The death of King Stephen Báthory: historical theories and modern medical knowledge

This paper presents issues concerning the illness and death of King Stephen BĂĄthory. The monarch’s demise caused a sharp dispute among the royal physicians and became the subject of many comments and hypotheses posited over the centuries by historians and medical practitioners. On the basis of available written sources we know that BĂĄthory’s life was one of a very physically active man.Deterioration of his general state, failure of several systems, must have then appeared later in his life. This correlates with the possible gradual loss of renal functions (in general) in the course of PKD. First, there was initially asymptomatic hypertension, leading to progressive circulatory failure (cardiac and possible atherosclerosis of the arteries), then renal and cardiopulmonary failure, complicated by infection within already weakened man. It all could have led to fatal multi-organ failure. Due to the lack of proper post-mortem examination of the head, the occurrence of an episode of intracranial bleeding can be neither confirmed nor excluded; statistics and neurological symptoms compell us to rule out that option with certainty. In addition, the mere fact of suffering a fall at night on December 7 could additionally contribute to raised intracranial pressure syndrome resulting from the formation of a cerebral hematoma. The lucid interval (immediate loss of consciousness, regaining it, and then losing it again) would suggest a subdural rather than epidural haematoma. Problems with walking, seizures, and impaired speech and/or consciousness may suggest a general problem, though previously noted neurological problems may indicate much longer history of pathology within CNS (central nervous system). Taking all the data into account, ADPKD as the primary disease would fully explain the subsequent stages, i.e. progressive renal failure, nephrogenic hypertension, increased risk of atherosclerosis (caused by hypertension) leading to coronary artery disease, cerebral atherosclerosis and transient ischemic attacks (TIA) (the symptoms reported include transient episodes of expressive aphasia, as the king understood what was said to him, but he could not answer coherently, of which he was fully aware). PKD is also associated with an increased risk of cerebral aneurysms and more frequent urinary tract infections. Such an infection, combined with the general deterioration of the king’s condition, could have easily turned into sepsis, perhaps the second independent cause of death (concurentio causae mortis). In conclusion ADPKD may be the explanation of the fatal course of King’s disease, and even if one could exclude one of the elements, it still remains the most plausible cause subsequent issues.