LOS ANGELES — Nearly 750 years ago, a mysterious illness felled Italian theologian Thomas Aquinas before he reached his sixth decade. Now, a team of medical students and a neurosurgeon think they’ve identified his killer: chronic subdural hematoma.
The researchers came to their conclusion after analyzing reports of the Catholic saint’s final days and examining a skull at an Italian abbey that may — or may not — be his.
“Ultimately, this is a classic chronic subdural hematoma story,” said University of Kansas Medical Center medical student Gabriel J. LeBeau, who presented the findings April 22 here at the American Association of Neurological Surgeons (AANS) 2023 Annual Meeting.
If they’re right, the researchers have pinpointed the cause of death of one of the most influential people who ever lived, a Dominican friar who wrote millions of words in the 13th century and is still revered today as a philosopher, reformer of Christian thought, and man of faith.
In a precursor to the ideological battles of the 21st century, Aquinas sought to reconcile science and religion. One of his core beliefs was that “reason and faith are eminently compatible, because God cannot be the source of a contradiction or of error,” according to the 2022 book The New Cambridge Companion to Aquinas .
Aquinas died on March 7, 1274, at the age of about 48, in an abbey halfway between Rome and Naples. According to historical accounts gathered by the research team, about 5 weeks earlier he’d hit his head on the branch of a tree fallen sideways while traveling from Naples to the Second Council of Lyon, a gathering of Catholic leaders in a French town.
Aquinas was “stunned” and fell to the ground, the accounts say, and he stayed nearby for 4 or 5 days. While he was weak and lost his appetite, he was still lucid, and had no fever and no focal neurological deficits. He was moved to the Abbey of Fossanova, where he stayed for a month. There, his condition worsened — symptoms included weakness, lack of appetite due to nausea, and somnolence. Then he died.
There are multiple theories about what killed Aquinas. According to LeBeau, the Italian poet Dante accused a monarch named Charles of Anjou of poisoning him to stop him from becoming cardinal or pope. But there’s no evidence to support this theory, LeBeau told Medscape Medical News.
In modern times, a 2017 report in The Lancet Neurology suggested that Aquinas had strokes or transient ischemic attacks prior to his encounter with the tree branch. They caused his brain to shrink, the report speculates, and worsened the effects when the tree branch caused an epidural hematoma.
For the new report, LeBeau and colleagues examined accounts of the saint’s illness and visited a partial skull that’s reputed to be his at the Abbey of Fossanova.
“The mandible is missing, and large portions of the occipital bone, parietal bone, and much of the skull base are missing,” LeBeau said. “However, the zygomatic bone, the facial bones, and the frontal bone were largely intact.”
The evidence convinced the team that Aquinas died of a chronic subdural hematoma that was caused by the earlier head injury.
“There was a minor trauma followed by a period of lucidity and relative normalcy, then gradual decline,” LeBeau said, which fits the theory of a growing hematoma. And Aquinas had “classic symptoms,” he said, including generalized weakness, loss of ability to speak or understand language, nausea, lack of appetite, and sleepiness.
It’s not clear if he suffered a concussion initially, LeBeau said, although it’s possible.
Chronic subdural hematomas grow slowly over time and can both compress the brain and cause it to swell, Mayo Clinic neurosurgeon Teodoro Forcht Dagi, MD, MPH, told Medscape Medical News.
Dagi, who studies medical history, said the hematoma diagnosis makes sense. There’s no evidence of a skull fracture, he said, and a stroke seems also unlikely. It would have occurred abruptly — hence the name “stroke,” which refers to the condition’s suddenness — and immediately affected the saint’s health, he said.
What if Aquinas lived in modern times and suffered from chronic subdural hematoma now? If there weren’t complicating factors, Dagi said, “we would have been able to image it, we would have operated on it, and he would have survived.”
While the theory about the saint’s death is “a strong clinical diagnosis,” LeBeau said that more evidence is needed. The researchers, he said, hope to use noninvasive x-ray fluorescence spectrometry to examine the skull in Italy and another skull in Toulouse, France, also believed to belong to Aquinas.
American Association of Neurological Surgeons (AANS) 2023 Annual Meeting. Presented April 22, 2023.
No study funding is reported. The authors and Dagi have disclosed no relevant financial relationships.
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