Download PDF | (Medicine in the Medieval Mediterranean) David C. Bennett - Medicine and Pharmacy in Byzantine Hospitals_ A Study of the Extant Formularies-Routledge (2012).
267 Pages
Scholars have made conflicting claims for Byzantine hospitals as medical institutions and as the forebears of the modern hospital. In this study is the first systematic examination of the evidence of the xen6n texts, or Xenonika, on which all such claims must in part rest. These texts, compiled broadly between the ninth and thirteenth centuries, are also transcribed or edited, with the exception of the combined texts of Romanos and Theophilos that, the study proposes, were originally a single manual and teaching work for doctors, probably based on xenon practice. A schema of their combined chapter headings sets out the unified structure of this text. A short handlist briefly describes the principal manuscripts referred to throughout the study. The introduction briefly examines our evidence for the xendnes from the early centuries of the East Roman Empire to the fall of Constantinople in 1453. Chapter 3 examines the texts in xenon medical practice and compares them to some other medical manuals and remedy texts of the Late period and to their structures. The xendn-ascribed texts are discussed one by one in chapters 4-8; the concluding chapter 9 draws together the common, as well as the divergent, aspects of each text and looks to the comparative evidence for hospital medical practice of the time in the West.
David Bennett was, for most of his career, a hospital executive in the British National Health Service. In retirement, he brought together his life-long love of the Greek language and the interest he had developed in hospital history by studying the texts associated with Byzantine hospitals, first for a Master’s degree and then a Ph.D. at the University of London. He died in 2012. This book grew out of his doctoral thesis.
Foreword
The author of this work would undoubtedly have loved to see his study published in the form of a printed book. After a life in the British public health service as a hospital manager, David Bennett returned in 1994 to his high-school love of Greece and Greek culture, and he embarked with youthful dedication and senior maturity on an exploration of Byzantine hospital texts, merging life experience with an interest in history that had remained intact through the years. But fate did not allow him to see the fruits of this professional endeavour after almost twenty years of study, as the thread of his life was cut short in 2012, not long after he delivered the draft of the present book.
As early as 1996, David Bennett obtained a master’s degree in Byzantine History with an essay on Byzantine remedy texts prepared under the direction of Professor Charlotte Roueché at King’s College London. In subsequent years, David Bennett continued along the line of investigation he had opened in his master’s thesis and deepened his approach to those Byzantine texts that apparently had come from — or were linked with — hospitals. Due to the limitations of available documentation, he focused on manuscripts produced between the recovery of Constantinople from the Latin Kingdom in 1261 and the fall of the capital in 1453, trying to go back in time to the source of the texts contained in these late codices.
Inspired by Timothy Miller — author of the first modern monograph on the Byzantine hospital, The Birth of the Hospital in the Byzantine Empire, published in 1985 with a revised edition in 1997 — David Bennett went further. He wished, not only to collect extant texts, but to understand how the practice they reflected actually worked. More so than Timothy Miller, he scrutinised available texts to provide a historical reconstruction of Byzantine hospital history based on accurate data, patiently collected from manuscripts. In so doing, he located his research at the intersection of different approaches to medical history with the attention to the social dimension of medicine more typical of British historians; the editorial and interpretative work particularly practised on the European continent, mostly by German, French and Italian philologists; and the interrogation of the practicalities of medicine and the workings of the ancient art of healing mostly investigated by North American historians of science, medicine and pharmacy.
This careful and patient research — not very different from that of the physician copyists whose texts he studied — constituted the substance of a doctoral thesis that David Bennett prepared under the direction of Professor Peregrine Horden at Royal Holloway University of London. David Bennett was awarded the title of Doctor of Philosophy in 2003.
I invited him to consider revising his philological thesis for publication in the series Medicine in the Medieval Mediterranean, something that he accepted with enthusiasm, although he saw it as a challenge, since it would require taking distance from his own recent work and being his own critic. While we agreed that I would supervise his revision of his doctoral dissertation, fate transformed me de facto into the editor of a posthumous work.
Editing should be an act of empathy, requiring the editor to penetrate the mind of an author through the author’s work, in order to serve the author and to improve the work without imposing on the author or altering the work — ifat all possible. It results in some sort of duplication of the author, who, at the conclusion of the process, faces a version of himself or herself that thinks and writes in a way that is typically his or hers. Once editing is completed, another transfer of authorship attributes to the author the work of the editor, who disappears and allows the author to have the credit of the work performed by this temporary twin. The editor appears to have borrowed the author’s identity.
In the case of a posthumous work, the task is more delicate than ever. The normal dialogue between the editor and the author — be it explicit or mute, but translated in the latter case into textual interventions acting as invitations to discuss and exchange ideas — is missing one of its actors. The editor’s activity is transformed from a dialogue into research, particularly if the manuscript the editor is working on is an unfinished draft. With the help of my colleague Peregrine Horden of Royal Holloway University of London and Ashgate Senior Editor John Smedley, I have tried to transform David Bennett’s manuscript into a book that, we all hope, he would have loved and been proud of, without modifying either the general architecture of the work or his typical writing style.
A particularly delicate question has been the edition of the texts on which the study is based. The editions included in David Bennett’s doctoral dissertation were tentative and mostly aimed at bringing to light texts not much studied until then. Nevertheless, such editions, which were not intended to be definitive, were still too much in a preparatory phase to be reproduced here. Furthermore, although David Bennett browsed a number of catalogues of manuscripts, he did not make a systematic search and had not yet inventoried the manuscripts and texts linked with Byzantine hospitals in an exhaustive way. It thus seemed preferable to publish the contents of the texts, more or less detailed according to the work in question, and also diplomatic editions of limited fragments of medical compilations, in order to provide readers with substantial, but not necessarily definitive, information.
At the conclusion of my work as editor, I wish to thank the board of the series Medicine in the Medieval Mediterranean, particularly its chair, Professor Vivian Nutton, who accepted without hesitation the proposal to publish this essay in the series; Ashgate Senior Editor Dr John Smedley, who made all possible efforts to recover files in an obsolete format and forward them to me in a readable format; Dssa Emanuela Appetiti, who checked the bibliography and proofread the manuscript; Dr Barbara Zipser for assistance with textual matters; and, more than anyone else, David’s wife, Winifred, who has provided access to David’s computer with the same discrete patience that she demonstrated during the years that David was preparing his master’s and doctoral theses and the manuscript of this book. To all of them, I express my sincere gratitude. Without their collaboration this book would have never come to light.
Alain Touwaide Senior Editor Medicine in the Medieval Mediterranean
Acknowledgements
Asa latecomer to Byzantine studies, the help and advice I have received have been immeasurable, and the thanks rendered here are an inadequate expression of the debts I owe. Four people in particular have encouraged and supported me. Professor Peregrine Horden, of Royal Holloway University of London, has been an endless source of wise counsel with the ability to make me see issues afresh. The late Julian Chrysostomides gave me invaluable advice on the art of editing texts of Byzantine manuscripts. Dr Charalambos Dendrinos combined encouragement, scholarship and patient help with my transcriptions. Mr John Bennett, F.R.C.S., with whom I was privileged to work in the National Health Service, readily discussed and advised me on medical issues. Their friendship has enhanced my enjoyment of the work that I embarked on many years ago. I remain, of course, solely responsible for the opinions expressed in the chapters that follow, as for all else in this study. I gladly record my thanks for early financial support in the earlier days from the Dover Fund, administered by the Hellenic Society, and from the Wellcome Trust Libraries. The privileges of membership of libraries and access to them have also been greatly appreciated.!
Over the years, many others have helped me in statu pupillari, most recently Professor Charlotte Roueché, then Director of the Centre for Hellenic Studies at King’s College London, who supervised my master’s studies from 1994 to 1996 and aroused my interest in xendnes, and Professor Brian Sparkes, whose student I was at Southampton University some fifty years ago. He embodies, in his scholarship, kindness and encouragement, all that I owe to those who have taught me in my early years and given me so firm a grounding in that happiest of languages, Classical Greek. I should also like to acknowledge the examiners of the doctoral thesis upon which this book is based, Professor Vivian Nutton and Mr Nigel Wilson, for their expert scrutiny and kind advice.
Above all I thank my wife, Winifred, who has so consistently supported me and endured so patiently my long hours of work after retirement, and the frustrations that have accompanied the pleasures of this academic commitment.
David Bennett January 2012
Introduction
The oft-quoted paper by the French physician and historian of Byzantine medicine Edouard Jeanselme (1858-1935) — “Sur un aide-mémoire de thérapeutique byzantin .. .” — was my gateway to the study of Byzantine manuscripts of xendn (that is, hospital) medical texts.' His paper, however, is confined to a commentary on, and translation of, the text designated here and subsequently as the Therapeutikai in three manuscripts available to him. The value of xendn texts to the study of the Byzantine xendnes was asserted in 1985 by the Byzantinist Timothy Miller in his monograph The Birth of the Hospital in the Byzantine Empire.
Other scholars have made conflicting claims for Byzantine hospitals as medical institutions. This book attempts to resolve them through a systematic examination of the evidence of the xenén texts, or xenonika biblia, on which all such claims must in part rest. Timothy Miller, in the introduction to the second and revised edition of his monograph, said that “the wealth of information [about medical texts] uncovered by simply examining one xen6n treatment list . . . demonstrates how fruitful careful philological and codicological research focused on a wider selection of Byzantine medical manuscripts might be in future.”* This essay takes up that implicit invitation.
What follows, though not a history of the xendnes, none the less is bound to take account of their origins and nature, for discussion of the manuscript texts is impaired without some knowledge of their historical setting. In the xendnes, the users of the texts, the iatroi (physicians) and archiatroi (chief-physicians) — in their training, education and everyday practice — relied on the copying, acquisition and availability of manuscripts; these, together with oral transmission, were the medium for recording and transmitting medical lore, as well as for chronicling medical practice. Xendn texts must, however, be read with caution. The vocabulary, definitions and classifications of a past age and a different medicine interpreted without care may lead to presumptions that the historian is not entitled to make. The historian must avoid “reducing history to a hunt for precocious signs of modernity’, a caution that applies especially to the reading of the foundation act — the typikon — of the Pantokrator xendn in Constantinople which is much quoted in the following pages. At the same time, the historian should acknowledge that ancient Greek and Byzantine medicine was neither crude nor unsophisticated.*
Although Hippocrates and other early medical writers are cited in the pages that follow, Galen, who had “somehow defined and completed medicine”, above all provides a constant point of early reference.* Similarly, the Epitome of Medicine by the seventh-century Alexandrian physician Paul of Aegina is an invaluable source with which the medicine of the xenén texts can be compared: of the four great scholar physicians of Late Antiquity — Oribasius in the fourth century A.D., and Aetius of Amida and Alexander of Tralles in the sixth — he is the nearest in time to their compilation. Theophanes Chrysobalantes, who may have been writing his medical texts in the tenth century — that is, about the time the xendn texts were first compiled — provides similarly useful comparisons.
There are a number of conventions in this study, the most important of which is the short title given to each of the principal texts discussed (Therapeutikai, Prostagai, Xenonika I and Xenonika I/). Other medical texts are designated by the standard Latin translation of their titles.° The other works by Greek and Byzantine writers are identified by the standard Latin form of their titles. When a catalogue of manuscripts describes a text as part of a collectanea, iatrika or iatrosophion, these terms are correspondingly used in this study. The spelling of proper names follows the Oxford Dictionary of Byzantium, except where a common Anglicised form has long been familiar. Most of the Greek terms cited in this study are accompanied by their transliteration into the Latin alphabet, which follows the standard practice for Romanization, except when a canonical and commonly accepted form is available. Where it is necessary to quote a manuscript, this is done either in the customary full citation (name of city, library, possible collection and shelf mark, or in the Latin usual designation as, for instance, Vindobonensis medicus graecus 48), or, if the context is clear, more briefly (for example, Vienna codex graecus 48). Where necessary, citations of texts or significations of passages from manuscripts refer to folio (recto or verso) and line, for accuracy. Translations from the Greek or Latin are the writer’s own unless otherwise stated. Diseases, ailments, illnesses, complaints and maladies are almost without exception called “affections”, a slightly archaic but all-embracing term for any pathological state or condition.
Editorial style is based on the usage of the series Medicine in the Medieval Mediterranean. Citations in the endnotes are abbreviated (author’s name, year of publication, page number[s], possibly note number[s]) with the full references at the end of the volume in the bibliography.
We still need to define the later period of Byzantium. It is a loose term, usually understood to comprise the years from the Latin conquest of Constantinople by the troops of the Fourth Crusade in 1204 to the fall of the Byzantine Empire in 1453. Although the manuscripts in this study are chiefly from this period, the date of first composition of each xenon text is important in the study of the xendnes and their clinical activity. Accordingly, this study frequently returns in time to the centuries before the Latin occupation of Constantinople within whose walls the xendnes are chiefly, if inadequately, documented in the chronicles of the time.
The contents of this book are divided into four parts, part 1 (chapters | to 3) being a prolegomenon to the study, in part 2 (chapters 4-8), of the texts. In chapters 1-3, the survival of these texts, the functions of the xendén deduced from them, xenon physicians and users of texts are surveyed. In part 2, the xendn-ascribed texts are discussed one by one. The concluding part 3 depicts, principally on the evidence of the texts, the xen6n as an institution in which physicians practiced medicine in a manner prefiguring practice in a modern acute hospital. It is justly described as the ancestor of the modern hospital. Part 4 completes the analysis made mainly in part 2 by providing information about the primary sources consulted in this research. It includes a summary description of the major manuscripts in which the five texts under study here can be found, together with a summary of three of them (in Greek) and a diplomatic edition of the other two.
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