Neurosciences in the Christian Roman Empire

Here we present selected parts of the very interesting paper titled “Neurosciences in byzantine era” (Journal of Neurology & Stroke, Volume 8 Issue 4 – 2018),  by Stavros J. Baloyannis.

“(…) Medicine in Byzantium was connected tightly with Greek and Hellenistic philosophy and Christian spirituality offering precious scientific and humanitarian accomplishments.

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Neurosciences and neurophilosophy in Byzantium were mostly based on Aristotelian, Neoplatonic and skeptical philosophical backgrounds, following also the long tradition of the ancient Greek and Hellenistic authorities in Neurology, Neuroanatomy, Neurophysiology and experimental Neurology. The relationship between soul and body was a crucial issue in Byzantine neurosciences, which considered, according to Aristotelian doctrines, that all the activities of the body were motivated by the soul. Aristotle considered that the wisdom would be the achievement of the harmonious homeostatic equilibrium between body and soul, resulting in interior peace and optima mental actualization.

The Hippocratic manuscripts, which composed the extensive canon, in association with the detailed multi-dimensional Galen’s dissertations have been accepted as the principal Handbooks in Medical Schools in Constantinople and the main “vade mecum” in practicing medicine for the physicians of the metropolitan Hospitals. The theories of Herophilus on the blood supply of the brain, the description of the stroke due to cardiac arrhythmias and the association of the high blood pressure with brain hemorrhages were highly respected by byzantine neurologists, who focus their diagnostic capacity on the meticulous physical examination of the patients. The knowledge of the Neuroanatomy and Neuropathology was based on the extensive research on that field by Erasistratus and Galen, who described the anatomy of the brain cortex, the cerebellum, the spinal cord as well as the interior structure of the brain, such as the hippocampus, the thalamus and the basal ganglia. The contributions of Soranus, who described paraplegia, vertigo and tetanus, and Areteus, who described the decussation of the corticospinal and spinothalamic tracts, in parallel way with the theories of Erasistratus on psychosomatic medicine and emotional disorders, helped in designing the scientific profile of the Neurosciences in Constantinople.

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The list of famous doctors, whose contribution in the field of neurosciences is much recognized, includes the following distinguished physicians and academic teachers:

i. Oribasius of Pergamos (325-403A.D) (…) During his long scientific carrier he published an encyclopedia of Medicine in seventy volumes, incorporating the corpus Hippocraticum, the works of Galen and many manuscripts of authors, who practiced Medicine in the Hellenistic period. He described many neurological issues, such as the function of memory, the dementia, the insomnia, the cephalalgia, the meningo-encephalitis and the traumatic lesions of the spinal cord.

ii. Aetius of Amida (sixth century A.C.) was the first doctor who described the neurological complications of diphtheria. He also published a Hand Book of Medicine composed of sixteen volumes, including therapeutics of mental disorders (…)

iii. Alexander of Tralles (525-605) described the various forms of cephalalgia, many epileptic phenomena and several mental dysfunctions (…) He described mainly mental disorders, caused by starvation and neurotoxicity. He wrote many dissertations, expressing his personal view on the etiopathology of the diseases of the brain and spinal cord, arguing also some Galen’s views and unproved speculations. His main offer as writer was a therapeutic syllabus, which described the current pharmaceutical and physical therapies of many serious diseases of internal medicine and neurology. His special interest for the disease of the eyes and the disorders of the vision resulted in writing a dissertation on the etiology and treatment of the ocular diseases, which may be assessed as the initial scientific approach to the field of Ophthalmology.

iv. Paulus of Aegina (625-690), was one of the most distinguished and highly esteemed physicians of Alexandria. He was in charge, as chief neurologist, of the seven hospitals of the city, which were founded by the saint Patriarch John the Merciful, the man of the real Christian love. Paulus must be considered as the first Child Neurologist, given that he accumulated substantial knowledge and important experience on new born and infant neurology, serving as chief neurologist in the maternity hospitals of Alexandria. He was one of the first authors who described the most frequent congenital malformations of the brain and the spinal cord. He described also thoroughly the meningitis and the encephalitis, underlining their fatal prognosis or their serious consequences on the mental development of the child. It is worth to mention, that Paulus of Aegina, was the first who described dementia due to depression (Pseudoanoia), which might be reversed by treating depression primarily. His main contribution in medical bibliography was the publication of the Epitome (Επιτομή). Epitome is an extensive work, a real medical encyclopedia, including in the sixth chapter a substantial number of brain disorders, lesions of the peripheral nerves and some useful neurosurgical techniques.

v. Theophilos Prorospatharios (9th century) (…) Theophilos was a very skilled neuro-anatomist, who published an excellent thesis entitled “On the structure of the Human body”. He was also the author of some short treatises “on pulses’, “on urine”, “on secretions”, “on the Hippocratic Aphorisms,” which contributed greatly in the perfection of medical education and practice. He believed deeply in the sacral character of the human life and the validity of the harmonious psychosomatic interactions.

vi. Theophanes “Nonnos” (10th century) (…) He became famous by his voluminous Handbook of Medicine, entitled Synopsis (Σύνοψις), which included three hundred chapters on internal medicine and neurology, one chapter on obstetrics and one on Pharmacology.

vii. Ioannis Zachariou, Actuarius, was one of the most eminent neurologists and psychiatrists in Constantinople (…) In his book entitled “On the function and the passions of the soul” he described the various properties and activities of the soul as well as the passions, which disturb the serenity of the mind.

viii. Nickolaos Myrepsos, Actuarius was one of the most distinguished doctors in Constantinople (…) His Textbook entitled Dynameron or Materia Medica was an extensive pharmacology, which included 2600 drugs and therapeutic substances. His contribution in the treatment of the neurological and mental diseases, exercised an enormous influence on the Arabic Medicine and Pharmacology.

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The most advanced expression of medical care, associated with philanthropy and social welfare was the foundation of many hospitals in Constantinople and in other major cities of Byzantine Empire, which were well organized, including among the others, units of Neurology and Psychiatry, intensive care units, outpatient clinics, Pharmacy, Library and Chapels. Among the therapeutic methods for the treatment of mental disease, the music therapy, the physical therapy and spiritual support were included and practiced daily. Some of the Hospitals were Teaching Hospitals, affiliated with the School of Medicine of the University of Constantinople, the famous Magnaura.

The greatest and highly respected Hospital in Constantinople was the Hospital of Pantocrator (Ξενών Παντοκράτορος, The Ruler of All), founded by the Emperor John B΄ Cοmnenos and his wife Theodora in 1136.

(…) Even from the initial period of its function, the hospital of Pantocrator included departments of Neurology and Psychiatry, equipped with laboratories of Neuroanatomy and Neurophysiology, and units of mental improvement and speech therapy.

(…) Among the five wards of the Hospital of Pantocrator the fourth and the fifth provided service to neurological and psychiatric patients, having in charge two doctors called protominite (πρωτομηνίται), who were well trained in Neurology and Psychiatry according to foundation charter (typicon) of the Hospital.

In the therapeutic protocols, which were addressed to those patients, who suffered from brain and mental disorders, the utilization of frequent baths and the administration of vegetarian diet played an important beneficial role, in association with the psychotherapy and the music therapy.

The training in Neurology in the Hospital of Pantocrator was primarily based on the detailed physical examination of the patients, the evaluation of the symptoms, the mental condition, the behavior, the speech capacity of the patients, and the correlation of each case with relevant ones, which were previously described in medical textbooks by eminent authors.”

Research-Selection: Anastasius Philoponus

 

 

 

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