“I have been all things, and all was of little value.”¹

Septimius Severus was Roman emperor from 193 to 211 CE and is remembered for his reforms, innovations, military campaigns, and severity.¹ Born in present-day Libya, he came to the throne after several emperors who ruled briefly after the death of Nero. As emperor, he had access to the finest medical authorities available at the time, including the famous Galen. Medical science, however, had little to offer other than dietetics, drug therapy (including opiates and herbal preparations), and various ineffective regimens.

According to contemporary historians, Severus was robust and physically resilient in his youth and middle age, but he later developed what appears to have been gout. It was severe and chronic, suggesting he endured significant discomfort and disability throughout the latter part of his reign. The disease impaired his mobility, potentially affecting his ability to carry out his duties as emperor, especially in military campaigns. Contemporary historians have suggested that he became increasingly frail and remarked on his declining physical condition. His final campaign in Britain between 208 and 211 CE marked a significant turning point in his health.

Historians and medical scholars have considered gout a plausible diagnosis, given his age (he was around sixty-six at his death), social status, and the classical symptoms described. The understanding of diseases such as gout was still limited at the time. There is also some indication that Severus may have suffered from another chronic illness. Symptoms such as fatigue and limited mobility may suggest possibilities such as rheumatoid arthritis or even a form of cancer, though such retrospective diagnosis remains speculative. His slow deterioration, however, was not so swift as to prevent him from continuing military command and maintaining political control during his last few months. Looking back on his life, however, as he lay dying at Eboracum (modern-day York), he sadly commented that he had been all things, and it was all of little value.¹

His death in 211 CE had profound implications. The transition of power to his sons, Caracalla and Geta, ushered in a period of dynastic instability. Gibbon summarized his reign harshly:

The contemporaries of Severus, in the enjoyment of the peace and glory of his reign, forgave the cruelties by which it had been introduced. Posterity, who experienced the fatal effects of his maxims and example, justly considered him as the principal author of the decline of the Roman Empire.¹

Reference

1. Gibbon, Edward. The History of the Decline and Fall of the Roman Empire, chapter 5. 1776.