Richard III's disfigurement: a medical postscript.

Abstract

T HE physical attributes of Richard the Third have been the subject of much discussion in the past. It is reasonable to claim that Shakespeare succeeded in depicting him in the most unfavourable terms, and obviously regarded him as being not only physically deformed and repulsive but a villain as well. The concatenation was not fortuitous. For almost four centuries Shakespeare's mordacious portrayal of Richard III has persisted as the familiar and accepted version, in spite of intermittent shafts of doubts directed against it. The portrayal is delineated in King Henry VI, Parts 2 and 3, and in King Richard III, and it is based on the description which was written in 1513 by Sir Thomas More. Scholars have not been content to accept More as an impartial historian in this matter, and regard him as being directly involved in the retrospective Tudor propaganda directed against the last of the Plantagenets. During this century there has been increasing medical interest in famous historical figures, and the subject exerts a remarkable fascination as a diagnostic clinical exercise which is made much more difficult by the inevitability of inadequate 'case-notes.' The lack of opportunity to question the 'patient' under review precludes a detailed past personal and family medical history in many cases, except by indirect approach along inferential lines. The final insurmountable hindrance to a satisfactory retrospective diagnosis except in the more recent cases is the absence of an adequate record of medical examination. And even when an autopsy was undertaken, as in the case of Napoleon, many questions remain unanswered. Such fundamental difficulties appear to stimulate rather than retard the enthusiasm of the modern medical detective. As the result of such zeal El Greco's astigmatism was revealed a relatively simple inference, and George III's porphyria was unearthed a masterly and convincing piece of investigation. Into this vast field of medico-literary history there is no need to enter now, except to mention that several classical volumes have been written on the subject, and new material is constantly emerging. It may be of interest to the general reader to know of such volumes as De Mortuis Essays Historical and Medical by C. MacLaurin; and this incorporated his two earlier volumes, Post Mortem and Mere Mortals. Of equal interest are The Infirmities of Genius by W.R. Betts, and Famous Illnesses in History by R. Scott Stevenson. An interesting but slight volume entitled Famous People and their Illnesses, by an anonymous writer, was published by Roche Ltd. and is not dated. It can be readily appreciated that Henry VIII has been under scrutiny in these publications, but the most comprehensive medical survey of his life appears to be Sir Arthur S. McNalty's Henry VIII: A Difficult Patient. McNalty was also the