This article first appeared in the September 2011 issue of the Ricardian Register, Vol. 42 No. 3.
Edward IV King of England 1461-83, the
original type two diabetic?
Peter Stride
Then you
conclude, my grandma, he is dead.
The King mine uncle is to blame for it.
King Richard 111, II, ii 12-131
Abstract:
Edward
IV, second son of Richard, Duke of York and Cecily Neville, was born on 22nd
April 1442. Edward IV was renowned for his radiant good looks on ascending the
English throne. He was the epitome of youthful vigour and health. Why did the
warrior king with an exuberant lifestyle die of natural causes at forty? The
new hypothesis of diabetes is suggested.
Introduction:
The
death of Edward IV was a pivotal point in history. The good aspects of the
following Tudor and Stuart dynasties are currently the dominant English
perception, but these two tragic centuries included a widespread civil war,
regicide, religious schism and genocide, torture and execution of women, the
risk of foreign invasion and the destruction of England’s architectural
heritage.
The Young King:
Edward
was a huge man. His skeleton, exhumed in 1789, measured 6 feet 3-3/4 inches,
thus in 15th-century England he was nearly a foot taller than average.
Contemporary writers described Edward in superlatives, "the tallest",
"the fairest", "the strongest”, and was well renowned for his
fair complexion and good looks. The Croyland Chronicles2 described
Edward as “a person of most elegant appearance and remarkable beyond all others
for the attractions of his person.” Thomas More,3 a Tudor supporter,
described his appearance:
“He
was of visage lovely; of body mighty, strong and clean made; howbeit in his
latter days, with over liberal diet, somewhat corpulent and burly but
nevertheless not uncomely.”
Ross
described Edward as neither scholar nor saint, but noted his charm, courage,
affability, leadership and especially his retentive memory.4
Edward’s Martial Prowess and Victories on
the Battlefield:
Edward
first fought in battle at nineteen, exhibiting a mature and calm control beyond
his years, and beyond that of his opponents. Edward destroyed the House of
Lancaster in a brilliant series of spectacular military victories. Friend and
foe could see his inspiring leadership in the front line of battle, using his
great height to advantage, and smashing his battle-axe at the nearest enemy.
Edward
was also an outstanding battlefield commander. Edward’s knowledge of flanking
movements and feints gained tactical battlefield advantages. Edward could
‘read’ a battleground and position his forces favourably. He manoeuvred his
forces, at both Barnet and Tewkesbury in the dark, such that Lancastrian
commanders found themselves in unfavourable situations by dawn.
Edward
also had Napoleon’s favourite characteristic, luck, winning decisive battles
when nature and fortune intervened. A snowstorm at Towton and heavy fog at
Barnet helped turn those battles into decisive Yorkist victories. Edward fought
and won seven battles, though twice he fled rather than risk a battle on
unfavourable terms. Paul Murray Kendall, described Edward as “The mightiest
warrior in Europe.”5
Health Issues:
Edward
enjoyed excellent health for many years. He had an acute illness, “the
sickness of the pockys,”6 perhaps measles, in 1462, but recovered
uneventfully.7 Edward escaped the plague, though this disease
claimed his son George in 1479. Edward‘s control over his destiny and his
instinctive mastery of events deserted him in the 1469 rebellion, before he
regained his throne, following the battles of Barnet and Tewkesbury. Falkus
theorized that Edward had a nervous breakdown. Speculation draws parallels to
Henry VI’s periodic insanity, and perhaps porphyria, present three centuries
later in the Royal Family.7
Declining Health:
On
regaining the throne, he ate and drank excessively. Mancini reported that he
used emetics 6, but still appeared grand and regal. Commynes saw
Edward in 1475 during the French Campaign and noted Edward was “beginning
to get fat and I had seen him on previous occasions looking more handsome.”4
Household records in 1478 state that Edward had health officers “including
the doctor of physic, who held consultation with the cook and stood much in the
kings presence at his meals, counseling or answering to the king’s grace which
diet is best according, and to tell the nature and operations of all the
meats.”8 Doctor’s advice clearly fell on deaf ears in the 15th
century as it does today!
Edward's
health began to fail, with increasing ailments. Between 1480 and 1482, England
and Scotland engaged in warfare. Edward planned to join Richard, Duke of
Gloucester in both 1481 and 1482 on Scottish campaigns. He ordered eighty butts
of wine for his 1481 campaign.3 Edward reached Fotheringhay Castle
to plan strategy with Gloucester in 1482, but returned to London, perhaps with
failing health and energy,7 never joining the campaign. A reluctance
to campaign in Scotland could reflect intolerance to cold, a symptom of
hypothyroidism or alternatively as common sense.
After
Richard’s army captured Edinburgh, Edward granted Gloucester extensive land,
income and power in the north of England in January 1483. Scofield7
described this as extravagant and ill-advised, and that “the fatal illness now
fast creeping upon him had so weakened his judgement and understanding that he
did not realize what he was doing.” Scofield is an acknowledged Edward IV expert.
She wrote a two-volume history of Edward, and read extremely widely among
primary and secondary sources about him. She did not offer any medical
evidence, but believed Edward had an underlying disease.
Death:
Edward fell fatally ill at Easter 1483,
initially collapsing while fishing on 30th March, and improved transiently, but
weakened daily. He improved to add codicils to his will, naming his brother
Richard as Protector. He then died on 9th April. The king’s barber-surgeon and
physician present at his death were Jacques Freis and William Hobbes. Hobbes
was appointed Serjeant Surgeon to Edward in 1461, being the first holder of
this eminent office persistent today with a current appointee.9
Hobbes received a salary of 40 marks, with a meat and drink allowance. The key
to this analysis is the medical knowledge base of the time, plus the experience
and skills of Hobbes.
Scofield,
Falkus, Hicks10 and Ross give accounts of his death, quoting the
primary sources of Edward’s last days. Suggested causes include apoplexy,
indigestion, typhoid, appendicitis, cirrhosis and even poisoning. The Croyland
Chronicle, so often accurate, reports that the court was baffled, and gave a
cryptic comment.2
“The king took to his bed neither worn out with
old age nor yet seized with any known kind of malady, the cure of which would
not have appeared easy in the case of a person of more humble rank.”
Mancini
wrote that Edward was depressed when his treaty with the Flemings unravelled,
that splendid Royal theatrical performances hid his sorrow, and that a cold was
the terminal event.8
“Edward
fell into the greatest melancholy, lamenting that by his inactivity the
Flemings, ancient friends, had been permanently estranged from him.
“...so as to mitigate or disguise this sorrow,
yet was he never able altogether to hide it
“...they say there was another reason for his
death was, that he being a tall man and very fat though not to the point of
deformity allowed the cold damp to strike his vitals, when one day he was taken
in a small boat, with those whom he had bidden go fishing and watched their
sport too eagerly. He there contracted the illness from which he never
recovered.”
Mancini
said the reconciliation between the Woodvilles and Lord Hastings occurred two
days before death, though More stated this was a few hours before death.8 Commynes
thought he was depressed following the Treaty of Arras, and twice states that
apoplexy caused death.11 Vergil said the cause was unknown, but
hinted at poison.12 Tudor historian Edward Hall suggested the
malaria Edward caught in France in 1475 had “suddenly turned into an incurable
quarten fever.” Thomas Basin, a French historian, said that a too-hearty dinner
on Good Friday killed him.8
After
Edward’s death his body was “laid upon a board all naked, saving he
was covered from the navel to the knees” for public display for 10-12 hours.7
No visible abnormality was recorded.
Exhumation:
David
Hughson detailed Edward’s exhumation. His skeletal measurements provided little
medical information beyond the height and apparent lack of skeletal trauma.13
“The body, enclosed in a
leaden and trooden coffin, measuring six feet three inches in length, appeared
reduced to a skeleton.”
Possible causes of death:
There
are no recorded clinical features of Edward’s terminal illness; hence his cause
of death remains undiagnosed. His character fluctuations with periods of
immense physical prowess, vigorous leadership and initiative, alternating with
periods of inertia and poor insight impose problems in detecting developing
medical problems between 1480 and 1483. Most historians believe Edward’s
obesity and inactivity contributed to his ailments, and eventually to his
death. His demise from an apparently minor infection suggests an underlying,
undetected ailment exacerbating the acute condition. Edward fell ill after
catching a cold on a fishing trip, rallied briefly, then deteriorated and died,
probably of pneumonia.
Rosemary
Hawley Jarman’s novel, We speak No Treason, places William
Hobbes, Edward’s physician, at the bedside, setting “blood irons to the royal
veins and vainly all but drained that vast body.”14 Though
fictional, this is a possible contributing factor to the king’s demise. Seven
generations later, excessive bleeding by equally enthusiastic but ignorant
physicians contributed to the demise of Charles II.
Edward
was a mediaeval sex addict, his legendary sexual activities and numerous
partners suggesting a sexually transmitted disease (STD). Mancini wrote “he
was licentious in the extreme...he pursued with no discrimination the married
and the unmarried, the noble and the lowly: however he took none by force.”8
Edward IV had ten children with his queen, Elizabeth Woodville, and
perhaps five illegitimate children, between 1466 and 1480, and then no more,
suggesting secondary infertility or erectile dysfunction, though Jane Shore
appeared happy with his company until his death. However, syphilis, the most
severe venereal disease, was not endemic in Europe for another decade15,
and the genital symptoms of other STDs were not recorded in his partners, nor
his partners’ other sexual contacts. Edward’s intact cognitive function on his
deathbed excluded the dementia of tertiary syphilis. Henry VIII probably was
the first English monarch with syphilis, though he may also have been diabetic.
All
Edward’s reports indicate progressive weight gain, not terminal wasting or
internal bleeding, making cancer or tuberculosis improbable. Mancini’s
implication of a stroke is unlikely with intact speech, cognitive and motor functions
during the deathbed scene. Increasing weight and lethargy suggest endocrine
disease, with diabetes and hypothyroidism possible. Cushing’s disease and
gigantism are feasible but very rare diseases of the pituitary gland, which
will not be further explored in this article.16
Hypothyroidism,
a deficiency of thyroid hormone, causes fatigue, weakness, weight gain,
intolerance to cold, depression, constipation, impaired memory and cognitive
function and decreased libido, then ultimately life-threatening depression,
heart failure or coma. The Greeks were aware of goitres, but in mediaeval days
diagnosis and treatment of hypothyroidism were several centuries away.
Hypothyroidism in England was found in Derbyshire, the only landlocked county,
from deficient iodine in the diet, hence the term Derbyshire Neck, a synonym
for goitre. Edward clearly enjoyed a diet of quantity, quality and variety,
including fish, excluding dietary iodine deficiency.
Annette
Carson in Richard
III: the Maligned King17 suggested arsenic poisoning
causing Edward’s death. She reviewed many original documents, but accepts
Collins'18 recent flawed medical analysis that arsenic poisoning
caused Edward’s death. However, arsenic causes severe abdominal pain, diarrhoea
and vomiting, thirst and excessive salivation; dryness in the throat with a
hoarse voice, difficulty of speech, then convulsions, circulatory collapse,
delirium and death. Arsenic is an improbable cause of Edward’s death, as these
severe symptoms were not recorded.
Collins excludes diabetes in Edward IV as a
wasting disease. He does not differentiate the improbable juvenile type 1
diabetes with weight loss from the possible type 2 diabetes associated with
obesity. Collins incorrectly excludes “...proposed mycoplasmosis (sic) pneumoniae,
an amoebic(sic) disease contracted from stagnant water” believing that
pneumonia always causes death within hours, not days. Mycoplasma pneumonia are
small bacteria lacking a cell wall found in animal hosts.
Diabetes:
Polyuria or excess urine output, a symptom of diabetes, was
first described three and a half millennia ago by the ancient Egyptian
physician Hesy-Ra in the Ebers Papyrus, and named diabetes by the Greek
Aretaeus of Cappadocia in 250 BC. The attraction of ants to diabetics’ urine was
noted in India at about the same time.
The Persian physician, Avicenna, (980-1037) noted the sweet
taste of diabetic urine, the abnormal appetite and erectile dysfunction in his
textbook, The
Canon of Medicine19, still used in 15th
century England, and European Universities as late as 1650 suggesting little
medical advance for six centuries. In Edward’s time medical knowledge was
probably less than in the Middle East four hundred years previously.
Gaddesden’s authoritative text Rosa Medicinae 2 written between
1307 and 1314, and possessed by many doctors, refers to diabetes, but omits the
taste of urine.20
Getz does not mention diabetes in her
Mediaeval Medicine text.21 Gilbertus Anglicus’s translation of Compendium
Medicinae22
around 1240 was often used by 15th century English doctors. Anglicus
stated “diabetes
is an vnmesurable pissing of vrin” and considers it is caused by “moche
medling with wymen” and “it cometh of drinking of stronge wyne.”
Anglicus appears to be ‘on to something’ lost in today’s’ texts perhaps
relevant to Edward! However he does not mention sweet urine. It is unknown
whether William Hobbes and Jacques Freis were aware of this condition, but the
available texts cast doubt on the ability of 15th century physicians
to diagnose diabetes.The English physician Thomas Willis revived the tasting of sweet urine, and in 1675 added the word mellitus. Matthew Dobson discovered sugar to cause the sweet taste of diabetic urine in 1776. William Heberden, a forefather of English medicine, wrote his celebrated text in 180223. He considered diabetes a rare wasting disease, typical of insulin dependent type 1 diabetes, having seen 20 or less cases. He omits the current common type 2 diabetes of obesity, Edward’s postulated condition.
Sir Harold Himsworth’s publication in January 1936, 543 years after Edward’s death ,clarified the distinction between juvenile type 1 diabetes and the maturity onset type 2 diabetes with obesity and insulin resistance.24 Today the association between obesity and type 2 diabetes is well understood. 20% of the Australian population are obese, 50% are overweight, 10% have diabetes or pre-diabetes, and diabetes is four times more common in the obese.
Maria
de Medici, Queen of France, is also hypothesized to have been diabetic. She
died in 1642, one hundred and fifty-nine years after Edward IV, still in a
medical period when type 2 diabetes was unknown and when testing for sweet
urine was not practised. Maria became grossly obese with overeating, died with
gangrene of her right leg and skin infections. Her autopsy revealed both
hardening of the arteries (arteriosclerosis) and pancreatic atrophy, both
features of diabetes25. Maria’s autopsy information is not available
for Edward, but both became grossly obese with overeating, and died of
infections, suggestive of type
2 diabetes.
Conclusion:
·
Edward clearly suffered from obesity and lethargy
·
He may have been depressed by his failed foreign policy, and appears
uncharacteristically unmotivated in his last year of life.
·
He may have suffered a terminal pneumonia.
·
Some underlying but undiagnosed disease may have been present. Diabetes
and hypothyroidism are possible explanations of increasing obesity and
lethargy, which could exacerbate a mild infection, contributing to death.
Diabetes is the more likely.
End Notes:
1. Shakespeare, William. The Complete Works of William
Shakespear.e Collins. London. 1961. pp 701-747
2. Historia Croylandensis translation Ingulph’s
Chronicle of the Abbey of Croyland ed H. Riley Bohn’s Antiquarian
Library London 1854 -The Croyland Chronicle: Part IX The Third
Continuation of the History of Croyland Abbey: July, 1485 - Apr, 1486 with
Notes.
3. More, Thomas. History of King Richard III.
ed Sylvester R. Yale. 1963. p3
4. Ross, C. Edward IV. University of
California Press Berkeley and Los Angeles. 1974. p9, p314-315, p232, p280
5. Kendall, P. M. Richard the Third. Redwood
Press. Trowbridge. Wiltshire. 1955. p414
6. Falkus, G. The Life and Times of Edward IV.
Book Club Associates. London. 1981. p64, p113, p206
7. Scofield, C. The Life and Reign of Edward the Fourth.
Frank Cass. London. 1923. II p161, I p264, II p218, II p359, II p365-366
8. Mancini, D. The Usurpation of Richard III.
trans. C. A. J. Armstrong. (Oxford, 1969, reprinted Gloucester, 1984). p 67,
p69-71
9. Talbot, C, Hammond E. The Medical Practitioners in Medieval
England. Welcome Historical Medical Library. London. 1965.
10. Hicks, Michael. Edward IV. Hodder Headline
Group. London. 2004
11. Commynes, P. de. Memoires de Phillipe de Commyne.s
ed B de Mandrot. Paris. 1901 p304, p344.
12. Vergil, Polydore. Three Books of Polydore Vergil’s
English History. ed Ellis H. Camden Society. John Bowyer Nichols and
Son. 1844. pp 171-172.
13. Hughson, David. London: Being an
Accurate History and Description of the British Metropolis. J
Stratford. London. 1808.
14. Jarman, R H. We Speak No Treason. William
Collins. Glasgow. 1971.
15.
Stride, Peter. Did Perkin Warbeck’s Mercenaries Introduce Syphilis Into the UK.
Ricardian
Bulletin. 2010. (Dec) 4:36-38.
16.
Braunwald, E, Fauci, A, Kasper, D. Harrison's Principles of Internal Medicine,
15th Edition McGraw-Hill Professional, Maidenhead, UK pp 318-323.
17. Carson, Annette. Richard III, the Maligned King.
The History Press. Chalford, Gloucester. 2008.
18. Dening, J, Collins, R. Secret
History, The truth about Richard III and the Princes.
The Lavenham Press. 1996.
19. Avicenna. The Canon of Medicine.
Trans: Gruner O, Luzac and Co. London. 1930.
20. Cholmeley, H. John of Gaddesden and the Rosa
Medicinae. Clarendon Press. Oxford. 1912.
21. Getz, Faye
Marie. Medicine
in the English Middle Ages. Princeton University Press. Princeton,
New Jersey. 1998.
22. Anglicus, G. Healing and Society in Medieaval
England A Middle English Translation of the Pharmaceutical Writings of
Gilbertus Anglicus. Edited Getz F. University of
Wisconsin Press. Wisconsin. 1991.
23. Heberden, W. The History and Cure of Diseases.
T Payne. London. 1802. p141.
24. Himsworth, H. Diabetes mellitus: its differentiation
into insulin-sensitive and insulin-insensitive types. Lancet.
1936. 1:127–130.
25. de Leeuw, I. J R Coll Physicians. 2009.
39: 185-6.
