The article examines Genghis Khan's death from the historico-medical perspective. Although several etiologies have been proposed over the years, most of these at a closer look appear to be later inventions by historians. A reassessment of the available evidence suggests instead bubonic plague as the most likely clinical scenario. Genghis Khan's death is also a reflection on the impact of pandemic diseases on leadership in ancient times as well as nowadays

Galassi F. M.

Henneberg M.

Varotto E.

You W.

English

Archivio istituzionale della ricerca - Università di Palermo

International Journal of Infectious Diseases 104 (2021) 347–348Short CommunicationGenghis Khan’s death (AD 1227): An unsolvable riddle or simply apandemic disease?Wenpeng Youa,b,*, Francesco M. Galassib,c,*, Elena Varottob,c,d, Maciej Henneberga,b,caBiological Anthropology and Comparative Anatomy Unit, Adelaide Medical School, University of Adelaide, Adelaide, Australiab FAPAB Research Center, Avola, Sicily, ItalycArchaeology, College of Humanities, Arts and Social Sciences, Flinders University, Adelaide, AustraliadDepartment of Humanities (DISUM), University of Catania, Catania, Sicily, ItalyA R T I C L E I N F OArticle history:Received 13 December 2020Accepted 29 December 2020Keywords:PlagueHistory of medicinePandemicGenghis KhanPaleopathologyInfectious diseasesMilitary medicineA B S T R A C TThe article examines Genghis Khan's death from the historico-medical perspective. Although severaletiologies have been proposed over the years, most of these at a closer look appear to be later inventionsby historians. A reassessment of the available evidence suggests instead bubonic plague as the most likelyclinical scenario. Genghis Khan's death is also a reflection on the impact of pandemic diseases onleadership in ancient times as well as nowadays.© 2021 The Author(s). Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).Genghis Khan, the honorific title of Borjigin Temüjin(1162–1227), was not only considered one of the most famousconquerors in history, but also praised as the founding father of theYuan Dynasty in China (1279–1368) and a supporter of religioustolerance. The Mongol Empire, 2.5 times larger by its territory thanthe Roman Empire, bridged Eastern and Western civilizations(Man, 2013).At the time of Khan’s demise, according to Mongolian culture,kings’ corpses retained their divine power after death, hence theirremains were buried in unmarked, highly protected and impracti-cable places, particularly on the mountains where they werethought to be closer to their final destination: heaven. Other burialoptions included inhuming the monarch’s body in a pit secretlydug in a field, or the corpse might even be cremated (Drobyshev,2006). Therefore, historians, archaeologists and even graverobbers, who have been trying to find Genghis Khan’s body andpotentially accompanying treasures, may never be able to succeedand a definitive paleopathological demonstration of his cause ofdeath may always be wanted.To date, the circumstances of Genghis Khan’s death remain amystery. In order to honour or denigrate his memory, friends andfoes of the Mongols created a plethora of intriguing, yet conflicting,legends about the famous king’s demise. These stories suggest,inter alia, that: (1) he died from injuries sustained after falling fromhis horse; (2) he succumbed to blood loss after being castrated by aTangut princess or simply stabbed by her (the Tangut people beinga Tibeto-Burman tribe inhabiting Northwest China); (3) he fell inbattle against the Chinese; (4) he died of an infected arrow woundthat occurred during his final campaign against the Western Xia(Man, 2013).All these legends were most likely created at a later stage andfailed to take into account–or even willingly ignored–an acceptedhistorical fact, namely that Khan’s family and followers wereinstructed to keep Khan’s death as their most hidden secret, since ithappened at the wrong time when the Mongols were at the vitalstage of their desired conquest of Western Xia, the empire againstwhich they had been fighting for over 20 years (1205–1227).By looking at Khan’s demise through a medical lens–amultidisciplinary approach which has been used when studyingthe diseases affecting other famed conquerors of the past (Galassiet al., 2016) – a more clinically complex story emerges. Yet, beforeexamining the noble patient’s clinical case, Yelü Chucai(1190–1244), a Confucian scholar, needs to be introduced. Chucaiis best known for his service as the chief adviser to the emperors ofthe Mongols for 29 years (1215–1244), of which 12 (1215–1227)* Corresponding authors at: FAPAB Research Center, Piazza Umberto I 5, 96012Contents lists available at ScienceDirectInternational Journal of Infectious Diseasesjournal home page: www.elsevier .com/ locat e/ i j idAvola, SR, Sicily, Italy.E-mail addresses: wenpeng.you@adelaide.edu.au (W. You),francescom.galassi@flinders.edu.au (F.M. Galassi).https://doi.org/10.1016/j.ijid.2020.12.0891201-9712/© 2021 The Author(s). Published by Elsevier Ltd on behalf of International (http://creativecommons.org/licenses/by/4.0/).were to Genghis Khan because of his exceptional educationencompassing various fields such as medicine, mathematics,astrology and music. His medical skills were first fully understoodSociety for Infectious Diseases. This is an open access article under the CC BY licensewtbMw“AsytYcthtnoCualhb(tTacalKdsmp(uiaob(W. You, F.M. Galassi, E. Varotto et al. International Journal of Infectious Diseases 104 (2021) 347–348hen, after the battle of Lingwu was won by the Mongols againsthe Tangut in 1226, he collected rhubarb ( , dahuang), which hadeen known to the Chinese, in order to later treat thousands ofongolian soldiers dying from the plague (Shinno, 2016). In theords of the German sinologist Erich Haenisch (1880–1966):thanks to this drug Chucai saved many soldiers’ lives “([m]it dieserrznei habe er, als bald danach eine Epidemie im Heere ausgebrochenei, einer Unmenge von Männer das Leben gerettet) (Haenisch, 1933).Genghis Khan attacked Western Xia six times over more than 20ears before he was able to conquer the kingdom in 1227. Duringhe last invasion, Khan directed his Mongolian troops to besiegeinchun, the capital of Western Xia, for 6 months. The longampaign must have both physically and psychologically worn outhe famed warrior, then 65 years old, which may well explain whye looked for distractions, such as an escape to the hot weather inhe Liuan mountains near Guyuan, while he was still planning on aew strategy to make Western Xia finally capitulate, and thinkingf an offensive against the Jin Empire (Man, 2013).The History of Yuan (Yuanshi), one of the Twenty-Four Histories ofhina, has it that between the 18–25 August 1227 Khan was feelingnwell with fever, which ultimately killed him within eight daysfter the disease’s onset. This pyretic rise was first examined in theight of a complication of the unhealthy climate by the Persianistorian Atâ-Malek Juvayni (1226–1283) and in the 17th centuryy Guush Luvsandanzan in his Altan Tobchi (or «Golden Summary»)Juvaini and Qazvini, 1997). The latter reference was interpreted byhe aforementioned Haenisch as typhoid fever (Hier möchte man anyphus denken) (Haenisch, 1933), a disease commonly affectingncient armies in the past, but not necessarily the sole possibility,onsidering that there is no mention of typical symptoms such asbdominal pain and vomiting.Instead of spectacular, highly sophisticated or even moreogically acceptable interpretations (e.g. typhoid fever) of Genghishan’s cause of death, the reported clinical picture and theuration of the disease, particularly given the general circum-tances of the disease gripping his army as early as 1226, suggest aore reasonable conclusion and retrospective diagnosis, that oflague, a most ancient, history-changing and still present diseaseBramanti et al., 2016; BBC News, 2020). The vague terminologysed to describe the king’s symptoms and the duration of thellness make it more reasonable to opt for bubonic plague, although pneumonic involvement secondary to a haematogenous spreadf the bacteria cannot be ruled out simply because signs such asloody sputum and vomiting are not mentioned in the sourcesMayo Clinic website, 2021; Rajerison et al., 2013). This decision toignore them fits well with the general atmosphere of secrecysurrounding Genghis Khan’s last days of life. Khan’s sudden deathfrom plague with minimal signs and symptoms likely made iteasier for his own people to keep his health condition secret inorder not to jeopardize the ongoing campaign. While the exactlocation of Genghis Khan’s burial site may forever remainmysterious, a closer look at the clinical likelihood and overallhistorico-medical context of his final campaign can help studentsof his life shed light on the important circumstances of his demise,as well as stress the need for taking into account pandemicdiseases as general causes of death of historical personalitiesrather than trying to assume particular, exceptional causes ofdeath.FundingNone.Conflict of interestNone declared.Ethical approvalNot required.ReferencesBBC News. China Bubonic Plague: WHO ‘Monitoring’ Case but Says it is ‘Not HighRisk’ https://www.bbc.com/news/world-asia-china-53325988 [Accessed 25July 2020].Bramanti B, Stenseth NC, Walløe L, Lei X. Plague: a disease which changed the pathof human civilization. Adv Exp Med Biol 2016;918:1–26.Drobyshev YI. Funeral and memorial Rituals of the Medieval Mongols and theirUnderlying Worldview. Anthropol Archeol Eurasia 2006;45(1):65–92.Galassi FM, Bianucci R, Gorini G, Paganotti GM, Habicht ME, Rühli FJ. The suddendeath of Alaric I (c. 370-410 AD), the vanquisher of Rome: a tale of malaria andlacking immunity. Eur J Intern Med 2016;31:84–7.Haenisch E. Die letzten Feldzüge Cinggis Han’s und sein Tod nach der ostasiatischenÜberlieferung. Asia Major 1933;9:503–51.Juvaini A-M, Qazvini MM. Genghis Khan: The History of the World Conqueror.Manchester University Press; 1997 p.180, n.3.Man J. Genghis Khan: Life, Death, and Resurrection. MacMillan; 2013.Mayo Clinic website: https://www.mayoclinic.org/diseases-conditions/plague/symptoms-causes/syc-20351291.Rajerison M, Ratsitorahina M, Andrianaivoarimanana V, et al. Plague. In: Farrar J,editor. Manson’s Tropical Infectious Diseases. Saunders Ltd.; 2013. p. 404–9.Shinno R. The Politics of Chinese Medicine Under Mongol Rule. Routledge; 2016. p.26.348

Genghis Khan's death (AD 1227): An unsolvable riddle or simply a pandemic disease?

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Genghis Khan's death (AD 1227): An unsolvable riddle or simply a pandemic disease?

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