The remains of Richard III were found under a car park in Leicester in 2012. Since then researchers (often through popular media) have tried to reinstate Richard’s lost glory by busting Tudor myths trough scientific evidence. One of the myth busting methods, also seen in the documentary series on Channel 4, was to diagnose him backwards in history.
The mysteries whether George III, Ludwig II of Bavaria or Vaslav Nijinsky suffered from lead poisoning, schizophrenia or ‘madness’ intrigue us. I think many medical historians would agree, however, that making diagnosis backwards in time based on myths, tales and historical documents is always, if not dangerous at least highly problematic.
Richard’s case is somewhat different: there is the rare opportunity to actually gather evidence on his bone structure in order to come to a modern diagnosis which can either bust or confirm some of the myths that have surrounded the king for centuries. What’s more, a 3D model of Richard’s spine is available to all of us to see online! So was Richard, Duke of Gloucester a limping huchback with an arm “like a blasted sapling, wither’d up”?
Scientists in a recent study and accompanying podcast claim to have found the answer. They show that Richard had a right scoliosis (lateral bending of the spine convex to the right) or, more precisely, the findings are compatible with idiopathic adolescent scoliosis, onset probably after the age of 10. The scoliosis had 70-90 degrees Cobb angle and some axial rotation but it wouldn’t have affected his lung capacity or exercise tolerance. The curve, the study further shows, was well balanced (King type 3, see figures 2 & 5 here) and the visual appearance could have been easily minimised by a good tailor and a custom-made armour. Moreover, they didn’t find any evidence that he had an overt limp or one arm smaller than the other.
In this post I shall take the intrigue that I share with many, which in my case arises both from my background in physiotherapy and philosophy, and unashamedly let my clinical imagination loose. I shall attempt to problematise Richard’s newly discovered diagnosis by arguing that without Richard’s animate body any attempt to diagnose how he moved and functioned is just speculation. Science can reach only a certain point by examining bones or by constructing 3D models of the spine. What we can never find out with certainty is how Richard ambulated, no matter how sophisticated computer models and 3D images are created or no matter how much we try to compare Richard’s scoliosis to people with the same condition living today.
The diagnosis: “It is now proved, Shakespeare lied!”
Why, love forswore me in my mother’s womb:
And, for I should not deal in her soft laws,
She did corrupt frail nature with some bribe,
To shrink mine arm up like a wither’d shrub;
To make an envious mountain on my back,
Where sits deformity to mock my body;
To shape my legs of an unequal size;
To disproportion me in every part,
Like to a chaos, or an unlick’d bear-whelp
That carries no impression like the dam.
(Henry VI part 3, Act III, Scene II)
Appleby et al. in their 2014 study showed that Shakespeare’s description was certainly exaggerated (although we didn’t really need the evidence to show that a Tudor play might have been influenced by Tudor propaganda). They now suspect that Richard, Duke of Gloucester had idiopathic adolescent scoliosis; not a hunchback, not a withered arm, nor a limp. The scoliosis was even visible when the remains were found and was further demonstrated by creating a 3D printed model of the spine.
John Rous wrote in the late 15th century some years after Richard had died in the Battle of Bosworth that Richard’s shoulders were unequal when he was alive. Although other things Rous reported (Richard was born feet first, with hair to his shoulder and teeth in his jaw after spending two years in his mother’s wound) might not hold any truth, this description fits well with the contemporary diagnosis. How about Shakespeare’s ‘diagnosis’? How ‘accurate’ was it? Or, do we even care?
Certainly from a physiotherapist’s point of view, if I may myself do a little exercise of backwards diagnosing, Richard might have shown an asymmetry of gait (i.e. a ‘limp’). Some studies have found that people with scoliosis may have changes or asymmetries in gait (Bruyneel et al. 2009; Haber & Sacco 2015; Kramers-de Quervain et al. 2004; Mahaudens et al. 2009a; Yang et al. 2013). The asymmetry depends of course on the severity of scoliosis and type of pelvis deformity (Syczewska et al. 2012). Muscles have also been found to be more inefficient with people with scoliosis (Kuo et al. 2011; Mahaudens et al. 2009b) which may cause imbalance in the gait pattern. The research is not conclusive but, I think, it is enough to show that we have no way of knowing whether Richard’s gait was symmetric or whether he indeed had some sort of imbalance or sway which might have been called a ‘limp’ (I doubt people in the medieval and Early Modern period talked about asymmetries and imbalances but limps) and which may have been, perhaps, exaggerated later.
If he did had a ‘limp’ it might have been caused by a muscle imbalance due to the lateral asymmetry and rotation of the spine which might cause a functional difference in length of lower extremities. This condition is not structural i.e. not caused by difference in length of the bones. A kind of limp might also have been caused by body compensation (upper body sway, a slightly longer stance phase on other side or perhaps a compensatory rotation to pelvis) to the body asymmetry or loss of thoracic rotation during walking.
The same goes with the descriptions of the withered arm. With right shoulder higher than the other, the right arm would have certainly appeared shorter than the left although, as Appleby et al. argue, the muscle mass was probably symmetric in both arms. But, add the political purposes of the new dynasty, the common association of sin/wickedness and deformity, and a century or so… There! You have your blasted sapling of an arm.
There is one problem, however. It wasn’t Richard’s right arm that is reported to be the withered one. There are a lot of myths surrounding Richard’s birth but one of them intrigues me the most. In Shakespeare’s Richard III, Richard describes himself as “Deformed, unfinish’d, sent before my time / Into this breathing world, scarce half made up”. Was Richard born prematurely, which is also associated with higher incidence of Cerebral Palsy (CP)? His withered left arm, “legs of an unequal size” (Henry VI Part 3) and right scoliosis are all certainly compatible with hemiplegia, the type of CP where only one side of the body is affected (this is also the posture Richard’s body is often seen on stage). But we now live in time After Richard’s Remains and scientist have no reason to believe that Richard had CP: the areas on the bones to which muscles attach show no signs of arm muscles being of unequal size or causing unequal strain to the bones (in the case of hemiplegia signs would have been seen in areas where calf muscles, thigh adductors, hamstring muscles, biceps, forearm pronators, and hand flexors attach to). But they seem to forget that there are very different levels of ‘severity’ of the physical hindrances in CP; from a mild, hardly noticeable hindrance to incapacity to ambulate at all. Would a mild CP really show in the bones? I’d remain sceptical.
Lastly, there might not have been an “envious mountain” on his back and we certanly wouldn’t call someone with scoliosis a hunchback, but scoliosis does cause a unilateral protrusion of the ribcage when bending forward (a common test used in clinical practice to examine scoliosis) and sometimes also when standing straight. This should not be confused with a kyphotic spine in which the spine and head bend forwards (and what we perhaps associate with the word ‘hunchback’ more often). People living in the medieval times and Early Modern period did not, most likely, see or make the difference between ‘unilateral protruding ribcage associated with thoracic scoliosis’ and ‘a kyphotic spine’.
In the end, not to undermine all the hard work that finding Richard and examining his remains has taken, none on this really matters for Shakespeare. I my view, a ‘historically accurate’ Shakespeare would miss everything that makes Shakespeare important for us today. All I can say is that damned be the day when someone rewrites Shakespeare’s Richard in a historically and medically accurate way: “To shrink mine arm up like hypertonic /as is common in hemiplegia; / although we have no evidence that / mine arm was withered because of CP, / which, by the way, affects hardly at all / ability to make use of that arm / To make an envious right scoliosis / on my back and its onset was after / I was the age of ten, or perhaps not.”
Remains or body?
During the whole time from excavation to finding the remains and re-burying them, the words ‘remains’ and ‘body’ have been used interchangeably. Now, I know that in everyday parlance ‘body’ means both a living body and a dead one. From a philosophical point of view ‘body’ signifies more than what was found (the remains) and what was constructed (the 3D model of the spine). A 3D model does not tell a story of how the body functions in motion. Because we cannot really observe Richard’s posture or his animated body in order to do e.g. a gait analysis, all of the ‘observations’ I made above are as likely accurate descriptions as any other.
What we could do is to compare the archeological findings and the 3D model of the spine with someone who has a similar spinal structure living today. However, there are factors that make even such comparison mere speculation. First, life was very different in Richard’s day. The kind of nourishment, metabolism, type and amount of physical strain, diseases, parasites, clothes, culture, experience, ‘habitus’ – all of these may affect the way the body moved compared to contemporary bodies. Second, no one body is exactly the same as another. Two bodies with similar clinical findings may move differently due to difference in motor skills such as balance, agility, coordination, speed, power and reaction time. They may also differ in muscle strength, muscle balance and flexibility, joint range of motion, and different qualities of the connecting tissues. In the end, bones tell little about these things.
To conclude: able-bodiedness and sovereignty – some unfinished thoughts
I cannot help but to feel that the quest of proving Richard’s able-bodiedness has also been a quest of proving that he was not the villain many think Shakespeare depicted him to be: if he was wrong about his body, he was wrong about his character too.
I wonder whether by proving an able body and trough it a good character causes a fall, unwittingly perhaps, to the trap of repeating the association of deformity with wickedness and sin. Deformity, let alone disability, do not after all go well with sovereignty. This was the case in Tudor times when Richard was discredited to undermine his ‘deformed’ royal body and its claim to the throne, it is true every time when sickness, mental health issues or otherwise unfitting social behaviour are airbrushed away to maintain a public image for the ruling monarchs, and it continues to be the case with contemporary royal PR-machines.
One thing is sure. While it is undeniable that Tudor propaganda played its part, Shakespeare’s Richard is not a black and white evil character. He is a complicated villain and his story is tragic. I have always felt sympathy towards him (I’m always especially moved by Richard’s pain of conscience after being visited by the ghosts). I think Shakespeare did give the option of not having to make the essentialist link between wickedness and deformity.
Finally, there is something ‘medical Shakespeare’ teaches us through Richard. Because of his deformity he is bound to be the villain, but not because of some link forged by nature but because of the social world expects it from him:
And therefore, since I cannot prove a lover,
To entertain these fair well-spoken days,
I am determined to prove a villain
And hate the idle pleasures of these days.
(Richard III, Act I, Scene I)
I, that have neither pity, love, nor fear.
Indeed, ’tis true that Henry told me of;
For I have often heard my mother say
I came into the world with my legs forward:
Had I not reason, think ye, to make haste,
And seek their ruin that usurp’d our right?
The midwife wonder’d and the women cried
‘O, Jesus bless us, he is born with teeth!’
And so I was; which plainly signified
That I should snarl and bite and play the dog.
Then, since the heavens have shaped my body so,
Let hell make crook’d my mind to answer it.
(Henry VI, part 3, Act III, Scene II)
This reminds me about disability and society today: is disability personal or social, that is, does the society disable people by stigmatising and excluding them as others?
This is a Thinking Through Shakespeare blog post. Please comment and give the writer feedback.