“My health is more unstable than that of any creature and I have all the greater need to rejoice in the testimony of a pure conscience.” Letter from Mary to the council of her brother King Edward VI, January 1552

It is always an interesting exercise to analyze the evidence presented for a person in history to come up with theories about their health. Of course retrospective diagnoses are impossible but we can garner clues to give us the ability to speculate as to what was happening. Queen Mary I’s brother Edward and half-brother Henry Fitzroy may have died of suppurating tumors of the lung or that old standby, tuberculosis. Her sister Elizabeth we know had decaying teeth causing toothache and a bout of smallpox that nearly killed her. Elizabeth also used makeup with a high content of lead that probably wasn’t good for her overall health.

From reading historical accounts we can develop a litany of symptoms Mary suffered from the time she was a teenager all the way to her death at age forty-two in 1558. In addition to these repeatedly frustrating and frequently debilitating illnesses, Mary lived in a state of stress and nervous tension from the time of her father’s decision to extricate himself from his marriage to her mother Catherine of Aragon which made her ability to deal with her illnesses even more difficult.

Mary’s appearance was described as thin and frail with a low-bridged nose, red hair and a fair complexion with light colored lips. She had a loud, deep voice. Her eyes were grey and she was extremely shortsighted like her father, a trait that caused her to have a penetrating gaze. When angry, she had a quick temper. She was stubborn and didn’t like to be crossed.

There is nothing to suggest Mary’s health was a considerable problem before she entered puberty. She most likely had the usual childhood illnesses but overall was healthy. She would have lived a pampered life with people to watch over her, a good diet and copious exercise as well as receiving a classic humanist education. In the spring of 1528, Mary had a bout of smallpox but survived unscathed.

When Mary entered puberty at the age of fourteen, she began to suffer from pains in her head and stomach. There would be times where she couldn’t keep down her food for eight or ten days. In these instances, her mother’s apothecary and physician were called in to treat her. She was diagnosed with “strangulation of the womb”. This covered a wide range of symptoms that included amenorrhea (the irregularity or cessation of menstrual periods), a depressed mental state indicated by heaviness, fear and sorrowfulness, difficulty breathing and pain and swelling of the abdomen. Other signs of the illness were headache, nausea, vomiting, and lack of appetite, trembling of the heart, fainting, melancholy and fearful dreams.

Before Mary went to live with her new half-sister Elizabeth, she engaged in regular horseback riding as part of her treatment. Once she was moved to her sister’s household, this was stopped. Her guardian, Lady Anne Shelton couldn’t allow Mary the freedom to ride and risk her making an escape. In late 1534, Parliament had passed the Act of Succession and it was being enforced with increasing harshness. Everyone was required to swear an oath, including Mary. The oath compelled Mary not to call herself Princess or her mother Queen at the risk of being put in the Tower or even death.

Shortly after this, several weeks before Mary’s nineteenth birthday, she became seriously ill. She lived in an atmosphere of severe strain under the care of Lady Shelton. Mary complained of headaches and indigestion and was basically prostrate. Lady Shelton called in an unfamiliar apothecary who prescribed pills which made Mary’s condition worse. This may have been an allergic reaction to the medicine or Mary could have had a psychosomatic response. Lady Shelton was terrified she would be accused of poisoning Mary.

With no one wanting to be blamed for her death, there was a reluctance for anyone, Imperial or royal to treat her. The Imperial ambassador Eustace Chapuys eventually got through to the King’s secretary Thomas Cromwell and he agreed to send the king’s personal physician Dr. Butts to see Mary. Dr. Butts advised the king that Mary’s sickness was not incurable and with diligent and careful treatment and improved living conditions she would get better.

Needless to say, the king refused this. Mary did recover somewhat but had a severe relapse in mid-March. By late March she was still convalescent and was eating a special diet with extra meat at uncustomary times of the day. Eventually she recovered at Greenwich. In the fall of 1535, Mary’s illness returned and doctors were called in to treat a rheum in her head.

Mary’s illnesses did not appear with a consistent pattern or conform to a known disease. Her bouts of amenorrhea and melancholia were basically seasonal with the greatest severity in the fall and early spring but it could also occur in the summer and winter. The usual symptoms did not appear every year or at least it was not severe enough to be mentioned. The symptoms could vary widely with each event. News of Mary’s frequent illnesses traveled throughout the kingdom and over to the continent. Her health had a deleterious effect on her marriage prospects. Ambassadors and those who were deliberating about making a match with her wondered about her ability to bear children.

When Mary was under pressure by her father and Cromwell to absolutely submit to the king’s will, Mary mentioned to Cromwell in a letter she was having headache, toothache, neuralgia and insomnia. Treatments prescribed would have included tooth pulling and bloodletting from her foot or other areas of the body. The bloodletting could have led to anemia.

Mary finally did sign her submission on June 22, 1536 and was admitted into her father’s household. Shortly after she served as chief mourner at the funeral of Queen Jane Seymour, Mary had a severe toothache. Her father sent his physician to have the tooth extracted. Mary was seriously ill again in December 1537 and January 1538 for several weeks. She was so sick she could neither sit nor stand and spent time in her bed with faintness. The physicians were cautious in treating her once again and Dr. Butts was consulted. In March and April of 1542, she suffered from a strange fever which made her weak and caused heart palpitations. She was so debilitated it appeared as though she was dead. Chapuys was worried she was in extreme danger and King Henry frequently inquired about her condition. By the first of May she was out of danger.

In the summer of 1543, King Henry married his sixth and final wife, Catherine Parr. Mary accompanied them on the honeymoon but soon became ill and had to turn back. She recuperated in the company of Edward and Elizabeth and looked after her own servants who were more ill than she was. In May 1547, Mary was having intermittent bouts of fever. With each fever, her mental state and melancholy would worsen. In the last years of her father’s reign, she mentions toothache and neuralgia along with the customary melancholia.

Under the reign of her brother King Edward VI, Mary was once again under extreme stress. Edward, who was Protestant, was pressuring her to cease and desist from hearing the daily Catholic mass. Of course Mary refused as it went against her conscience. Relations between the brother and sister were tense and Mary would have bouts of her illness. In a letter to her brother, she described how she had a catarrh in her head and it greatly pained her to bend her head down to write him.

When Edward died, Mary was forced to make a power play to depose Jane Grey who had been declared queen by some of the nobility. Mary was triumphant and made her rightful claim to the throne. She was now the first crowned Queen Regnant of England. One of the first orders of business was to marry. It was suggested by her cousin, Holy Roman Emperor Charles V that she marry his son Prince Philip of Spain. Philip and Mary were married on July 25, 1554.

Soon after the nuptials, the thirty-seven year old queen declared herself pregnant. Philip decided to await the birth of the child in the spring. Curiously, Mary’s health improved with this purported pregnancy. As the due date approached, Mary withdrew into her chambers to await the birth at Hampton Court. On April 30, 1555, it was announced the queen had delivered a child and wild celebrations broke out in the streets. Soon it became clear this was a mistake. The doctors said there was a miscalculation of the date and her servants kept up the pretext.

Mary persisted in believing she was with child and became more and more reclusive. She would sit for hours wrestling with depression and anxiety. She looked pale and ill to those around her. She assumed the position of sitting on cushions on the floor with her knees drawn up to her chin, most unusual for someone who was supposedly pregnant. Eventually, Mary accepted the reality there was no child. By May 21, the swelling of her belly had gone down and her health improved. The pretext of a delivery was kept up until July when Mary moved the court to Oatlands so Hampton Court could be cleaned. This was an episode of pseudocyesis, commonly known as “phantom pregnancy”.

Philip left England for the Low Countries after this, leaving Mary alone to rule her kingdom. He would return to England from March through July of 1557. Shortly before his arrival, there was rebellion in the realm. Mary feared assassination and complained of insomnia. Some commented that she looked ten years older than she was. She became ill again with melancholia and insomnia. Philip left England for the last time. Mary thought she was pregnant again. No one believed her this time. Her belly was swollen with what may have been a dropsy. Eventually, talk of her pregnancy was no longer mentioned.

Mary recovered but in January of 1558, England lost Calais on the continent to the French. The country was experiencing unremittent torrential rains, ruining crops and creating famine. On top of this, a vicious strain of influenza was killing people at the rate of the plague. This illness was not like the sweating sickness where people died within days if not hours. The disease lingered for long periods before the victim died.

In the spring and summer, Mary was sick again with melancholia and insomnia. In August, she had a low fever and dropsy and was in such grave condition, she was moved from Hampton Court to St. James Palace. By September, Mary had a high fever, headaches, and periods of confusion along with an almost complete loss of vision. She would sink into a fever for a few days and then revive in a chronic pattern. Waves of depression became more frequent making her illness worse.

In October it became evident this illness would be her last and she made a codicil to her will. She still had short periods of rationality and at times was able to work with the council. In the third week of October, Philip received news from England that she was gravely ill. He sent his personal physician.

In early November there was some relief in her condition. On the 8th, she agreed to name Elizabeth her successor and then awaited death with paroxysms and long periods of unconsciousness. As she grew weaker and weaker, nobles, officials and household officers began to desert St. James for Hatfield where Elizabeth was staying. She was essentially blind and could no longer read. Those servants who were faithful surrounded her bed in grief. She would pray for her own salvation and describe her joyous dreams to them when she was lucid. She saw many little children playing and singing like angels before her, giving her great comfort.

Mary heard mass in the early hours of November 17. Then between four and five in the morning, she died so peacefully that her servants thought she was better. But the attending doctor knew she had passed away.

Possible Diagnoses for Mary’s Illnesses

One theory regarding Mary’s phantom pregnancies points to a condition known as ovarian dropsy. In this condition, a cyst forms on the ovary and gradually enlaces itself until it becomes, in some instances, a great size and fills with fluid. Cysts can be painful and produce widespread abdominal pain. The causes of the dropsy are obscure. In some cases, the condition can be attributed to inflammation of the ovary. The ovary can also be subject to the growth of various other tumors such as fibrous or cancerous tumors and also cause deformation of the ovary, leading to infertility. Ovarian dropsy usually lasts for a few years.

Prolactinoma Pituitary Tumor

Dr. Milo Keynes wrote an article on this subject for Journal of Medical Biography in 2000. After careful consideration of the historical evidence, Keynes believed Mary’s symptoms indicated a tumor on the pituitary endocrine gland. These tumors are typically benign and can press on surrounding structures such as the optic nerve, leading to blindness and headache. The gland will also create an over-secretion and under-secretion of hormones. In this case the hormone involved is prolactin. In excess, prolactin can cause infertility, amenorrhea, infrequent and irregular uterine bleeding and galactorrhea (swollen breasts that secrete milk). The tumor can also cause depressive disorders.

Most significantly, patients with this type of tumor have been diagnosed with pseudocyesis or “phantom pregnancy”. A non-pregnant woman has a delusional belief that she is with child. The patient will manifest the signs of pregnancy such as weight gain, increase in abdominal girth, the sensation of fetal movement, vomiting, nausea, aberrations of appetite and galactorrhea.

Enlargement of the tumor can also affect the function of the thyroid gland and create the condition of hypothyroidism. Symptoms include rough, deep voice, loss of hair and eyebrows, flushing of the cheeks, dryness and thickening of the skin, constipation resulting in an extended abdomen, increase in weight, chronic anemia, headaches, depression and mental confusion.

Keynes discusses the portrait of Mary above which was painted in 1554 when Mary was thirty-eight. He notes the portrait signifies Mary had flushed cheeks and a pudgy face, pallor to her skin, the loss of her eyebrows and a receding hairline. All of this is indicative of a deficient secretion of the thyroid gland.

Influenza

Did Mary have influenza and is that what killed her? Due to the particularly virulent outbreak of the flu at the time, it’s entirely possible Mary did contract the flu. Some in her household had it and it was highly contagious. People with this flu lingered for some time before dying and it took Mary several weeks to succumb. It is entirely possible that Mary suffered from the above mentioned diseases already and then caught the flu, leading to her death. We will never truly know but there are many tantalizing clues to make some educated guesses.

Further reading: “Bloody Mary” by Carolly Erickson, “Mary Tudor: The Spanish Queen” by H.F.M. Prescott, “The Myth of Bloody Mary” by Linda Porter, “The Aching Head and Increasing Blindness of Queen Mary I” by Dr. Milo Keynes in the “Journal of Medical Biography”, 2000, Volume 8, pages 102-109