In a paper titled “Has the Diagnosis of a Stroke been overlooked in the Symptoms of Julius Caesar?” doctors Francesco M. Galassi and Hutan Ashrafian of Imperial College London argue that the Roman general may have been afflicted by cerebrovascular disease. Their study, published in the journal “Neurological Sciences,” offers a provocative new take on Caesar’s mysterious illness, which began in the years after his meteoric rise through the ranks of the Roman power structure. Conventional wisdom has long held that he suffered from epilepsy, but Galassi and Ashrafian suggest that his symptoms are more in line with Transient Ischemic Attacks, more commonly known as “mini-strokes.”
“The theory that Caesar was epileptic appears not to have very solid philological foundations,” Dr. Galassi told Discovery News. “If carefully re-examined, the facts appear to suggest a simpler and more logical diagnosis of stroke.”
Caesar wrote widely about his life and military campaigns, but he never addressed his health. What little evidence historians have on his physical condition comes from ancient chroniclers, a few of whom make reference to a sickness that plagued him in his later years. Suetonius tells of “sudden fainting fits” and “nightmares”; Appian writes of “convulsions”; and Plutarch describes Caesar as suffering from “distemper in the head” and “epileptic fits.” According to Plutarch, Caesar collapsed while on campaign in Cordoba, Spain in 46 B.C., and he later had to retire from the Battle of Thapsus in modern day Tunisia after “his usual sickness laid hold of him.”
Despite Plutarch’s diagnosis of epilepsy, Galassi and Ashrafian argue that Caesar’s late-life health woes—including weakness in the limbs, dizziness and headaches—were caused by mini-strokes, which occur when there is a temporary shortage of blood to the brain. His mercurial personality and bouts of depression, meanwhile, may have been the result of stroke-induced brain damage. “All of the symptoms reported in Caesar’s life are compatible with him having multiple mini-strokes,” Galassi told the Guardian newspaper.
As evidence, the researchers point to a famous incident in which Caesar scandalized the Roman public by remaining seated when the Roman Senate presented him with an honor. According to Plutarch, he later blamed his failure to rise on his sickness, which he claimed caused his senses to be “speedily shaken and whirled about, bringing on giddiness and insensibility.” On another occasion, Caesar exhibited bizarre behavior upon hearing a speech by the silver-tongued orator Cicero. Plutarch describes him as being so affected by Cicero’s words “that his body trembled, and some of the papers he held dropped out of his hands and thus, he was overpowered.”
The authors argue that these fits would have inspired much more comment from Caesar’s contemporaries had they been the kind of seizures that usually accompany epilepsy. They also note that Caesar’s “morbus comitialis,” as the Romans called it, didn’t manifest until his later life, which is exceedingly rare in cases of epilepsy. “The idea that he was epileptic is unfounded,” Dr. Galassi told the Guardian. “We think others start from the assumption that he had epilepsy. Our theory is simpler and more logical.”
Since Caesar was known for his physical toughness, historians had previously written off stroke or heart attack as a possible explanation for his illness. He reveled in the military life, and was described as being remarkably fit well into his 50s. Nevertheless, members of his family did have a history of sudden and unexplained death. Pliny the Elder wrote that his father and another relative both dropped dead without warning while putting on their shoes, leading Galassi and Ashrafian to speculate that Caesar may have inherited a health defect. “Even if Caesar participated in an active lifestyle and may have benefited from an environmental background of a Mediterranean diet,” they write, “there is the added possibility of genetic predisposition towards cardiovascular disease.”
The new study is not the first attempt to offer an alternative explanation for Caesar’s illness. In the past, researchers have proposed everything from migraines, malaria and Ménière’s disease to a parasitic infection, a brain tumor and even syphilis. Interestingly, Caesar may have had good reason to present himself as epileptic. The ailment was well known to the Romans, having been described by the famed Greek physician Hippocrates in a 400 B.C. treatise entitled “On the Sacred Disease.” Many in ancient Rome believed the seizures and fits caused by epilepsy to be a sign of divine possession, and it was often associated with the powerful. According to Galassi and Ashrafian, Caesar may have played up evidence of his epilepsy as a means of bolstering his public profile.