Epilepsy & Behavior 49 (2015) 4–7

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Epilepsy & Behavior
journal homepage: www.elsevier.com/locate/yebeh

Historical Note

The demise of Archbishop Wolf Dietrich — A historical note on a fatal
status epilepticus documented at Salzburg in 1617
Gudrun Kalss a,b,⁎, Julia Höfler a,b, Alexandra Rohracher a,b, Ildiko Deak a,b, Judith Dobesberger a,b,
Giorgi Kuchukhidze a,b,c, Markus Leitinger a,b, Kathrin Ogris d, Mark Mc Coy e, Eugen Trinka a,b
a

Department of Neurology, Christian Doppler Medical Centre, Paracelsus Medical University Salzburg, Ignaz Harrer Strasse 79, 5020 Salzburg, Austria
Centre for Cognitive Neuroscience, Ignaz Harrer Strasse 79, 5020 Salzburg, Austria
Department of Neurology, Medical University of Innsbruck, Innrain 52, Christoph-Probst-Platz, 6020 Innsbruck, Austria
d
Department of Legal Medicine, Medical University of Graz, Universitätsplatz 4/2, 8010 Graz, Austria
e
Division of Neuroradiology, Christian Doppler Medical Centre, Paracelsus Medical University Salzburg, Ignaz Harrer Strasse 79, 5020 Salzburg, Austria
b
c

a r t i c l e

i n f o

Article history:
Accepted 21 March 2015
Available online 29 April 2015
Keywords:
Status epilepticus
Archbishop Wolf Dietrich
Vascular epilepsy

a b s t r a c t
Introduction: Wolf Dietrich of Raitenau (WD) ruled the archiepiscopal Salzburg from March 2nd 1587 to
December 17th 1611. He was condemned by his successor Archbishop Markus Sittikus of Hohenems to spend
his last years imprisoned at the Fortress Hohensalzburg, where he died on January 16th 1617. This historical
note describes the causes of his death.
Materials and methods: The original Latin handwriting, including the detailed medical history and the autopsy
of the Archbishop's body performed by his personal physician, was analyzed in conjunction with historical handwritings provided by St. Peter's Abbey, Salzburg handwriting assigned to Markus Sittikus.
Results: Wolf Dietrich of Raitenau had his first well-documented left hemispheric stroke in winter 1604/05. He
had palsy of his right arm, was unable to write, and, therefore, used a stamp instead of his signature until October
1605. After another stroke, right hemispheric in origin with persisting palsy of his left arm [“leva corporis pars iam
pridem simili ex apoplectico assultu in paralysin resoluta”], he developed symptomatic epilepsy with recurring seizures [“epileptico insultu quo etiam alias correptus est”].
On January 15th 1617, he suffered from a secondarily generalized convulsive status epilepticus [“toto corpore
convellitur epileptico insultu”] with stertorous breathing and distortion of his face [“spuma stertore insigni faciei
perversione”] and was unconscious for 8 h. He recovered from coma and showed dysphagia, buccofacial apraxia
[“abolitam diglutiendi facultatem”], reversible speech disturbance [“accisa etiam verba loqui”], and left-sided hemiplegia [“leva corporis pars… immobilis prorsus est reddita”]. The following day, he had speech disturbances, and he
died at noon.
His autopsy showed large but intact liver [“hepar magnum sanum”] and heart [“cor magnum in quo lapsus nullus”].
There was intrapulmonal mucus [“pituita imbutus”], and part of the lungs adhered to its pleura. He had five kidney stones and a partly cirrhotic spleen. The cause of his death was assumed to be intracerebral [“causa mortis in
capite requienda fuisset”].
Discussion: The terminal suffering of Wolf Dietrich of Raitenau is the first witnessed case report on a fatal status
epilepticus in Salzburg. Most likely, he suffered from vascular epilepsy due to a right hemispheric stroke, leading
to status epilepticus with left-sided Todd's palsy and speech disturbances. An acute symptomatic etiology of this
disease cannot be ruled out, as for religious reasons, the Archbishop's brain was not autopsied.
Conclusion: Meticulous medical reporting including autopsy was already available in Salzburg in 1617, and the
symptomatic etiology of epilepsy was diagnosed correctly.
This article is part of a Special Issue entitled “Status Epilepticus”.
© 2015 Elsevier Inc. All rights reserved.

1. Introduction
Abbreviations: WD, Wolf Dietrich of Raitenau; SE, Status epilepticus.
⁎ Corresponding author at: Department of Neurology, Christian Doppler Medical
Centre, Paracelsus Medical University Salzburg, Ignaz Harrer Strasse 79, A-5020 Salzburg,
Austria. Tel.: +43 662 4483 56013; fax: +43 662 4483 3004.
E-mail address: g.kalss@salk.at (G. Kalss).

http://dx.doi.org/10.1016/j.yebeh.2015.03.024
1525-5050/© 2015 Elsevier Inc. All rights reserved.

Wolf Dietrich of Raitenau (WD) was born on March 26th 1559. He
was one of the most influential Catholic Archbishops (Fig. 1) and ruled
Salzburg from 1587 to 1611. He lived together with his mistress Salome
of Altenau and their 15 children.

G. Kalss et al. / Epilepsy & Behavior 49 (2015) 4–7

5

to Markus Sittikus; Claudius Galen's Commentary III on Hippocrates'
book IV; and historical records of the archives of the Institute for Applied
Geographics (Landeskunde) Salzburg and the University of Salzburg.
3. Results

Fig. 1. Wolf Dietrich of Raitenau by Kaspar Memberger, Salzburg 1589, © Salzburg
Museum.

His failure to live a celibate life and the conflict on the salt mines between Bavaria and Salzburg were the reasons for his imprisonment on
December 17th 1611. He was condemned by his successor Archbishop
Markus Sittikus of Hohenems to spend his last years at the Fortress
Hohensalzburg, where he died on January 16th 1617.
His medical history was documented by his personal physician
Vincentius Cratinus, who executed his autopsy on behalf of Markus
Sittikus and the Chapter of Salzburg.
2. Material and methods
The personal physician's original Latin handwriting, including the
medical history and the autopsy report of the Archbishop's body, was
translated (GK, ET) and interpreted in conjunction with historical handwritings provided by St. Peter's Abbey, Salzburg; handwriting assigned

Wolf Dietrich of Raitenau had his first well-documented left hemispheric stroke in winter 1604/05 with palsy of his right arm. He was
not able to write and used a seal instead of his signature from June to
October 1605 [1].
He realized his own mortality and tried to serve his heirs. He
commissioned the construction of the castle of Altenau, today called
Mirabell, for his mistress and their children. The marble inscription
placed above the castle's entrance is now placed at the Faculty of Law,
University of Salzburg. Its text clearly describes his health condition
and intentions (Fig. 2).
Later, he suffered from another stroke, which was right hemispheric
in origin with palsy of his left arm [“leva corporis pars iam pridem simili
ex apoplectico assultu in paralysin resoluta”] and recurring symptomatic
epileptic seizures [“epileptico insultu quo etiam alias correptus est”] [2].
On January 15th 1617 he suffered from a secondarily generalized convulsive status epilepticus (SE) [“toto corpore convellitur epileptico insultu”]
with stertorous breathing, salivation, and facial distortions [“spuma
stertore insigni faciei perversione”] (Fig. 3) and was unconscious for exactly 8 h. He recovered from coma and showed speech disturbances [“accisa
etiam verba loqui”], buccofacial apraxia, dysphagia [“abolitam diglutiendi
facultatem”], and a complete left-sided hemiplegia [“leva corporis pars…
immobilis prorsus est reddita”] [2] (Fig. 4).
Markus Sittikus described, in a letter addressed to WD's brother,
speech disturbances after the generalized convulsions [“fraiß angegriffen”]
but noted that he completely recovered from them that night [“die
Sprach, wie auch den Verstand völlig widerumben erlangt”] [3], although
hemiplegia, dysphagia, and buccofacial apraxia persisted. Liquor made
of oriental pearls and other medications were administered to suppress
the status [2].
The next day, WD's speech was impaired again [“loquela amplius
impediri cepit”], and he died at noon that same day [2].
His autopsy was performed by his personal physician and witnessed
by several physicians, natural scientists, politicians, and representatives
of cleric dignitary [2].
His body was obese and unviolated. His limbs were emaciated and
covered with ulcers [“Corpus … symmetricum se exhibuit et pingue,

Fig. 2. Marble inscription, decorating the entrance at the Castle of Altenau, nowadays placed at the Faculty of Law, University of Salzburg, 2nd floor, room “Wolf Dietrichs Ruh”. © Gudrun Kalss.
“Raitenauiae stirpis divino e munere princeps, ad rapidas salzae praetereuntis aquas, impatiens ocii et spirans magis ardua quondam; nunc, ubi morbus corpore deficio: has tactas aedes
fessus, portumq siletem hunc mihi, semestri tempore, constituo.”
“born in the house of Raitenau, sovereign by grace of God, at the fast flowing river Salzach, once impatiently longing for outstanding achievements; now, that my body is decayed by diseases: I
build this quiet house, this silent port for me within six months.”

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G. Kalss et al. / Epilepsy & Behavior 49 (2015) 4–7

Fig. 5. Examination protocol: part three.
“Causa mortis in capite requirenda fuisset, in cerebri potissimum ventriculis…”.
“The cause of his death would have had to be searched for in his head, most likely inside
the brain's ventricles…”.

dehiscent on the right (2.3 mm) than on the left (1 mm) side. His
teeth showed an excellent nutritional condition for a nearly 60-yearold man, even if considered by today`s standards [4].
Fig. 3. Examination protocol: part one.
“… sensu privatur ac toto corpore convellitur, epileptico insultu, quo etiam alias correptus
est, cum desperanda symptomatum magnitudine, sui scilicet alienatione, quod signum
herculei affectus est pathognomicum, spuma, stertore insigni, faciei perversione.”
“…he loses consciousness. His whole body is jerked by an epileptic seizure, as he suffered
from before. The symptoms are of such desperate magnitude, namely unconsciousness,
salivation, breathing in a stertorously way and distortion of his face, which are pathognomonic for the disease of Hercules.”

tibia, brachia, singula singulis fonticulis insignita, demaciata videbantur”].
The subcutis showed a thick fat layer. Part of his spleen was cirrhotic.
One kidney was obstructed by five very hard little stones. The heart
[“cor magnum, in quo lapsus nullus”] and liver [“Hepar magnum, sanum”]
were large but considered intact. The peritoneum, omentum majus,
mesenterium, stomach and intestines were intact [2]. The lung was
fraught with viscous mucus [“pituita imbutus”]. Part of it adhered to the
pleura. Its livid colored parenchyma was covered with dark blue maculae
and looked as if strewn with hailstones [“Hujus parenchyma atroceruleis
distinguebatur maculis et ceu grandinibus scatebat”] [2]. The cause of his
death was assumed to be intracerebral, most likely inside the ventricles.
However, for religious reasons, it was felt inappropriate at that time to
open the skull and perform a brain autopsy [“causa mortis in capite
requienda fuisset, in cerebri potissimum ventriculis, … curiosius ultexiora
rimari vix aequum fuit.”] [2] (Fig. 5).
Wolf Dietrich of Raitenau was buried at St. Sebastian' s Cemetery at
Salzburg. The mausoleum was opened several times for the last time
on April 20th 2004. Only part of the skeleton was preserved,
suboptimally stored in plastic bags, and, therefore, molded. On the exhumed cranium, a squamous suture was found, which was more

Fig. 4. Examination protocol: part two.
“… leva corporis pars, jam pridem simili ex apoplectico assultu in paralysin resoluta,
immobilis prorsus est reddita.”
“… The left part of his body, which was paralyzed due to a former apoplectic insult, was
now completely immobile.”

4. Discussion
4.1. Semiology and functional anatomy
The terminal suffering of Wolf Dietrich of Raitenau is the first
witnessed case report on fatal SE in Salzburg.
He suffered from two strokes in different vascular territories [1,2].
His personal physician clearly points out epilepsy in his autopsy protocol. He differentiates between the terms “apoplectico assultu” and
“epileptico insultu” not only using these terms but also in describing
the symptoms. Moreover, he uses the term “herculeius affectus” [2]. In
the baroque era, epilepsy was named “disease of Hercules” or, in Latin,
“morbus Herculeius” documented by Hippocrates and commented on
by Galen later [5]. Salivation, stertorous breathing, and unconsciousness
were considered pathognomonic to this disease [2]. The description of
WD's last days fulfills today's definitions of SE even in the absence of
an EEG because the Archbishop's unconscious state lasted for 8 h and
because fluctuation of focal clinical symptoms was clearly documented.
This SE had a focal right hemispheric onset, as documented by
postictal left-sided Todd's hemiplegia [2]. At this passage in the text,
his personal physician deals inaccurately with the focal symptoms in
WD's face: “facies perversione” may be translated as “distorted face”,
“grimacing”, or “tonic movement of his face”, or, more precisely, “eye
deviation”. All possible translations point to a focal onset as well.
4.2. Etiology of epilepsy
Wolf Dietrich of Raitenau was in an abundant nutritional shape.
Although imprisoned at Hohensalzburg, he received good food provided
by his successor who feared and aimed to prevent malicious gossip. The
former Archbishop still was very popular with the Salzburg people [6].
An older theory hypothesized a posttraumatic etiology of WD's seizures. The CT examination of WD's exhumed cranium performed in
2004 showed a prominent dehiscence in the squamous suture on the
right side. This dehiscence could be posttraumatic (intra vitam) as a
result of a horse-riding accident in his youth and eventually lead to
right hemispheric posttraumatic epilepsy. However, most likely, this
dehiscence was caused by mold and liquidation of the bone postmortem
as a result of storage in the crypt in a plastic bag for years [4]. Thus, posttraumatic epilepsy seems less likely to the authors.
There are only a few hints on the etiology of his ischemic strokes
within the autopsy protocol. The autopsy protocol notes an obese
torso and macerated limbs, covered by ulcera [2]. A male body fat
distribution type is a risk factor for diabetes mellitus and may reflect
metabolic disease. However, micorangiopathy is less likely to be responsible for a putative lacunar lesion in the brain, as this would be too small
to explain the clinical signs of hemiplegia, dysphagia, and buccofacial
apraxia.

G. Kalss et al. / Epilepsy & Behavior 49 (2015) 4–7

With regard to a macroangiopathic stroke etiology, arteries were not
examined in detail. However, signs of coronary artery disease were not
documented. On the other hand, a partly cirrhotic spleen [2] may be
interpreted as old infarction. Possible etiologies for spleen infarction
may be macroangiopathy or vasculitis.
A frequent stroke etiology in the baroque era was luetic vasculitis.
Not living the celibate lifestyle, this stroke etiology cannot be ruled
out strictly. The limbs covered by ulcera [“singula singulis fonticulis
insignita”] could illustrate lues II. On the other hand, this hypothesis
does not explain the stroke back in 1604 because it seems unlikely to
the authors that a patient would have secondary syphilis for so many
years, and there was no radiologic evidence for lues in the postmortem
CT scan of his bones [4].
Symptoms or signs of cardiac arrhythmia (e.g., dilated left atrium)
were not documented among the existing literary sources, but, because
of the magnitude of the focal symptoms and the fact that he suffered
from two strokes in different vascular territories, the cardio embolic
etiology remains the most plausible cause for his ischemic strokes,
leading to symptomatic vascular epilepsy.
4.3. Cause of his death
The autopsy of his body (excluding the brain) did not resolve the
cause of his death completely in respect to medical knowledge at that
time. Most of the organs were unremarkable. However, there are
some important clues to the diagnosis.
First, as mentioned above, there are hints for a microangiopathic
cardiovascular risk profile.
Second, of special interest are the following pulmonal findings. The
partial adherence of the lung to the pleura perfectly fits to the horse-riding accident in WD's youth [4] or may illustrate a previous pneumonia.
The lung, covered by blue maculae, may illustrate a normal postmortem finding, and its parenchyma strewn with hailstones [“grandinibus
scatebat”] [2] may be interpreted as pulmonary tuberculosis or signs of
aspiration. However, tuberculosis seems less likely to the authors
because of WD's abundant nutritional shape.
The amount of intrapulmonal viscous mucus together with the
detailed description of salivation during 8 h in combination with
persisting buccofacial apraxia, dysphagia, and the several attempts to

7

wipe the saliva off his mouth [2] clearly points to aspiration leading to
lethal respiratory insufficiency.
5. Conclusion
Archbishop Wolf Dietrich suffered from vascular epilepsy and most
likely died of aspiration, leading to respiratory insufficiency after symptomatic status epilepticus. An acute symptomatic etiology of this fatal
SE cannot be ruled out, as for religious reasons, WD's brain was not
autopsied.
Meticulous medical reporting including autopsy was already available in Salzburg in 1617, and the symptomatic etiology of WD's epilepsy
was diagnosed correctly.
Acknowledgments
The authors would like to thank Mag. Dr. Gerald Hirtner, St. Peter's
Abbey Salzburg and Prof. Dr. Maximilian Fussl, University of Salzburg
for their support with ancient Latin literature; Dr. Eleonora Telsnig,
Landeskunde Salzburg, for her support with art history sources; and Dr.
Jürgen Höfler, Brothers Hospitallers Salzburg, for discussing aspects of
Internal Medicine.
Conflict of interests
The authors have no conflict of interest to declare which is relevant
to this research.
References
[1] Welti L. Schwester Clara von Welsperg stirbt. Graf Kaspar von Hohenems. Innsbruck:
Universitätsverlag Wagner; 1963. p. 37.
[2] Cratinus V. Obduktionsbericht. Felner Nachlass 71. Salzburg: Landesarchiv Salzburg;
1617. p. 384–5.
[3] Sittikus M. Brief an Hans Rudolph von Raitenau. Familienarchiv. Lodron: Landesarchiv
Kärnten; 1617. p. Lade 347.
[4] Cemper-Kiesslich J, Schumann F, Neuhuber F, Tutsch-Bauer E, Mc Coy M. Wolf
Dietrichs letztes Geheimnis. In: Ammerer G, Hannesschläger I, editors. Strategien
der Macht. Salzburg: Mitteilungen der Salzburger Gesellschaft für Landeskunde;
2011. p. 315–23.
[5] Kühn KG. Galenii in Hippocr. epidem. libr. VI comm. III. Opera omnia Claudii Galenii;
1829. p. 342–3.
[6] Ergott L. Befragung. Felner Nachlass 3. Salzburg: Landesarchiv Salzburg; 1614. p. 368.