“Anne Boleyn and the Spanish Influenza”, by JoAnn Spears

By JoAnn Spears


Queen Anne Boleyn
Queen Anne Boleyn


For Tudorphiles, ‘Spanish influenza’ might sound like something that Anne Boleyn could be accused of calling the thorn in her side, Katherine of Aragon. It was, in fact, a most lethal strain of influenza, killing millions during the World War One era. The epoch of the Spanish flu has been largely forgotten by history. However, it may still be relevant to those interested in Anne Boleyn theory, specifically in regard to Anne’s experience with the Sweating sickness, which she suffered with in 1528. That was the fourth of the disease’s five appearances; the others were in 1485, 1508, 1517, and 1551.

In the Latin that united the cosmopolitan Renaissance medical world, the sweating sickness was called sudor anglicus, the English sweat. The Brits, however, thought it an imported commodity, courtesy of the mercenaries from continental Europe who helped Henry VII, the first Tudor king, to win his throne. In the sickness’ last rampage, it spread eastward through northern Europe as far as Russia, but largely spared Scotland, Ireland, and the more southern portions of Europe.

Erasmus Artist: Hans Holbein the Younger
Desiderius Erasmus
Artist: Hans Holbein the Younger

Much of Europe thought Tudor England a bit behind the times when it came to cleanliness and hygiene practices. Desiderius Erasmus described floors covered with “rushes, renewed from time to time but so as to leave a basic layer, sometimes for twenty years, under which fester spittle, vomit, dog’s urine and men’s too, dregs of beer and cast off bits of fish, and other unspeakable kinds of filth. As the weather changes, this exhales a sort of miasma which in my opinion is far from conducive to bodily health.”

The grasses and straw which comprised rushes, and which were also used to fill mattresses and cushions, were often infested with critters such as lice and bedbugs. Thus, two of modern science’s earliest hypotheses about causes of sweating sickness: potties and pests.

Early epidemiologists associated sweating sickness with bacterial disease, particularly typhoid fever. Salmonella typhi is a bacteria that spreads through contaminated food or water by what is known as the fecal-oral route and is strongly associated with poor sanitation and waste disposal. This ailment probably killed such prominent Brits as Prince Albert and several of the literary Brontes. Typhoid fever has, however, a marked gastroenterological component. Such symptoms are largely absent, or not emphasized, in contemporary descriptions of the English sweat.

Relapsing Fever, caused by the louse-borne bacteria Borrelia recurrentis, was another early bacterial contender and, like the sweating sickness, was known for causing a drenching sweat. It originated in the warmer parts of the world, including Africa and South and Central America. In the early Renaissance era, European exploration of these areas was just beginning. The plants, animals, and people that Europe’s explorers brought back home to the Old World could have been inadvertent Borrelia vectors. Most of these early explorations, however, originated out of, and returned to, Southern European countries, and these were largely, unlike England, sweat-spared.

Relapsing and Typhoid Fevers are caused by bacteria. Bacteria were understood long before the discovery of viruses, which occurred around the turn of the 20th century. Since that time, rodent-borne hanta virus has been proposed as a sweating sickness contender, but research has proven inconclusive. However, the possibility of a viral origin provides another most intriguing possibility for categorizing the English sweat: avian influenza or virus.


We’ll discuss the possibility of sweating sickness being viral in Part Two.


The Dance of Death
The Dance of Death


Influenza has been around since at least Hippocrates’ time. It is thought of today mostly as a nuisance that can be sanitized or vaccinated away. This testifies to a short collective memory when the story of the Spanish flu pandemic of 1918 is considered.

Within 25 weeks of the beginning of the Spanish flu pandemic in March 1918, an estimated 25 million people died worldwide. When the pandemic finally ended in 1920, as many as 50 million people had died. In an era when supportive care for influenza symptoms such as fever was better understood than it was in Tudor times, the mortality rate for Spanish flu was still around 10%.

It doesn’t take much math to figure out that as many as 500 million people developed Spanish flu between 1918 and 1920. It was an era when people knew a lot more about disease transmission than they did when Anne Boleyn retreated to Hever with the sweating sickness in 1528. As a result, many a large public gathering was cancelled for preventive purposes during the Spanish flu pandemic, and people around the world wore surgical-type face masks when in public. These efforts were unavailing against the spread of the infection; Spanish flu was as mysterious and maddening as Anne Boleyn herself could be.

Many believe nowadays that Spanish flu was an avian virus, akin to the modern H1N1 or bird flu virus which originates in, and is spread by, infected poultry. Birds shed avian influenza A virus, for example, in saliva, mucous and feces. Human infection can happen when viral matter is touched, inhaled, or ingested.

Anne Boleyn is unlikely to have personally prepared poultry for consumption. She did, however, feast in the Tudor court where feathered fare ranging from swallows to game birds to swans were prepared by ‘the help’ and consumed by ‘the quality’ with gusto. The Tudor court was also a home to falcons which were used by both men and women for hunting for sport–Anne Boleyn’s family crest actually features a falcon. Parrots and parakeets, novelty birds from the New World, were also present at the Tudor court as pets. Henry VIII himself was said to have an African grey parrot which could mimic calls to boatmen on the Thames, leading more than one of them on a fool’s errand. One tale says that when the parrot fell into the Thames on one occasion, it was recognized and rescued only because it started to scream ‘boat!’ as it fell into the river.

The sweating sickness and the Spanish flu do not have only a surprising possible causation in common. Both claimed, for the most part, a surprising set of victims.

The English sweat and the Spanish flu did not prey on vulnerable folk such as the weak, the compromised, the very young, and the very old, as most modern flu viruses do. According to Caius, speaking about the sweating sickness, “they which had this sweat sore with peril of death were either men of wealth, ease or welfare, or of the poorer sort, such as were idle persons, good ale drinkers and taverne haunters.”

Contemporary sources also tell us that men were disproportionately affected; “mortalitie fell chieflie or rather upon men, and those of the best age as between thirtie and fortie years. Few women, nor children, nor old men died thereof”.


Spanish Influenza


The Spanish flu likewise claimed the least likely as its victims, with many heretofore healthy young adults succumbing. The Spanish flu pandemic started, in fact, in an army base in Kansas, claiming the lives of robust young World War I soldiers while their physicians looked on, helpless. It is thought today that this was due to a phenomenon known as cytokine storm, a scenario in which a healthy immune system is actually a liability.

If a virus such as bird flu enters the body through inhalation, the infection will center in the lungs. It is normal for the body to fight infection in the lungs with inflammatory responses that are familiar: increased circulation to the area, mucus production, coughing, fever to ‘burn out’ the infection, etc. In a cytokine storm, too much of all of these symptoms creates as much of a problem, if not more of a problem, than the infectious agent itself. Soldiers with Spanish flu were drowned by copious blood and fluids produced by their own lungs, possibly as a result of this phenomenon. Cytokine storm has also been associated with avian H1N1 virus.

Perhaps a similar phenomenon caused the dramatic symptoms of Tudor-era sweat-sufferers. Caius describes typical flu symptoms of myalgia and headache, followed by delirium, cardiac palpitation, tachycardia, tachypnea, chest pain and agonal breathlessness. Physician Thomas Forrestier describes the symptoms in contemporary parlance: The exterior is calm in this fever, the interior excited . . .the heat in the pestilent fever many times does not appear excessive to the doctor nor the heat of the sweat particularly high . . . .but it is on account of the ill-natured, fetid, corrupt, putrid, and loathsome vapors close to the region of the heart and lungs whereby the panting of the breath magnified and increases and restricts itself…

Was the English sweat an avian flu? The sweating sickness and the quite possibly avian Spanish flu were both maddening, mysterious forces, capable of bringing about a strong man’s downfall, and yet as elusive and as hard to contain as a bird in flight. The association with Henry VIII and Anne Boleyn, surely, is fitting.



Centers for Disease Control and Prevention: Avian Influenza A Virus Infections in Humans

Center for Infectious Disease Research and Policy, University of Minnesota: Study shows cytokine storm in fatal 2009 H1N1 cases 

The Correspondence of Erasmus: Letters 1356 to 1534, 1523 to 1524

The Encyclopedia Britannica: Sweating System

The Guardian: Talk the Squawk

Hektoen International: A Journal of Medical Humanities: The sweating sickness in Tudor England: a plague of theRenaissance

Journal of the History of Medicine and Allied Sciences: The English Sweating Sickness (Sudor Anglicus): A Reappraisal 

On the Tudor Trail. Anne Boleyn and the Tudor Sweating Sickness

Pubmed. The English ‘sweate’ (Sudor Anglicus) and Hantavirus pulmonary syndrome 

United States Department of Health and Human Services: The Great Pandemic 

The Washington Post: Flu’s lethality is attributed to immune systems overreacting to the virus 


JoAnn Spears
JoAnn Spears

JoAnn Spears couldn’t decide whether to major in English or History in college. Life stepped in, and she wound up with a Master’s Degree in Nursing instead. A twenty-five year nursing career didn’t extinguish that early interest in books and history-especially Tudor history. It did, however, stoke a decidedly gallows sense of humor.

Eventually, JoAnn read just about every spin there was on the stories of Henry VIII and the extended Tudor family. Every spin, that is, except the one with the gallows humor. The Tudors certainly qualified for it, but it just wasn’t out there. JoAnn decided that with gallows humor to spare, she would do her best to remedy the Tudor comedy gap. A little inspiration from the classic Wizard of Oz showed her the way to go, and Six of One, a new kind of Tudor novel, was born.

JoAnn thought Six of One, her story about Henry VIII’s six wives, would be an only literary child. Then, two years after its birth, she was caught by surprise with the idea for a sequel. In October, 2015, Seven Will Out made its debut and bought the latter-day Tudors into the comedy mix.

JoAnn enjoys writing but maintains her nursing license because a) you never stop being a nurse and b) her son thinks she should be sensible and not quit her day job. She also enjoys life in the beautiful mountains of northeast Tennessee, where she gardens, embroiders antique reproduction samplers, and teaches yoga in her Methodist church basement. JoAnn shares her home with three cats and the works of Jane Austen, Barbara Pym, Louisa May Alcott, and of course, Alison Weir.


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Beth von Staats

is the owner and administrator of QueenAnneBoleyn.com. Blogger of "The Tudor Thomases", Beth specializes in writing magazine articles, online historical articles, short stories, and flash fiction.

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