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New study re-examines the death of Edward the Black Prince

Whatever disease killed Edward the Black Prince—heir apparent to the English throne in the 14th century—is unlikely to have been chronic dysentery, as is commonly believed, according to a study in the journal BMJ Military Health.

But whether it was malaria; brucellosis, caused by eating unpasteurized dairy products and raw meat; inflammatory bowel disease; or complications arising from a single bout of dysentery—all possible causes—the disease changed the course of English history, says Dr James Robert Anderson, the lead author of the article.

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And what happened to the Black Prince, who pretty much continuously fought wars and was exposed to violence from the age of 16, has been endlessly repeated throughout millennia, with disease, rather than battle injury, taking the heaviest toll on life during warfare, he says.

Edward of Woodstock, the Black Prince, was never seriously injured despite the number of military campaigns he led. The authors note how his healthy changed in 1367:

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The Black Prince’s illness is thought to have started after his victory at the Battle of Nájera in 1367. He paused in the town of Valladolid, in northern Spain. It was the start of summer and “his army endured sore distress and of hunger, for lack of bread and wine”. A chronicle suggested that up to 80% of the Prince’s army may have died from “dysentery and other diseases”. Chandos Herald’s Life of the Black Prince documents his movements from Spain to France and reported “Soon after this, the Prince of Aquitaine came to stay at Angoulême, and while he was there, the illness began which lasted for the rest of his life”. Before the Siege of Limoges in 1370, he was described as “lying sick in his bed” being carried in a litter to direct the battle.

Edward died on 8 June 1376. Most later accounts of the Black Prince’s death suggest that he died from chronic dysentery, possibly the amoebic form, which was common in medieval Europe.  Amoebic dysentery can cause long-term complications, including internal scarring (amoeboma), intestinal inflammation and ulceration (colitis), and extreme inflammation and distension of the bowel (life threatening toxic megacolon), points out the author.

But if he really did have amoebic dysentery, with its symptoms of chronic diarrhoea, would he really have been well enough, or even welcomed aboard, a ship with a cargo of soldiers heading for battle in France in 1372, asks the authors?

Edward being carried in a litter during the siege of Limoges in 1370 – Bibliothèque nationale de France MS Français 7 fol. 371r

Complications from surviving a single bout of dysentery are a possibility, particularly as historical records indicate that paratyphoid—similar to typhoid, but caused by a different bug—and a recently discovered cause of dysentery, was in circulation in 1367. Complications from this could have included long-term health issues, such as anaemia, kidney damage, liver abscess and/or reactive arthritis.

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Dehydration due to lack of water during the hot Spanish campaign is another possibility. This could have caused kidney stones which would fit with a fluctuating illness lasting several years.

The authors also point to inflammatory bowel disease as another possibility:

which may have led to his relapses in symptoms and gradual deterioration. Perhaps this may have also been complicated by perianal pathology, such as fistula. The surgeon John Arderne was on campaign in France at the same time as the Black Prince and wrote the Treatises of fistula in ano, haemorrhoids, and clysters in 1376, although no records survive that he ever treated the Black Prince.

Brucellosis was also common in medieval Europe, and its sources (dairy products and raw meat) were often kept aside for the nobility on military campaigns, says the author. It can produce chronic symptoms of fatigue, recurrent fever, and joint and heart inflammation.

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Another common disease in medieval Europe was malaria, the symptoms of which include fever, headache, myalgia (muscle aches and pains), gut problems, fatigue, chronic anaemia and susceptibility to acute infections, such as pneumonia or gastroenteritis, leading to multiorgan failure and death, he adds.

“This would fit the fluctuating nature of his illness and the decline towards the end of his life. Any anaemia would not have been helped by the purging and venesection [blood letting] treatments of the time,” Anderson suggests.

“There are several diverse infections or inflammatory conditions that may have led to [the Black Prince’s] demise…However, chronic dysentery is probably unlikely,” the authors write. “Even in modern conflicts and war zones, disease has caused enormous morbidity and loss of life, something that has remained consistent for centuries. Efforts to protect and treat deployed forces are as important now as in the 1370s.”

The article, “The death of the Black Prince: a case of disease in 1376 that changed the course of English history,” by James Robert Anderson, D S Burns and D N Naumann, appears in BMJ Military Health. Click here to read it.

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See also: The tomb of the Black Prince reveals its secrets

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