Hektoen International

A Journal of Medical Humanities

The most loathsome disease of the emperor Galerius

“His disease was occasioned by a very painful lingering disorder. His body, swelled by an intemperate course of life to an unwieldy corpulence, was covered with ulcers, and devoured by innumerable swarms of those insects who have given the name to a most loathsome disease.”

— Edward Gibbon, The Decline and Fall of the Roman Empire, Chapter XIV

The Roman emperor Galerius (260–312) was appointed by Diocletian as second in command for the Eastern part of the empire (Caesar) and became its sole ruler after the latter’s death (Augustus). A fierce persecutor of Christians, his mode of death has long interested historians. In 2012 Kousoulis et al suggested that he died from a severe infection of the skin and soft tissue of the pubic area called Fournier gangrene, basing their diagnosis on the description by the ancient historian Lactantius:

And now when Galerius was in the eighteenth year of his reign, God struck him with an incurable disease. A malignant ulcer formed itself in the secret parts and spread by degree. The physicians attempted to eradicate it . . . But the sore, after having been skimmed over, broke again; a vein burst, and the blood flowed in such quantity as to endanger his life . . . The physicians had to undertake their operations anew, and at length they cauterized the wound . . . He grew emaciated, pallid, and feeble, and the bleeding then stanched. The ulcer began to be insensible to the remedy as applied, and gangrene seized all the neighboring parts. It diffused itself the wider the more the corrupted flesh was cut away, and everything employed as the means of cure served but to aggravate the disease. The masters of the healing art withdrew. Then famous physicians were brought in from all quarters; but no human means had any success . . . and the distemper augmented. Already approaching to its deadly crisis, it had occupied the lower regions of his body, his bowels came out; and his whole seat putrefied. The luckless physicians, although without hope of overcoming the malady, ceased not to apply fermentations and administer remedies. The humors having been repelled, the distemper attacked his intestines, and worms were generated in his body. The stench was so foul as to pervade not only the palace, but even the whole city; and no wonder, for by that time the passages from waste bladder and bowels, having been devoured by the worms, became indiscriminate, and his body, with intolerable anguish, was dissolved into one mass of corruption.

The authors concluded that the description of the case was consistent with a Fournier gangrene, a rapidly spreading and still often fatal progressing soft tissue infection of the pubic area by many organisms, leading to tissue breakdown, small vessel occlusion, and spread of the infection. The disease was named after Jean Alfred Fournier (1832–1914), a French dermatologist and venereologist, even though it had been described by Baurienne in 1764. But other accounts just suggest that Galerius merely died from an infected wound, and that the deaths of other persecutors of Christians have been described in a rather similar gruesome manner—as they clearly deserved!


  1. Kuosoulis, AA, Economopoulos K, Hatsinger M, Eshraghian A, Tsiodras S. The Fatal Disease of Emperor Galerius. Journal of the American College of Surgeons 215 (2012): 890-893.

GEORGE DUNEA, MD, Editor-in-Chief

Summer 2018



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