if his femur hadn’t been broken, a hairline fracture or a puncture on his leg could have created the conditions necessary for the bone to become diseased. Some of the symptoms of this kind of infection are bone pain; swelling which can show up in just a small, tender, inflamed spot or that can puff up the whole leg into a red, bloated agony-sausage; redness near the affected area; fever; nausea; chills; sweating and an overall impression that death would be a sweet mercy. Osteomyelitis can last the patient’s whole life if not properly treated. When it is severe, the illness can cause tiny splinters of bone to separate from the femur and start migrating upward through the muscle and skin, creating suppurating ulcers. These sores are putridly smelly and grievously painful.

Another possibility is that Henry developed venous ulcers
³
. Venous skin ulcers are the result of poor blood circulation in the legs. Usually this is caused by venous insufficiency, when the one-way valves in your veins are damaged. The valves go only one-way in order to prevent blood from backwashing down the vein after every heartbeat, and if they can’t do their job then the blood forms little pools that compromise the veins. This pooled blood may seep out of the unsound veins and flood the surrounding tissues. The saturated tissue can collapse and allow an open sore to form.

Venous leg ulcers are usually found on older patients who already have limited mobility, lack of physical exercise, high blood pressure, obesity, diabetes and varicose veins. Henry first developed a “sorre legge” in 1527 when he was only 36 and still very physically fit
⁴
. Other causal factors, such as smoking or working at a job that required him to stand for hours at a time, did not apply to the king. Venous ulcers also typically manifest below the knee, which does not fit the reoccurring ulcers on Henry’s thighs.

Although the ulcers on the king’s thighs were more likely to have been osteomyelitis during the first decade that they bedevilled Henry, he may have later additionally developed venous ulcers on his upper leg due to complications of a deep vein thrombosis (DVT) following his jousting accident in 1536. The accident not only knocked him unconscious for more than two hours, it also crushed his legs when his horse landed on top of him. A crush injury can cause a blood clot in the deep veins of the legs even if none of the bones were broken or fractured and would have increased Henry’s chances of developing venous ulcers
⁵
.

In the 1540s, Henry began evincing ulcers below the knee that were more likely to have been caused by damaged veins than infected bones. Henry was also very fond of foods that were high in cholesterol, such as red meat, and dairy products, like cheese and butter. High levels of cholesterol in the blood (hypercholesterolemia) can exacerbate peripheral vascular disease. If Henry developed peripheral vascular disease, it “would seriously exacerbate venous ulceration, reducing the capacity for healing and causing difficulties in the fight against distal infection”
⁶
. Eating food fit for a king meant that Henry would have had a harder time healing and his ulcers would only grow worse.

The ulcers were not only unsightly and painful, they almost killed him. In the spring of 1538 one of the ulcers closed up, and seems to have loosened or created a blood clot that travelled to his lungs and caused a pulmonary embolism. Henry nearly died, and for more than a week he lay “black in the face without speaking”
⁷
. It is frankly a puzzle why he
didn’t
shuffle off his mortal coil. A pulmonary embolism can easily kill a patient even now, despite the modern technological help of thrombolytic medicines and a surgical embolectomy. One of Henry’s ulcers once again “suddenly closed to his great alarm” in March of 1541, terrifying him because “in the like case, he thought to have died”
⁸
. Fortunately for Henry, his physicians were somehow able to prevent a pulmonary embolism from occurring a second time.

Henry’s legs were not only cankerous, they were also atrophying in some way. In May 1544, the imperial ambassador wrote that Henry had “the worst legs in the world, such that those who have seen them are astonished that he does not stay continually in bed”, and that the king was “so very ill in his legs that it is a wonder he can stand”
⁹
. Henry’s locomotion became so severely limited that he had two custom chairs, referred to as “trams”, made so he could be carried throughout the palace and he “could not go up or down stairs unless he was raised up or let down by an engine”
¹⁰
.

It has been argued that the king’s enormous bulk was the source of his immobility, not any kind of muscular wasting. Thanks to his “marvelous excess” at the table, Henry had grown increasingly fat. His waist measured 54’’ in 1541
¹¹
. Nevertheless, that did not mean he was too fat to walk. Even morbidly obese people who are more than 200lb (90kg) overweight are usually still ambulatory, so his weight alone would not explain his lessened ability to traverse. Furthermore, the muscular weakness Henry experienced appears to have been worse in his lower limbs. At the age of 44, Henry was still healthy and strong enough to ride and hunt, in spite of his weight, but he needed a “hoist” to successfully mount his horse
¹²
. He would have required another underlying medical condition, one that centred on his lower limbs in particular, to have compromised his mobility to such an extent without impairing his ability to ride. Rather than Henry’s weight affecting his ability to move, the reverse might be true. The king did not attain truly gargantuan proportions until after he was bedridden and unable to ride any longer. His chronic incapacitation from muscular atrophy may have been the reason why Henry weighed just shy of 400lb (180kg) at the time of his death
¹³
.