George Dunea, MD

BRITISH MEDICAL JOURNAL - VOLUME 308 - JANUARY 29, 1994

Modern tourists know Hadrian mainly for his mausoleum in Rome or for the wall that he built in the north of England to keep out the barbarians. Historians think of him as an effective emperor and a capable administrator. But he was also a complex personality, full of contradictions during his reign as well as during a lengthy illness characterized by intractable anasarca.

Succeeding to the throne in AD 117, he devoted most of his time to maintaining the peace of the empire, travelling extensively, and building on a large scale. He fought few wars, but in AD 132 put down Simon Bar-Kochba's rebellion in Judea, razing Solomon's temple and so desolating the region that wolves and hyenas rushed howling through the cities. He maintained strict army discipline, himself walking as much as 20 miles a day fully armed, breakfasting without wine, and not covering his head winter or summer. He had a prodigious memory and could dictate, listen, or speak to many people at once. Fond of literature, he had an insatiable ambition to surpass everybody, not merely in letters but also in arithmetic, geology, and music. He even wrote his autobiography.

Always changeable, he could be cruel or merciful, an enlightened ruler or an autocratic tyrant. He mostly ignored his wife, but ran to excess in the gratification of his desire. When his lover Antinous died under mysterious circumstances in Egypt, he wept like a woman and had him declared a god. Later he adopted as successor, with sole recommendation his beauty, a youth who frequently vomited blood, was so weak that he could barely speak at his inauguration, and died in his sleep after too large a dose of medicine.

Hadrian's final illness began with epistaxes and gradually increasing anasarca, for a while relieved by certain magic or charms but then he would soon be filled with water again. In Marguerite Yourcenar's novel he decides to commit suicide, a seemingly simple matter since a man has the right to decide how long he may usefully live. But then doubts set in, everything serving to postpone the final act, the knowledge that he could finish his life at any time actually helping to make life more bearable, acting as a sedative, and even giving him renewed interest in this life that was leaving him.

Then as his infirmities increased he asked for poison, but his physician refused to act against the Hippocratic oath and apparently took a lethal potion himself. It is also said that Hadrian tried to have his slave stab him in a colored spot that he had his physician draw below the nipple. According to Ms Yourcenar he became resigned and peaceful, suffering less and less, so that life became almost sweet again. I have ceased to quarrel with physicians: their foolish remedies have killed me, but their presumption and hypocritical pedantry is of our making: if we were not so afraid of pain they would tell fewer lies. But Dio Cassius describes how he abandoned his careful regimen and by indulging himself in unsuitable foods and drink met his death, shouting aloud the popular saying: Many physicians have slain a king.

The cause of his edema lends itself to tantalizing speculations, but it must have been due to renal disease, heart failure, and perhaps hypertension. A more recent medical historian (1911) has attributed his nosebleeds and edema to chronic glomerulonephritis and vitium cordi - this presumably meaning hypertensive heart disease.