Every year, doctors and historians gather at the Historical Clinicopathological Conference at the University of Maryland School of Medicine to try to figure out the cause of death, be it an ailment or battle wound, of a prominent historical figure. Over the weekend, the sleuths pored over the medical history of Saladin, the legendary sultan who battled Christian crusaders invading the Holy Land in the 12th century, reports Nicola Davis at The Guardian.
Saladin passed away in 1193 C.E. at the age of 56, not from battle wounds but from a mysterious illness. According to historical accounts, Saladin’s end came after a two-week series of sweating attacks of “bilious fever” with headaches. Conference organizers say he was weak, restless and lost his appetite. His doctors bled him and gave him enemas to no avail. Eventually he could not even sip water and began sweating profusely before falling into a coma and dying 14 days after the symptoms began. Diseases including viral encephalitis and tuberculosis were suggested in a 2010 paper by Philip Mackowiak of the University of Maryland School of Medicine, who founded the conference 25 years ago.
“It’s difficult to work it out because there is essentially no information—there are no tests and the historical accounts are a little questionable, and there isn’t much anyhow,” Stephen Gluckman, the professor of medicine at the University of Pennsylvania School of Medicine who conducted the investigation, tells Davis.
Despite the fuzzy descriptions, according to a press release, Gluckman has come up with a diagnosis: the military leader died of typhoid, a bacterium known to infect people throughout the Middle East at the time.
Laura Geggel at LiveScience reports that Gluckman was able to rule out some other diseases. Plague can kill within 24 hours and smallpox victims usually go in the first or second week, so they were not the culprits. Tuberculosis was ruled out since the accounts did not mention its most visible symptom, breathing problems. And while Saladin had fits of sweating, the accounts do not mention periods of chills and shivers, which would accompany malaria. The symptoms of typhoid, however, fit the description perfectly and include periods of high fever and sweating, headache, loss of appetite and weakness. “It is really based on what the common diseases were at that time, and of those which were fatal, and of those, which were fatal in a time period of around two weeks,” he tells Davis. Gluckman says it’s also possible that Saladin suffered from typhus, a similar disease that includes a rash and is spread by body lice, fleas and other parasites.
In his earlier paper, Mackowiak had ruled out typhoid because Saladin did not present with stomach pain, an "altered sensorium" or cloudy thinking and poor concentration, in the early stages.
According to the press release, typhoid is still around today, infecting 200 million people per year and killing 200,000. It is treatable with antibiotics, but getting medicine to people in remote and rural areas is difficult.
“This is an intriguing piece of medical detecting. If antibiotics had been around in the 12th century, history may have been quite different,” says Mackowiak. Then again he says the diagnosis is just speculation, and we’ll likely never know the real cause of Saladin’s death. “I couldn’t say that any of the cases that we have discussed, and this is the 25th, are closed, because we don’t have any definitive test results for obvious reasons,” he tells Davis.
In the past, conference participants have diagnosed a Who’s Who of historical notables. Last year, they looked at the illnesses of Spanish painter Francisco Goya, whose diagnoses were inconclusive, and in 2016 a presenter speculated that Christina Olson, the subject of Andrew Wyeth’s 1948 painting “Christina’s World,” suffered from a hereditary condition known as Charcot-Marie-Tooth disease. They have also looked at whether Abraham Lincoln would have survived if he had been treated in a modern trauma unit after being shot (verdict: probably) and found that Mozart likely died of acute rheumatic fever among many other findings.