Remedies of animal origin and their indications in Nikolaos Myrepsos׳ Dynameron.

ETHNOPHARMACOLOGICAL RELEVANCE: Dynameron is a Byzantine medical compendium, divided into 24 sections, in accordance with the letters of the Greek alphabet. Being the largest medical and pharmaceutical book ever written in Byzantium, Dynameron contains 2667 recipes intended to treat many pathological conditions. A lot of information convey to us through prescriptions. In addition to plants, Nikolaos Myrepsos proposes the use of many animals, animal parts and animal by-products, for the treatment of various diseases. This article presents for the first time a full account of the animal products included in Dynameron. AIM OF THE STUDY: In continuation to our previous studies, this paper focuses on the use of animal products in composite medicines described in Dynameron. An effort was made to trace down the use of similar or identical animal products in texts of earlier medical writers. Recording recipes with animals or animal products intended for use in everyday medical practice highlights the timeless belief in their healing properties. MATERIALS AND METHODS: Our main source of material is the recent digital edition of Nikolaos Myrepsos' Dynameron. This huge treatise was written in the 13th century and reflects in many ways the long medical tradition of the Greek, the Hellenistic and the Roman eras, having also received influences from the materia medica of Arabic medicine. In addition, information from dictionaries and databases were cross-checked to confirm and classify the animals and their products and to identify them. For the various pathological conditions these products are meant for, we have used the current medical terminology. RESULTS: In the present study, we could identify the therapeutic use of 93 animals. In several instances, Myrepsos suggests the use of specific organs of an animal, and for that reason he includes in his treatise 16 anatomical parts of different animals. Moreover, Dynameron comprises also 34 animal by-products, such as milk and honey. Medicines of animal origin are used in recipes concerning diseases of the respiratory, the digestive, the cardiovascular and the urinary system, as well as gynecological diseases, and ailments of the eyes, the ears and the skin. CONCLUSIONS: Of the 2667 recipes of Dynameron, 344 recipes contain medicines of animal origin, which can be detected in totally 769 citations. In addition, 626 citations for animal by-products are found in 268 recipes. Honey and milk are quoted in 2136 recipes, mostly as excipients. Dietary instructions are present on many occasions, reflecting the attitude for a healthy everyday life, similar to the modern beliefs pertaining to food as an essential factor for a good health.

From poison to drug: new recipes discovered containing colchicine as a remedy for Podagra in Rome and Byzantium.

OBJECTIVES: In Antiquity, colchicine was used as a poison and as a remedy for Podagra. Research so far has revealed that the physician Alexander of Tralles was the first who used it in the 6th century AD. Alexander recommended a plant he called "Hermodaktylon", which takes off the pain in the feet immediately. "Hermodaktylon" is identified with Colchicum autumnale L., which contains colchicine in his bulbs and seeds. We will present new data that varieties of Colchicum were used for medical treatment of Podagra far earlier than hitherto known by research. METHODS: We performed a systematic full text search in Greek and Latin original sources of Antiquity for "Hermodaktylon"/"Hermodactylus" and for the synonyms "Ephemeron"/"Ephemerum", "Kolchikon"/"Colchicum", and "Bolbos (agrios)"/"bulbus (agrestis)". We analysed our findings with philological and historico-critical methods. RESULTS: There are 48 text passages in original sources. Lucian of Samosata (2nd century AD) was the first who mentioned a plant he called "bolbos" as a remedy for Podagra. The Byzantine physician Jacobus Psychrestes (5th century AD) developed two recipes. Aëtius of Amida (6th century AD) transmitted two recipes. One case with an overdose of colchicine was discovered which resulted in the death of a patient in Byzantine times. CONCLUSIONS: New specific recipes containing Colchicum were discovered. Jacobus Psychrestes and Aëtius used Colchicum systematically for the therapy of Podagra earlier than the 6th century AD. However, the therapeutic use of Colchicum was already known in the 2nd century AD.

Pearls of Neonatal Intertrigo in Ancient Greek and Byzantine Medicine.

OBJECTIVE: Confirmation of knowledge of neonatal intertrigo in ancient Greek and Byzantine medicine. METHOD: A search of Thesaurus Linguae Graecae was conducted with the following terms as key words, "syggama", "xyggauma", "paratrimma" and "ektrimma". RESULTS: Ancient Greek medico-philosophers introduced therapeutic measures based upon herbs and minerals, while a similar therapeutic approach was also used by the Byzantines. Hippocrates of Kos (460-377) was among the first to introduce written instructions, also proposing preventive treatment with palliative and aromatic herbs. Cataplasms, thalassotherapy, and fumigation were used, combined with hygienic measures in the affected area. Chalk powder was also prescribed to absorb moisture. CONCLUSION: The main principles in the treatment of intertrigo remain the same, celebrating the ancient Greeks' methodology and rationalism.

Colchicum Genus in the Writings of Ancient Greek and Byzantine Physicians.

The plants of the Colchicum family were known during the archaic period in Greece for their deleterious properties. Later on, they were used for the treatment of podagra. The treatment was introduced by the ancient Greek physicians and passed on to the Byzantine and Arabian physicians to endure until nowadays. The first plant was most probably named "Medea" from the notorious Colchican witch. As the most common member of the family blossoms in autumn, the plant was named Colchicum autumnale. Various nominations were also used, such as Ephemeron, Hermodactyl, Anima articulorum and Surugen. Our article discusses them, while at the same time presents the most notable authorities who have used Colchicum plants in herbal medicine and toxicology.

Women Physicians in Byzantium.

Women were allowed to practice the medical profession during the Byzantine Empire. The presence of female physicians was not an innovation of the Byzantine era but actually originated from ancient Greece and Rome. The studies and the training of women doctors were apparently equivalent to those of their male colleagues. The principal medical specialties of the female doctors were gynecology and midwifery. Byzantine legislation treated relatively equally both female and male doctors. For this reason, it can be assumed that the presence of female doctors was correlated with the position of women in Byzantine society. However, there is not sufficient information in the literature to clarify whether female and male doctors used to earn equal payment for the same service.

Doctors and baldness: a five thousand year old challenge.

The history of trichology follows a thread that continually intersects with that of the history of medicine in general. Even Hippocrates believed that the approach to baldness should be of a medical nature. This confrontation between doctors and hair loss, which has lasted for five thousand years, begins with the invocations of the head physicians in the Egyptian era and ends with the recent institution of postgraduate Master's degrees at Faculties of Medicine and Surgery. The biggest names in medicine concerned themselves with trichology beginning with Hippocrates, who dealt with the topic in his most famous work: the Aphorisms. Even the most celebrated doctors of the Roman era, such as Galen and Pliny the Elder, did not disdain considering hair loss, leaving important scientific contributions before passing on the baton to their distinguished colleagues of the Byzantine Empire. The narrative then flows through the most prestigious institutions of the Middle Ages, such as the Salerno School of Medicine and the Siena Accademia del Fisiocritici where, at the end of the 1600s, the distinguished anatomical describer Marcello Malpighi also taught trichology, and left his contribution to "Hair Science" with a fine description of the hair follicle in the pages of his Opera Posthuma. At the turn of the late Middle Ages and the early modern era, barbers formed the primordial nucleus of surgery and at the same time became the ones to concern themselves with hair loss. In the 1800s, several doctors published the first texts dealing with the anatomy and physiology of the hair and taking into account the principal forms of alopecia, but at the therapeutic level did not yet propose anything scientifically valid. Until a few decades ago trichology still lent itself to various commercial speculations. It was not until the twentieth century that the pathogenetic mechanisms of baldness were clarified in a scientific manner. With this knowledge, the pharmaceutical industry has been able, then, to develop the necessary drugs, and doctors have become willing and able to reappropriate treatments to counteract conditions that lead to hair loss.

History of colorectal surgery: A comprehensive historical review from the ancient Egyptians to the surgical robot.

BACKGROUND: Colorectal surgery has its roots in the early civilisations and its development followed a complex pathway never disjoined from the social and cultural environment where it took place. METHOD: The most relevant historical sources have been evaluated. RESULTS: A comprehensive review of the history of colorectal surgery is presented, from the ancient Egyptian culture to the modern achievements. The development of surgery of colon, rectum and anus is reported with particular reference to the social environment and history; as the development of colorectal surgery parallels the occurrence of human historical events, the study of the former cannot be disjoined from the latter. CONCLUSION: Study and knowledge of the history of medicine--and, in particular, of colorectal surgery for those interested in this particular subject--is a privileged way to understand who we are nowadays and where we come from.

Uterine cancer in the writings of Byzantine physicians.

Byzantine physicians recognized uterine cancer as a distinct disease and tried to suggest a therapeutic approach. The work of Oribasius, Aetius of Amida, Paul of Aegina, Cleopatra Metrodora and Theophanes Nonnus reflects the Hippocratic-Galenic scientific ideas as well as their own concept on this malignancy. According to their writings uterine cancer was considered an incurable disease and its treatment was based mainly on palliative herbal drugs.

Holy fools: a religious phenomenon of extreme behaviour.

Monks in Byzantine times (330-1453 AD) often expressed their faith with extreme manifestations of behaviour, such as living on a high column (stylites), on a tree (dendrites) or in crowded urban centres of the empire pretending to be fools for Christ's sake. These Holy Fools exposed themselves to the ridicule and the mistreatment of the citizens, being protected, however, by their state of insanity to mock and violate moral codes and social conventions. The official Church barely tolerated these religious attitudes as promoting deviations from standard orthodoxy, and the Quinisext Ecumenical Council (592 AD) judged them as dangerous and formally denounced the phenomenon. The two most famous of them in Byzantium were Symeon of Emesa and Andrew of Constantinople, whose lives constitute unique testimonies to insanity and the simulation thereof. The survival and transplantation of the Holy Fools in Russia, called "yurodivye", where they met widespread acceptance, confirm their appeal in specific geographic areas and their endurance over time. We attempt to approach the symbolism of holy lunacy and to analyse the personality trends of these "eccentric" saints.

Neurosurgery in the Byzantine Empire: the contributions of Paul of Aegina (625-690 AD).

Paul of Aegina (625-690 AD) was born on the island of Aegina and was one of the most prominent physician-writers of the Byzantine Empire. His work Epitome of Medicine, comprised of 7 books, was a comprehensive compendium of the medical and surgical knowledge of his time and was subsequently translated into multiple languages. Paul of Aegina made valuable contributions to neurosurgical subjects and described procedures for the treatment of nerve injuries, hydrocephalus, and fractures of the skull and spine. His work combined the ancient knowledge of Hippocrates and Galen with contemporary medical observations and served as a bridge between Byzantine and Arabic medicine. He is considered to be one of the great ancient Greek medical writers and his work has influenced the subsequent evolution of Western European and Arab medicine. This paper provides an account of his contribution to the management of neurosurgical pathologies during the Byzantine era, as described in his medical compendium, Epitome of Medicine.

[The Justinian plague (part one)]. / La peste di Giustiniano (prima parte).

In their medical-historical review, the authors assess the evolution of bubonic plague epidemics: after breaking out in the Egyptian port of Pelusium in October 541 AD, the epidemics hit several regions in the Mediterranean basin in a succession of waves. The so-called Justinian plague took its name from the Byzantine emperor of the period, and seriously conditioned the expansionary aims of the Eastern Roman empire towards Italy (which was occupied by Goths), and Northern Africa (where the Vandals had settled), during the first decades of its spread. In the Eastern Empire the plague played a considerable role in reducing the tensions between Persians and Byzantines, especially on the Syrian and Anatolian fronts. It had a major demographic impact, reducing the possibility of recruitment to the Roman legions and leading to a significant drop in tax revenues, which were essential to sustain the state and its military machine. Finally, the plague also took its toll on economic resources (especially agriculture), indirectly leading to a vicious inflationary circle. In the space of over two centuries, plague epidemics paralyzed most trade and commercial exchanges. Furthermore, the Justinian plague, halting the consolidation of the influence of the Eastern Roman empire over some Western regions (including Italy and Northern Africa, which were ruled by Barbarians), supported the development and rise of a number of Roman-Barbarian kingdoms. It may therefore be suggested that the Justinian plague occurred at a very critical historical moment, which represents the real watershed between the Ancient World and the upcoming Middle Ages.

[Medicine after Galen]. / La medicina postgalenica.

The article briefly traces the history of medicine in late antiquity, from Galen's death to the end of VIth century until the early VII century AD; it examines the medical literature, medical writers, anonymous literary production - synthesis of previous literature - recipe books and collections of simple drugs, comments, specialist books and literature in translation, the main characteristics of medical practice and training, and finally the influence of Christianity on the formation of scientific thought and on the new vocabulary of medical language.

Byzantine doctrines on uroscopy in the Liber Orinalibus of Hermogenes (codex 69 Montecassino).

The Liber medicine orinalibus (codex 69 Montecassino) of Hermogenes is the first known manuscript to have a Latin translation from the original Greek work of Magnus of Emesa (or Nisibis). The particular text here translated, from the so-called Commentatio, mentions direct transliteration of Greek concepts such as chyma and hypostasis, suggesting that the Latin text derived directly from the Greek original, without the intermediation of Arabic translations. The implementation of our text is considered to have been undertaken in the city of Ravenna, which housed a medical school during the sixth century ad, or in southern Italy, with its scriptoria. Evidence of the presence of Latin translations of Greek medical texts in Calabria during the Gothic age is provided by Cassiodorus (Inst. 1, 31, 2). The Greek to Latin workshops testify to an uninterrupted activity of copying from Greek medical texts, with particular attention to the Iatrosophists of the Alexandrian school, of which Magnus was a representative.

Late Byzantine mineral soda high alumina glasses from Asia Minor: a new primary glass production group.

The chemical characterisation of archaeological glass allows the discrimination between different glass groups and the identification of raw materials and technological traditions of their production. Several lines of evidence point towards the large-scale production of first millennium CE glass in a limited number of glass making factories from a mixture of Egyptian mineral soda and a locally available silica source. Fundamental changes in the manufacturing processes occurred from the eight/ninth century CE onwards, when Egyptian mineral soda was gradually replaced by soda-rich plant ash in Egypt as well as the Islamic Middle East. In order to elucidate the supply and consumption of glass during this transitional period, 31 glass samples from the assemblage found at Pergamon (Turkey) that date to the fourth to fourteenth centuries CE were analysed by electron microprobe analysis (EPMA) and by laser ablation-inductively coupled plasma-mass spectrometry (LA-ICP-MS). The statistical evaluation of the data revealed that the Byzantine glasses from Pergamon represent at least three different glass production technologies, one of which had not previously been recognised in the glass making traditions of the Mediterranean. While the chemical characteristics of the late antique and early medieval fragments confirm the current model of glass production and distribution at the time, the elemental make-up of the majority of the eighth- to fourteenth-century glasses from Pergamon indicate the existence of a late Byzantine glass type that is characterised by high alumina levels. Judging from the trace element patterns and elevated boron and lithium concentrations, these glasses were produced with a mineral soda different to the Egyptian natron from the Wadi Natrun, suggesting a possible regional Byzantine primary glass production in Asia Minor.

[The establishment of the hospital-system in the Byzantine Empire]. / A kórházi rendszer kialakulása a Bizánci Birodalomban.

Byzantine hospitals developed out of Christian institutions for the poor and homeless. Philanthropy provided the initial impulse to create hospices (xenons) and to expand these institutions into specialized medical centers (iatreons or nosokomeions). However the Byzantine nosocomeions resemble more closely modern hospitals than they do any of the institutions of Greek-Roman antiquity or any of the houses of charity in the Latin West during the Middle Ages. Since the 4th century the Byzantine hospitals have stressed the central position of the nosocomeion in Byzantine society at the intersection of state, ecclesiastical and professional interest. In the great cities and in the capital, more than hundred hospitals worked in the East-Roman Empire. The Byzantine hospital rules guaranted patients private beds, required physicians to wash their hands after each examination and arranged the physical plant to keep all the sick warm. The Byzantine hospitals had separate sections (in modern terms: surgery-trauma surgery, internal medicine, ophthalmology, etc.) and at the beginning of the sixth century a separate institution for women. From the sixth century at least, bathing facilities normally adjoined Byzantine nosocomeia. By the twelfth century Byzantine hospitals also set aside a room or perhaps a separate building to treat outpatients. In addition to the main dormitories the surgery, baths and outpatient clinic, the large parts of hospitals also had separate rooms (or adjoining buildings) for library, for lecture hall, for administrative functions and record keeping for storage and for other services.