Chronic dysentery was unlikely to have led to the death of Edward the Black Prince, despite the popularly held belief, a military medical expert has suggested.
Writing in the journal BMJ Military Health, Dr James Anderson of the Royal Army Medical Corps, suggested that malaria or inflammatory bowel disease were among the more probable causes of death.
The study author, and colleagues from the Royal Centre for Defence Medicine, also highlighted that disease – rather than battle injury – has proved the biggest killer during warfare for millennia.
Edward, who was heralded as the greatest English soldier ever to have lived, was heir apparent to the English throne in the mid-14th century, and his early demise changed the course of history.
Dr Anderson, a Major serving with 21 Engineer Regiment, has speculated that possible causes of death were brucellosis, caused by eating unpasteurised dairy products and raw meat, or complications arising from a single bout of dysentery.
Long-Term Chronic Illness
Edward of Woodstock, the Black Prince, was never seriously injured in battle, despite participating in almost continuous military service since he was 16 years old. But he had a chronic illness for almost 9 years, to which he finally succumbed in 1376 at the age of 45.
After his death the Crown passed directly to his 10-year-old son, Richard, in succession to King Edward III. The young King Richard II was later deposed and possibly murdered, sparking over a century of instability, including the Wars of the Roses and the rise of the Tudors.
Dr Anderson described how the Black Prince's illness might have started after his victory at the Battle of Nájera in Spain in 1367. A chronicle suggested that up to 80% of his army may have died from 'dysentery and other diseases'.
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.
Going to Battle With Chronic Dysentery?
Dr Anderson pointed out that amoebic dysentery can cause long term complications, including amoeboma, colitis, and toxic megacolon.
He questioned whether, if Edward really did have amoebic dysentery, with its symptoms of chronic diarrhoea, he would have been well enough, or even welcomed, to board a ship in 1372 alongside soldiers heading for battle in France.
More Likely Causes of Death
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, suggests Dr Anderson.
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, he says.
Dr Anderson also suggested that another candidate was inflammatory bowel disease, which might have accounted for relapsing-remitting symptoms and gradual deterioration.
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, according to the authors. It can produce chronic symptoms of fatigue, recurrent fever, and joint and heart inflammation.
Another common disease in medieval Europe was malaria, the symptoms of which include fever, headache, myalgia, gut problems, fatigue, chronic anaemia, and susceptibility to acute infections, such as pneumonia or gastroenteritis, leading to multiorgan failure and death.
Disease Biggest Battlefield Killer
"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," he suggested.
"There are several diverse infections or inflammatory conditions that may have led to [the Black Prince's] demise. However, chronic dysentery is probably unlikely," he writes.
Dr Anderson concluded: "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."