Généalogie and Heritage

Source: Alfred the Great: a diagnosis - Journal of the Royal Society of Medicine Volume 84 May 1991

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Titre	Alfred the Great: a diagnosis - Journal of the Royal Society of Medicine Volume 84 May 1991

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ALFRED The Great King Of Wessex RF01

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King Alfred 'England's Darling' (849-900 AD) suffered from a painful illness for much of his life, the nature of which has been the source of some speculation amongst Anglo-Saxonists. We are fortunate to have a contemporary record of the king's symptoms as recorded by Asser, King Alfred's Welsh bishop and admirer. The study of Asser's work the 'Life of King Alfred' has fuelled many guesses as to the nature of the sovereign's illness. The suggestions that have been made cover a wide range of ailments: neuritis, epilepsy, a sexually transmitted disease associated with homosexuality, some sort of psychosomatic illness and so on... Crohn's disease It is said, for instance, that an anal lesion occurs in one quarter of all cases of Crohn's disease3 and in about 80% of cases in which the colon is involved4. The distribution of the lesions depends upon whether it is ulcerative colitis or Crohn's disease in any of its forms. In some cases the anal lesion precedes the development of intestinal disease by several years5. The perianal lesions of Crohn's disease may ofcourse take the form of abscesses or fistulae, ulceration of the anal or perineal skin or large fleshy oedematous skin tags. The lesions often have a cyanotic tinge and if they are ulcerated they tend to be chronic. The ulceration may be extensive with destruction of the anal sphincter and although the lesions may not be very painful in themselves,-they are likely to give rise to some degree of discomfort and soreness. Asser tells us that Alfred's perianal problem miraculously disappeared, to be replaced by a sudden and severe attack of pain at his wedding feast, when Alfred would have been about 19 years old. He continued to be afflicted with this far more serious illness from his 20th year to his 45th. This fits in well with the usual onset of Crohn's disease. It is an illness that begins in early adult life, approximately one half beginningduring the twenties, and 90% between the ages of 10 and 40 years6. Its aetiology remains unknown. There is a greater tendency for Crohn's disease, ulcerative colitis -and ankylosing spondylitis to occur in families which suggests that all three diseases share a common but incomplete genetic basis. A current hypothesis is that Crohn's disease is the consequence of an abnormal immune response in the gut wall to an unidentified antigen7. Although the disease may run a course causing permanent ill health or death, in other cases it is self limiting8, so that we could expect that if the onset of the disease occurred in youth it might well burn itself out by early middle age. Asser gives us a picture of a stricken monarch who suffers almost unremittingly from his symptoms9. Only a little further on in his account does he tell us that despite this, the king was able to pursue matters of state and the things that gave him pleasure with some energy. Thus the list runs that he contended with wars, Viking attacks and was still able to direct the governing of his kingdom, pursue all manner of hunting, give instructions to all his goldsmiths and craftsmen, direct his falconers, hawk trainers and dog keepers, as well as making his own designs for treasures9. The king was able to fight, study, pursue his leisure interests, worship and govern, in short he lived a very full life. Either.we are to understand that Alfred was of such fortitude that he continued doing all of this whilst very ill, ie with all of his symptoms present, or more plausibly, that his illness was intermittent. The former seems quite incredible. Asser in his admiration for the king treats us to the occasional exaggerated notion. Crohn's disease is a chronic disease characterized by relapses and remissions. In an attack there is abdominal pain, diarrhoea sometimes with mucus and blood, that may alternate with periods of constipation. There may be fever and wasting depending on the severity of the illness. Some sufferers, a minority, experience eye problems (iritis), joint pains (without any destructive pathology) and skin problems. The king dreaded the attacks of his illness, which suggests that they placed quite a burden on him. The symptoms of Crohn's disease are nasty enough for sufferers to fear relapses and to worry about themselves during an attack. If this worrying gets thought of as neurotic behaviour then it is a feature that usually disappears when the attack has past. It would be particularly inappropriate to describe King Alfred as neurotic, as some have done, as the king had great strength of character, he was not short of courage nor the capacity to make far reaching military decisions for the defence of his realm. He also had a keen desire that there should be an upsurge in learning, starting with his own ministers and then generally extending down to the lower eschalons. Alfred's reign saw a renaissance in education, craftsmanship and national pride, which is all the more remarkable when one considers that the country was struggling for its very survival against the fierce onslaught of the Vikings. Elias of Jerusalem The physicians of the day could not diagnose the king's problem which is not too surprising given how difficult the condition can be to diagnose. As the king sought for relief from his symptoms the news of Alfred's condition must have travelled widely. It is known from 'The Leechbook of Bald' that Elias, Patriarch of Jerusalem sent King Alfed some medical remedies for the alleviation of constipation, diarrhoea, pain in the spleen and internal tenderness9. If we assume that these were remedies aimed at specific symptoms that Alfred complained of, rather than a random pharmacopoeia, then our diagnosis looks even more likely as there is a very nice, fit between his remedies and the main symptoms of Crohn's disease. Elias sent Alfred a remedy for constipation and diarrhoea the general feature of bowel disease, with or without an underlying pathology. A remedy was given for spleenic pain,;which could refer to the area over the spleen or referred pain, rather than the spleen itself. Another of the Patriach's remedies was for internal tenderness which is usual when the disease is active and would certainly be the case if loops of bowel were bound up together with inflaatory exudate, with possible communication between the loops caused by fistulae. Abscesses within the abdomen would also give rise to some fairly serious pain and tenderness. Differential diagnoses As noted above the fit between the remedies and the sort of symptoms experienced by a sufferer from Crohn's disease is very close. However, it would be bad medical practice not to consider some other diagnostic possibilities. In some-respects of pathological detail Crohn's disease is similar to tuberculosRs, although with all of the resources available. to the modern physician no direct connection has everbeen found. If King Alfred had tubercular disease of the intestine then we could possibly expect a rapid deterioration in his condition with an early demise. The same would be true for cancer of the colon. Diverticular disease, as a rule, is a disease of the middle aged or elderly, the features of which are not readily distinguishable from those of cancer of the colon. It is not, on the whole, a young person's disease and its development is not preceded by perianal problems. Repeated infections are a possibility, but infection is an unlikely candidate to be the cause of a major health problem that spanned a period in excess of 25 years. The lesions of Crohn's disease may become infected, which would undoubtedly exacerbate the symptoms, so infection might have a minor role to play, but rates as an improbable cause. A serious venereal disease is not really in contention. The symptomology would have been understood in a rather basic fashion by the Dark Age physician. There is no evidence of a communicable disease. Such a condition would not have escaped attention. The communicability of a serious venereal disease would have had disastrous effects on his lineage. As there is no evidence to this effect this hypothesis ought to be ruled out of play. The evidence available points to inflammatory bowel disease with a particular inclination towards Crohn's disease. King Alfred died at the age of 50 years and his name passed into history. His life and reign was one ofthe most inspiring in English history. A great man beset by the rigours of offlce, wars and illness.

King Alfred 'England's Darling' (849-900 AD) suffered from a painful illness for much of his life, the nature of which has been the source of some speculation amongst Anglo-Saxonists. We are fortunate to have a contemporary record of the king's symptoms as recorded by Asser, King Alfred's Welsh bishop and admirer. The study of Asser's work the 'Life of King Alfred' has fuelled many guesses as to the nature of the sovereign's illness. The suggestions that have been made cover a wide range of ailments: neuritis, epilepsy, a sexually transmitted disease associated with homosexuality, some sort of psychosomatic illness and so on...
Crohn's disease
It is said, for instance, that an anal lesion occurs in one quarter of all cases of Crohn's disease3 and in about 80% of cases in which the colon is involved4. The distribution of the lesions depends upon whether it is ulcerative colitis or Crohn's disease in any of its forms. In some cases the anal lesion precedes the development of intestinal disease by several years5. The perianal lesions of Crohn's disease may ofcourse take the form of abscesses or fistulae, ulceration of the anal or perineal skin or large fleshy oedematous skin tags. The lesions often have a cyanotic tinge and if they are ulcerated they tend to be chronic. The ulceration may be extensive with destruction of the anal sphincter and although the lesions may not be very painful in themselves,-they are likely to give rise to some degree of discomfort and soreness. Asser tells us that Alfred's perianal problem miraculously disappeared, to be replaced by a sudden and severe attack of pain at his wedding feast, when Alfred would have been about 19 years old. He continued to be afflicted with this far more serious illness from his 20th year to his 45th. This fits in well with the usual onset of Crohn's disease. It is an illness that begins in early adult life, approximately one half beginningduring the twenties, and 90% between the ages of 10 and 40 years6. Its aetiology remains unknown. There is a greater tendency for Crohn's disease, ulcerative colitis -and ankylosing spondylitis to occur in families which suggests that all three diseases share a common but incomplete genetic basis. A current hypothesis is that Crohn's disease is the consequence of an abnormal immune response in the gut wall to an unidentified antigen7. Although the disease may run a course causing permanent ill health or death, in other cases it is self limiting8, so that we could expect that if the onset of the disease occurred in youth it might well burn itself out by early middle age. Asser gives us a picture of a stricken monarch who suffers almost unremittingly from his symptoms9. Only a little further on in his account does he tell us that despite this, the king was able to pursue matters of state and the things that gave him pleasure with some energy. Thus the list runs that he contended
with wars, Viking attacks and was still able to direct the governing of his kingdom, pursue all manner of hunting, give instructions to all his goldsmiths and craftsmen, direct his falconers, hawk trainers and dog keepers, as well as making his own designs for treasures9. The king was able to fight, study, pursue his leisure interests, worship and govern, in short he lived a very full life. Either.we are to understand that Alfred was of such fortitude that he continued doing all of this whilst very ill, ie with all of his symptoms present, or more plausibly, that his illness was intermittent. The former seems quite incredible. Asser in his admiration for the king treats us to the occasional exaggerated notion. Crohn's disease is a chronic disease characterized
by relapses and remissions. In an attack there is abdominal pain, diarrhoea sometimes with mucus and blood, that may alternate with periods of constipation. There may be fever and wasting depending on the severity of the illness. Some sufferers, a minority, experience eye problems (iritis), joint pains (without any destructive pathology) and skin problems. The king dreaded the attacks of his illness, which suggests that they placed quite a burden on him. The symptoms of Crohn's disease are nasty enough for sufferers to fear relapses and to worry about themselves during an attack. If this worrying gets thought of as neurotic behaviour then it is a feature that usually disappears when the attack has past. It would be particularly inappropriate to describe King Alfred as neurotic, as some have done, as the king had great strength of character, he was not short of courage nor the capacity to make far reaching military decisions for the defence of his realm. He also had a keen desire that there should be an upsurge in learning, starting with his own ministers and then generally extending down to the lower eschalons. Alfred's reign saw a renaissance in education, craftsmanship and national pride, which is all the more remarkable when one considers that the country was struggling for its very survival against the fierce onslaught of the Vikings.
Elias of Jerusalem
The physicians of the day could not diagnose the
king's problem which is not too surprising given how
difficult the condition can be to diagnose. As the king
sought for relief from his symptoms the news of
Alfred's condition must have travelled widely. It is
known from 'The Leechbook of Bald' that Elias,
Patriarch of Jerusalem sent King Alfed some medical
remedies for the alleviation of constipation, diarrhoea,
pain in the spleen and internal tenderness9. If we
assume that these were remedies aimed at specific
symptoms that Alfred complained of, rather than a
random pharmacopoeia, then our diagnosis looks even
more likely as there is a very nice, fit between his
remedies and the main symptoms of Crohn's disease.
Elias sent Alfred a remedy for constipation and
diarrhoea the general feature of bowel disease, with
or without an underlying pathology. A remedy was
given for spleenic pain,;which could refer to the area
over the spleen or referred pain, rather than the
spleen itself. Another of the Patriach's remedies was
for internal tenderness which is usual when the
disease is active and would certainly be the case
if loops of bowel were bound up together with
inflaatory exudate, with possible communication
between the loops caused by fistulae. Abscesses within
the abdomen would also give rise to some fairly
serious pain and tenderness.
Differential diagnoses
As noted above the fit between the remedies and the
sort of symptoms experienced by a sufferer from
Crohn's disease is very close. However, it would be
bad medical practice not to consider some other
diagnostic possibilities. In some-respects of pathological
detail Crohn's disease is similar to tuberculosRs,
although with all of the resources available. to the
modern physician no direct connection has everbeen
found. If King Alfred had tubercular disease of the
intestine then we could possibly expect a rapid
deterioration in his condition with an early demise.
The same would be true for cancer of the colon.
Diverticular disease, as a rule, is a disease of the
middle aged or elderly, the features of which are
not readily distinguishable from those of cancer of
the colon. It is not, on the whole, a young person's
disease and its development is not preceded by perianal
problems. Repeated infections are a possibility, but
infection is an unlikely candidate to be the cause of
a major health problem that spanned a period in
excess of 25 years. The lesions of Crohn's disease may
become infected, which would undoubtedly exacerbate
the symptoms, so infection might have a minor role
to play, but rates as an improbable cause. A serious
venereal disease is not really in contention. The
symptomology would have been understood in a
rather basic fashion by the Dark Age physician. There
is no evidence of a communicable disease. Such a
condition would not have escaped attention. The
communicability of a serious venereal disease would
have had disastrous effects on his lineage. As there
is no evidence to this effect this hypothesis ought to
be ruled out of play.
The evidence available points to inflammatory
bowel disease with a particular inclination towards
Crohn's disease. King Alfred died at the age of 50
years and his name passed into history. His life and
reign was one ofthe most inspiring in English history.
A great man beset by the rigours of offlce, wars and
illness.