Henry VIII's leg ulcers

I read with interest the essay by Chalmers and Chaloner speculating on Henry VIII's leg ulcers and their possible impact on the course of history, but would take issue on the subject of aetiology.¹

Lower-limb venous insufficiency severe enough to cause venous ulcers is much less common in men and particularly at Henry's relatively young age. Likewise, bilateral deep vein thromboses would be most unusual. In any case, venous ulcers, while always infected, are surprisingly painless unless complicated by cellulitis. The precise location of Henry's leg ulcers would aid diagnosis, but are demurely hidden in Hans Holbein's painting. Unless therein lies a subtle clue that he is actually wearing prescription Class 2 compression hosiery. It seems more likely that his patience was sorely tried by the pain incurred by traumatic ulceration, chronic infection, suppuration and 16th-century ‘treatment’ that would have been detrimental to almost any medical disorder. His diet and nutrition may have been excessive (BMI approx 50+) but at least poor healing due to vitamin deficiency could safely be ruled out.

It is a shame that for all Henry's reported interest in matters medical, he didn't have the foresight to create a 16th-century prototype NICE.

Footnotes

Competing interests None declared