The King In The Lab – The Unsanitary Lifestyle Of Richard III

Today’s blog focuses on another widely-reported discovery from Richard III’s skeletal remains: the presence of roundworms in his gravesite and the scientific theory that he suffered from an intestinal infection prior to death. We’ve previously reported on how the scoliosis of his spine was literally twisted out of proportion by mass media and some historians to arrive at dubious conclusions, so it would seem a worthy endeavor to take a closer look at this issue to see if a similar dynamic is playing out, and whether certain myths and misconceptions are being created even as others have been solidly debunked.

A quick internet search for the topic of Richard III and roundworms immediately leads to headlines and stories suggesting that the king’s body was “riddled” and “crawling” with parasites, that his infection produced symptoms that limited him physically and mentally, and that his lifestyle was dissolute with luxuries yet simultaneously unsanitary and hazardous. Richard III has the unique attribute of being both too kingly and too banal: a regal monarch on the outside yet rife with disease on the inside. But do the scientific findings support these conclusions?

Riddled With Parasites

Let’s begin with the actual study, reported by the British medical journal The Lancet, in September 2013. There, the scientists reported that they collected soil samples from the area where they discovered the king’s skeleton, from the dirt near the pelvis and head. They also collected soil from outside the grave cut for comparison. After putting the soil samples through a series of fine mesh sieves and the application of chemicals, they examined the residue with powerful microscopes and saw the presence of multiple roundworm eggs (Ascaris lumbricoides) in the pelvic sample, where the intestines would have been during life. The sample from the skull was negative for parasite eggs, and the control sample from outside the grave cut showed only scanty environmental soil contamination with parasite eggs. This led them to conclude that Richard III’s intestines were infected with roundworms at the time of his death, and it was this finding that prompted the flurry of media reports that he was “riddled” and “crawling” with parasites.

Richard III Roundworms

A sacral sample (S) taken from Richard III revealed ancient roundworm eggs. Control samples from his skull (C1) and outside of the grave (C2) linked the infection to his body. Photo: Mitchell et al., The Lancet.

What was not reported as widely, however, was the very critical finding that the king’s remains did not have many of the parasites they would expect to see from someone who lived in the 15th century and who had a nobleman’s diet:

“Past research into human intestinal parasites in Britain has shown several species to have been present prior to the medieval period, including roundworm, whipworm (Trichuris trichiura), beef/pork tapeworm (Taenia saginata/solium), fish tapeworm (Fasciola hepatica). We would expect nobles of this period to have eaten meats such as beef, pork, and fish regularly, but there was no evidence for the eggs of the beef, pork, or fish tapeworm. This finding might suggest that his food was cooked thoroughly, which would have prevented the transmission of these parasites.”

So, there was evidence of only one type of common parasite, but not three others that would have been expected of a man who ate meat and fish regularly. Richard III was known to have eaten a “high protein” diet rich in these foods; this was reported here. Of course, no journalist would have written a headline saying “Richard III was remarkably free from common parasites of his day”. That wouldn’t be as attention-grabbing, right?

Ironically enough, not long after the report of Richard III’s roundworm infection had hit the news cycle, another study was published showing that parasitic infections of the gut were more widespread than previously known. This time it was the Vikings who lived hundreds of years earlier than Richard, but had the reputation of being “robust types, feared throughout much of Europe” and who “enjoyed excellent living conditions”. The study showed that the soil samples from Viking latrines contained parasite eggs from roundworm and human whipworm, along with liver fluke from cattle or sheep.  “You can’t tell if they come from parasites that infected humans or animals by simply looking at the eggs,” said one of the scientists. “But by examining their DNA, we are able to confirm what we until now have only believed to be the case: that a thousand years ago, humans carried these parasites around.” It certainly puts Richard III’s infection into perspective: not as shocking or even really that unexpected given that roundworms and other parasites had been carried around by humans for generations.

Another feature of Richard III’s infection that went under the radar screen was the very circumstantial nature of the evidence. According to the lead investigator of the The Lancet article, 15 roundworm eggs were located in the king’s gravesite, and one was found from outside it. This disparity in number only circumstantially suggests Richard III had the infection. But it’s also possible that the control sample collected from outside the grave was not representative. That the gravesite was later penetrated by a Victorian latrine might explain the presence of roundworms.  Dr. Philip Mackowiack, an infectious disease specialist, has observed that the samples from the soil surrounding the grave might have contained fewer eggs than usual just by chance; the researchers might have seen much more if they had taken additional samples from neighboring areas. If they had, then there might have been no basis to say the parasites were contained in Richard III’s body. They could have been part of the background environment in which the king’s remains were deposited.

Suffering An Infection At The Battle Of Bosworth

Another narrative that has crept into the finding of roundworms in Richard III’s grave emerges from the impact an intestinal infection might have had on his mental and physical health during his last year of life. Some people find it just too tempting; he must have been very sick at the Battle of Bosworth or very frightened by what he saw when he relieved himself in the privy or garderobe. Some seek to use the roundworm infection to explain what they see in retrospect as irrational behavior, such as his last cavalry charge at the Battle of Bosworth. Science, however, does not support these speculations.

The symptoms of a roundworm infection depend largely on the type of roundworm that infects a person. Roundworms, like all living organisms and parasites, come in many different types; some are more “virulent” than others and make the human host sicker. Others are less so, and create no symptoms at all. Since no DNA testing was done by the scientists on the roundworms found in Richard III’s grave, no one knows exactly which strain they were. They could have been the virulent type or the non-virulent type.

The scientists who reported on their findings in The Lancet have concluded that they were probably the most common strain that has been observed in English and European archeological sites.   Assuming this to be the case, what are the symptoms? It turns out they are relatively minimal. What would have happened is that Richard, as duke or king, would have eaten something that had traces of human feces on it; probably from a cook who just used the privy and then went to the kitchen to prepare food. Or it could have come from vegetables that were raised with fertilizer that had been mixed with human waste. In either case, no one would have noticed this contamination, roundworms being invisible to the naked eye, and since the Germ Theory of Disease was not yet discovered, no one would have thought to thoroughly wash the food or their hands before it was prepared. Most of the food would be cooked, but sometimes it was served without being cooked to the temperatures that would have killed off any bacteria or parasites. Neither Richard nor his contemporaries would have known that they were eating something contaminated and he would have gone for weeks without noticing anything at all.

It is only after an incubation period that the roundworm eggs ingested by human hosts begin to infect them. The eggs hatch miniscule larvae, which then migrate to the lungs from the gut, and travel up the “wind pipe” or trachea. This causes a mild tickling sensation in the airway, and the human host coughs. And, just like everyone who has a very mild cold or some phlegm upon coughing, they swallow the sputum into their stomach. From there, the roundworm larvae develop into long worms, which live in the intestines and create new roundworm eggs to be excreted. The intestinal worms themselves cannot survive burial conditions and cannot be examined by archeologists; so the “crawling” with roundworms headline is really not accurate. Moreover, the scientists who wrote The Lancet article cannot say how many intestinal worms Richard III had; if he had only a few, then they probably would have done him no harm and would have had no impact on his robusticity. Treatment for intestinal worms in the 15th century included a change in diet, ingesting wormwood or other abortifacients, or blood letting. Whether Richard III ever had these treatments is unknown but, if he had submitted to extensive blood letting, it’s possible that the treatment was worse than the infection.

The NHS says that most people do not even know that they are infected with roundworms, and that at most, one will experience a passing low grade fever, mild abdominal discomfort, nausea, and in the most extreme cases they will pass a worm the size of an earthworm in their feces or have intestinal obstruction leading to malnutrition. People who have a good diet and plenty of food usually experience no problems at all, as they will not lose nutrition and will not suffer weight loss or other vitamin deficiencies.

monty python king

Anyone who has studied Richard III’s last years of life will be very disappointed to see any references to the king being sick or lacking in nutrition. As shown by John Ashdown-Hill in his book THE LAST DAYS OF RICHARD III, he went about his business without any disruption. There were no contemporary reports of him being ill or in extremis from an intestinal blockage – the symptoms of which would have been very obvious and difficult to suppress or disguise. Stories sprung up in the Tudor era saying that Richard suffered from a restless, fevered night before Bosworth; but that would have not been caused by roundworms since Richard III’s infection had gone past the initial incubation stage. Most historians have rejected this tale and, if they give it any credence at all, they tend to attribute it to the “sweating sickness”. In any case, it is difficult if not impossible to reach any conclusion as to how Richard III’s roundworm infection affected his life. The scientists who have commented on it have described it as being mildly annoying or a mere nuisance.

A Filthy Medieval Age

Aside from being riddled with parasites and made irrational in mind, the last myth that has arisen from the finding of roundworms in Richard III’s gravesite is the notion that medieval society was filthy and extraordinarily unhygienic. The Lancet article actually shows that Richard III had fewer parasites than the scientists expected, leading them to conclude that the technical preparation of his food had reduced the transmission of intestinal parasites. Of course, he was from society’s elite class, so his hygienic standards would have been much better than those in the lower economic strata.

Nevertheless, people in the medieval day did take baths, wash their hands, clean their teeth, and change their undergarments regularly. I was visiting The Cloisters in New York City and was struck by their collection of medieval aquamanile – vessels that were used to wash hands in liturgical and secular settings.

Aquamanile

Collection of aquamanile vessels at The Cloisters, NYC

A nobleman always washed his hands before and after eating a meal — to not do so would have been considered bad manners. During banquets, people would take their food from shared platters, but care was taken to minimize touching it. Most food was thoroughly cooked, as there was a preference for roasts and highly flavored/spiced dishes, and the sale of reheated cooked food was outlawed by the City of London. Eating raw vegetables and salads was not as common as it is today.

Roundworms continue to infect humans despite our improved personal hygiene, public sanitation, antibacterial soaps and knowledge of germs. Estimates of roundworm infection in the 21st century range from affecting between 800 million to one billion people, including millions of people living in the United States. The persistence of this parasite shows that it cannot be eradicated even in first-world countries.

Conclusion

Although the 2012 discovery of Richard III’s skeletal remains is an archeological feat of our modern age, we must remember that no other medieval monarch’s skeleton has been subjected to such a rigorous scientific analysis using today’s cutting-edge laboratory tests and forensic tools. It makes Richard III’s skeleton a novelty and novelties have a way of exaggerating their significance because we have no others to compare it to. One wonders what scientists would find today if they exhumed the remains of other monarchs from the 15th century such as Henry V who is believed to have died of an intestinal infection (dysentery), or Edward IV who suddenly died from an unknown cause. We might then be able to put Richard III’s physical condition into a much more accurate context, but until then, the narratives which continue to shape him as diseased in body say more about the way we tell his story rather than the way he actually lived it.

Book Sources:

John Ashdown-Hill, THE LAST DAYS OF RICHARD III (2013)

P.W. Hammond, FOOD AND FEAST IN MEDIEVAL ENGLAND (1993)

Charlotte Roberts & Keith Manchester, THE ARCHEOLOGY OF DISEASE (3d ed.) (2010), pp. 217-220.

Toni Mount, DRAGON’S BLOOD & WILLOW BARK: MYSTERIES OF MEDIEVAL MEDICINE (2015)

Peter Barnet & Nancy Wu, THE CLOISTERS: MEDIEVAL ART AND ARCHITECTURE (75th anniversary ed., rev’d and expanded)

Journal Sources:

F. E. G. Cox, “History of Human Parasitology”, Clinical Microbiology Reviews, October 2002, vol. 15, no 4, pp. 595-612 [doi:  10.1128/CMR.15.4.595-612.2002]

Michael O. Harhay, John Horton, and Piero L Olliaro. “Epidemiology and Control of Human Gastrointestinal Parasites in Children”, Expert review of anti-infective therapy 8.2 (2010): 219–234. PMC. Web. 18 Apr. 2016.

Piers D. Mitchell, Hui-Yuan Yeh, Jo Appleby, Richard Buckley, “The intestinal parasites of King Richard III”, The Lancet, Vol. 382, September 7, 2013.

Martin Jensen Søe, Peter Nejsum, Brian Lund Fredensborg, and Christian Moliin Outzen Kapel “DNA Typing of Ancient Parasite Eggs from Environmental Samples Identifies Human and Animal Worm Infections in Viking-Age Settlement”, Journal of Parasitology: February 2015, Vol. 101, No. 1, pp. 57-63.

Internet Sources:

Parasites – Ascariasis FAQs, Centers for Disease Control (USA), http://www.cdc.gov/parasites/ascariasis/gen_info/faqs.html

Roundworm, NHS Choices (UK), http://www.nhs.uk/Conditions/Roundworm/Pages/Introduction.aspx

Was Richard III Riddled With Roundworms? http://www.history.com/news/was-richard-iii-riddled-with-roundworms

Soil samples show Richard III suffered from roundworm,  http://www.bbc.com/news/science-environment-23878424

Infected and Hunched: King Richard III Was Crawling With Roundworms, http://www.livescience.com/39392-king-richard-iii-roundworm-infection.html

Into the bowels: Richard III’s remains riddled with roundworms, http://www.nbcnews.com/science/richard-iii-roundworms-8c11067779

King Richard III suffered from roundworm infection, scientists say, http://articles.latimes.com/2013/sep/03/science/la-sci-sn-king-richard-iii-roundworm-infection-20130903

Did People in the Middle Ages Take Baths? http://www.medievalists.net/2013/04/13/did-people-in-the-middle-ages-take-baths/

Ancient Toilet: Parasites Seen in Crusaders’ Feces Puts Spotlight on Medieval Hygiene, http://www.huffingtonpost.com/2013/06/19/ancient-toilet-parasites-crusaders-feces-medieval-hygiene_n_3466373.html

What was Dental Hygiene Like During the Middle Ages? http://www.slate.com/blogs/quora/2015/04/10/dental_hygiene_did_people_in_the_middle_ages_have_bad_teeth.html

Video Sources:

Richard III ‘Had Roundworms’, The Telegraph, https://www.youtube.com/watch?v=Ljri1MMDOWc

Richard III – The New Evidence, BBC4, https://www.youtube.com/watch?v=0_CcB2-zUMk

Blog Sources:

Bathing in the Middle Ages, https://keripeardon.wordpress.com/2012/06/14/bathing-in-the-middle-ages/

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