The Byzantine physicians on epilepsy.

The aim of this study is to present epilepsy according to the most famous and representative Byzantine physicians throughout the whole period of the Byzantine empire. Mainly Byzantine medical texts were used as sources. The Byzantine physicians considered epilepsy to be a serious medical problem and followed the Hippocratic tradition as far as the etiology of this disease is concerned. Their pathophysiological theories of epilepsy identified the brain as the site of the problem, but, based on the Hippocratic humoral theory, emphasized causes such as an excess of humors or insufficient circulation of phlegm in the brain. It is surprising to note the accuracy of the details they provide regarding the clinical description of the disease, especially the seizures; many of these are still accepted today. It is also surprising that there was a concurrent opinion during all this medieval period that epilepsy was strictly an organic disease of the brain and the demonic origin of it a prejudice of uneducated people.

Nursing homes for the old ('Gerocomeia') in Byzantium (324-1453 AD).

BACKGROUND: Research into the welfare institutions for the elderly, which were established in the Byzantine Empire. OBJECTIVE: The purpose of the study is the research into the texts of the Byzantine chroniclers and the contemporary historical sources so as to determine the social policy of the Byzantine State regarding the homes for the aged. METHODS: The histories and chronicles of the Byzantine writers, written in the original Greek language, were studied and analysed, so as to locate the extracts in the texts concerning the interest shown by the Byzantine State to establish institutions for old and ailing people. RESULTS: The care for the elderly in Byzantium was undertaken in special infirmaries, called 'gerocomeia', which operated all over the empire mostly in or near the monasteries. All these nursing homes were highly esteemed and the governor of the institution seems to have been a person of high importance. The most important nursing home was located in Constantinople and was established by Emperor John II Comnenus in the 12th century in the famous monastery and hospital of the Pantocrator. CONCLUSION: The study and analysis of the historical texts of the Byzantine period (324-1453 AD) prove that human-oriented behaviour, which derived from the intervention of religion, contributed to the foundation of many welfare institutions for the elderly by the Byzantine emperors, the church and some individuals who showed great interest in them.

Alexander the Great's relationship with alcohol.

AIMS: This study sought to clarify if Alexander the Great indulged pathologically in alcohol and whether it contributed to his death. DESIGN: The texts of the historians Diodorus of Sicily, Plutarch, Arrian, Curtius Rufus, Athenaeus, Aelian and Justin were studied, with their information concerning wine consumption by Macedonians, and especially Alexander, and were evaluated. The surviving historical texts, all later than Alexander's epoch, are based on a series of contemporary histories and especially on the 'Royal Journals', an official diary written in the imperial court. FINDINGS AND CONCLUSIONS: Alexander consumed large quantities of undiluted wine periodically, reaching pathological intoxication. However, the existing data do not provide convincing evidence that Alexander the Great manifested abuse of or dependence on alcohol according to DSM-IV or ICD-10 criteria and it seems unlikely that alcohol was involved in his untimely death.

Oribasius (fourth century) and early Byzantine perinatal nutrition.

BACKGROUND: The purpose of the study is the investigation of perinatal nutrition in the early Byzantine period. METHODS: The original Greek language works of the celebrated physician of the fourth century, Oribasius, were studied. RESULTS: The first Byzantine author who studied perinatal nutrition, Oribasius, provided his own concepts about the topic, focusing on the suitable choice of wet nurse and evaluation of the quality of the milk. His research proves that physicians from early Byzantine times were greatly interested in perinatal nutrition. He was aware of the knowledge of eminent ancient Greek and Roman physicians, whose extracts he quoted and opinions he generally followed. CONCLUSIONS: The study concludes that concepts of perinatal nutrition in the early Byzantine period followed those of the Hippocratic, Hellenistic, and Roman periods. The early Byzantine physicians then influenced later Byzantine and Arab physicians, and afterward, their research was introduced to European medicine.

A tragic case of complicated labour in early Byzantium (404 A.D.).

OBJECTIVES: Presentation and comment on the problematic delivery of the Byzantine empress Eudoxia's stillborn child. STUDY DESIGN: The original Greek language Byzantine histories, chronicles and hagiographical sources were investigated. Comparisons were then made of the knowledge of obstetrics among contemporary and ancient physicians. RESULTS: The case of Eudoxia's delivery is described in various literary sources with details regarding the fatal clinical picture of the parturient after the embryo's death. The study of early and contemporary medical texts proves that in similar cases conservative treatment was preferred but embryotomy was followed in the event of failure. CONCLUSIONS: Eudoxia's labour represents a characteristic paradigm of the difficulties involved in the confrontation of complicated deliveries in mediaeval times, often resulting in the death of both the mother and embryo. The treatments follow the ancient Hippocratic, Hellenistic and Roman traditions and influence medieval European medicine, thus constituting significant roots of obstetrics.

Dietetics in ancient Greek philosophy: Plato's concepts of healthy diet.

Plato (5th-4th century BC), one of the most important philosophers of Greek antiquity, left a valuable spiritual heritage, compiled in his famous dialogues. His teachings extend to almost every single field of human knowledge. Among other philosophical concepts, Plato's works are imbued with the fundamental principle of moderation. This spirit is characteristically evident in his references to human diet. According to the philosopher, a moderate and thus a healthy diet, consists of cereals, legumes, fruits, milk, honey and fish. However, meat, confectionery and wine should be consumed only in moderate quantities. Excesses in food lead to ailments and therefore should be avoided. Plato considers physicians responsible for the regulation of human diet, for medicine is a science and not merely an art as in the case of cookery. The dietary pattern presented in Platonic dialogues shares many common components with the highly-reputed Mediterranean diet. As a whole, Plato's writings represent a valuable source for the study of the nutritional customs during the classical period of ancient Greece.

Is consent in medicine a concept only of modern times?

Although the issue of consent in medical practice has grown immensely in recent years, and it is generally believed that historical cases are unknown, our research amongst original ancient Greek and Byzantine historical sources reveals that it is a very old subject which ancient philosophers and physicians have addressed. Plato, in ancient Greece, connected consent with the quality of a free person and even before him, Hippocrates had advocated seeking the patient's cooperation in order to combat the disease. In Alexander the Great's era and later on in Byzantine times, not only was the consent of the patient necessary but physicians were asking for even more safeguards before undertaking a difficult operation. Our study has shown that from ancient times physicians have at least on occasion been driven to seek the consent of their patient either because of respect for the patient's autonomy or from fear of the consequences of their failure.

Surgery on varices in Byzantine times (324-1453 CE).

OBJECTIVES: The purposes of this article are to describe Byzantine varicose vein surgery and to note its influence on the development of these operations after that time. A study and analysis of the original texts of the Byzantine physicians, written in Greek and containing the now mostly lost knowledge of the earlier Hellenistic and Roman periods, was undertaken. RESULTS: The Byzantines paid special attention to varicosis surgery from the early period of the empire. The famous fourth-century (ce) physician Oribasius meticulously described a number of surgical methods of confronting varicosis, some of which were derived from the texts of earlier Greek surgeons, to which he added his own keen observations. Later, eminent Byzantine physicians developed these techniques further and evaluated their usefulness. CONCLUSIONS: The study of Byzantine medical texts proves that several surgical techniques on varicosis were widely practiced in Byzantine times and were derived from the work of ancient Greek and Roman physicians. The techniques described had a great influence on western medieval and later European surgery, thus constituting significant roots of modern angiology.

Sperm disorders according to the Byzantine medical writers (4th - 14th centuries).

Research in the works of the Byzantine medical authors brought to light significant information concerning disorders of the sperm as causes of infertility. The eminent Byzantine physicians give detailed accounts about the anatomy of the genitals, the creation of the sperm and its disorders as regards its quantity, quality, appearance, consistency, colour, ejaculation etc. According to those authors, the disorders of the sperm are due to, dietetic reasons (a list of foods and drugs influencing the production of sperm is referred to by many Byzantine physicians); constitution and age of the patient; obesity; diseases, such as "gonorrhea" (involuntary loss of sperm), oneirogmus, stenosis of the spermiducts, hypospadias and atrophy of the genitals; iatrogenic reasons (traumatic cutting off of the spermiducts during a lithotomy); castration. These concepts were based on the works of the ancient Greek physicians of the Hippocratic, Hellenistic and Roman eras. However, such ideas, enriched by the personal experience of the Byzantine doctors, were transmitted to and influenced Islamic and European medicine and thus the rest of the world.

The roots of geriatric medicine: care of the aged in Byzantine times (324-1453 AD).

BACKGROUND: The search for the roots of geriatric medicine, which has been considered a relatively new branch. OBJECTIVE: The purpose of the study is the research of the original Byzantine medical texts and the contemporary historical sources so as to bring to light knowledge about ancient medical care. METHODS: The medical texts of Byzantine physicians were studied and analysed, as well as the Histories and Chronicles of their contemporary writers, so as to locate the extracts in the texts concerning geriatric care from the scientific point of view and that of the 'vox populi' which the historians and chroniclers express. RESULTS: The problems of old age occupied physicians from earliest Byzantine times. They had dealt with the characteristics, symptoms and accompanying diseases of the aged and endeavoured to confront all the medical problems faced by the elderly, providing a special healthy regimen for the third age and taking steps for the prevention of diseases of this age group and their treatment. Parallel to this, the research of contemporary historical texts proves the concern of all society for the special problems of the aged and the significant impact of scientific geriatric medicine on the population. CONCLUSION: The study and analysis of the original medical and historical texts of the Byzantine period (324-1453 AD), written in Greek language, prove that the roots of medical care of old age could be traced from ancient Greek and Byzantine medicine.

Treatment of nasal polyposis in Byzantine times.

The goal of this study was to describe the therapeutic methods and surgical techniques used during Byzantine times (AD 324-1453) for a disease that has occupied physicians since antiquity: nasal polyps. The original Greek-language texts of the Byzantine medical writers, most of which were published after the 17th century, were studied in order to identify the early knowledge of the definition, symptoms, conservative treatments, and surgical intervention in cases of this disease. A considerable number of conservative treatments, etiologic and local (with inunctions or blowing of caustic substances), with evident influence from Roman medicine, were identified even in the early Byzantine medical texts (4th century). Further, some surgical techniques were described that seem to constitute evolution of the Hippocratic tradition. From the study of the original texts of Byzantine medical writers, their interest in the rhinological diseases is evident; in the case of nasal polyps, new techniques were mentioned. The first meticulous intranasal surgical removal of polyps was described. These techniques, obviously developed during the Hellenistic period, initially influenced European medicine and later the rest of the world.

Child sexual abuse: historical cases in the Byzantine empire (324-1453 A.D.).

OBJECTIVE: The aim of this article is the presentation and brief analysis of some historical cases, unknown in the broader medical bibliography, of child sexual abuse in Byzantine Society (324-1453 A.D.). METHOD: The original texts of the Byzantine historians, chroniclers and ecclesiastical authors, written in the Greek language, were studied in order to locate instances of child sexual abuse. RESULTS: Although the punishment provided by the laws and the church for cases of child sexual abuse were very strict, a number of instances of rapes under cover of premature marriages, even in the imperial families, are revealed in these texts. Furthermore, cases of child prostitution, pederasty, and incest are included in the historical texts and some contemporary authors confirmed the presence of many such cases in all classes of Byzantine society. CONCLUSION: The research of original Byzantine literature disclosed many instances of child sexual abuse in all social classes even in the mediaeval Byzantine society which was characterized by strict legal and religious prohibitions.

The epilepsy of Emperor Michael IV, Paphlagon (1034-1041 A.D.): accounts of Byzantine historians and physicians.

PURPOSE: Presentation of epilepsy suffered by Byzantine Emperor Michael IV, Paphlagon (who reigned from 1034 to 1041 A.D.) and the attitude of his contemporary society to his disorder. METHODS: Research into the accounts of Byzantine historians and chroniclers referring to the case of the emperor and Byzantine medical texts revealing the opinion of official medicine about the disorder. RESULTS: Byzantine historians and chroniclers provide detailed clinical descriptions of the seizures of Emperor Michael IV. Nearly all, expressing popular opinion, considered his disease to be demonic possession that constituted a form of divine punishment for the emperor's adultery and act of murder; his royal entourage continually attempted euphemistically to present this condition as a psychic disease. On the contrary, research into Byzantine medical texts reveals that the physicians, already from the 4th century, following Hippocratic tradition, believed that epilepsy was primarily a brain-related disorder and based their treatment on this etiological principle. CONCLUSIONS: From the study of the Byzantine histories and chronicles, it can be deduced that Emperor Michael IV, Paphlagon, suffered from generalized tonic-clonic epileptic seizures. Despite the concept then held by well-educated Byzantine doctors, who considered epilepsy a brain disorder, information indicates the deep prejudices of his social environment.

Fatal wounding of the Byzantine Emperor Julian the Apostate (361-363 A.D.): approach to the contribution of ancient surgery.

Byzantine surgery flourished from the early stages of the Byzantine empire (324-1453 A.D.). The first great Byzantine physicians, among the most eminent being Oribasius from Pergamun (fourth century), not only compiled anthologies of the works of ancient Greek, Alexandrian, and Roman physicians but added their own personal practical experience and observations. The circumstances surrounding, and the treatment of, the fatal abdominal wounding of one of the most renowned emperors of Byzantium, Julian the Apostate (361-363 A.D.), is examined based on historical accounts unknown in the broader medical bibliography, namely, the histories and chronicles of Byzantine writers. From this analysis it can be concluded that the emperor's physician, Oribasius, in all probability, applied knowledge of ancient Greek and Roman surgery to save his famous patient. The techniques of "gastrorrhaphy" and pharmaceutical confrontation of the wound in that era, adopted later by the surgeons of the Medieval West, seem to constitute noteworthy roots of modern surgery.

Surgery on the larynx and pharynx in Byzantium (AD 324-1453): early scientific descriptions of these operations.

We present the techniques of various operations on the larynx and pharynx (incision of abscesses of the tonsils, tonsillectomy, tracheotomy, uvulectomy, and removal of foreign bodies) found in the Greek texts of Byzantine physicians. The techniques of these operations were the first to be so meticulously described and were compiled from the texts, now lost, of the ancient Greek physicians. These medical texts, which followed and enriched the Hippocratic, Hellenistic, Roman, and Galenic medical traditions, later influenced medieval European surgery, either directly through Latin translations or indirectly through works of Arab physicians.