In comparison to the history of medicine in medieval Europe and Islamic word, Byzantine medicine – a tradition that extends from the late Roman period to the fifteenth century – is a neglected field, suffering from an absence of primary source editions as well as a lack of extensive analyses of major Byzantine medical writers. Petros Bouras-Vallianatos’ monograph on the corpus of the late Byzantine physician/medical writer John Zacharias Aktouarios is a most welcome enterprise that presents the structure, sources and audience of John Zacharias’ three major works – On Urines, Medical Epitome and On Psychic Pneuma – in a very clear and successful manner. This monograph is, and will likely remain, the most extensive treatment of John Zacharias, especially taking into consideration the partial and disorganized treatments that this early-fourteenth century physician has previously received.
The choice of John Zacharias as a subject of a detailed examination is extremely appropriate not only because he was a very popular writer both among his contemporaries and in later centuries, as the number of manuscripts prove, but also because he astutely combined the teachings of his predecessors with his own authentic contributions, and he supported his theoretical views with practical observations. These two sets of dualisms, or rather two concepts dialectically in dialogue with each other – tradition versus originality, and theory versus practice – has never stopped guiding modern scholars studying Byzantine medicine, as the title of Owsei Temkin’s article from 1962, ‘Byzantine Medicine: Tradition and Empiricism’, shows.Footnote 1
After an introduction that portrays the political, cultural and medical setting in which John Zacharias produced his literary output, Bouras-Vallianatos examines in Chapters 2 and 3 John Zacharias’ On Urines, a masterpiece of Byzantine uroscopy that had its match only in the uroscopic treatise of Theophilos, another Byzantine medical writer from the seventh or ninth century. These two chapters are indispensable for anyone interested in the history of uroscopy as well as clinical narratives, thanks to their extensive discussion of John Zacharias’ theoretical elaborations together with his clinical observations and in-depth examination of urine vials. Bouras-Vallianatos further provides analysis of case histories that offer the best examples of physician–patient relations in Byzantine history. Bouras-Vallianatos performs at his best in donning the mantle of a cultural historian in his discussion of these eleven case histories. He views these short encounters between John Zacharias and his patients as ‘an interaction between the performer and other individuals’. In addition to employing the perspectives offered by performance studies à la Goffman, being conscious of the textual nature of his evidence, Bouras-Vallianatos subjects his material to a narrative analysis in terms of characters, mise en scène, and authorial voice. This section on clinical narrative would impress the reader even more if he employed contributions from the field of oral history and from modern historical works that use trial or inquisitional records such as Emmanuel Le Roy Ladurie’s Montaillou or Karen Sullivan’s The Interrogation of Joan of Arc. Footnote 2
Chapters 4 and 5, most beneficial for readers interested in Byzantine pharmacology, are devoted to John Zacharias’ longest but relatively little studied handbook, Medical Epitome. As Bouras-Vallianatos shows, this encyclopaedic work, composed of six books devoted to diagnostics, therapeutics and pharmacology, is the work of a medical writer who effectively and carefully brought together selections from previous works and added his own experience and knowledge. The traditional assumption that Byzantine pharmacological works, especially recipes, were collages of previous texts with outdated information and without much originality is being replaced by a view that pays attention to the role of experience and adaptation in the production of the very same texts. Bouras-Vallianatos’ meticulous analysis of John Zacharias’ composition and presentation methods as well as Zacharias’ incorporation of ‘oriental’ materia medica into his work proves that late Byzantine physicians updated their material according to contemporary needs and interests. The sixth and final chapter before the conclusion is an exposé of how John Zacharias defines psychic pneuma and connects it to the soul, which Galen did not attempt to do. In his treatise On Psychic Pneuma, John Zacharias presents his theory of pneuma and, with a clearly practical purpose, a method for purifying the soul through a specific regimen to attain spiritual perfection.
A definite strength of Innovation in Byzantine Medicine is the attention given to context. Bouras-Vallianatos places John Zacharias in late Byzantine society, Byzantine medicine and the wider Mediterranean medical traditions. Throughout the book, a picture emerges of a late Byzantine physician who was well connected to the intellectuals, spiritual leaders and physicians of Constantinople within the framework of a politically declining but culturally flourishing Byzantine society. Bouras-Vallianatos’ discussion of John Zacharias’ cultural milieu would be much clearer if he gave more information on the status of physicians in late Byzantium. Before delving into the specific subject matter in each chapter on John Zacharias’ works, such as uroscopy, medical case histories and pharmacology, Bouras-Vallianatos provides his reader with an introduction to the larger medical tradition surrounding that subject matter (under the subheadings of ‘The Art of Examining Urine’, ‘Clinical Narratives in History’ and ‘Pharmacological Manuals in Late Byzantium’). These windows into the various contexts, plus comparisons of John Zacharias’ approach to those of ancient, medieval European and Islamic writers, gives the reader the chance to see John Zacharias not only in the setting of Byzantine medicine, but also in the wider context of the Mediterranean medical traditions.
As is well known, meaning is a process that is in constant formation in the triangle formed by the author, text and audience. Bouras-Vallianatos addresses each member of this triad very astutely, giving the chance to even the most humble reader to grasp the spirit of John Zacharias’ works fully. While demonstrating how John as an author showed originality and cared to include his experience in his works, Bouras-Vallianatos traces the vast network of medical texts, which John Zacharias borrowed and modified. However, the most innovative aspect of Innovation in Byzantine Medicine pertains to the discussion of the audience of John’s literary output. Examining John’s statements as well as the way he structured and presented his work, Bouras-Vallianatos wonderfully shows how the early-fourteenth century physician targeted different types of audiences in his various works, ranging from specialised professionals to philiatroi (amateur physicians); from his inner circle including his patients to physically distant readers. The various registers of the audiences become even more multi-layered when Bouras-Vallianatos presents in detail the later medieval and modern reception of John’s work.
As a reviewer – a member of the modern scholarly audience who has the mission of introducing Innovation in Byzantine Medicine to you – I am not only convinced by the argument that John Zacharias used various epistemological and literary means to make his texts original, practical and accessible; but I am also pleased to note that Petros Bouras-Vallianatos as a writer is as original, practical and accessible as the subject of his research.
