—Reviewed by John D. Haley, B.A., M.A., M.A.
 

In ancient Rome, no one was more powerful than the emperor.  It is therefore understandable that historians (both ancient and modern) have often analyzed and explained Roman history in terms of its rulers.  From their intrigues at the palace to the wars they fought on the frontier, every aspect of their lives has been exhaustively researched and debated.  Every aspect, that is, except one—their health.  Michael Grant's book Sick Caesars (New York:  Barnes and Noble, 2000) is therefore a welcome contribution to the body of knowledge.

Admittedly, there are certain limitations to the study of illness and disease in antiquity.  All too often, sources are vague, ambiguous, and/or biased.  It is also a documented fact that the ancients privileged prognosis over diagnosis.  In other words, they were more concerned with the treatment of a disease than with its cause or origin.  Finally, it is highly probable that the symptoms of any disease have changed over time and from place to place.  Malaria, for example, is usually less virulent in a cooler, dry environment than in one with high levels of humidity.  Any attempt to identify a disease in antiquity, then, is at best inconclusive.

Grant also opens his book with two reminders;  First, one must remember that the Caesars were absolute monarchs.  "Whom do you know who would behave really decently in such a situation, if it could ever exist?  Or would you behave decently yourself?  Just think:  if one had all that power, what would one do, or not do (xiii)?"  Under the circumstances, then, some of the Caesars' maladies (e.g., alcoholism, sadism, satyriasis) may be rationalized as the manifestations of unchecked power.  One should also bear in mind that, because of their extraordinary power, the Caesars were extremely liable to conspiracies and assassination attempts.  Even in the best of situations, this susceptibility would cause stress and, possibly, related complications (e.g., headaches, insomnia, ulcers, paranoia, and drug addiction).  At the least, this stress would exacerbate certain pre-existing conditions.

For these reasons, it is difficult to assess the actual impact of an emperor's illness on his reign or on the state of the Empire.  Nevertheless, it is clear that there was an impact.  The earliest example is, of course, Julius Caesar (r. 46-44 B.C.).  The ancient sources all agree that he suffered from some illness comparable to epilepsy (apparently a common affliction in the Julio-Claudian dynasty).  Plutarch records an incident in which Caesar received a visit from an important delegation of senators who were planning to confer a series of honors upon the ruler.  On this occasion, Caesar chose to remain seated—thus insulting the dignitaries in public.  In all likelihood, Caesar had planned his actions to demonstrate his superiority over the Roman senate; but,  when it became evident that this was a public-relations disaster, his apologists tried to excuse his behavior by suggesting that some infirmity prevented him from standing.  Cassius Dio even claims that it was diarrhea.  In any event, this incident surely became an issue which contributed to Caesar's assassination in 44 B.C.  As Grant notes, if Caesar had lived, he might very well have been the one to establish the principate.  Instead, that honor fell to his successor Octavian (Augustus).

When Augustus died in 14 A.D., power passed to his stepson Tiberius (r. 14-37 A.D.).  Most historians agree that he had the potential to be a good emperor; unfortunately, he was a rather bitter and cynical man.  Of course, it is dangerous to interpret the psychological makeup of any historical figure, but it does seem likely that part of Tiberius' bitterness can be attributed to a facial disfigurement.  Suetonius reports that the emperor's countenance was covered with sores and blotches—so many that he had to use plaster.  It is understandable that, over time, he would become extremely sensitive to people's stares and comments.  Indeed, Tacitus says that this was one of the reasons that, in 26 A.D., Tiberius withdrew from Rome to the island of Capri (where he remained until his death in 37 A.D.).  Certainly, his absence from the capital and from the senate did not bode well for the Empire.

There are also instances in which the emperor's health affected the expansion of the Empire.  Ancient sources are not clear on what ailed Marcus Aurelius (r. 161-180 A.D.).  It may have been pulmonary tuberculosis or perhaps a gastric ulcer.  Still, the consensus among historians is that his failing health prevented him from annexing Germany.  Likewise, the emperor Septimius Severus (r. 193-211 A.D.), who seems to have suffered from gout or arthritis, was unable to conquer Scotland.  In each case, the ruler's illness may have had a significant impact upon the longevity of the Empire.

Finally, one of Grant's most compelling examples is Diocletian (r. 284-305 A.D.).  Apparently, he was the first ruler to recognize a fundamental problem with the Empire:  it was simply too large for one man to manage.  By dividing the Empire in half and creating the Tetrarchy, he eliminated this problem and established a system under which the two new empires would have prospered.  Sometime in 304 A.D., however, he suffered a "collapse in health" from which he never fully recovered.  In 305 A.D., he became the first and only Roman emperor to abdicate the throne.  In the turmoil that followed, the Tetrarchy was dissolved, and the monarchical system was restored under Constantine.  Thus, had it not been for his breakdown and subsequent abdication, Diocletian might have ruled long enough to ensure the survival of his system, and this too would have contributed to the stability and continued growth of the Eastern and Western Empires.

For those who may be interested, Mr. Haley also recommends the following works:

Death and Disease in the Ancient City.  Ed.  Valerie M. Hope and Eireann Marshall.  New York:  Routledge Univ. Pr., 2000.

Diseases in Antiquity.  Ed.  Don Brothwell and A. T. Sandison.  Springfield, Ill.:  Charles C. Thomas, 1967.

Green, Vivian H. H.  The Madness of Kings:  Personal Trauma and the Fate of Nations.  Dover, NH:  A. Sutton, 1994.

Jackson, Ralph.  Doctors and Diseases in the Roman Empire.  Norman:  Univ. of Okla. Pr., 1988.

Lissner, Ivar.  The Caesars:  Might and Madness.  New York:  Putnam, 1958.

Porter, Roy.  A Social History of Madness:  The World Through the Eyes of the Insane.  New York:  E. P. Dutton, 1987.