PHYSICIANS
A little-known emperor-physician:
Manuel I Comnenus of Byzantium (1143-1180)
John Lascaratos and Sryros Marketos
Athens, Greece
Keywords: Byzllntium; Mllnuel I Comnenus
Manuel I Comnenus (Figure 1), who ascended to
the throne of Byzantium after the death of his
father, John II, was a brilliant, versatile and gifted
ruler'. He was a born commander and a brave
soldier who shrank from no personal danger. The
contemporary historian Eustathius, Bishop of
Salonica, writes- that he was proud of his war
wounds, which "adorned" all his body, while
Nicetas Choniates, another contemporary historian
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\ German Bertha-Irene of Sulzbach, sister-in-law of
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Figure 1. The Emperor Manuel I (miniature from the jourtffllth
century). (Latin Code 399. f 76. Marcillna Library of Venice.)
Correspondence to: John Lascaratos MD, Assistant Professor of
History of Medicine, Hippocratous 164 B St, Athens 11471,Greece
Journal ofMedical Biography 1996; 4: 187-190
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and secretary of the royal court, expresses his
bewilderment at how the Emperor could survive
after such a plethora of wounds from the Turks in
the battle of Myriocephalon in Asia Minor (1176
AD). Despite his being hard and persevering in
battle and immune to hunger, thirst and cold-, after
his battles, in his private life, he loved to live well,
and "a spirit of gaiety and joie de vivre reigned
supreme in the Comnenian palace of the
Blachernae'". Furthermore, according to Nicetas
Choniates, he was sexually obsessed and his sexual
adventures were well known. He did not hesitate to
deceive his wife, and had numerous mistresses, the
best-known of whom was his famous niece,
Theodora Comnena, with whom he had an illegi-
, timate child'', Above all, however, he was a skilled
diplomat and a statesman with bold and far-
reaching ideas'. In spite of being a true Byzantine,
believing in the conception of universal imperial
sovereignty and possessed of the characteristic
Byzantine passion for theological discussion, his
whole way of life bore the stamp of Western
chivalry'. He liked Western customs, such as
jousting tournaments, and introduced them at his
court. He twice married Western princesses, the
the Emperor of Germany, Conrad III, and Margaret-
Constance-Maria (Figure 2), daughter of the Prince
of Antioch, Reymondo de Poitiers',
Manuel I as a physician - the Emperor of
Byzantium as a symbol of medicine
Basic higher education at the universities of
Byzantium included medicine'. Anna Comnena, as
is evident from the information given by herself in
her Historia, with her medical education, was in a
position to observe the fatal disease of her father,
Emperor Alexius I Comnenus (1081-1118), as
president of the councils of physicians", It is
virtually unrecorded in the wider medical biblio-
graphy that an Emperor, Manuel I Comnenus,
practised medicine extensively, alongside his duties
as Emperor, because he passionately loved this
sciences, It must be stressed that all the emperors of
188 Journal of Medical Biography Volume 4 November 1996
Figure 2. The Emperor Manut'l 1. Comnenus, with his wife Emprt'Ss
Margaret-Constance-Maria (miniature from theIwt'lfth century). (Code
Vaticanus Graecus 1176./ 11. Vatican Library.)
Byzantium were interested in the health of their
people and were, as well as symbols of the state and
church, symbols of protectors of health. According
to the imperial Byzantine ideology, the sovereign
had an obligation to appear as "the great healer and
physician", and because of this political concept the
organization of health services in Byzantium devel-
oped to a great extent; the hospitals of the Empire,
as Hunger states", reached a level which the West
attained several centuries later. A characteristic
example of such a hospital was the famous Xenon
of the Monastery of Pantocrator (Figure 3), estab-
lished by Emperor John II Comnenus, the father of
Manuel (Figure 4)8. However, Manuel's involve-
ment in the field of health care was not limited to
the formal and traditional interests and the hospital
policy of the state, but it was more apparent and
personal because he himself practised medicine.
The medical activities of the Emperor
The historian John Cinnamus", private imperial
secretary, confirms that the Emperor was more
capable in the practice of medicine than many
professional physicians. Furthermore, the same
historian was an eyewitness to some specific
medical interventions by the Emperor, who was
accustomed to offering his services to his people, as
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he practised in the hospitals of Byzantium. He states
that he saw the Emperor carry out phlebotomies
and give the patients pioneering pharmaceutical
treatments. He adds that Manuel offered much to
the science of Asclepius and introduced drugs
unknown until then, especially for oral administra-
tion and localized use, which the hospitals of the
state, the Xenones, provided for whoever needed
them. Eustathius- calls Manuel "The Healing
Emperor", who treated very serious, even life-
threatening diseases successfully, and he adds that
he had special experience in diseases considered
difficult to treat, which he dealt with skilfully. The
historian provides further details of the manner in
which Manuel practised medicine. These are inter-
esting because it seems that the Emperor followed
the Hippocratic principles. First he took a meticu-
lous case history, with questions, and then
physically examined the patient, diagnosed the
disease and, after consulting the medical books,
prescribed a course of treatment and systematically
followed the patient's progress until recovery.
Eustathius/ also maintains that the Emperor dis-
covered effective drugs, which were made available
in plentiful amounts to patients and their physicians
without charge, being paid for from public funds.
The Emperor, alongside the new, had great experi-
ence of the earlier drugs and used them in the most
effective way2.
Cases of care by the Emperor
In the historical texts, cases are referred to in which
the Emperor volunteered his medical services, in
addition to the hospitals, to certain personalities.
During the Second Crusade (1147) the Emperor of
Germany, Conrad III (1138-1152), was brought ill
from Ephesus to Constantinople!", Immediately
Manuel rushed to his side, together with the
Empress Bertha-Irene (Conrad's sister-in-law), and
examined him with great interest, prescribing him
the right course of treatment!'. Some years later,
during the expeditions to Syria, the King of
Jerusalem, Baldwin III (1143-1162), during an
imperial hunt, fell from his horse and broke his
Figure 3. Thefamous Xenon of Pantocrator, established in the twelfth
centurv (nineteenth-century I'ngral'ingJ.

Figure 4. Till' Emperor Malluel (top middle) betwel'lI Iris father JOIrIl II
(topleft)and hi«SOli Alexius (top right) (miniature from tirefourteenth
centuru). (Code a-S-5-5, f 294, Est,'IISt' Library-Modena.)
arm, as John Cinnamus testifies", Then Manuel,
without following the strict Byzantine etiquette,
according to which the Emperor of Byzantium had
precedence over the other kings, rushed to him and
attended to his injury, which in a few days healed
under his personal medical attention". William of
Tyre'? confirms in his Chronicle the medical super-
vision which Manuel Rrovided for the King of
Jerusalem. R Grousset 3 considers the event an
example of good neighbourliness between Manuel
Figure 5. The Emperor Malluel I 011 a coill millted during. his reign.
(Numismatic Mus('l/m of Athcns.)
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Lascaratos and Marketos. Manuel I Comnenus 189
and the Frankish sovereigns and adds that during
Baldwin's convalescence the Emperor passed by
daily to ask after his health, and when the bandages
were changed by the surgeons, Manuel personally
helped them as if the King of Jerusalem were his
own child.
Another case of medical assistance refers to his
nephew John, son of his brother Andronicus. In
1154 John came across a wild boar, had to struggle
with it and was bitten all over his body", The
Emperor, as soon as he had been informed of the
event, although he was far away, rushed to tend his
wounds and keep him under observation until these
were healed",
Nicetas Choniates'', writing of the reign of
Manuel, in his Historia describes the last moments
of the Emperor and the course of his fatal disease, of
an unknown nature. This disease, according to the
historian, lasted from the spring until 24 September
1180, when he died. Nicetas'' refers to the fact that
the Emperor followed the course of his disease as a
physician. On his last day, he continually examined
his pulse and himself realized his imminent death.
Then he sighed deeply and, nervously tapping his
thigh with his hand, asked to become a monk,
following a custom of the Byzantine emperors on
their deathbed. His courtiers, who had not expected
such an event in the case of this robust Emperor,
brought him a black robe which they chanced to
find and dressed him in it, after removing his royal
garments. The Emperor died as a monk with the
name of Matthew, at the age of 623.
Conclusion
The study of the life of Emperor Manuel I
Cornnenus (Figure 5) proves that the Emperor not
only had a brilliant medical education but also
practised the profession of a physician system-
atically, offering his services to the hospitals of the
Empire, preparing drugs and proferring assistance
in emergencies affecting other monarchs and
princes. His medical activities were not undertaken
for political reasons but because of his love of
medical science. This is indicated by the fact that he
offered his services, despite his numerous obliga-
tions as a leader, in the examination and treatment
of his subjects in the Xenones of Byzantium.
Moreover, he himself made up new drugs, which
were supplied free of charge to the hospitals.
The evidence of contemporary historians (such as
Eustathius), who did not all belong to the closed
circle of his entourage, confirms his successful
practice of medicine, together with love for his
science. He is the only Emperor of Byzantium who
personally practised medicine, while all the others
were confined to the role of protector of health and
charitable institutions and hospitals. There were
moments during which the demonstration of his
medical capacity overshadowed the imperial role,
as when he breached the rules of imperial etiquette
190 Journal of Medical Biography Volume 4 November 1996
to offer medical help to King Baldwin, a fact which
impressed the historian Cinnamus". This latter beha-
viour of Manuel's certainly constitutes an undeniable
expression of his passionate love of medical science.
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