The Noble Enemy
May 4, 2018 | 1:30pm
Our annual conference is devoted to the modern medical diagnosis of disorders that affected prominent historical figures. Below is the case presentation for this year’s program.
Of all the warriors who fought in the Crusades, none cast a larger shadow over the era than this patient. He was the one who annihilated King Guy’s army at the Horns of Hattin in 1187 and reclaimed Jerusalem for Islam after it had been ruled for nearly a century by a Christian coalition of “Franks.” And yet, he became a figure of myth and legend more for his image as a “noble enemy” than for his victories on the battlefield.
Only fragments of the patient’s medical history are known. He was born in Tikrit in 1138 to a Kurdish family originating from a highland village in Greater Armenia. His first serious illness apparently began in December 1185, when he was 47 and besieging Mosul. The illness lasted more than two months and was so severe his associates thought he would die. No records exist of its signs or symptoms, though some have speculated that fever was a prominent feature of the illness.
The patient improved, though his health seems to have waxed and waned with recurrent bouts of “fever and colic” in the months that followed. Although sufficiently recovered to lead his troops in battle in July 1190, by October of that year, he was again ill with an attack of what was called “bilious fever,” which confined him to bed for a month. A close associate was similarly affected with “two successive fevers,” suggesting that both his illness and the patient’s involved periodic fevers.
The patient then seems to have done well until overtaken by his final illness at age 56. He was feeling old then, and complained of loss of appetite, weakness, lassitude, and indigestion. Though the weather was damp and cold, he eschewed the quilted tunic he always wore in public and “seemed like a man awakening from a dream.” In the evening, his lassitude increased, and “a little before midnight he had an attack of bilious fever, which was internal rather than external.” The next day his fever was worse. However, when it was suppressed (by unknown means), he seemed to improve and to take pleasure in conversation with associates. However, from that time, his illness grew more and more serious, with headaches of mounting intensity. Those in attendance began to despair for his life. After being bled on the fourth day of his illness, the patient “grew seriously worse, and the humours of the body began to cease their flow.” On the sixth day, he was propped into a sitting position and given lukewarm water “as an emollient after the medicine he had taken.” During the next two days his “mind began to wander.” By the ninth day of illness, he was stuporous and “unable to take the draught that was brought to him.” On the 10th day, a clyster was applied twice, which seemed to give him relief. He took a few sips of barley-water. That night, he began to perspire, which his attendants regarded as a hopeful sign. The next day, “the perspiration was so profuse that it had gone right through the mattress and the mats, and the moisture could be seen on the floor.” On the 12th night, the patient grew weaker, wavering in and out of consciousness. His attendants expected him to die. However, he lingered on until the 14thday of illness. On Wednesday, the 27th of Safer in the year 589 (March 4, 1193), after the hour of morning prayer, the patient died.
Stephen J. Gluckman, M.D., is professor of medicine at the University of Pennsylvania School of Medicine and medical director of Penn Global Medicine. After earning his medical degree from Columbia College of Physicians and Surgeons, he received residency training in internal medicine at the Hospital of the University of Pennsylvania where he remained for a fellowship in infectious disease. He has particular interest in parasitic disorders and international medicine, and he has provided care and taught in many countries in multiple capacities. A recipient of more than 20 teaching awards, Gluckman is a founding preceptor of Penn’s refugee clinic, providing free health care to recent political refugees.
Thomas Asbridge, Ph.D., is a reader of medieval history at Queen Mary University of London. He earned a bachelor of arts degree in ancient and medieval history at Cardiff University and PhD at Royal Holloway, University of London. He specializes in the history of the crusades and has published numerous books and articles on this subject, including The Crusades: The War for the Holy Land (2010) and The First Crusade: A New History (2004). He chairs an international research network focusing on the careers of Saladin and Richard the Lionheart, and the course of the Third Crusade. Asbridge also wrote and presented a landmark three-part documentary series The Crusades (2012) for BBC Two.