The Byzantine Empire Had Hospitals: What Were They Like?

The Romans were mostly known for their military might and the ability to conquer and pacify their neighbors for long periods of time. While they made significant strides in medicine as well, much of this work occurred on the battlefield during war. The Byzantine Empire took medicine off the field of battle and put it into the hands of the everyday citizen by constructing hospitals and advancing the science behind these treatments to the next level.

But of course Byzantine hospitals were much different than our own.

Technically, they weren’t for the public at large. Instead, churches created hospitals as a place where those who were destitute might go to find access to amenities that they couldn’t find anywhere else. Men and women were segregated. Historians believe that these humble beginnings paved the way to the hospitals that treat us today — even though archaeologists have yet to find physical evidence that this is the case.

Most of what we know is derived from texts.

The “first” hospital was supposedly put together by Leonitius of Antioch sometime between 344 and 358 AD. We know that they probably weren’t a means for anyone to recover from serious illness. Instead, they were probably more like Hospice care — a means to make the transition to death more comfortable for those living in poverty or migrants who were traveling from one place to the next when they fell ill. 

It wasn’t long before these organizations began to pop up all over the Byzantine Empire. Only a century later, they could be found among the ashes of the old Roman Empire (in the west) as well. Some scholars believe they had spread as far as Egypt and Syria.

The spread began to slow down by the sixth century. That’s because they were already a basic part of Byzantine society in many of the empire’s larger cities, offering medicine and shelter to their patients. Constantinople had more than a few. 

Byzantine physicians practiced Hippocratic principles when treating patients. That means they believed that the body was made up of four basic “humors.” These were blood, phlegm, black bile, and yellow bile; all were directly connected to the season of the year.

Diagnostic procedures more directly parallel the practices of today’s physicians. They would check pulse and breathing, analyze urine and excrement, and pay attention to speech patterns. These procedures are probably more complex than you might think. For example, John Zacharias Aktouarios was able to separate a person’s urine into at least eleven distinct components inside a vile. By analyzing those components, he was able to determine whether or not a person was suffering from infection. 

Although medicine made strides, it would be centuries before hospitals transitioned into larger, more organized institutions.

The Vienne Dioscurides: Early Pharmacology

There was a time where innovations in medicine moved slowly, but there were also brilliant men who set foundational standards that were not questioned for hundreds of years.

Before Big Pharma and complex machinery, society was quite simple and, shall we say, organic. Much of the medicine in the world to help the sick came in the form of various plants and herbs found natively, and that was the case up until the Renaissance period in Europe.

For 15 centuries, in fact, healing agents really didn’t change much after a comprehensive manuscript was formed and compiled by a Roman military surgeon by the name of Dioscurides. Dioscurides lived in the first century A.D. and served in the military of the Roman Empire under Emperor Nero, and as a military officer in an expansive empire, Dioscurides was a heavy traveler, according to Herman Law.

As he traveled throughout the Empire, we started taking notes on the various plants and herbs he came across that were native to the areas in which he traveled. He would create accurate illustrations of the herbs and plants, describe each and give their medicinal values either as sanative or harmful. Hundreds of these species were observed and described in this manuscript, making it the most comprehensive “medical book” up to that time, and – it turned out – the most dependable resource for about 1,500 years, known in the early years as De Materia Medica (Materials of Medicine).

Dioscruides’ work was published sometime around 70 A.D., but the oldest known copy of the manuscript comes from the sixth century A.D. and was first called the Anicia Juliana codex, named for the Byzantine princess for whom the manuscript was created as a gift of gratitude. The princess was the daughter of the Byzantine emperor Olybrius, and was a patron and supporter of many of the arts that were occurring in the empire, and this codex (about 1,000 pages) was a gift specifically for her support of the building of a church in the Byzantine capital of Constantinople (present-day Istanbul, Turkey).

After that time, the manuscript went missing for most of the next nine centuries, until a monk in Constantinople named Nathanael asked John Chortasmenos to rebound the work in 1406. In 1423 was another sighting, as Aurispa, a traveler from Sicily came through Constantinople and witnessed the codex. Thirty years later, the city fell to the Turks of the Ottoman Empire, and the codex that had been solely in the original Greek had some Arabic and Turkish entries added to it.

Then, a century later, Hebrew names were added to the codex when Hamon, physician to Suleyman the Magnificent, came to be in possession of the manuscript. Finally, however, in 1569, Emperor Maximilian II received the manuscript and he dedicated it to what is now the Austria National Library in Vienna, where it gathered its current name of Vienna Dioscurides, though it is in the library as Codex Vindobonensis med. gr. 1.

The manuscript was also used as the basis of the Pope Alexander VII Dioscurides, which is currently housed in the Vatican Library. For its historical significance, it was listed on UNESCO’s Memory of the World Programme Register in 1997.

Overview of Byzantine Medicine

We all know that innovation can come fast and furious in modern times, especially in technology.

But every so often, there comes a “perfect” innovation that withstands the test of time with very minor improvements or decades or even centuries.

When it comes to medicine in the Byzantine era (5th century to 15th century A.D.), there was such an innovation that came in the form of medical knowledge and education. This was in a medical textbook that was used to train doctors for nearly eight centuries after its completion.

It wasn’t until the Renaissance period that medicine underwent massive updates and innovations, but for 800 previous years, medicine was pretty well covered by a seven-book set of texts called The Medical Compendium, written by noteworthy Byzantine physician Paul of Aegina in the last part of the seventh century and was considered the medical textbook of the age and in future generations.

Unlike the perception of Byzantine science, which was not considered much on innovation but instead a “transmitter” of ancient Greek and Roman knowledge forward into the Renaissance, the Byzantine Era provided not only vital compilations of medical knowledge from predecessors but also some of their own innovations and theories. Most Byzantine medicines was based on original Greek and Roman sources, primarily those works of Hippocrates and Galen.

The biggest contribution to medicine came in the compilation of knowledge, as several early iterations of what we would call today “textbooks” came into being by several Byzantine-era physicians, the most noteworthy being Paul of Aegina but also including Nicholas Myrepsos of the 13th century, whose textbook about pharmaceutics lasted well into the Renaissance, including French pharmaceutics, until the middle of the 17th century.

Another noteworthy work was called the Vienna Dioscurides, which was written for the emperor’s daughter early in the 6th century. It was vital in medicine at the time, as much of the remedies were herbal in nature, and the work compiled information about more than 600 plants and how they each could be used as remedial agents.

Another achievement of the Byzantines was the concept of the hospital for the public. Early hospitals, including those of the Roman Empire, were primarily for soldiers and slaves. But starting with John II Comnenus in the 12th century, hospitals became facilities for the sick and poor to provide basic needs and were overseen and developed by churches to develop more Christian followers and to do some healing. Much of that has carried forward into modern times.

Oribasius was one of the great contributors to the Renaissance as a compiler of resources in medicine, including several textbooks. The works were taken from Greek, updated into English and French during the Renaissance, and were corrected by Oribasius when some of the existing theories were deemed incorrect by practice.

With the work of Byzantine medical practitioners and members of the Christian church that dominated culture in the Empire, medicine did take some steps forward leading into the Renaissance and the Enlightenment. The work of Oribasius, Paul of Aegina and Nicholas Myrepsos, among others, by compiling the historical record and knowledge of medicine from the Greco-Roman era was vital in the practical progression of medical practice into a more modern era.