Henry VIII: Did history lose a true prince of the Renaissance to traumatic brain injury?

An armored Henry VIII and his charger at the Tower of London
in London, England.  Photo by Mary Harrsch © 2006

A history resource article by Mary Harrsch © 2015

Today, I read an interesting paper by Muhammad Qaiser Ikram, Fazle Hakim Sajjad, Arash Salardini published in the Journal of Clinical Neuroscience proposing that Henry VIII's erratic behavior, particularly after 1536, was the result of repeated traumatic brain injuries.  Furthermore, the researchers propose that his dramatic weight gain and even his leg ulcers could have been the result of post-traumatic growth hormone deficiency, one of the many afflictions that accompany traumatic brain injury.

They begin their examination of the historical record by pointing to a report by the Spanish ambassador in 1507 pronouncing “There is no finer youth in the world than the Prince of Wales”. A 16-year-old Henry was "lighthearted, merry, and easily given to laughter.” One could say this was long before Henry had experienced the heavy weight of kingship.  But eight years later in 1515, despite suffering a bout of smallpox the previous year, Henry meets with the Venetian ambassador who says of Henry he was “prudent and wise and free from every vice.”

With Henry's love of often dangerous medieval sports, especially jousting, however, his easy-going personality would not last.

"In March 1524 the king was unseated after a jousting lance found its way into his open visor and broke into many splintered pieces. Henry was de-horsed and dazed, although he continued to joust for the rest of the day. He is said to have had recurrent headaches after this point." - Muhammad Qaiser Ikram, et al, The head that wears the crown: Henry VIII and traumatic brain injury

Henry VIII's blackened, etched and gilt Italian field armor
at the Metropolitan Museum of Art in New York.
Photo by Mary Harrsch © 2007

Then, in 1525, while hawking, Henry, attempting to vault over a hedge with a pole, plunged head first into a water-filled ditch.

"He may have been dazed or unconscious because it is said of the incidence that if Edmund Mody had not pulled him out of the ditch, legs first, he may have drowned." - Muhammad Qaiser Ikram, et al, The head that wears the crown: Henry VIII and traumatic brain injury

An avid outdoorsman, Henry VIII enjoyed hunting.  Here he hunts deer with Anne Boleyn in this 1903
painting by William Powell Frith.  Image courtesy of Wikimedia Commons.

Although now plagued with headaches and having suffered two bouts of malaria, Henry still seemed amiable to court visitors.  Desiderius Erasmus, a noted Dutch Renaissance humanist, while visiting the Tudor court in 1529, described Henry as "… a man of gentle friendliness, and gentle in debate; he acts more like a companion than a king".

Then on January 24, 1536, the king was unseated while charging at full speed in a joust and his steed fell upon him.  Henry was said to be unable to speak for two hours which the researchers attribute to a loss of consciousness.

Members of Henry's court began to notice the king appeared to be suffering from significant memory problems. In July 1536, Henry's illegitimate son Henry FitzRoy, Duke of Richmond, died of tuberculosis.

"He was buried in near-secret in the presence of his father-in-law the Duke of Norfolk, and two other personages, by the king’s own instructions. Yet in a few days Henry appears to have forgotten his own role in the funeral and was accusing the Duke of Norfolk of inappropriate behavior towards FitzRoy." - Muhammad Qaiser Ikram, et al, The head that wears the crown: Henry VIII and traumatic brain injury

The researchers explain, "Traumatic brain injury disproportionately damages white matter tracts  [the cells in the brain that transmit signals from one region to another] which may manifest as amnesia, apathy and loss of initiative, executive dysfunction [executive processes include goal formation, planning, goal-directed action, self-monitoring, attention and response inhibition] as well as impulse and emotional dysregulation [radical mood swings including angry outbursts, behavior outbursts such as throwing objects or destroying things and aggression]."

In fact, his possible loss of impulse control may have led to his beheading of Queen Anne Boleyn in May 1536 and his, increasingly brutal, dissolution of the monasteries from 1535-1540. (My observation not theirs) He also married three more times during this period although the death of Jane Seymour from childbirth complications could not be attributed to Henry's mental illness.

Anne Boleyn in the Tower by Edouard Cibot, 1835.

The researchers point out that Henry began to demonstrate explosive and murderous anger that was relatively easily provoked.

"The irascibility and changeability of Henry was a source of constant anxiety for Tudor courtiers. Several ambassadors noted the unpredictability of Henry, who was often furious for reasons not immediately obvious to his ministers and advisers. The French ambassador for example speaks of his 'lightness and inconstancy' in 1540. His explosive anger could often end in the execution of an unsuspecting courtier or friend. The king was unable to control other impulses, whether these were related to his unreasonable suspicions or his lust for other peoples’ property."  - Muhammad Qaiser Ikram, et al, The head that wears the crown: Henry VIII and traumatic brain injury

Henry also suffered from depression and extended periods of self-pity.  After executing Thomas Cromwell in July 1540, Henry fell into a deep depression and in 1541, claiming to mourn Cromwell, confined himself to Hampton Court for a long period.

One of the ornate towers and Tudor-era chimneys at
Hampton Court Palace, East Molesey, England.
Photo by Mary Harrsch © 2008

Another result of traumatic brain injury that is often overlooked is damage to the pituitary gland. Such damage may result in growth hormone deficiency and hypogonadotrophic hypogonadism.  In an adult, growth hormone deficiency may result in loss of strength, stamina, and musculature, poor bone density, diminished lean body mass and visceral obesity. So Henry's ballooning weight may not have been entirely attributable to a gargantuan appetite.

Closeup of a portly Henry VIII by American miniaturist
George S. Stuart at the Museum of Ventura County, CA.
Photo by Mary Harrsch © 2006

Psychological symptoms include poor memory, social withdrawal, and depression which also coincide with reports we have already examined.

Symptoms of hypogonadism in an adult include low libido, and infertility.  You may think with court tales of countless sexual liasons and the king married six times, Henry surely must not have suffered from a diminished libido.  But, in fact, the researchers find repeated references to Henry's inability to perform in the bedroom.

"Anne and George Boleyn were accused of ridiculing the king. Anne appears to have told her sister-in-law that Henry 'was not adept in the matter of coupling with a woman and that he had neither vertu [skill] nor puissance [vigour]'." - Muhammad Qaiser Ikram, et al, The head that wears the crown: Henry VIII and traumatic brain injury

They also point to his inability to consummate his marriage to Anne of Cleves in 1540.

"Various excuses were made from 'misliking of her body for the hanging of her breast and the looseness of her flesh', to the charge that the king was duped by an unnecessarily complimentary portrait of Anne." - Muhammad Qaiser Ikram, et al, The head that wears the crown: Henry VIII and traumatic brain injury

Anne of Cleves by Bartholomäus Bruyn the Elder 1540s

The researchers also suspect Henry's disastrous marriage to Catherine Howard, a young woman who took many lovers while Henry's lack of extra-marital activity was attributed to his fidelity.  They say this seems highly unlikely in view of his long history of youthful virility and sexual indiscretions.

I find it particularly tragic that Henry's own traumatic brain injury may have been ultimately responsible for the lack of an heir he so desperately craved all of those years.

By the late 1540s, Henry's symptoms had reached catastrophic proportions affecting both his personal life and ability to lead his country.

In 1544, Henry declared war on France and besieged the town of Boulogne.  At one point he simultaneously ordered fortification of the city while issuing an oral order to demolish it.

His sixth and final wife, Catherine Parr, was not spared from his irrational tirades either.

"...the king loved religious debates and during one acrimonious argument between Catherine Parr and Gardiner [in 1546] he unreasonably ordered the transportation of the queen to the Tower of London. The next day he appears to have forgotten about the incident and was consoling his distraught wife. When the soldiers arrived to take her away, he could not remember the original orders he had given and had to be prompted to remember the episode. When he remembered he flew into another fit of rage." - Muhammad Qaiser Ikram, et al, The head that wears the crown: Henry VIII and traumatic brain injury

A miniature portrait of Catherine Parr circa 1543
by Lucas Horenbout

Within months, Henry VIII was dead.

Since his death there has been a flurry of diagnoses proposed to account for Henry's physical symptoms and erratic behavior.

 "One of the hypotheses regarding the health of Henry VIII is that he had Cushing’s syndrome [a condition with symptoms that include high blood pressure, abdominal obesity but with thin arms and legs, reddish stretch marks, a round red face, a fat lump between the shoulders, weak muscles, weak bones, acne, and fragile skin that heals poorly]. There appears to be a temporal relationship between Henry’s documented head injuries and the stepwise worsening of his health which this hypothesis cannot explain. Another older hypothesis is that Henry had syphilis but this is now largely abandoned. Other hypothesized mechanisms for Henry’s change include diabetes and hypothyroidism, neither of which can account for the whole picture. Another recent hypothesis regarding Henry’s health is that he had McLeod syndrome [a genetic mutation with symptoms of peripheral neuropathy, cardiomyopathy and hemolytic anemia along with late-onset dementia and behavioral changes usually not noticed until the individual is in their 50s] with infertility and psychosis. Henry, however, is not reported to have had choreiform movements [irregular muscular movements that make walking difficult] or dystonic reactions [twisting and repetitive movements caused by sustained muscle contractions]." - Muhammad Qaiser Ikram, et al, The head that wears the crown: Henry VIII and traumatic brain injury

So, the researchers conclude, "We know of at least three major head injuries in Henry’s life. He may have had headaches and more subtle changes to his personality after his first head injury, but there is a marked stepwise change in him after 1536. It is entirely plausible, though perhaps not provable, that repeated traumatic brain injury lead to changes in Henry’s personality. This is not to discount the complex time in which he lived or the impact of events on him. Whether some of the metabolic problems he faced later in life can be explained in terms of his head injury is a longer bow to draw but not outside the realms of possibility."


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Fluorosis a problem for ancient Palmyrans and Herculaneum victims

A history resource article by Mary Harrsch © 2015

The great archway leading to the grand collonade in Roman Palmyra.  Image
courtesy of Wikimedia Commons.

A study suggests Palmyra's waters may have been ruinous in the end for the city's inhabitants. Palmyra, today, is a World Heritage Site, a designation bestowed by the United Nation Educational, Scientific and Cultural Organization in 1998. About 140 miles southeast of Damascus, the trading town known as Tadmor (also spelled Tadmur) to the ancients, later Palmyra, had been a center of trading since around 2000 B.C.E. But the town really bustled during the Roman Empire, and was filled with magnificent buildings throughout the 1st and 2nd century, beginning with the reign of Roman emperor Hadrian in 129 A.D.

Hadrian renamed the oasis town "Palmyra Hadriana." Modest guys, those Roman emperors. The city's wealth faded with the decline of Roman influence in ancient Syria.

Starting in 1990, Japanese archaeologists began excavating the southeast necropolis of Palmyra and examined remains from the Roman era. Despite Palmyra's prosperity, "skeletal remains uncovered from the underground tombs of Palmyra have been found to retain an arthropathy of the joints, especially in the knee joint, bone fracture, marked bone lipping, spur formation, and eburnation (smoothed bone cavities)," reports the team led by Kiyohide Saito of the Archaeological Institute of Kashihara in the Journal of Archaeological Science.

Funerary Portrait of Yarkhai, Son of Ogga and Balya his Daughter
from Palmyra in Roman Syria 150-200 CE Limestone.  Photographed at the
Portland (Oregon) Art Museum by Mary Harrsch © 2012.

Fluoride in small concentrations is thought to deter microbes that cause tooth decay, the reason why about 66% of public water supplies in the United States are now fluoridated, according to the federal Centers for Disease Control and Prevention. But the Palmyrans' symptoms, along with discolored teeth, point to "fluorosis," a skeletal and enamel-damaging syndrome caused by ingesting too much fluoride over a long time, the researchers note. Looking at two large tombs for example, 25 of 33 individuals (76%) had discolored teeth in one, and 45 out of 65 (69%) had discolored teeth in the other.

Palmyrans drank, and still drink, water from wells tapped from ground water by long tunnels called "qanats" (an excellent Scrabble word). The area's geology and water table has been stable for about 7000 years, meaning water conditions now aren't greatly different from those during Roman times. In a bid to estimate the fluoride burden suffered by the town's ancient inhabitants, the researchers analyzed the water from these wells. Fluoride levels were as high as three parts per million in the water, a level that a National Academy of Sciences report in March warned could lead to fluorosis.

Archaeologists also ground up seven discolored teeth from tomb inhabitants, and compared them to seven others without discoloration, to reveal their fluoride concentration. In a chemical reaction, fluoride tends to replace some calcium in tooth enamel, making overexposure to fluoride particularly worrisome for children with growing teeth and bones. The ground-up teeth revealed that in the most discolored ones, about 22% of the calcium had been replaced by fluoride. "Thus, it was possible to directly verify that the ancient inhabitants of Palmyra did suffer from fluorosis," they conclude.

Update, 2/19/2015:

Vesuvius still hovers threateningly over the remains
of Herculaneum near Naples, Italy.
Photo by Mary Harrsch © 2007.

In 1981 when skeletal remains of victims of the Vesuvius eruption were found in the boat chambers on the shore of Herculaneum, researchers were provided with another opportunity to study dental conditions of Roman residents in a different ancient setting. In The Lancet, researchers Gino Fornaciari, M. Rognini and M. Torino reported finding only 3.8% of teeth recovered from 41 adults and 12 children damaged from tooth decay.

"This percentage is very low for both modern and ancient populations, in which values were between 8.5%, as in classic Magna Graecia and 11.4%, as in Roman Britain," the researchers stated.

However, the researchers also discovered a high percentage of individuals with calcium-deficient tooth enamel - a condition often resulting from starvation at an early age but also found in well nourished individuals suffering from fluorosis.

"To elucidate this hypothesis, we examined thin sections of permanent teeth enamel (first molar) from 8 individuals found in the Herculaneum arches site and from a present-day patient from Pisa without evidence of fluorosis, as control," the researchers explained, "Enamel was analysed by energy dispersion system (EDS) with an SEM (Jeol) 6400 connected to a microanalysis system (EDS) (Noran-Tracor) with a detection of Z-MAX 30. Enamel fluorine concentrations were greater than 10-fold higher than normal (1500-3600 parts per million [ppm]) were recorded in 6 individuals."

Skeletal remains of 32 victims awaiting evacuation in the boat chambers of
Herculaneum.  Image courtesy of Tom Huesing via Flickr.

However, the condition was not found uniformly throughout all individuals in the sample and no fluorine was found in soil samples. But, researchers did find a strong concentration of fluorine in the water-bearing stratum of Herculaneum (3-8 mg/mL), with a calculated intake of 11.4-19.0 mg a day per person at the time of the volcanic eruption.

Researchers concluded that some of the sampled remains may have been visitors to the area, since the Roman aristocracy maintained vacation villas in the area.

Mary Queen of Scots Miscarriage Points to Collusion in Death of Lord Darnley

Mary Queen of Scots at Madame Tussaud's Wax Museum in
London.  Photographed by Mary Harrsch © 2006

A history resource article by Mary Harrsch © 2015

Interesting article in the Times Online about research by modern gynecologists:

"Mary Stuart, Queen of Scots, was an “adulteress and liar” who plotted to kill her husband in order to marry her lover, a study by modern gynecologists has suggested.

An intriguing medical analysis claims that Mary, the cousin of Elizabeth I, concocted a story of kidnap and alleged rape to justify her marriage to her third husband – potentially shedding light on a 400-year-old royal murder mystery.

Far from being the saintly and wronged Roman Catholic monarch portrayed in portraits and films, Mary was actually a “moral loose cannon”, whose striking beauty and sex appeal gave Elizabeth other reasons to imprison and execute her, the researchers suggest.

The study revolves around the report by Claude Nau, Mary’s adviser and secretary, that on July 24, 1567, at Loch Levan Castle, Kinross, Mary miscarried twins. Information about the miscarriage is scant, but in May 1567, just 12 weeks after the murder of Mary’s second husband, Lord Darnley, the Scottish Queen married James Hepburn, fourth Earl of Bothwell, who had abducted and “ravished” her at Dunbar Castle, in April, some sources say.

Henry Stuart (Lord Darnley) with his wife/cousin, Mary Queen of Scots circa 1565
by unknown artist.  Image courtesy of Wikimedia Commons.

Mary later claimed that her pregnancy began after her marriage but experts now say this is impossible.

In a study published in the Journal of Family Planning and Reproductive Healthcare, Lesley Smith, a medical historian, claims that it would have required modern microscopes and knowledge about fetal development to identify that the miscarriage was of twins after the seven weeks of pregnancy that Mary claimed.

It would also have been an “astonishing coincidence” if conception occurred at the time of the “rape”, and even then the twins would have been just 12 weeks old and hard to identify upon miscarriage.
Instead, it is more likely that “the widowed Mary had an affair with Bothwell, became pregnant and had used the abduction story as a cover for her condition and justification for marriage,” Ms Smith says.

Along with other historians, she believes both Mary and Bothwell to have been implicated in the death of Darnley, a drunken and controversial figure who was found strangled at Kirk O’Fields, Edinburgh, after being married to Mary for just 19 months.

Bothwell was a prime suspect but was acquitted at what is now regarded as a sham trial.

James Hepburn, the 4th Earl of Boswell c. 1535-1578.
Image courtesy of Wikimedia Commons.

“Mary had an undoubted passion for Bothwell, her supposed kidnapper, and did not try and escape from him despite ample opportunity. By contrast, she hated Darnley and was publicly separated from him by the time of his murder. The suspicion of an affair is not a new idea,” Ms Smith says, “but the medical evidence brings us very much closer to the likely truth.”

Tony Roberts, a consultant obstetrician at Queen’s Hospital, Burton on Trent, says that it would have required “a sensible and weathered eye” to identify a twin miscarriage at 12 weeks.

“If you want to prove pregnancy, a midwife in those days should have been able to do this, but standards were low, even for a queen,” he adds.

As such, Claude Nau’s report of the miscarriage implies that Mary became pregnant by Bothwell well before the abduction. The unlikely possibility that Darnley was the father would have left the Queen at least five months pregnant with the twins, a condition which would have been “hardly unnoticeable”, Ms Smith says.

The researcher, who is the curator of Tutbury Castle in Staffordshire, where Mary was held prisoner, says her theory further explains the animosity between Mary and Elizabeth I.

Remains of Tutbury Castle in Staffordshire, England where Mary Queen of Scots
was held prisoner.  Image courtesy of Wikimedia Commons.

“Mary Stuart was a remarkable specimen of humanity,” she writes. “She was 5 ft 11 in when the average woman was around 4 ft 11 in, so she was the equivalent of 6 ft  5 in by modern standards. [She] was also beautiful and very sexually attractive. “All in all, Mary Queen of Scots was a very dangerous creature to the unmarried Protestant Elizabeth, and her physical presence made her positively intoxicating to anyone who met her.”

She said: “All the available evidence creates a damning impression. Elizabeth probably considered Mary to be a moral loose cannon and fool for men. It is also interesting that, while Mary was prisoner in England there was no Catholic nation that made a serious attempt to release her: was there a more widely held view that she was better out of the way?”

Queen of plots

December 1542 Mary born to James V of Scotland. Her father dies when she is six days old and Mary becomes Queen of Scotland

1548 Henry VIII begins his “rough wooing” — a military campaign designed to impose marriage to his son on Mary. Instead she promises to marry the French Dauphin and flees to France

1559 Marries François II

1561 She returns to Scotland following François’s death

1565 Marries Henry Stuart, Lord Darnley, her first cousin, below. Their son, James I of England, is born the following year

February 1567 Darnley found dead. James Hepburn, 4th Earl of Bothwell, bottom, is prime suspect

April 24 1567 Mary visits her son for the last time at Stirling but is abducted by Bothwell and taken to Dunbar Castle, where she is allegedly raped

May 15 1567 She marries Bothwell, a Protestant, to preserve her honour, but is condemned by the Scottish nobility

July 24 1567 Imprisoned at Loch Levan Castle by her own people, she miscarries twins and is forced to abdicate the Scottish throne

May 1568 Mary escapes but is defeated at Battle of Langside and flees to England, where she is captured and spends the next 19 years as a prisoner

1578 Bothwell dies, insane and imprisoned in Denmark

1587 Mary is found guilty of treason and executed.

Shakespeare's Portraits Point to Mikulicz Syndrome and Systemic Sarcoidosis

A history resource article by Mary Harrsch © 2015

Several years ago I posted an abstract from an article about the controversy surrounding a death mask identified as William Shakespeare. I received an email from University of Mainz academic Hildegard Hammerschmidt-Hummel, who is a champion of the mask, pointing out that she has written a book about the mask entitled "The True Face of William Shakespeare. The Poet's Death Mask and Likenesses from Three Periods of His Life". In it, she explains the scientific methods she used to analyze the mask and compare it to four Shakespearean portraits.

She also includes information about how the portraits and mask point to the cause of Shakespeare's early death at 52 years old.

"By combining exhaustive academic research with the latest technology and collaborating over
many years with specialists from the most varied disciplines - including forensic experts from the German Federal Bureau of Criminal Investigation (BKA=CID), Professors of Medicine, 3D imaging engineers, archivists and an expert on old masters - Hildegard Hammerschmidt-Hummel has proved the authenticity of the Chandos portrait, the Darmstadt death mask and the Flower portrait (recently incorrectly dismissed as a ‘fake’ by the National Portrait Gallery, as shown by the author's latest evidence). Her revolutionary research has also authenticated another true face of Shakespeare - the Davenant bust. This haunting sculpture has resided in the Garrick Club since 1855 and was thought to be the work of an eighteenth century sculptor. According to the author’s new documentary sources, it derives from the collection of Sir William Davenant (1606-1668), Shakespeare’s godson, who also owned the Chandos portrait.

William Shakespeare at Madame Tussaud's
Wax Museum in London.  Photo by Mary Harrsch
© 2006

By tracing the development of certain signs of illness in each of the images, first noticed by
Hildegard Hammerschmidt-Hummel, the author’s medical experts have identified and verified the most probable cause of Shakespeare’s death. The conspicuous growth on the upper left eyelid, they interpreted as Mikulicz Syndrome (a probably cancerous abnormality of the tear glands), the swelling in the nasal corner of the left eye as a fine caruncular tumour, and the considerable swelling on the forehead (in conjunction with the other pathological symptoms) as systemic sarcoidosis, an inner disease that affects the organs and takes a very protracted course, but proves to be fatal."

Beethoven: A Symphony of Illness

A history resource article by Mary Harrsch © 2015

Portrait of Ludwig Van Beethoven by Joseph Karl Stieler, 1820.
Image courtesy of Wikimedia Commons.

"A 56-year-old Beethoven sought medical care after suffering chills, fever, respiratory distress, and spitting up blood. He complained of chest pain on the right side. He said he had been in good health until two weeks before when he noted a loss of appetite, diarrhea, weight loss, increased thirst, and a swelling of his feet and abdomen. He admits he had been working in the cold at his brother's country home dressed in only flimsy clothing and returned in an open-air cart."

Thus begins a study to determine what may have caused Beethoven's death as a clinical exercise at a 1999 clinical pathologists' conference at the University of Maryland School of Medicine. Each year, a team of practicing pathologists select a famous individual from the past whose manner of death remains speculative and attempt to derive a definitive cause of death.

Beethoven's case is examined by Drs. Michael S. Donnenberg, Michael T. Collins, R. Michael Benitez and Philip K. Mackowiak with their results entitled "The Sound That Failed" ultimately published in The American Journal of Medicine in 2000 (Volume 108, p. 475-480).

The pathology team continues:

"In addition to suffering from progressive deafness that began in his early twenties, the patient suffered recurrent bouts of depression, social isolation and personal neglect. He also began suffering from abdominal pain that he relieved with alcohol. The patient had survived smallpox as a child as well as typhus or typhoid fever. He subsequently claimed to have intermittent winter attacks of "asthma" since the age of 17. In his late forties he noted the onset of chronic headaches and recurrent joint pains which were thought to be rheumatism or gout. At age 51 he suffered an episode of jaundice that lasted six weeks. He also developed a painful eye affliction that was resolved after nine months of patching and noted that he experienced increasing swelling of the lower extremities accompanied by intermitten bouts of nosebleeds, vomiting blood, and coughing or spitting of blood."

"Physical examination revealed a stocky, powerfully built but somewhat emaciated man of swarthy complexion. His face was flushed and prominently pockmarked. His lips were thin and parched, his tongue dry and coated. The skin was hot, flushed , and dry and showed evidence of hair loss."

What was the instrument of the famous composer's death?  (PDF of original article reprinted with permission)