Some of history's most notorious despots demanded absolute authority over their states, but could never claim it over their own bodies. All of the rulers on this list are believed to have suffered from various afflictions, ranging from the curable to the fatal. In some cases, these afflictions shaped their reigns and reputations by exacerbating their worst and most vicious impulses.
The medical conditions don't excuse their deeds. The belief that Adolf Hitler suffered from Parkinson's, for example, does not explain the Holocaust or encourage a more sympathetic view of one of history's biggest villains. It simply presents context to understand his rule in Germany.
Despotic rulers' conditions provide a window into how the precarious health of those in power can shape history, for better or for worse.
The leader of Chinese Communism was not devoted to personal hygiene as doggedly as he was to his revolution. He refused to bathe (opting instead to have his attendants swab him with hot towels) and preferred to rinse his mouth with tea rather than brush his teeth. This led to the development of abscesses and tooth decay.
Mao tried to keep his deteriorating health a secret in order to maintain his grip on authority. In 1974, doctors diagnosed him with amyotrophic lateral sclerosis (ALS). His muscle weakness worsened, and he lost the ability to speak coherently before he passed two years later.
Age: Dec. at 83 (1893-1976)
Birthplace: Shaoshan, China
Born in 1926, the Cuban revolutionary turned Communist leader generally enjoyed good health for most of his life. However, by 2007, at the age of 80, Castro came down with a serious case of diverticulitis, or intestinal inflammation.
Though relatively common in elderly adults, diverticulitis can be incredibly painful and can lead to fatal complications. Castro had multiple operations for diverticulitis that year, with one failed surgery requiring five months of recovery while his brother Raúl took the reins of government.
Castro's health issues became so severe he retired in 2008 and passed eight years later.
Birthplace: Birán, Cuba
When in his 70s, Chiang Kai-shek - the iron-fisted nationalist leader of the Republic of China - developed urinary problems. Though he had surgeries for the issue in the 1960s, they left him incontinent, or unable to control his bladder.
Chiang's incontinence was so bad biographer Jay Taylor reports "he began a routine of remaining seated at the conclusion of meetings until everyone - except his aides - had departed," lest anyone notice his urine-soaked pants.
Chiang's struggles with incontinence ended only with his demise in 1975.
Age: Dec. at 88 (1887-1975)
Birthplace: Xikou, China
Roman general-turned-dictator Gaius Julius Caesar was one of the most gifted military minds of the ancient world - and he battled an unknown ailment later in life.
Roman biographer Suetonius claimed Caesar "was subject to sudden fainting fits and disturbances in his sleep. He was likewise twice seized with the 'falling sickness,' while engaged in active service." Plutarch, another ancient writer, believed Caesar's health issues started cropping up in 46 BCE when he was 54.
According to Plutarch, Casear's ailment - whatever it was - didn't impact his work:
He never allowed his weakened health to slow him down but instead used the life of a soldier as therapy. He marched endlessly, ate simple food, slept outside, and endured every hardship. In this way, he strengthened his body against illness.
The only things that brought Caesar down were the knives of his assassins: he was slain on the floor of the Roman Senate on March 15, 44 BCE.
Age: Dec. at 56 (99 BC-43 BC)
Birthplace: Rome, Italy