Recently I was reading The Plantagenets by Dan Jones (https://www.amazon.com/Plantagenets-Warrior-Kings-Queens-England/dp/0143124927). As I got into the life of Richard the Lionheart, I came upon this passage:

Within a week setting up camp, Richard had fallen grievously ill with a scurvylike disease known as Arnaldia or Leonardie. His teeth and fingernails began to loosen, and his hair fell out in clumps.” (Jones, p. 109)

Jones does not go into more detail about this particular disease and what it might be. I became curious as to whether there is a modern equivalent and if anyone had looked further into what this disease could be.  As it happens, there are publications on this subject. The consensus in the historical community seems to be that Richard suffered trench mouth (Woodings, 1971; Peters, 1971; Reston 2001… among other examples). So, we have at this point two possible diagnoses:

Trench mouth and Scurvy

Let’s start with scurvy. While loose teeth and fingernails certainly sound like scurvy, other factors make this unlikely. Both King Richard and King Philippe of France suffered this disease at the same time. Reaction to a vitamin deficit would be unlikely to appear in two individuals simultaneously. One might also imagine that these two individuals would have access to the highest quality food available.  Also, scurvy was quite common on the third crusade, and recorded in the historical records. A different word is used for scurvy in texts of that time and place, yet that word does not appear in the description of Richard’s or Philippe’s illness. Finally, the symptoms don’t quite match. A number of record note that both kings had fevers. Typically, fever does not accompany scurvy (CWD).

Peters (1971) mentions the disease “Vincent’s Infection” (another name for trench mouth) and this is taken up by a number of other authors (Woodings, Reston). However, this appears to be mentioned in passing more than being fully dissected as possible diagnosis in many of these texts. Today, trench mouth is the common name for acute necrotizing ulcerative gingivitis, a non-contagious gum disease. Like scurvy, it seems unlikely that this disease would appear in two individuals at the same time and resolve without issue in these individuals, as well. However, trench fever does include symptoms that are similar to typhus and include a number of symptoms that are consistent with the historical descriptions of leonardie. These include fever (missing from scurvy). Trench fever is caused by a bacterial infection (Bartonella quintatna) which is spread by body lice (e-medicine and CWD). But again, something is missing. In no modern description of trench fever do we see the loosening of the teeth or the fingernails.

Perhaps a different disease is the cause? Something that is no longer even around?

A bygone disease?

In 2011, another paper was published that looked into this disease in some depth. The Illness of King Richard and King Philippe on the Third Crusade: An Understanding of arnaldia and leonardie by Thomas Wagner and Piers Mitchell explored what they called the social diagnosis and modern biological diagnosis.  They eventually conclude that “… there is not enough information in the sources to allow any kind of guess as to which infectious disease caused the two kings to develop fever and become so ill that their hair and nails fell out.” Still, they offer some interesting alternate theories to scurvy or trench mouth.

These include febris Romana (Roman fever) and a form of Schweissfieber (Sweating Sickness) known as Frieselfieber. Both of these diseases are mysteries in their own right and I plan on looking into them more in coming posts.

They also dissect the etymology of the words used in contemporaneous texts. These suggest that the origin of the words come from symptoms that had been observed in foxes or sheep. In particular, they explore the idea of the symptoms being similar to those seen in sheep. This made me think of the possibility of a zoonotic disease that “jumped,” then died out. In fact, one of the more common scenarios for a “jump” of a disease from an animal to a human is to cause disease in one or a few individuals, but be unable to effectively be transmitted from individual to individual. As this disease appears to be described in only two individuals and then disappears from the historical record, I would suggest this is a strong possibility.

Although we will likely never know exactly what disease caused the illness of the two kings, it is interesting to think of the various possibilities…

Sources:

 

Kiple KF, ed. (1994) The Cambridge World History of Human Disease. Cambridge University Press: New York, NY.

 

Peters E (1971) Christian Society and the Crusades, 1198-1229. U Penn Press. Pennsylvania.

 

Reston J (2001) Warriors of God: Richard the Lionheart and Saladin in the Third Crusade. Random House. New York, NY.

 

Wagner TG and Mitchell PD (2011) The Illnesses of King Richard and King Philippe on the Third Crusade: An Understanding of arnaldia and leonardie. Crusades 10: 23-44.

 

Woodings AF (1971) The Medical Resources and Practice of the Crusaders States in Syria and Palestine 1096-1193. Medical History  15: 268-277.