Nephrol Dial Transplant (2001) 16 [Suppl 6]: 2–3

Joannes Zacharias Actuarius. A witness of late Byzantine uroscopy, closely linked with

A. A. Diamandopoulos

Renal Unit, St Andrew’s State Regional Hospital, Patras, Greece

Introduction Material

I choose to speak in this Congress about Joannes From all of Actuarius’ writings, I will elaborate on his work Zacharias Actuarius, the famous Byzantine doctor ‘Peri´ ou´rvn’ (On Urines) [2] which is an extended treatise on of the 13th–14th century AD, writer of an extensive uroscopy, i.e. the macroscopic examination of the urines, in treatise about the urines, and linked with Thessaloniki, order to reach a diagnosis and prescribe the appropriate the host city of our congress. He was born c. 1275 and treatment [3]. My comments are classified in two parts. The died c. 1328. He studied medicine in first comment describes the literary character of the treatise, while the second is concerned with the medical value of it. and from a letter of his friend Georgios Lakapenos in (i) Joannes’ writing style is very attractive but never over- 1299, we learn that John was considering moving to sentimental. The language he used was rather archaic, a Thessaloniki. We do not know if he had family links revival of Classical Greek, a style distinct to the aristocracy with the city, but Lakapenos discouraged him and of Constantinople and quite different to the everyday tongue suggested to stay in the capital and to work his way of the people. He himself apologizes for his love for beauty, towards the top of the profession. In Thessaloniki he which distracts him from his main theme in writing the book would not have the appropriate opportunities for this on uroscopy. I quote: ‘As it happens with the ardent spec- pursuit, as his friend wrote to him [1]. He stayed in the tators, whenever they enter a house, they don’t examine only capital and later he was appointed chief physician to the necessary elements, like foundations, and arcades, and light the Emperor. During the widespread rivalries between bearing columns [...], but also anything from an easily shaped beauty that was probably added to it, either by different designs the members of the ruling dynasty, Joannes was and paintings and transparent floors; something similar attached to Emperor Andronicos’ II party. However, happened to me having studied not only the necessary about his main patron was Grand Dux Alexios . the (medical) art, but not least I have offered as a safe base Joannes dedicated his work De Methodo Medendi (The for the lectures the beauty (of the speech)’. The widespread Therapeutical Method) to him as a companion manual eloquence of Joannes style, combined with his strong during his campaign to South Russia. Thessaloniki, the Christian belief, led him to an abundance of comparisons host city of our congress, comes again into the scene. between the body’s several functions both in health and Apokaukos had appointed his son Ioannes Apokaukos disease and the greater celestial and earthly worlds. This governor of the city. Due to his administration, a intellectual scheme was an expression of the overall paral- disastrous civil war started there and terror reigned for lelism in the Byzantine thinking between microcosm and macrocosm [4]. Acturius e.g. writes: ‘Because it has also been months. Seven years after Actuarius’ death, his patron said that during obstructions the excreted urines may appear to Alexios Apokaukos was killed in jail. It looks strange be thin, it is worth mentioning the presumed causes. [...] at first sight that Joannes managed to preserve his Because whenever some people had a muddy and thick wine, scientific productivity in such a turbulent period. On they had passed it repeatedly through a straining cloth, and second thoughts, it is not a paradox. True scientists are satisfactorily thinned it, having taken away the thickness not compulsorily sidetracked be the events of the day, through the passage, [...] similarly, it must be considered that as serious they may be. Let us not forget that William the same may happen if during obstructions in any quarter the Kolf made his milestone discovery of the artificial urine is seen thin, [hence] someone would rather blame the kidney machine during the Second World War while material obstructing the passages than a metabolic disorder’, Holland, his country, was occupied by the German and further ‘Already, due to the excess of heat (during vig- orous exercise) the color of the urine turns to reddish or yellow, troops. because the mixing sap is diminishing, while the bilious sap is increasing [...]. Exactly, as it usually happens in con- Correspondence and offprint requests to: A. A. Diamandopoulos, flagrations, it suffice the materials to be accumulated, and if Renal Unit, St Andrew’s State Regional Hospital, Patras 26500, moreover some external movement is added, then easily the Greece. materials are inflamed and set the whole lot in fire; readily also

# 2001 European Renal Association–European Dialysis and Transplant Association Joannes Zacharias Actuarius 3 the thrown upon additional material is spent. But if there is not granular deposit in haematuria as a result of primary renal any additional external movement, it is difficult to burn the disease as opposed to that as a result of fever from systemic offered material. [...] Something similar usually happens to diseases. He noticed that the sediment may not settle in the the people who take exercise and to the sedate ones. Hence, the bottom of the amis (the examining bottle, which he was the color of urines turns towards the white in the case of those who first to insist that it should be made from an excellent quality live a lazy and quiet life. And the residual of their urine is of glass) but that it may fluctuate. He, very correctly, noticed larger and looks coarser, because in the case of sedateness the that the more severe the disease or the fever (causing pre- delivery and alteration of (undigested) material is easy, while sumably heavier proteinuria and a higher specific gravity), the digestion (is promoted) if there is an excess of heat.’ the higher these formed elements stand in the amis. When Another underlying reason for these parallels was the the disease subsides (and hence, proteinuria decreases) the attempt of ancient and medieval medical writers to explain sediment precipitates. Another novel observation was that the physiology of body function. Experimental physiology, if the external temperature changes, then the thickness biochemistry and other medical methods for a closer and translucency of urine also changes. The same happens, observation of the body’s interior had not be invented. as he noticed, when we artificially warm the urine in order Hence, metabolism and the product of body waste, to examine their properties, a technique thought to be predominantly urine and faeces, could not be understood introduced initially by Richard Bright [7]. in any other way than by comparison with what was Acturius enthusiastically praised the use of uroscopy in happening in the external world. foreseeing the outcome of any disease. He followed on this (ii) The treatise is expounded in 270 pages and is divided the doctrine of the Byzantine poet philosopher and politician into seven entities, called ‘logoi’. The first logos relates the of the 11th century Michael Psellus, who in a poem of his different kinds of urines, the next two logoi regard the dia- wrote: ‘[...] and uroscopy frequently suffices to show the gnostic values of uroscopy, the fourth and fifth are concerned future as the Pythian tripod’ [8]. with the aetiology of urinary abnormalities in different diseases, while the sixth and seventh logoi explain the use of uroscopy in prognosis. Each logos is subdivided into roughly 20 chapters. The last chapter of the seventh logos is Conclusions practically a summary of the whole treatise. It is impossible to try to write even an abstract of each chapter in this short Joannes Zacharias Actuarius, was a characteristic paper. I have undertaken to write a small book on the subject product of his era. Intellectual, politically involved, that will be presented at the 5th BANTAO Congress in admirer of the classical wisdom and simultaneously Thessaloniki. Hence, here I shall only attempt to focus on the essential mechanisms of Actuarius’ medical thought, which deeply Christian, an esthete and a down-to-earth were the basis for his theories about uroscopy. observer of the human excrements, he epitomized Joannes Zacharias was upholding the ancient medical what was thought to be the ideal physician. Even writer’s ideas about the four humors. He classified the three nowadays we recognize that many of his ideas were kinds of digestion, but added a fourth one, corresponding novel, with a ‘modern’ trait of clarity and precision. with the transformation of blood to flesh [5]. The urines are considered the products of the third digestion. He also elaborated on the differences of the urine’s characteristics between male and female healthy persons and also, on the References influence of bodily and environmental temperature on urines. He repeated all the accumulated knowledge about the physi- 1. Hohlweg A. John Actuarius’ de Methodo Medendi. In: ology of urine formation, and also adhered to the classi- Scarborough J, ed. Symposium on Byzantine Medicine. fication of urines according to their colour. He differentiated Dumbarton Oaks Papers, Washington, Columbia, 1984; 121–133 between nine different basic colors that were multiplied 2. Joannii Actuarii, De urinis. In: Ideler JL, ed. Physici et Medici by three, as he added to each colour a darker and lighter Graeci Minores, vol. 2. Reimer, Berlin, 1842: reprint Hakkert, version. Basically, he suggested that normal urines are of Amsterdam, 1963 3. Diamandopoulos AA. Uroscopy in Byzantium. Am J Nephrol a yellowish colour and any variation towards the darker 1977; 17: 222–227 side was a result of the excretion of abnormal metabolic 4. Diamandopoulos AA, Goudas P, Diamandopoulou AH. The products, while any variation to the lighter side was a result human skin: a meeting ground for the ideas about macrocosm and of either a weakness of the body to create the normal end- microcosm in Ancient and Medieval Greek literature. Vesalius, stage metabolic products, or to the inability of the kidneys 2001, in press to excrete them. The Arab writers influenced Joannes in 5. Dambasis I. Ioannes Actuarius. Iatrika Chronika, 1966; vol. 7: 206 his theses, and certainly he was aware of Ibn-Sina’s tract on (in Greek) urines, whose translation he improved. It is worth mention- 6. Touwaide A. On uroscopy in Byzantium. In: Diamandopoulos AA, ing that a copy of this Ibn-Sina’s translation was originated ed. The History of Greek Nephrology. Papazisis, Athens, 2000; 218 7. Wershub LP. From the antiquity to the 20th century. In: Green W, in the 14th century at Thessaloniki, the city so closely ed. History of Urology. St Luis, 1970; 124 linked with Actuarius world; now it is kept in Rome [6]. 8. Mixag´l Yellou´, Po´ngma iatriko´n a´ristondi’ ia´mbvn (Michael A novel contribution of Joannes was his detailed study Psellus’ An excellent medical work in the iambic manner), 11th about the diagnostic and prognostic value of the urine’s century. In: Ideler IL, ed. Physici et Medici HGraeci Minores. sediment. He made a brilliant distinction between the Berolini, 1841; vol. 1: 202