The Case of the Corpulent Commander Who Sustained a Fatal Fall

Albert B. Lowenfels, MD; Jennifer Dore, MD

Disclosures

February 19, 2008

Brief Biography

Little is known of the circumstances surrounding William's birth in either 1027 or 1028 except that he was the illegitimate son of Robert II, Duke of Normandy. (William was always quick to retaliate against anyone reminding him of this in later years.) His father, when he died in 1035, named William as his heir. He was only 8 years old at the time and he lived in fear for his life and his dukedom, but he survived, becoming an apt pupil as he and his regents fought off endless rebellions by other Norman dukes.

William (1028-1087) ruled Normandy, France as a duke (1035-1087), and England as king (1066-1087).

William became a superb fighter and a seasoned leader, and as he grew older was able to fight and charm his way to undisputed power in Normandy. As William and the now loyal local dukes began subduing neighboring regions, the French king grew wary of William's growing power, especially in 1051 when Edward the Confessor, the King of England, designated William to succeed him as next English king. When Edward died in 1066, William claimed what he considered to be his legitimate right to the English throne and invaded England. William's victory in 1066 at the Battle of Hastings marks a seminal point in English history. The Normans gradually established control of English political and religious life, ruling England for nearly a century.

William the Conqueror on Horseback at the Battle of Hastings (1066). The Bayeux tapestry, actually an embroidery, was made about 2 decades after the battle.

In spite of the chaos and violence accompanying the reigns of early English rulers, a lawful government somehow eventually emerged. William's contributions to this evolution were his powerful government bureaucracy and his all important Domesday Book, which was the first English census and provided valuation of every landholding in each shire of the country. Current and previous landowners were listed, as well as the numbers of peasants and animals. Thus, the new English king now had a powerful tool for valuation and taxation -- and for legitimizing the Norman conquest of England.

Summary

At the time of his injury William had attained the advanced age of 59 years -- remarkable for the early medieval period. After falling from his horse, William's physicians recognized that he was severely injured, but they were at a great disadvantage: there were no obvious external signs of injury and little in the way of available therapy other than allowing their patient to rest and praying for his recovery.

Blood letting or phlebotomy had been widely used to restore the balance of body "humors" at least since the time of Galen, but there is no evidence that William underwent this procedure, which would only have hastened his demise. The concept of abdominal surgery was utterly unknown at the time and did not become feasible for another 8 centuries.

The records clearly indicate that William died from some type of internal abdominal injury. Although the exact organ cannot be accurately determined, a retroperitoneal injury to the bladder or perhaps the pancreas seems likely, leading to his delayed death several weeks after his horseback accident. Horseback riding is still a dangerous activity, but today an injured rider is unlikely to die.

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