Medical history has been particularly unkind to some historical figures. The, so-called, ‘mad emperors’ Caligula, Tiberius and Nero cannot question their various psychiatric diagnoses or request a second opinion. Neither can Maximinus Thrax, Nero or Caligula demand further testing to refute or confirm the suggestions that they all suffered from a type of hormonal disorder.
By undertaking a detailed evaluation of the ancient sources relating to Augustus, he has been re-characterised as an individual surviving to the age of 75 with a long-term lung condition. Perhaps some of his enigmatic behaviours and actions represented a reaction to developing a chronic disease at a young age?
Claudius suffered from a movement disorder that affected his mobility and speech. Although highly intelligent, the response of the Imperial family to his disability was to keep him in the shadows, out of politics and public affairs. He became of figure of fun, ridiculed within Roman high society and subjected to insults and cruel tricks. The indignities and hardships he experienced in his youth probably had an impact on his character, health and behaviour. Also, it seems much more likely that he died due to a stroke or a heart attack rather than from consuming poisoned mushrooms!
Marcus Aurelius might not have been as physically unwell as has been suggested by both modern and ancient historians. Despite suffering from sinusitis, gastroenteritis plus various aches and pains, there is no evidence that he had any longer-term health problems.
Diagnosing the illnesses of Roman emperors might not be viewed as an appropriate line of enquiry given the enormous gulf that separates ancient and modern medicine. However, although there are certainly some major challenges in using present medical knowledge to identify past diseases, there are potential opportunities too in augmenting – or even correcting – the historical record.
Thanks to Pen & Sword and NetGalley for this review copy!
This book approaches an inherently tempting subject — the illnesses and deaths of Roman emperors — with admirable restraint, rigor, and intellectual honesty. From the outset, Roman Emperors and Their Diseases makes clear that it is not interested in exploiting the past for novelty or easy diagnostic speculation. Instead, it opens with a thoughtful methodological framework that challenges what the author describes as a “presentist” approach to medical history — the assumption that modern medical knowledge can be cleanly mapped backward onto ancient lives.
As the author notes, many modern doctors are keen to exploit the past as a source of amusing anecdotes, yet far less attention is given to understanding ancient medical writing or archaeology as tools that might inform modern healthcare or population wellbeing. This mindset, the book argues, risks portraying ancient medicine as inherently inferior and history as a simple, linear march toward improvement — an assumption that oversimplifies both medicine and the human experience of illness.
Before addressing individual emperors, the book carefully prepares the reader by examining the nature of retrospective diagnosis, the problem of language, the concept of disease, and the limitations of historical sources. The author repeatedly emphasizes that we cannot exhume bodies, conduct examinations, interview family members, or even be certain that recorded symptoms reflect what a patient truly experienced. What survives is filtered through cultural expectations, political motives, and linguistic constraints.
One particularly effective section explores the distinction between illness, disease, and sickness. As the text explains, illness refers to a person’s subjective experience of poor health (including situations where no disease can be identified), while sickness reflects a socially negotiated role. How a condition is labeled — or whether it is acknowledged at all — depends heavily on societal metaphors, stigma, and expectations. These frameworks may even explain the behavior of historical figures, including the feigning of illness or the denial of certain conditions.
This attention to sociocultural framing carries through the book’s discussion of diagnosis itself. Drawing on historians of medicine, the author argues that diseases do not possess a fixed identity across time. Rather, diagnosis emerges from a compound of biological, cultural, and social elements — of which the medical component is sometimes the least important. What constituted “disease” in Roman medicine often diverges sharply from modern classifications; for example, fever was considered a disease in its own right by writers such as Celsus and Galen, rather than a symptom as we understand it today.
When the book turns to the emperors themselves, it does so with admirable caution.
Throughout the text, there is a recurring acknowledgment that many emperors may not have died of natural disease at all. Poisoning — subtle, chronic, or acute — remains a plausible alternative in numerous cases, and the author does not shy away from that reality. Rather than forcing definitive conclusions, the book presents competing possibilities and weighs them thoughtfully against available evidence.
The section on Augustus is notably long and detailed, reflecting both the abundance of surviving material and the complexity of his prolonged decline. In general, the book draws on an impressive range of primary and secondary sources, weaving together historical writings, medical interpretation, and political context. The scholarship feels thorough without being pedantic.
Readers should be aware that the text makes liberal use of Latin (and occasionally Greek), often presenting original phrases alongside English translations. While this will delight readers with a classical background, others may find it slows the pacing at times — though it does reinforce the author’s emphasis on linguistic precision and source fidelity.
Overall, Roman Emperors and Their Diseases succeeds because it resists easy answers. It respects both the limits of modern medicine and the complexities of the ancient world, offering a careful, well-researched exploration rather than speculative certainty. This is a rewarding read for those interested in medical history, Roman history, or the intersection of power, health, and mortality — provided they appreciate nuance over neat conclusions.
Recommended for readers who enjoy:
- The Butchering Art by Lindsey Fitzharris
- The Emperor of All Maladies by Siddhartha Mukherjee
- Pale Rider by Laura Spinney
This is not a book about diagnosing the dead — it is a book about understanding how medicine, society, and power shape what illness means in the first place. Want your own copy? You can pick it up here.




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