Byzantine Medicine and Healthcare: Knowledge, Practitioners, and Hospitals

Byzantine physicians worked from Greek medical writings, particularly those of Hippocrates and Galen. Compilers assembled handbooks for diagnosis and treatment, while practitioners prepared drugs and performed operations. Christian foundations provided institutional care, and the Pantokrator charter of 1136 specified fifty ordinary beds with medical staff and an outpatient service.

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Medical knowledge between inheritance and experience

Compilers selected, arranged and abbreviated earlier medical works for use by practitioners. They also added observations and rejected particular claims. This supplied manageable handbooks for physicians unable to consult the full bodies of Hippocratic and Galenic writing.

Oribasius, a physician associated with the court of Julian, produced extensive compilations based on Galen and other medical authorities. In the sixth century, Aëtius of Amida assembled a collection of sixteen books covering subjects such as disease, drugs, and medical procedures. Alexander of Tralles wrote from the perspective of an experienced practitioner and discussed a wide range of illnesses and remedies.

The illustrated Vienna Dioscurides was made around AD 515 for Anicia Juliana. Its principal section presents medicinal substances from Dioscorides’ first-century De materia medica. In 1406, the scholar and notary John Chortasmenos arranged restoration and rebinding of the manuscript, documenting its use nearly nine centuries after production.

Paul of Aegina’s Medical Compendium in Seven Books, written in the seventh century, became a standard medical textbook for roughly eight centuries. The wider tradition of practical medical handbooks continued in the form of iatrosophia, collections that combined inherited learning, prescriptions, and observations.

Practitioners, standards, and medical work

Justinianic law addressed physicians’ qualifications and responsibility for malpractice. Medical care took place in homes and organised institutions. Patients could consult local practitioners or use household remedies, depending on their resources and available services.

Large medical establishments developed internal hierarchies. Records from Byzantine hospitals refer to chief physicians, senior female supervisors, and nurses or attendants. Women also worked in medical care. Hospital staff had to combine diagnosis and treatment with feeding, washing, supervision, and the management of medicines and equipment.

Constantinople’s position helped concentrate learned medicine there, especially after political changes reduced access to some earlier centres. The city’s medical culture was connected to the wider eastern Mediterranean, and Byzantine physicians and texts circulated beyond the empire. Yet the ability to consult a learned physician, purchase prepared drugs, or enter a hospital depended on location, money, social position, and the capacity of charitable institutions.

Diagnosis through the body’s signs

Byzantine diagnosis commonly used the Hippocratic and Galenic theory of four humours: blood, phlegm, yellow bile, and black bile. These were understood in relation to qualities such as hot, cold, dry, and moist, as well as to the seasons. Physicians used this model to interpret illness and to choose treatments intended to restore an appropriate balance.

Physicians inspected pulse and urine and observed breathing, speech and other bodily signs. Galenic pulse classification distinguished size, strength, speed and regularity. John Zacharias Aktouarios described diagnosis as requiring sensitive touch and careful attention.

Aktouarios developed uroscopy, diagnosis through inspection of urine. He divided a vessel conceptually into eleven sections and interpreted colour and sediment in each as signs of disorders affecting particular body regions. These readings operated within humoral medicine.

Diet, drugs, and surgery

Treatment could alter changes in diet, administer medicines or use bloodletting to correct a supposed excess of a humour. Nursing and observation accompanied these interventions.

Alexander of Tralles described more than six hundred preparations in twelve books. His account of melancholy concerned a disorder defined within humoral medicine. Byzantine pharmacological writings included autumn-crocus preparations. Nicholas Myrepsos’s thirteenth-century collection later became an important pharmaceutical authority at the medical faculty of Paris.

Surgery was described in considerable technical detail. Paul of Aegina’s writings discuss more than forty operations and around fifteen surgical instruments, including procedures for hernias and other conditions. His account of hernia treatment emphasizes incision, the careful handling of tissue, suturing, and applications for the wound. The sources also mention workers called akonetes, associated with sharpening surgical instruments.

A tenth-century account records an attempt to separate conjoined twins after one had died. The other survived for three days. The episode is recorded as an exceptional operation.

Hospitals and the organization of care

Byzantine hospitals emerged from institutions of refuge and charity and gradually developed more specialized medical functions. Early establishments were associated with churches and bishops and often served poor people, strangers, migrants, and the homeless. The term xenon referred to a house of hospitality, while other terms, including iatreion and nosokomeion, were used for medical or hospital institutions. The boundaries between a hospital, hospice, shelter, and charitable house were not always sharp.

Leontius of Antioch established an institution between 344 and 358 for strangers and migrants seeking refuge. Later in the fourth century, around the beginning of the 370s, Basil of Caesarea developed the Basileias, a complex that provided assistance to the sick and homeless.

Hospitals spread through the empire during late antiquity. Evidence from Edessa describes a hospital associated with Bishop Rabbula where residents received clean clothing and sheets. Written accounts portray hospital buildings with large communal spaces and central hearths, and hospitals were commonly divided into areas for men and women. Some institutions were intended mainly to shelter the poor or ease the suffering of people with chronic or terminal illness. Others increasingly offered beds, medicines, staff, and treatment, so the category “hospital” covered establishments with very different purposes.

After the sixth century, hospitals became a more ordinary part of urban life rather than a wholly new institution. Michael Psellos records hospitals founded in Constantinople under Basil I, Romanos I Lekapenos, and Constantine IX. The twelfth-century hospital connected with the Pantokrator monastery in Constantinople included about fifty beds, specialized departments, and an outpatient service according to the surviving description. A hospital in Thessalonica is also reported to have provided beds, shelter, and medicines to people who came for help.

An institution’s capacity depended on the estates and income assigned to it, together with its staff. Foundation charters describe intended arrangements for each establishment.

The former Pantokrator monastery survives in its church buildings, now Zeyrek Mosque. The 1136 charter describes a hospital with wards, medical personnel and a pharmacy supported by landed income.

Christian charity and the experience of illness

Christianity shaped both the institutions that delivered care and the language used to describe illness. Churches and monasteries often stood near hospitals, and bishops played important roles in founding or maintaining charitable establishments. Care combined bodily assistance with religious support. When medical treatment failed, patients might be encouraged to pray, and Cosmas and Damian were particularly associated with healing and physicians.

Practitioners used medicines and nursing alongside prayer and devotion to healing saints. Aktouarios, for example, recommended holy water mixed with a plant preparation for epilepsy.

Access remained unequal despite the charitable ideal that care should be available to the vulnerable. Hospitals were especially associated with the poor, but their functions ranged from shelter and hospice care to active treatment. Wealthier people could seek private physicians and purchase medicines, while people in remote areas had fewer opportunities to use urban institutions.

Change, crisis, and the wider circulation of medicine

From the tenth century onward, some writers continued to compile ancient authorities while incorporating more personal or clinical experience. Michael Psellos wrote on subjects including epilepsy and other disorders, and later authors such as Myrepsos developed pharmacological writing. John Aktouarios, active in Constantinople in the early fourteenth century, was the last major Byzantine physician named in the surviving tradition and is especially associated with studies of urine.

Warfare, epidemics and loss of territory placed pressure on the income and population supporting medical foundations. Texts and practitioners nevertheless continued to circulate, including through western translation of Greek works.

Byzantine medical texts also crossed political and linguistic boundaries. Greek medical learning reached Islamic physicians through contact, conquest, migration, and translation, while Byzantine works influenced medical writers in western Europe. The late twelfth-century physician Roger of Salerno drew on writings associated with Aëtius, Alexander of Tralles, and Paul of Aegina. A thirteenth-century treatise by Demetrios Pepagomenos on gout was translated into Latin and published in Venice in 1517.