JMS Pearce
Hull, England

Tiberius Claudius Caesar Augustus Germanicus (10 BC – AD 54) (Fig 1) was a Roman emperor from AD 41 to 54.¹ His eventful life was revivified in Robert Graves’s much-admired fictionalized autobiography.^2,3 Although one of the most successful Julio-Claudian emperors after Augustus, he is perhaps more widely known for his physical disabilities.

The signs, according to Caius Suetonius Tranquillus, were first noticed during childhood and included an abnormal gait, involuntary movements of the head and hands, and disturbance of speech. Antonia, his mother, regarded him as a fainéant youth, nothing but an “abortion that nature had begun to form, but never ended.” In The Lives of the Twelve Caesars, Suetonius wrote:

When he walked, his weak knees gave way under him and he had many disagreeable traits both in his lighter moments and when he was engaged in business; his laughter was unseemly and his anger still more disgusting, for he would foam at the mouth and trickle at the nose; he stammered besides and his head was very shaky at all times, but especially when he made the least exertion. Though previously his health was bad, it was excellent while he was emperor…⁴

He was attended by his physician, Xenophon of Kos, who was also physician to Herod Agrippa. Xenophon observed Claudius’s limp and disabling stammer and diagnosed infantile paralysis, later known as poliomyelitis. He treated him with diet, exercise, massage, and botanical remedies.⁵ He prescribed a tincture of bryony, after which Claudius said: “For the first time in my life I knew what it was to be perfectly well. I followed Xenophon’s advice to the letter and have hardly had a day’s illness since.”⁵ Suetonius (c. AD 69–140) also noted that while he was emperor, his health was excellent, which suggests a lessening of his unsightly abnormal movements with age. There is no evidence of neurological illness in his parents, siblings, or children.

It is often said that Claudius received his name from the Latin verb claudicare, to limp. Not so: the words are etymologically unrelated since Claudius derives from the patrician branch of the Claudian House in Rome—nothing to do with claudicare.

His family erroneously considered his disabilities evidence of mental infirmity and therefore excluded him from all public life and political office. According to Tacitus (AD 56–113), this was owing to Tiberius, emperor from AD 14 to 37, who largely blocked him from such preferment because of his weak-mindedness.

During the assassination of his infamously brutal, cruel nephew, the emperor Caligula, Claudius timorously hid behind a curtain. However, the responsible Praetorian Guards, pressed by the populace to replace Caligula, and aided by a little bribery, swiftly declared Claudius their emperor.⁶ His life and activities changed drastically thereafter.

Of the twelve Caesars, most died a violent death. Only three died a natural death, and only Vespasian was succeeded by his own son. Claudius was cautious of his safety, and abjured contention. Consequently, he refused to take the forename Imperator. Before becoming emperor at the age of fifty, he had shown signs of considerable historical scholarship. During his reign and despite his disabilities, he completed the Roman conquest of Britain in AD 43, allegedly his greatest achievement. He brought two major aqueducts to Rome, and developed new canals, roads, and construction projects across the Empire. Claudius secured peace in several turbulent imperial provinces under Roman control. He modified activities of the Senate, influenced the judicial system, and presided over many public trials.⁷ These facts confirm Rice’s opinion that he did not suffer from cognitive impairment.⁸

What caused his symptoms?

Rice excludes a primary childhood-onset dystonia but tentatively favors a secondary dystonia consequent to a central nervous system infection or a head injury in childhood,⁸ of which there is, however, no evidence.

Ruth suggested he was the subject of infantile diplegia, or Little’s disease,⁹ but this would not account for his stammering or shaking head. A more plausible suggestion is that Claudius had Tourette’s syndrome. However, Perkin concluded that he probably had multiple tics, without the vocal coprolalia that would establish a diagnosis of Gilles de la Tourette’s syndrome.¹⁰

The evidence suggests that Claudius suffered from the athetoid (dyskinetic) variant of cerebral palsy from birth.¹¹ Mottershead offered a similar opinion.¹² His gait disorder, abnormal movements of the head and hands, dysarthria, hypertrophy of sternomastoid (Fig 2), and unseemly laughter are characteristic. Seneca described his speech as a confused sound in an unintelligible voice with indistinct utterance.

Cassius Dio related:

In mental ability he was by no means inferior, as his faculties had been in constant training (in fact, he had actually written some historical treatises); but he was sickly in body, so that his head and hands shook slightly. Because of this his voice was also faltering, and he did not himself read all the measures that he introduced before the senate, but would give them to the quaestor to read… prey to great terror he feigned a stupidity greater than was really the case…⁷

Claudius published many works, but none survive. They included forty-three books on Roman history, twenty-one Etruscan and eight on Carthaginian history, a book on philology, and a rhetorical defense of Cicero. These works and his mastery of government institutions testify to high intelligence, which is not uncommon in athetoid cerebral palsy.

Historians, including Tacitus, Suetonius, and Dio Cassius, suggested that he died of poisoning, possibly by a poisonous mushroom, Amanita phalloides.¹³ Many rumors asserted this effected by Agrippina, his beautiful fourth wife and the great-granddaughter of the first emperor Augustus. She had dominated their marriage and schemed to have her son Nero succeed to the throne as emperor.

But a note of caution: Tacitus rightly commented that the Julio–Claudian dynasty was beset by intrigue, tyranny, and murderous plotting for power, status, and wealth. Robert Graves’ acclaimed fictionalized autobiographies^2,3 of Claudius tells that the writings about him in his time were notoriously unreliable, so the nature of his illness, like his cause of death, are to some extent issues of conjecture.

The Senate deified Claudius to bolster Nero’s status as “Son of the Deified.”

End note

* From the families: Julii Caesares and Claudii Nerones of the imperial dynasty

References

1. Potter TW. (2006, May 25). “Claudius [Tiberius Claudius Nero Germanicus] (10 BC–AD 54), Roman emperor.” Oxford Dictionary of National Biography.
2. Graves R. I, Claudius. Penguin Classics, 2006. Televised in 1976, by BBC, awarded three BAFTAs.
3. Graves R. Claudius the God. Penguin Classics, 2006.
4. C. Suetonius Tranquillus. The Lives of the Twelve Caesars.Loeb Classical Library, 1914.
5. Metzler S. Emperor Claudius and his physician, Xenophon of Kos. Hektoen International Winter 2023, Volume 15, Issue 1.
6. Appler AC. Claudius: The Caesar never meant to be emperor. Hektoen International Spring 2016.
7. Cassius Dio. Roman History. Vol. VII of the Loeb Classical Library edition, 1924.
8. Rice JE. The emperor with the shaking head: Claudius’ movement disorder. Journal of the Royal Society of Medicine 2000;93: 198-201.
9. Ruth TD. The Problem of Claudius: Some Aspects of a Character Study. Baltimore: The Lord Baltimore Press (Med. 8vo, pp.138.). Cited in British Medical Journal Jan 1926.
10. Perkin GD. More movements. J Neurol Neurosurg Psychiat 1996; 60(5): 563.
11. Pearce JMS. The emperor with the shaking head. Journal of the Royal Society of Medicine 2000;93:335-6.
12. Mottershead J. Claudius’ physical appearance and health. In: Suetonius. Claudius. Bristol: Classical Press, 1986;145-8. [1]  Valente WA, Talbert RJA, Hallett JP, Mackowiak PA. Caveat Cenans! American Journal of Medicine 2002;112:392-8.
13. Valente WA, Talbert RJA, Hallett JP, Mackowiak PA. Caveat Cenans! American Journal of Medicine 2002;112:392-8.