Tuesday, May 21, 2013

642 A.D.: Stephanus, the last Bryzantine physician

Stephanus (550-630 A.D.) is generally referred to as the last known Byzantine physician to be educated at the school of Alexandria.  He was professor of philosophy and medicine when the school was captured by Arabs in 642 A.D.  (1, page 213)

Perhaps it's because he was born in Athens that some refer to him as Stephanus of Athens.  Perhaps it was because he was educated at Alexandria, and later became a physician at the school, that some refer to him as Stephanus of Alexandria. Perhaps it was because he flourished in Byzantine during the reign of Justinian I (527-565) that he is sometimes referred to as Stephanus of Byzantine.

Despite the various names, little is known of him.  Rather, perhaps that so little is known about him has resulted in such a wide variety of names for him.

Oxfordreference.com says he was a contemporary of Justinian and that he was a Christian. He was neither a a geographer nor a historian, but a grammarian.  He was not completely uncritical, although his main task was as a compiler of the ancient writers whose works had been lost.  (8)

At some point during the reign of Heraclius (575-641) he migrated to Constantinople. (7, page 52)

He is known to have expounded on the works of Hippocrates, Aristotle and Galen, and is important to our history mainly because he expounded on the Hippocratic view regarding asthma. (2, page 82)

Garrison says that Stephanus was a "pupil of Sylvius at Paris, and a prominent publisher of medical books during the Renaissance, was persecuted and imprisoned for heresy and died in prison. (5, page 156).

I'd delve further into the life of Stephanus, although apparently he left no clues as to his life, and nothing was written by anyone who followed him.  All that we know of him is that he was the last of the Byzantine physicians and that he published books, one of which is relevant to our history: "Commentary on Hippocrates' Aphorisms."  

Jackson quotes Stephanus form this book as saying the following about asthma:
We know already what asthma is: quick and frequent breathing.  And how do we explain the asthma?  There is an inward pressure on the vertebrae at the occiput (the back portion of the skull), it presses on the esophagus, which presses on the larynx and thus narrows the air passage, so that there is quick and frequent breathing called asthma by Hippocrates.  (3, pages 26-27)(6)
Furthermore, Galen explained that the faculties of nature were those naturally occurring events in the body that result in life.  For example, the soul and nature make life, the veins and liver make blood, the blood makes nutrition, nutrition is assimilated into the organ to make growth, and adequate growth assures continued life as long as possible, or good health.

He likewise explains that diseases are caused when changes in the body, perhaps caused by a weakening of the natural faculties, results in an increase or decrease in any one of the four humors: blood, yellow bile, black bile or phlegm.  An increase in phlegm in the lungs, for example, is what he thought caused asthma.

Staphanus expounded on this, as he's quoted here by Jackson:
Middle age is characterized by an irregular temperament, and by this irregularity of temperament the natural faculties are weakened, in consequence of which various and manifold diseases  are produced in this group; in the same way autumn with its irregular temperament produces various and manifold bad humors, which naturally cause various and manifold bad humors, which naturally cause various and manifold diseases owing to the weakening of the faculties, since irregularity of any kind weakens the faculties and upsets the constitution... middle age is analogous to autumn, the prime of life to summer; and because of this analogy, just as autumn is the cause of many diseases, so there are many various diseases which middle age tends to produce. (3, page 27)(6) 
These people are prone to asthma. We have heard more than once what asthma is: heavy and very fast breathing.  The asthma is easily explained by the irregularity of the temperament. Phlegm is produced by weakening of the faculties and failure to digest the food; this phlegm flows to the pharynx, the larynx, and the trachea, thus the air is prevented from passing, and this causes asthma.  (3, page 27)(6) 
It's a shame we know so little about a man who worked so hard to save the works of Hippocrates, Aristotle and Galen.  Regardless, his works provide an essential ingredient to our history of asthma.    

References:
  1. Frampton, Michael, "Embodiments of Will: Anatomical and Physiological Theories of Voluntary Animal Motion from Greek Antiquity to the Latin Middle Ages, 400 B.C.- A.D. 1300," 2008, page 213
  2. Smith, William Sir, "A Dictionary of Greek and Roman Biography and Mythology," page 964-5
  3. Jackson, Mark, "Asthma: A biography," 2009, New York, Oxford University Press
  4. Prioreschi, Plinio, "A History of Medicine," 2004, Omaha, Horatius Press
  5. Garrison, Fielding Hudson, "An introduction to the history of medicine," 1913, Philadelphia and London, W.B. Saunders Company
  6. Jackson, op cit, page 27, reference used by Jackson:  Stephanus of Athens: Commentary on Hippocrates' Aphorisms Sections III-IV, translated by Leendert G. Weserink (Berlin, 1992), page 151
  7. Galen, De Diebus Decretoriis, from Greek into Arabic, translated by Glen M. Cooper, 2011, Great Britain, MPG Books
  8. Stephanus of Bryzantium, Oxfordreference.com, http://www.oxfordreference.com/view/10.1093/oi/authority.20110803100531207, accessed 11/22/13

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