Tuesday, February 5, 2013

Hail To The Scoliotic King

Can the history of the world hinge on a back brace?

England is abuzz with the news today that a skeleton found beneath a Leicester parking lot is in fact that of the infamous King Richard III.  The king was slain during the Battle of Bosworth Field on August 22 (my birthday) in the year 1485 at the age of twenty-seven.  His short reign as the last Yorkist king of England at the very end of the Wars of the Roses was notorious for murders and family cabals, immortalized in a rather nasty and politically charged play by William Shakespeare.  Although there is a Richard III Society in England sworn to reclaim the reputation of a ruler they feel was unfairly maligned, there is no denying that his reign was shaded by mysterious deaths (his brother George, the Duke of Clarence, the Princes of the Bloody Tower and even his wife, Anne Neville) and by other percieved misdeeds.

One of the great mysteries about Richard, and a fact that seems to make him the perfect Pantomime villain is his appearance.  Shakespeare has the king describe himself as "rudely stamp'd" and "unfinished, deform'd."  Comment is made in the play and in other chronicles about his halting gait and deformed feet.  And his twisted back is probably his most notable feature.  In time he was known to the theater-going masses (and thus to posterity, such is the power of Shakespeare) as the Hunchbacked King.  However, contemporary portaraits show a troubled but well-appointed young man, with no evidence of rib prominence.  Of course who would paint the king with warts and all?

The findings in the Leicester parking lot are particularly breathtaking, largely because Richard's skeleton is unquestionably scoliotic.  The spine as reconstructed appears to have an unbalanced sixty or so degree right apex curve centered at the 7th Thoracic vertebrae.  There are modest rib anomolies, but no evidence of any significant chest wall deformity.  As for the rest of the skeleton, besides the obvious war wounds, there is not much in the way of other deformity.  The jaw is somewhat jutting, but this was not an uncommon trait in Europe's ruling families even at this early time.  Although Shakespeare and others would have us believe that Richard was clubfooted with a short limb, the remains of the legs seems proportional.  Although the feet are not seen in the reconstruction, the shin bones appear normal, with none of the secodary signs of untreated deformity.

Although I am aware of no pedigree regarding deformities in the English Royal family at this time, there does not seem to be any record of heritable spinal abnormality.  If there were, I think, Richard's curve would have been less remarkable even to the poison pen of the Bard.  Richard had one son, who as far as we know had no spinal curvature and no evidence of a syndrome.

In short, Richard did not seem to have any horribly deforming syndrome, but probably had an untreated idiopathic scoliosis.  His gait was probably disrupted by the trunk imbalance and the rotation of the spine which frequently leads to apparent leg length differences.

Obviously in the 1460s there were no orthopaedists lurking around the courts, least of the pediatric variety.  But from what I can see from the pictures, I think Richard's curve would have been very amenable to bracing, and if all else failed to a fairly straightforward corrective surgery.

It is hard for me not to imagine how life would have changed for the young and apparently dashing prince, brimming with the confidence of a corrected spine and straight stature that we often see after surgical correction.  Would his bitterness have softened, his ambitions been less brutally driving?  Would the poor princes of the tower have been spared and the many crimes which are associated with Richard's legacy never have occurred? 

What would Shakespeare have written about then?