Chapter 4 : Final Stages
If Jane was anaemic and dehydrated, her heart would have been under tremendous strain. The presence of an embolism may have been more than it could endure. Her heart was relatively young so it would have taken longer to wear out, hence the duration of her last illness.
In Jane’s day, newly delivered mothers were expected to lie-in after the birth: there was no getting up and walking around soon afterwards as now, and of course no understanding of the risks of blood clots and pulmonary embolisms, which may well have accounted for a number of fatalities in childbed. It was believed that the body needed time to cleanse itself during the period following labour. The lying-in period could be anything from fifteen to sixty days, and it ended with the mother’s churching. The new mother might spend up to two weeks on her back before her ‘upsitting’.
The medical experts I consulted considered that there might have been a period of severe low blood pressure or a blood clot leading to low blood flow to the intestines, causing all or part of the bowel to die, which might have caused the diarrhoea. If the diarrhoea was severe enough, or accompanied by vomiting, a severe electrolyte imbalance could have led to delirium and death. But someone with a dead bowel would not want to eat, and bowel death is usually fatal within a day or two. And if the diarrhoea was a sign of bowel injury or multiple organ failure, Jane would have been in a coma and dead in two days. Of course, it is possible that contamination from the diarrhoea was the source of an infection, which would explain her rapid decline afterwards. It is also possible she had a mild infection, and would have survived it, if other factors, such as anaemia, dehydration and possibly an embolism, were not present.
Naturally, the medical experts I consulted wished to emphasise that they were making educated guesses based on the limited information that survives, which is all historians have to go on. Overall, they believe that Jane's death was most likely caused from a combination of factors: that anaemia, possible postpartum blood loss after a long labour, dehydration from diarrhoea, and extended bed rest and inactivity caused an embolism, and probably more than one - not enough to trigger instant death, but enough to put Jane gradually into cardio-respiratory failure, shock and death. Her symptoms at the end, especially being cold, suggest she was cyanotic, or turning blue in her extremities.
Suzanne Schuld, who has seen this condition many times, very kindly described to me the stages of Jane’s last illness, and explained the medical terminology of the doctors’ theories for me, for which I am hugely grateful. Much of this article is based on her account, and printed with her permission.
She described how, after the bout of diarrhoea, Jane must have felt weak and tired. Her heart rate, possibly already faster than normal to compensate for the anaemia and blood loss after birth, would be even higher. She might have felt weakness and even a little tingling, especially in her extremities, due to a loss of potassium. She would have been very thirsty. Perhaps she ate or drank things that prolonged the diarrhoea. Eventually, it cleared up, and she felt better. Possibly she did not take enough fluid to rehydrate her properly.
Shortness of breath and chest pain are the two most prominent signs of a pulmonary embolism. The pain would have worsened with breathing. As her illness worsened, Jane’s heart rate would have risen even higher. Lying flat would have felt suffocating. She would have wanted to sit up or be propped up with a lot of pillows, or have instinctively assumed a ‘tripod position’ (sitting up leaning forward, arms on either side) to facilitate easier breathing. She would have been breathless on speaking, restless and anxious, and wanted cool air blowing across her face. She might have developed generalized swelling (oedema or dropsy) due to a weakening of her heart. Her urinary output would have decreased and eventually stopped. Her limbs would be cool and dusky (cyanosis); her lips would be blue as well. She could have been confused or delirious. Eventually, she would have lost consciousness, with the pulse at her wrists no longer palpable. At the end, she would have had been gasping for breath, possibly for hours. We can only imagine how Henry VIII, the doctors and others in attendance felt watching Jane’s sufferings, helpless in the face of an illness of which they had no understanding.