There was the same imperious glance across the room as the accused was led into court, but the swagger had gone.
The judges may decide to call time on the Milosevic trial
The suit and tie were still immaculate, but his face was flushed red.
In short, Slobodan Milosevic did not look like a well man.
His health problems have been documented almost daily since the start of this trial - but now the whole legal process is heading for intensive care.
According to one of Mr Milosevic's advisers, his blood pressure was so high this morning that he should have been in a hospital, not in a court of law.
The judges insisted that he was well enough to take part in a short hearing on "administrative matters".
But it did not take too long for the most famous defendant at the International Criminal Tribunal for the Former Yugoslavia to get back into action - feisty and combative, criticising the court and comparing his treatment to the Spanish Inquisition.
"You've now decided to rule on biology and medicine, let alone on the reshaping of history," he thundered.
The judges and prosecutors looked on wearily - they have seen this side of Mr Milosevic many times before.
Prosecutors tried to link the Serb dictator to war crimes in Bosnia
But it was the intervention of one of the "amicus curiae" - appointed by the court to observe proceedings on the defendant's behalf - that really set them on edge.
Lawyers choose their words carefully, so British barrister Steven Kay's contribution was not made lightly.
He pressed the local equivalent of the nuclear button.
"It may well be that the court is at the stage now," he said, enunciating every word, "of having to consider his very fitness to stand trial at all."
The prosecutors glowered; one of the judges raised a cautious eyebrow. High blood pressure all round.
"This is a case which must be tried. The accused wishes it to be tried," prosecutor Geoffrey Nice insisted.
He suggested that the court should impose a defence lawyer on Mr Milosevic to help relieve some of his stress.
Fork in the road
It will not be an easy decision for the judges to make, and Mr Milosevic has already dismissed the idea out of hand.
He wants his own day in court - he dreams of putting questions to Bill Clinton, Tony Blair, Gerhard Schroeder and others, but it may never happen.
His health problems are "chronic and recurrent", the chief judge Patrick Robinson concluded, as he promised a "radical review" of the way things are going.
It all sounded rather ominous.
So after more than two years, this trial seems to have reached a fork in the road.
It still has the ability to deliver compelling drama. But the big question now is - can it still deliver justice?