Does there not lurk within the heart of every orthopedist interest in the unusual? With childhood days, there were always Sherlock Holmes, the Shadow, the Green Hornet, Charlie Chan and Nero Wolfe. The current spate of forensic offerings notwithstanding, we were all fairly sophisticated many years ago.
That being the situation, let us introduce a classic case for your perusal and deductions. The year was 1560. It seems that Sir Robert Dudley, soon to be Earl of Leicester, was infatuated with the good Queen Bess and she with him. Rumors abounded that there was early and probably frequent consummation. A certain "Mother Dowe of Brentwood" questioned whether Sir Robert had, on one occasion, given Elizabeth the gift of a petticoat or of a child! Mother Dowe had big legal troubles, but finally escaped with her neck intact. Others, for the same offense, had their ears cut off.3
The fly in the ointment, so to speak, was Sir Robert's marital status. His twenty-eight year old wife Amy Robsart, was the prime heiress of the wealthy Sir John Robsart. She was said to be ravishingly beautiful. However, there was the question of her health-it was rumored that she suffered from what we now know as advanced carcinoma of the breast and that Sir Robert and Elizabeth had plans for the future after her anticipated sad demise.4
All of this changed on September 8th, 1560. The beauteous Amy was found dead of a broken neck neck1.1. Sprawled at the foot of a flight of stairs at her mansion, Cumnor Place, the hood of her robe still covered her lifeless head. Her relatives cried "Murder!" and the matter was put to a closed coroner's jury. Their verdict was never formally disclosed, but obviously death was attributed to accidental causes. This was as well for Sir Robert, because even in that era trial by ordeal was often practiced. Could he have withstood having his hands held in a fire or other dreadful tortures and still proclaimed his innocence? That might have been what he would have faced were he formally charged! Patricia Cornwell specifically referred to this case in her recent book.1
Now is the time to cogitate, to ruminate or however it is that you usually reach a conclusion about serious matters. Was it murder? Many loyal Englishmen thought so, despite the jury verdict. Rumors persisted, and years later on the London stage, an actor uttered the lines "The surest way to chain a woman's tongue is to break her neck! A politician did it . . . "
The scandal was such that it put an end to the affair between Sir Robert and Elizabeth. The politically canny daughter of Henry VIII and Anne Boleyn was not about ready to risk her reign by further dalliance, however sweet it might be. I am assured by a prominent hand surgeon of English descent with strong ties to the Iowa Orthopedic program "She was pushed!" He also shared the further information that Anne Boleyn had reduplication of the distal phalanx of the little finger on each hand-she was never caught short-handed.
Another possibility is metastatic carcinoma to the cervical spine. Difficult to prove when they didn't even have the concepts of Virchow and microscopic pathology in that era! We all remember Mike Bonfiglio and our study of the work of Batson in explanation of spinal spread of carcinoma of the breast! Without radiographic evidence and even in the absence of trauma, she could have suffered "a broken neck."2
What we now know as tuberculosis was endemic in that era. Did she have tuberculosis of the spine at a higher level and suffer quadriplegia instead of the more common (Sir Percivall) Pott's paraplegia?
Did she have a berry aneurysm and a fatal stroke?
Did she have a lethal arrhythmia?
Did she have the Guillain-Barre syndrome or some acute transverse myelopathy?
Did she have cervical spondylosis?
Did she have Gorham's vanishing bone disease?
Did she have extradural lymphoma deposits?5
We think not, for two main reasons. First, because we treasure the memories of scoundrels past. They give color to the lifestream without any threat. This is what is called history! Second and even more germane, Adrian told us "she was pushed!" We have, after all, the utmost trust in him!