"He was of spare habit, had a soft and white skin, suffered from distemper in the head, and was subject to epileptic fits, a trouble which first attacked him, we are told, in Corduba." -- Plutarch's Life of Caesar 17.2
Famous words from the Greek historian Plutarch have offered tantalizing clues to the causes of Julius Caesar's ill health prior to his assassination on the Ides of March 44 BC. But Plutarch was born long after Caesar's death, and his writing in particular has been interpreted a number of ways over the past two millennia. Caesar had migraine headaches. Or hypoglycemia. He had a tapeworm in his brain. Most commonly, he has been diagnosed with morbus comitialis, the Latin term for epilepsy.
Francesco Galassi and Hutan Ashrafian have been fascinated by the ancient world since childhood. The medical doctors, who practice at Imperial College London, have proposed a new diagnosis based on their reading of the ancient sources: cardiovascular disease causing strokes. Galassi told me that they are "reconsidering the very Greco-Roman sources philologically and medically, liaising with experts in the field in Italy, the UK, and the US" to better understand Caesar's health. "We refuse to accept a priori the diagnosis of epilepsy."
Epilepsy in ancient Rome was well known and its symptoms often reported. Galassi therefore thinks that there should be more numerous accounts of Caesar's epileptic episodes in historical records if he truly suffered from it. By combing through the ancient literature, Galassi and Ashrafian have come to a different interpretation of Caesar's reported symptoms.
In a letter to the editor of Neurological Sciences published last month, Galassi and Ashrafian explain their reevaluation. "Together with the symptoms of headache, vertigo and falls as a possible result of limb paresis, gait disturbance, sensory deficit or syncopal episode can be considered in terms of cerebrovascular insults and stroke," they write, and depression and personality changes Caesar suffered "may also be consistent with cerebrovascular disease."
As doctors, Galassi and Ashrafian know that a good medical and family history is key to understanding a person's health. Pliny the Elder mentions the sudden death of Caesar's father and another close relative, which can easily be associated with "cardiovascular complications of stroke episode or a lethal myocardial infarction." If Caesar's relatives died of a heart attack, it is reasonable to question the dictator's symptoms in light of a possible family history of cardiovascular issues. Galassi says that "we think the TIAs [transient ischemic attacks or mini strokes] started at the end of his life; likely in 46 BC or a littler earlier."
Barry Strauss, a Cornell University military historian whose book The Death of Caesar represents the latest research into the dictator's life, told me that, while he finds the cardiovascular theory intriguing, he is not convinced. "Caesar's illness is said to have begun in Cordoba, Spain," Strauss says, referencing Plutarch, "which would suggest a specific event such as head trauma." Traumatic head injuries can cause neurological problems, and since Caesar is reported to have recovered quickly from each episode, Strauss finds a diagnosis of epilepsy more convincing.
If Julius Caesar was suffering from mini strokes, as Galassi and Ashrafian believe, why would his problems be documented as epilepsy? It is not necessarily the case that ancient historians did not understand the disease. Rather, Galassi and Ashrafian suggest that "Caesar and his adopted son Octavius may have contributed to the diagnosis of epilepsy, as this was considered a 'sacred disease'." It may have made Caesar look more powerful and more divine, shoring up his public profile and ensuring his eventual deification. But Strauss counters that "it was not to Caesar's advantage to admit that he had epilepsy because Romans considered epilepsy to be a bad omen and the Hippocratic Greek corpus denied that epilepsy was a sacred disease."
Deification of Julius Caesar. Engraving by Virgil Solis for Ovid's Metamorphoses Book XV, 745-850. (Public domain image via Wikimedia Commons)
In the end, Caesar's diagnosis may not be a case of either/or. Strauss notes that in researching his book, he learned from neurologists that strokes and head trauma are both risk factors for developing epilepsy later in life. "Caesar could have had both epilepsy and transient ischemic strokes," Strauss says. Did cardiovascular disease cause strokes that in turn caused epileptic episodes? Did Caesar suffer a blow to the head in Cordoba that resulted in epilepsy? Considering that even with modern medical technology there is no test that can confirm or rule out epilepsy, Strauss points out "we can't be sure about a diagnosis 2,000 years after the fact."
Reanalysis of ancient diseases is not a new phenomenon, and with staggering advances in medical technology recently, both medical doctors and archaeologists are learning more about disease in the past. Research into the lives and deaths of King Richard III or Ötzi the Iceman would not have been possible a couple decades ago. The difference between these men and Julius Caesar, though, is that their skeletons were found intact. As Caesar was cremated following his assassination, there is little hope of bioarchaeologists finding his mortal remains and poring over them for additional clues to his health. We may be debating about one of the most powerful figures in history for a long time to come.
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