Byzantine medicine has been unfairly neglected by academic research: at best Byzantine medical writings are seen as a potential source for the secondary transmission of ancient medical writings. It is therefore refreshing to read a book that counteracts this trend, focusing on innovation in Byzantine medical writings.
PB-V's work is rich and diverse in the content it presents. It starts off with a basic introduction, assuming that some of its audience will not have had any previous exposure to key ancient and medieval medical principles such as the four humours theory. This feature makes the book more accessible to the majority of scholars from Classics and Byzantine studies, but also from other parts of medieval studies and beyond.
It then moves on to the main topic of the book, John Actuarius: his person, intellectual environment, and position. In this section PB-V presents content that is not easily accessible to medical historians.
The main part of the book is divided into sections focusing on the main works of John Actuarius, with his treatise on urinary disorders forming the start. Here, PB-V takes an unexpected angle in that he examines John's work from a literary perspective, analysing how John narrates case studies. This technique derives from Classics, and PB-V was definitely correct in applying it. He is also right in comparing John's case studies to Galen's rather than the better known yet structurally very different Hippocratic predecessors. The analysis is well structured, and the evidence is on occasion broken down in a table, which makes the argument easier to grasp.
The case studies themselves make haunting reading. They describe extreme suffering and on occasion death. Some patients were acquaintances. Persuasion and trust have always been a key feature of the medical profession. Seeing an analysis of these techniques against the backdrop of real people suffering from extremely painful urinary disorders is chilling, but it also provides valuable insights into the practice of a physician who had to convince patients or their next of kin to follow a given treatment.
From this point onwards, the book presents highly specialized content on diagnosis and therapy, comparing John's work against earlier writers and elaborating his technique and achievements. This part of the book is very much written for scholars from the field of Byzantine, or at any rate ancient Greek, medicine. To an outside reader, it may not be evident that these chapters draw on an enormous amount of primary source work, often in manuscript, which presents the gold standard in the field. For some of this content, there are no editions available, PB-V had to start from scratch.
Particularly impressive is the analysis of pharmaceutical ingredients. Here, PB-V demonstrates an in-depth understanding of the complex inventory of ancient and medieval pharmacists and its provenance, both in the geographical and intellectual sense. Primary sources are helpfully presented in tabular form or in footnotes.
The final part of the book discusses neurological and physiological theory, in its most abstract sense. In style and presentation it is accessible to the broader public, which is not easy to achieve.
The appendices present rich and helpful content for specialists in the field, and here in particular a survey of manuscripts along with an analysis of the transmission. While it does not move into a full stemmatic analysis or complete critical edition, which would not have been feasible within the limits of a volume, the content suffices to present an overview and general tendencies. This occasionally list-style content is based on extensive, complex, and certainly laborious research, which also involved autopsies.
Overall, PB-V demonstrates familiarity with the most complex of topics of ancient and medieval medical writings, which then enable him to identify content in John's works that constitutes innovation. Just one example is his mention of a specific type of pneuma, αὐγοειδές, (p. 126). His analysis is not limited to new medical theory or therapeutics: he extends his inquiry into literary form, occasionally comparing John's techniques to modern works of art.
This is not a book that closes the debate. Rather, it opens the topic up for further inquiry, by PB-V and others, over decades to come. A lot more remains to be discovered, both in detail and general trends.
With regard to its potential readership, some parts of the book would be suitable for inclusion on an undergraduate syllabus, other parts for postgraduate studies; some sections are only suitable for experienced researchers. Given that there is at present a distinct dearth of teaching materials for Byzantine medicine studies, this book will support the training of the next generation of researchers. One can also hope that Byzantine medicine will now finally move on from featuring as a brief addendum to studies and syllabi on Greek medicine and be recognized as an independent field of study in its own right.
The book is also beautifully presented with photos of manuscripts, some of which are illuminated. Of particular interest are here technical drawings, which are rarely included in ancient Greek medical writings.
The key advantage of combining entry level with highly advanced and complex content is that it might convince readers to take up studies of ancient and medieval Greek, palaeography and codicology in order to continue the research.
