What disease did Augustus recover from in 23 BC?

Question

I am currently reading John Williams' "Augustus", or, to be precise, the German translation. I know the book is mostly fiction but there is one thing I'd like to know. The book dwells on Augustus' disease in 23BC, which was so serious that everyone believed he would die (see Wikipedia). Then, the book says that his nephew Marcus Claudius Marcellus died soon after Augustus' unexpected recovery "of the same fever".

I know from the above article on Wikipedia that the cause of Marcellus' sudden death at the age of 19 is unknown. But is Augustus' disease known? What did he suffer from?

Answer 1

From A Dictionary of the Roman Empire by Matthew Bunson, in the section on Augustus, we learn that he suffered from health problems his whole life. While it does not mention specifically what he suffered from in 23 B.C., it is possible that it was a strain of influenza, which he might have been more susceptible too, being so sickly. He had previously suffered from influenza before.

His teeth were decayed, and his messily tended hair was yellow. Although he was only five feet, seven inches tall (perhaps less), he was elegantly proportioned. His health was always a concern. There was a weakness in his left hip and right forefinger, and ringworm was probably present. More importantly, Augustus fought terrible bouts of illness: abscessed liver, influenza and seasonal complaints. The worst came in 23 B.C., when it was generally believed that he would die. His private physician, Antonius Musa, managed to heal him.

Answer 2

SHORT ANSWER

There are conflicting views as to what almost led to the death of Augustus in early 23 BC. It is unlikely that we will ever know for sure, but the main suspects are liver problems, a fever or plague afflicting Rome at the time or a combination of life-long health problems and stress.

FULL ANSWER

1. Liver problems. Suetonius connects Augustus’ illness to his liver:

All his life he experienced at certain times dangerous fits of sickness, especially after the conquest of Cantabria; when, his liver being injured by a defluxion upon it, he was thrown into such great discomfort that he was obliged to undergo a desperate and doubtful methos of cure: for warm applications having no effect, his physician Antonius Musa, recommended the use of cold.

Source: Suetonius' Lives of the Twelve Caesars' (trans: H. M. Bird)

2. A fever or disease, possibly the same as the one afflicting Rome at the time. Anthony Everitt, in Augustus: The Life of Rome’s First Emperor notes that

It has been suggested that Augustus was, in fact, suffering from typhoid fever, which could well have been the cause of the epidemic devastating Rome at the time; cold packs were a well-known treatment for the disease in the nineteenth and early twentieth centuries.

Later the same year, Augustus’ nephew Marcellus fell ill. He was given the same treatment by the same doctor (Musa) as his uncle but did not survive. Musa must have seen similar symptoms and Rome was in the grip of an epidemic so it wouldn’t be a surprise if uncle and nephew got it too (whatever it was). On the other hand, if uncle and nephew suffered from the same illness, it seems strange that the younger, healthier man should die – but then Augustus lived to the then ripe old age of 75 so he must have been pretty tough despite all his afflictions.

3. A combination of work stress and a lifetime of poor health. Werner Eck, in The Age of Augustus suggests that Augustus’ illness may have been work-related.

It was a time of extreme stress for Augustus. Finding the right path in the elaborate and complex new system was not easy, and he was learning along with the others. It would not be surprising if the demands on him were the cause of the serious illness he developed in the late spring of 23 BC.

Although Eck cites no evidence, the stress of running an empire is a possible contributory factor if we consider that Augustus had a life-time of health problems.

His health was poor; he suffered from nervous indisposition and chills and could abide neither heat nor cold. He wore four tunics and a thick toga and never went without a hat.

Source: T. Mommsen et al, ‘A History of Rome under the Emperors’

Postscript

Whatever it was that afflicted the emperor, Augustus recovered against all expectations. According to Everitt, he had not expected to live so

He gathered around his bedside the officers of state and leading senators and equites. He spoke to them on matters of public policy and handed his fellow consul, Gnaeus Calpurnius Piso, the breviarium imperii, a book that recorded the empire’s financial and military resources.... the dying man handed Agrippa the symbol of his authority: his signet ring bearing the head of Alexander the Great.

Other sources

The Cambridge History of Greek and Roman Warfare

Anthony A. Barrett, 'Agrippina'

The Cambridge Ancient History, vol. X