King Richard’s worms
By Philip MackowiakIt has been said that the only persons who refer to themselves as “we” are royalty, college professors, and those with worms. In the 4 September 2013 issue of the Lancet, Piers Mitchell and colleagues present evidence that Richard III, one of England’s best known medieval kings and the deformed villain of Shakespeare’s Richard III, had two reasons for referring to himself in the first person plural. Not only was he a king, but he also appears to have had worms. Mitchell et al base the latter conclusion on the presence of multiple eggs of the roundworm, Ascaris lumbricoides in soil taken from the sacral area (i.e. the location of the intestine) of Richard’s recently unearthed skeletal remains.
Finding ascaris eggs in the resting place of King Richard’s intestines is interesting but hardly surprising. Even today, ascariasis (infestation of the human intestine by A. lumbricoides) is all too common, especially in areas of the world lacking proper sanitation. In such places, in fact, as many as 80% of the population is infected by the worm. Fifteenth century Britain had no proper system for dealing with human excrement. Therefore, it is likely that the vast majority of its people — royalty as well as commoners — harbored A. lumbricoides in their intestines.
And yet, likely as it is that Richard III did have worms, the findings of Mitchell et al do not prove it to be so. Although A. lumbricoides eggs were found in the soil where Richard’s “intestines would have been” at the time of his burial, they were also detected (though in lesser number) in “the control [soil] sample from outside the grave cut.” Thus, Richard’s apparent ascariasis might simply have been the consequence of his having been interred in soil already seeded with eggs of the roundworm, rather than evidence of an infection of his own.Such problems, in fact, are common when trying to determine the clinical significance of archeological findings. For example, if and when the teeth and fragments of bone Hugo Chavez had removed from Simon Bolivar’s casket in July 2010 are finally examined by Venezuela’s State Forensic Laboratory, the results of the analyses will likely generate many more questions than answers. The actual assays being performed have not been revealed to the public, but presumably will include ones for arsenic (in an attempt to validate Chavez’s claim that Bolivar was assassinated), Mycobacterium tuberculosis (the pathogen generally believed to have killed the general), and paracoccioidomycosis (a fungal infection having all the characteristics of Bolivar’s final illness). If and when the results are available, the challenge will be interpreting their meaning. Were the remains examined actually those of El Libertador? If arsenic or the fungus responsible for paracoccidioidomysis is found is it because Bolivar was poisoned or infected by Paracoccidioides braziliensis or because his remains had rested in soiled contaminated by these? If the TB bacillus is not found, is it because the general died of something other than tuberculosis, or because the infection had simply not spread to the teeth or pieces of bone that were examined? For reasons such as these, archeological post mortem examinations rarely close the book on the etiology of disorders of giants of the past. Rather, they tend only to open the book at some new page.
Philip A. Mackowiak is Professor and Vice Chairman, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland. He is the author of Diagnosing Giants: Solving the Medical Mysteries of Thirteen Patients Who Changed the World.