Arpan K. Banerjee
Solihull, UK

Books about illness in political figures are not a new phenomenon. Lord Moran, Winston Churchill’s personal physician, wrote an important work based on his experience. David Owen, a physician and distinguished Foreign Secretary in the British Labour Government under Prime Minister James Callaghan, in 2008 wrote In Sickness and Power, an insightful study of how illness affected British Prime Minister Anthony Eden, US President John Kennedy, the Shah of Iran, and French President François Mitterrand.

In this new book, Nick Summerton, author of a previously acclaimed book on Greco-Roman medicine, has produced an important new tome on the lives and illnesses of Roman emperors including Augustus, Tiberius, Nero, Claudius, Caligula, and Marcus Aurelius.

The opening chapter provides an insightful analysis of the challenges involved in making retrospective diagnoses in figures from the past, including the analysis of ancient medical and historiographic writings in Greek and Latin, understanding concepts of disease from ancient eras, and difficulties in obtaining information from primary resources such as paintings, coins, medical and religious manuscripts, and paleopathological materials. Retrospective diagnoses are subject to iterative processes, although the level of diagnostic certainty remains lower.

A chapter on Roman therapeutics reminds us that ancient Romans knew about the importance of clean air, regular exercise, adequate sleep, and a healthy diet. A diet rich in pulses, bread, and meat was common, although vegetables were also recommended. The importance of cooking food would have reduced the risk of diseases from raw produce, and public bathing and cleanliness were important.

The first emperor described in the book is Augustus. According to the historian Suetonius, Augustus was prone to illness throughout his life, including before, during, and after the Battle of Philipi in 42–41 BC. He may have suffered from bronchiectasis, asthma, or tuberculosis, as well as diarrheal disease.

Unlike Augustus, Emperor Tiberius, according to Suetonius, was in better health and was wary of doctors. However, he was known to have relatively poor vision, suffered regularly from bowel colic, and possibly had gallstones. He had skin problems that are thought to have been caused by herpes simplex infection, and he also suffered depressive episodes.

Caligula, who followed Tiberius, is remembered today for his excesses. It is thought he had epilepsy when young and may have suffered an infective encephalitic illness that left him with lifelong behavioral manifestations such as anger, violence, insomnia, and restlessness. He may also have had thyrotoxicosis. Tacitus and Seneca both wrote that he had a disturbed mind. His violent assassination occurred via multiple stabbings.

Claudius was fifty when he became emperor. Information about his health can be gleaned from his physician, Scribonius, who is famous for his magnum opus Compositiones Medicamentorum, an important early work on therapeutics. Claudius suffered from a movement disorder with tremors and speech problems, although his intellect was unaffected. He also suffered abdominal pains, possibly from gastritis, gallstones, or pancreatitis. It is thought that he died from poisoning by his wife, Agrippina.

Nero, Agrippina’s son, was the next emperor. It is thought he may have had Cushing’s syndrome. His eyesight was poor, and he had problems with his mental health. Although he had an interest in the arts, he is remembered today for presiding over an era of debauchery and violence. He committed matricide and was affected by the death of his daughter and second wife, finally leading to his death by suicide.

Much of the chapter on Marcus Aurelius is obtained from the writings of Galen, his physician. Galen was attracted to the ideas of the Stoic philosopher Xeno, who believed that humans were characterized by their ability to think rationally, should spurn negative emotions, and ought to try to live a virtuous life. In Meditations, Marcus Aurelius incorporates Stoic philosophy and medical ideas that were likely influenced by Galen. Marcus Aurelius suffered from sinus problems, gastroenteritis, insomnia, and an addiction to theriac, an ancient cure-all containing opium. In the time of Galen, it was thought to be an antidote to poisons, the plague, and a bad diet. Marcus Aurelius died at fifty-eight of exhaustion and weakness, likely a result, in part, of his overuse of theriac and a poor diet.

Nick Summerton has researched this subject in great depth and has made an important, scholarly contribution to the field of ancient history and medicine. The book is well written with an extensive bibliography, and provides insightful and fascinating information on the physical and mental illnesses that afflicted these ancient Roman leaders.

Roman Emperors and Their Illnesses
Nick Summerton
Pen and Sword Books Limited, 2026