Medical coverage at the Pantocrator Xenon was as hierarchical as in modern times. At the top were two salaried senior doctors (protomenites) assigned to each of the sections for serious diseases and for eye and intestinal diseases. Lower down the ranks were two surgeons for wounds and fractures, two doctors for womens’ diseases, and four for outpatients. The doctors typically worked on alternating months, one month in the hospital on low pay, one month visiting private patients and charging higher fees.
In the hospital they were not to take tips from patients, but private practice in their time off was allowed as long as they did not leave the city. When on duty they were expected to make two ward rounds in the summer but only one in the winter; and they were followed on their rounds by young doctors and students.
The hospital also employed assistants, pharmacists, servants, an usher, five laundresses, two cooks, two bakers, one miller, one latrine cleaner, four pallbearers, and a priest for the living and for funerals. Overall supervision was by a superior and four other monks (oikonomos) who formed a board of directors, and by salaried officials, some physicians, who managed the day to day operation of the hospital. Also attached to the building was an old age home or gerokomeion.
Hospital physicians kept records of the medical treatments they prescribed, and were supervised by two senior doctors (primmikerioi) who made rounds, re-examined patients, monitored their treatments, listened to their complaints, and checked the diagnoses made in difficult cases.
Treatments included blood-letting, baths, plasters, sitz baths, and a whole array of herbal medicines taken orally and prescribed in accordance with Galen’s theories of the humors, depending on whether they had an excess of the cold humor (phlegm) or an excess of the hot one (bile).
What surgical procedures were done can be deduced from some of the instruments reported to have been available, tool sharpeners, phlebotomy knives, cautery irons, catheters for bladder problems, dental pliers, and instruments described as useful for the head and stomach.
After the eleventh century more hospitals were founded in Nicomedia, Thessalonica, Philadelphia, and Nicaea. Many seem to have become even more like modern medical centers, treating patients with serious conditions, with specialized wards for surgery and also for women, and sections providing outpatient treatments such as enemas.
Home visits were also done but were expensive, presumably reserved to the very wealthy. Medical students in the early centuries were more likely to be taught in schools and colleges not attached to hospitals, but by the twelfth century hospitals seem to also have provided medical instruction.
Thus it appears that the direct ancestors of the modern hospital originated in the Byzantine Empire. From there they spread to the West, one wave in the fifth century, another in the twelfth century when introduced by the Crusaders. They also inspired the establishment of hospitals in the Muslim world (bimaristans).
It has been said that to trace the birth and evolution of treatment centers in the Byzantine world is to write the first chapter in the history of the hospital itself.
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Excerpts from an article at Hektoen International
References
Plinio Prioreschi: History of Medicine, Volume 4, Byzantine and Islamic Medicine, 2000, Horatius Press, Omaha NE. page 103-119.
