Dioscorides_De_Materia_Medica_Byzantium_15th_centuryBYZANTINE MEDICINE – WHERE ARE THE BARBER SURGEONS?

By Paul Kastenellos

We do not have a lot of detail about Byzantine medicine nor is what we read in some Byzantine author necessarily true for the entire 1,100 year life of the empire. But both the Emperors Maurice (582-602) and Leo IV (886-912) wrote on medical subjects during the high points of Byzantine history and Manuel I Comnenus himself ministered to the German king Conrad of Hohenstaufen. Of course, as with the “Renaissance man,” it was pretty common for the educated layman of the ancient, medieval, and Arabic worlds to have a scholarly and often self-schooled interest in many disciplines including astronomy, architecture, mathematics, and medicine. Procopius of Caesaria, while not a doctor, gave a fine description of the Justinian plague which hit the empire in 541 AD. He accurately describes how it arrived first in seaports and was not necessarily spread by contact with the victims. As important, he admits his ignorance rather than giving an otherworldly explanation. There is not a word to indicate the wrath of God or the machinations of the devil. Without a knowledge of germ theory he could not recognize the source of infection now known to have been the bite of rat-born fleas. None the less, he is recognized in medical education for accurate observation without preconceived notions.

https://hefenfelth.wordpress.com/2011/07/31/procopius-account-of-the-plague-in-constantinople-542.

Besides these gentlemen scholars, there were the practitioners trained in the schools of medicine who were disciplined by day-by-day medical practice and the need to perform actual surgery. Modern authors are not always helpful, at times exaggerating Byzantine expertise and specialization. With that reservation it can be admitted that though hampered by the dead hands of Galen and Hippocrates the East Roman doctors were – if not very innovative of theory – at least willing to modify theory with practical experience. They operated successfully on head wounds, haemorrhoids, and hernias, removed tonsils and performed hysterectomies. According to the chronicle of Ioannes Skylitzes surgeons even attempted to separate a dead conjoined twin from his still living brother. (The living twin survived the surgery itself but died only a little later.) The following interesting link gives a thorough description of several methods employed to correct aneurisms:

http://www.sciencedirect.com/science/article/pii/S1078588498801305.

Steven Runciman notes the static nature of Byzantine theory but praises its practicality. Physicians would encourage common sense preventatives while picking and choosing elements from the revered Greek and Roman authors that supported their favored treatments.

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Byzantine history is one of nearly constant warfare so there was considerable expertise in treating wounds. The East Roman Army had a medical corp with medics to follow the soldiers into battle, provide first aid, and carry the wounded to  MASH units behind the lines. For the cavalry there would be a unit of 8 to 18 men assigned to each detachment of 200 to 400 men. They would follow some 200 feet behind the front line troops in order to bring the badly wounded away from danger. To that end, the saddles of their horses had two ladder-stirrups on the left side, and flasks of water to revive the faint. There were VA hospitals. The emperor Justin II (565-578) founded such an institution in Constantinople as did Alexius Comnenus I (1081-1118) – Alexius placing his own daughter Anna in charge.

Throughout the middle ages it was probably better to have a bone set by an experienced craftsman than by a university educated doctor who might consider surgery below his dignity anyway. As always, village “old wives” ministered with success and certainly monasteries cultivated herbs. Herbals were common and were translated into Arabic and then to Latin and eventually passed into western Europe via Spain. But as noted, the teaching of Hippocrates and Galen had a death grip on medicine throughout Europe so there was not much advance in the theory until Harvey discovered the circulation of the blood. The invention of the microscope showed (or confirmed) the existence of microorganisms. Only then did it become worthy to think outside the box. Byzantium was no exception.

Monastic hospitals for the poor were common throughout the empire, established by an emperor, or by aristocrats and civil servants trying to buy their way into heaven at the end of a less than edifying life. It was usual for monasteries to contain hospital wards for the poor. As elsewhere in medieval Europe these mainly served to let peasants die in clean bed linens just as third world hospices minister to those dying from AIDS today. The first Christian hospital considered to have been built to cure disease rather than just ease the pain and depression of impending death was built by St. Basil the Great of Caesaria in the late fourth century This holy bishop has been credited with convincing other Christians that medical care was a gift from God and not a proscribed paganism.

In the 8th and 9th Centuries true hospitals began to appear in provincial towns as well as cities. Towns were required to have sufficient doctors for their populations. Presumably these were trained at Alexandria or the university of Constantinople. Self taught practitioners like Alexander of Thalles – who produced a medical compendium – used their common sense. Another compendium in seven books by the seventh century practicing physician Paul of Aegina remained in use as a standard textbook for the next eight hundred years.

By the twelfth century Constantinople had two well organized hospitals staffed by medical specialists including women doctors. John II Comnenus established a then modern well organized institution which according to Tamara Talbot Rice was staffed by medical specialists. These contained special wards for various types of diseases and employed systematic methods of treatment. There were ten wards of fifty beds each and there was a dedicated hierarchy including the Chief Physician (archiatroi), professional nurses (hypourgoi) and orderlies (hyperetai). Each qualified male doctor had twelve qualified assistants and eight helpers while the lone woman doctor had eight assistants and two helpers. There were also two “pathologists” and a dispensary to tend outpatients. Talbot Rice also notes that outside the capital everyday practice by state supported doctors – begun by Justinian I – had already somewhat modified ancient theory.

Christianity always played a key role in the building and maintaining of hospitals. Many hospitals were built and maintained by bishops in their respective prefectures. These were nearly always built near or around churches and great importance was laid on the idea of healing through salvation. When medicine, bathing pools, clean air, and cleanliness failed, doctors would ask their patients to pray. This usually involved symbols of saints especially Saints Cosmas and Damien who were the patron saints of medicine and doctors. That said, the Byzantines drew a distinction between miraculous cures, in which everyone believed, and magic. Prayer before icons was encouraged for both its spiritual and psychological benefits. But amulets and spells, while common in the empire, were decried by the church and merely tolerated by doctors

Anna Comnena emphasized preventive medicine with life style changes, but Andrew Dalby’s Flavours of Byzantium reports extensively on the Hippocratic concern with balancing hot and cold, dry and moist, and the four humors: blood, phlegm, yellow and black bile. In fact we know more about the East Roman obsession with diet and health than we do their actual recipes. He reports that to the Byzantines wheat is the best of all grains and produces healthy blood; that rice is midway between hot and cold and inhibits movement of the bowels but if boiled with seasoning becomes good for the bowels; that broad beans have a high degree of coldness and cause gas while chickpeas which have a high proportion of heat also cause gas, etc. Milk and hen’s eggs produce good humors. Fibrous parts of animals produce phlegm. The meat of oxen and goats produce black bile.

Besides diet other lifestyle recommendations for each month are quoted by Dalby from a Byzantine calendar. For December, which was thought to govern the salty phlegm, one should avoid cabbage and seris (endive or chicory), and eat no goat, deer, or boar. All other meats should be eaten lean, served hot, boiled, and spiced. In December one should also eat fenugreek soup in moderate amounts as well as young green olives in brine and olives in honey vinegar … He should take eight baths using an ointment containing aloes and myrrh washed off with wine and sodium carbonate. … and make love.

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