Chronic dysentery was likely not the killer of Edward the Black Prince, despite what is commonly believed

Whatever disease killed Edward the Black Prince—heir apparent to the English throne in the mid 1300s, and heralded as the greatest English soldier ever to have lived—is unlikely to have been chronic dysentery, as is commonly believed, writes a military expert 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 of 21 Engineer Regiment.

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. But he had a chronic illness that waxed and waned for almost 9 years, to which he finally succumbed in 1376 at the age of 45.

His early death changed the course of English history, because the crown passed directly to his 10 year-old son after the death of King Edward III. Young King Richard II was later deposed and murdered, sparking over a century of instability, including the Wars of the Roses and the rise of the Tudors, notes the author.

The Black Prince's illness is thought to have started after his victory at the Battle of Nájera in Spain in 1367, writes the author. A chronicle suggested that up to 80% of his army may have died from "dysentery and other diseases."

And 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 diarrhea, 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 author?

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 anemia, kidney damage, liver abscess and/or reactive arthritis, suggests the author.

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.

Another candidate is inflammatory bowel disease, which might have accounted for relapsing-remitting symptoms and gradual deterioration, suggests the author.

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.

Another common disease in medieval Europe was malaria, the symptoms of which include fever, headache, myalgia (muscle aches and pains), gut problems, fatigue, chronic anemia 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 anemia would not have been helped by the purging and venesection [blood letting] treatments of the time," he 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," he writes.

And he concludes, "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."