The Pepagomenos Problem

Formally-dressed 15th C Byzantines.

When Manuel Palaiologos came to the Morea in 1415, he brought with him a doctor, Demetrios Pepagomenos who served as a secretary. This Pepagomenos, a correspondent of John Chortasmenos, is said to have also been a correspondent of John Eugenikos and Bessarion. This Pepagomenos is further identified as the Demetrios Pepagomenos who delivered a monody on the death of Cleofe Malatesta, the wife of Theodoros II, and an author of at least four medical treatises. I resist the idea that these are all the same individual. I cannot definitively prove otherwise, although I can try.

In Mazaris' Journey to Hades, composed in 1414-1415, Mazaris encounters a Dr. Pepagomenos in Hades and has a long conversation in which Pepagomenos mentions two of his his sons -- Demetrios ("Lizard-Eyes"), also a doctor, and the highly ambitious Theodosios ("Little Shit"). Mazaris makes a good deal of humor out of Pepagomenos once poisoning himself, and refers to his stopping bleeding with the herb ox-eye (βοόφθαλμον). The significance of its being mentioned at all lies in the fact that a Demetrios Pepagomenos made a collection of "folk" remedies.

Mazaris' Pepagomenos is sometimes identified with the first Demetrios Pepagomenos here, though that is a problem if Mazaris' Pepagomenos is actually dead. If the death is a literary device, there is no problem. But the Pepagomenos of interest to me is the Pepagomenos who was a friend of Bessarion and Eugenikos, and spoke at the death of Cleofe, who is more often identified as the son of Pepagomenos-in-Hades, Demetrios "Lizard-Eyes" Pepagomenos. (You can see the kind of eyes that were probably meant in Piero della Francesca's King Solomon.)

The Pepagomenos of my interest was a man of wide-ranging curiosity and great empathy, loving, and much-loved by his friends. He wrote a famous treatise on the treatment for gout, which was translated into Latin and printed in 1517 and reprinted as late as 1743. He is an easy writer, concerned for his patient's pain (he used opium, and colchicine, still the drug of choice for gout pain), frequently writing, "Δοκεῖ μοι" -- "it seems to me." He also made a collection of folk remedies, wrote treatises on the feeding and medication of hawks, and on dogs. He seems to have become the court doctor, and to have attended Cleofe's childbirths.

Chortasmenos' letters can be clearly dated to 1414-1415, when their addressee was in the Morea with Manuel II. One of the letters comments on problems that Pepagomenos had had with a patient. Dating the Eugenikos and Bessarion letters is a little more chancy. Their addressee, the doctor and writer Pepagomenos, was most likely to have met Bessarion at Mistra, where Bessarion was only between 1433 and 1437.  At the time of the letter from Bessarion, Pepagomenos' wife has given birth while they were away. It is  possible that this absence, or the first absence, can be identified with some specificity.

On March 25, 1436, the despot Theodoros II arrived in Constantinople on the ship with the bride for his brother Demetrios. Theodoros had come to Constantinople with the intent of remaining as successor to the throne. Four years earlier, his brother, the emperor John, had had a long period of extremely painful and paralyzing illness, possibly an aggravated chronic rheumatism, with extreme muscle weakness, if not actual paralysis.

Accounts from 1437 through 1440 give similar descriptions of a fugitive illness which was diagnosed as gout. I suggest that John had had another grave episode, and of course Theodoros had great familiarity with the family gout, having watched his uncle Theodoros I in his illness and death. A letter from Bessarion to Theodoros while he was in Constantinople remarks on the grand procession with which John had honored Theodoros, and acknowledges that Constantinople had made a great deal of him. Theodoros had found himself quite popular. Bessarion and Scholarios both comment on what a good talker he was -- they seem to suggest discourse rather than conversation -- and, of course, perceived proximity to the throne contributes greatly to popularity.

Theodoros had taken with him an elaborate epitaphios for the tomb of his parents (though his mother was still living) with double portraits of both and sixty-some lines of poetry, all embroidered in gold. I believe he took another present. He took Pepagomenos, the great specialist in gout and treatment of pain. Pepagomenos' treatise on gout is dedicated to "the emperor," and although the emperor is unnamed and the dedication gives no hint of identity or of illness, I suggest that Pepagomenos dedicated his treatise to John. There is no evidence of this, only coincidence, but a great deal of Byzantine history is written on coincidence. I also believe that Pepagomenos was unwilling to leave his pregnant wife in Mistra without good medical care and took her with him to Constantinople where his skill did save her life and that of their child. It was a boy: Bessarion's letter tells of the delight when they learned about it in Mistra.

Bessarion's moving letter compliments him on the survival of his wife and son: Pepagomenos had written Bessarion about his concerns, and then Bessarion praises the exceptional -- equal -- relationship between husband and wife. But there is another aspect to Pepagomenos writing Bessarion about those lives saved from a dangerous childbirth. They had both spoken at the memorial for Theodoros' wife, Cleofe, who died in childbirth, together with her child -- in Pepagomenos' care. Both friends had shared a specific and terrible loss, which could not have been away from their minds with this new pregnancy. 

And the warmth and affection of Bessarion and later of Eugenikos for Kyria Pepagomeni and the boys contrasts strikingly with the fact that Theodoros has left in Mistra his eight-year old daughter, Helena, and has no intention of returning. Perhaps he thought John would die soon, he would become Emperor, and he could then send for her, but her later life was not the life of a person who had received much affection as a child.  

It fits with what we learn of Pepagomenos from these letters that it was he who gave Helena, "your dear child who weeps for you bitterly," more than a bare mention at her mother's memorial -- "Your beloved daughter mourns you, bereaved of her dear mother at so young an age, at a time when she most needed you, and required your instruction and advice, who have left her with no maternal consolation."  He was the one who described the quality of companionship in marriage that Theodoros and Cleofe had achieved, who described Cleofe  visiting the poor, taking firewood, and fixing food for them -- "taking no account of the heat of the fire, the intense burden of the smoke, and the inescapable duration of this service," giving assistance to widows and strangers. He was the one who noted that Cleofe made marriages possible for women of the court.

While Papagomenos was away on another trip, he left his sons with the Eugenikos family.  John Eugenikos is said to have been at Mistra between 1439 and 1447, which somewhat suggests a date for the trip. (Cleofe and Bessarion were gone when Eugenikos arrived: his presence must have been a great joy to Pepagomenos and Theodoros.) A manuscript in Pepagomenos' handwriting, containing his own writings and others that he copied -- surely in Constantinople -- can be dated by the watermarks on the paper between 1437 and 1444, which focuses the date a little more.  His wife was with him on this trip, too.

John Eugenikos compliments the excellence of two boys, calling them "that pair of ours, and especially Nicholaos" (there was a remarkable and brilliant Nicholaos Pepagomenos in Constantinople in the 14th century), and then he compliments their mother's excellence and intelligence, and again, the relationship between husband and wife. In another letter, Eugenikos describes a group that he had invited to hear a new letter from Pepagomenos that had brought spring to their winter. (This is a topos in Byzantine letters, but that does not mean that it was not winter.)  He included "our good Nicholaos" and his friends in the audience -- it looks as if Nicholaos was the older son. (I think -- can't prove -- that the younger was Giorgos.) 

Everyone was tremendously enthusiastic about the letter (this is a topos in Byzantine letters, too),  then Nicholaos and his friends took the letter, "treating it lovingly," and tried to work it out for themselves. Their Greek had not yet become Byzantine. It is an appealing glimpse of Mistra life, the circle of friends including the boys in their reading. All three of these letters reveal a warmth in relationships that -- if it existed -- is concealed in the pompous oratory and discourses on Athenian history and the Muses in the letters of Chortasmenos. These are letters from different generations, from different cultures. (Chortasmenos taught Bessarion in Constantinople: the generation difference is clear.)

[LATE NOTE: I have learned that Eugenikos was not in the Morea between 1430 and 1440, so if Theodoros took Pepagomenos to Constantinople in 1436, the boys were not with Eugenikos that year.]
 

Unusual for a name that shows up over and over, Pepagomenos seems not to have been a name involved in political matters, or representing one court or another in the West, and mercifully he left no letters of advice to emperors or disquisitions on the Procession of the Holy Spirit.  He hasn't left any letters at all, which is only to be regretted. He seems to have died about 1450.

Possibly the doctor and writer Pepagomenos who interests me is the same individual who accompanied Manuel and corresponded with Chortasmenos. If the sons of Mazaris' Pepagomenos-in-Hades were adult in 1415, the older son Demetrios is a much more reasonable candidate. However, other than the coincidence of name, there is no positive evidence. That a Demetrios Pepagomenos corresponded with Chortasmenos, and a Demetrios Pepagomenos corresponded with Bessarion and Eugenikos, does not require belief that they were the same Demetrios Pepagomenos. 

I have several publications on my desk on Demetrios Pepagomenos.  I have the PLP and the ODB which give the bones.  I have four articles that discuss the manuscripts associated with the medical writer Demetrios Pepagomenos, and I needed those articles, particularly the splendid one by Lazaris,* to overcome my unhappiness at finding an important source described as "oral tradition." I have the Greek, Latin, and French versions of his book on gout, and the Greek of his collection of medical cures.  Assorted texts mention him as one of the intellectuals at Mistra. Nothing considers him as a human being and an exceptionally humane one.  But if you look at the character of Demetrios Pepagomenos, Bessarion, and Cleofe, you could really believe that for a brief shining hour, Mistra lived an ideal.

*  S. Lazaris. "La Production nouvelle en médecine vétérinaire sous les Paléologues et l’oeuvre cynégétique de Dèmètrios Pépagôménos," in M. Cacouros & M.-H. Congourdeau, eds., Philogophie et Scences à Byzance de 1204 à 1453. Actes de la Table Ronde organisée au XXe Congrès International d’Études Byzantines. Leuven 2006: 225-267.

The Doctor: Part Two

1431, Pseudo-Apuleius, Bodleian Library

I wrote here earlier about Dr. Pepagomenos' treatment for gout, and I also wrote up what is known about him, including the fact that he attended Cleofe Malatesta Palaiologina in childbirth and was one of the speakers at her memorial service.  I recently came across a small Italian publication of his notes on medicine, a collection of mostly short paragraphs on drug treatments for specific conditions.

Some of these are copied from Dioscorides, or Galen, or Paul of Aigina, and some appear to be notes he collected from informants.  The first two notes of the book, printed here in Greek and my translation, are what Pepagomenos included on childbirth.

Ἰατρικόν. Παρασημειώσεων τοῦ μακαρί του Πεπαγομένου ἐκείνου.

1. Πρὸς τὸ γεννῆσαι ταχέως γυναῖκα: κολίανδρον κουκκία ια’ δήσας εἰς πηνίον δίδου παρθένῳ κόρῃ, καὶ δησάτω ταύτην εἰς τὸν μυρὸν τῆς τικτούσης, καὶ μετὰ τὸ γεννῆσαι εὐθέως λυσάτω. ‒ ἐκ σμιλακίων ποιήσας στέφανον ἐπίθες ἐπὶ τὴν κεφαλὴν τῆς τικτούσης καὶ εὐθέως τέξεται.

2. Πρὸς δεύτερα γυναικός: παγούρους ποταμίους θὲς ἐπ´ ἀνθράκων καὶ ὑποκάπνισον αὐτήν, ἀγριοκαννάβου ῥίου δίδου πίνειν νῆστις.

Medicine. Notes of the blessed [late] Pepagomenos.
1. For a woman to give birth quickly: bind 11 coriander seeds on a spool; give it to a young virgin girl [who] should bind it on the thigh of the woman in labor. After she gives birth, unbind it quickly -- put a crown of smilax cuttings on the head of the woman in labor and she will give birth immediately.

2. For a woman’s seconds [afterbirth]: put river crabs on charcoal and smoke her, give [her] fasting a drink with grated cinnamon wood.

These notes say nothing about what he actually did in his own medical practice and if any readers know of crabs in the river Eurotas, I would appreciate being informed.  The two prescriptions here are harmless and non-invasive. There are vague, associative, reasons for the use of each of the herbs, but possibly not in the forms prescribed.

Coriander, of which there is a contemporary image above, was considered stimulating, and was used for inducing menstrual cycles and reducing pain.  Smilax, taken internally, was an analgesic for painful menstruation, and for urinary tract infections. Cinnamon was used for nausea, menstrual cramps and heavy menstruation, among other things.  I can imagine that the crown of smilax had some association to crowning.

The book is Demetrio Pepagomeno, Prontuario Medico, ed. Maria Capone Ciollaro. Hellenica et Byzantina Neapolitana Collana di Studi e Testi. Naples, 2003.

The Emperor in Pain: Part Two

I wrote earlier about the physical pain suffered by John VIII. This entry is going to be about John's salad and why his brother Theodoros wouldn't go to bed with his wife. 

Look at this picture of John's right ear, made in Florence 1439, when we know he was in severe pain:

I didn't see it at first, but Dr. Tom Morgan, with whom I was consulting about the reported incidences of gout among the Palaiologoi,wrote me about the earlobe:  "Several people to whom I have shown the images believe that there is a round swelling in the posterior, lower earlobe. What this may be is a gouty tophus, that is, a collection of uric acid crystals with surrounding inflamed, swollen tissue."    

Dr. Morgan summarizes gout this way: "Gout is due to abnormal production of uric acid from the diet and thus to increased amounts of uric acid in the bloodstream. The uric acid forms needle-like crystals especially in the joints and kidneys.  When the needles occur in the joints - especially in the great toe [podagra] - pain, often severe, and swelling occurs. The slightest movement induces severe pain; not only in the feet but also in the hands, wrists and elbows. The pain is episodic and debilitating and may be accompanied by fever and malaise. Ingestion of meat (especially kidney, brain, pancreas) and alcohol leads to high levels of uric acid and precipitates attacks."  

The same feature can be seen on the earlobe of the bust Pisanello made of John the same year, 1439. John was diagnosed by contemporaries as having gout, as was his uncle Theodoros I of Mistra, and his younger brother Andronikos who died of it in his twenties. 

On July 27 of that year, John -- with quite a large entourage -- was returning to Florence from a religious pilgrimage, which is shown on the reverse of the medal Pisanello also designed.  They stopped in Pistoia and asked Giovanni di Pigli for a place where John could rest and get something to eat.  Giovanni wrote down what happened that day, commenting that John had difficulty walking:

"And note, the first food the Emperor ate was a salad of purslain and parsley, with some onions, which he himself wished to clean. After that there were chickens and pigeons . . . As the dishes came, they were all placed before him, and he took what he wanted, and sent them along to the others. His last dish was eggs thrown on hot bricks where the other things were cooked."  

You may be asking just what the salad and the gout report of 1439 have to do with Theodoros' private life which centers on 1421.  John's earliest reported episode of gout was in 1432 so he can be discounted for a while. Recall that Theodoros was sent to Mistra in 1407 at the age of 10.  His uncle Theodoros I, Despot of Mistra, was dying in extreme pain from gout so the child was able to watch the sores, the smells, the excruciating pain, and know that this is what happened to people in his family. His brother, Andronikos, despot of Thessalonike, suffered extremely from gout.   Andronikos had a son, although we don't know how old he was when that happened, but in 1421 he was 21 years old.  [Late correction:  Andronikos actually didn't have gout.  Read this.]

In 1415, their father Manuel had visited Andronikos in Thessalonike, and then Theodoros in Mistra.  Traveling with him was the doctor Demetrios Papagomenos, a specialist in gout, and respected enough that his treatise on gout -- written at Manuel's request -- was continually printed, first in Greek and Latin in Venice in 1517, and then steadily afterwards in various translations for the next 250 years.  Manuel left Pepagomenos in Mistra to be court physician for Theodoros.

We can be absolutely positive that two of the books Theodoros owned and read thoroughly were Pepagomenos on gout, and his father on marriage. The combination would have been anything but encouraging to a young man. This is where the salad and Theodoros' marriage come together.

Pepagomenos' treatise on gout is about prevention and probable cure.   Cure consisted of planned vomiting, purging, and bleeding -- getting the bad humors out of the body.  Prevention consisted of a light diet, with a lot of green leafy vegetables and avoidance of meat and wine.  Eggs were fine.  (See what John was eating above.) And avoidance of excess sexual activity because -- I love this -- the motion required in sexual activity shook up the little particles in the body and precipitated them into the legs and joints.  Pepagomenos didn't specify what excess might mean, but he himself was married and had two adult sons, so the average intuitive person might have drawn reasonable conclusions from that.

But Theodoros, on the other hand, who was raised by clerics and intellectuals in an all-male environment -- except for  the cleaning women and laundresses -- learned nothing of marriage but a great deal about how to be a hyper-intellectual.  The poor man was set up to make the decision in 1421 -- perfectly rational from what he knew from books -- that sex, even in marriage, was something he could not do, if he was to avoid his uncle's fate. There is no doubt that he was encouraged in this by his religious advisors, particularly John Eugenikos who for reasons unclear to me is highly regarded even today as an intellectual but who totally opposed any Union of the churches, and who -- after Theodoros had married Cleofe and had a child -- was still encouraging him to take monastic vows.   (All wrong.  I have learned too much about Eugenikos.)

Sometimes these Mistra people are enough to make you want to forego the intellectual thing altogether.

We also have a letter from Battista (#3) reporting that Theodoros had said he would not have sex with Cleofe and he would not eat meat.  She seemed to have learned this at least second-hand, and by word-of-mouth, so the reasons might not have filtered through, or been understood.  But Theodoros who as a lonely child had watched the extremes of gout was desperately afraid.  This is, to be sure, another reading of the not-eating-meat statement which is conventionally interpreted to suggest that meat inflames sensual passions, but I have come to think that too simple an explanation.


The writing of history depends on survivals, coincidences, intuition, likelihood -- and faith that all of those can, together, make sense.

My gratitude to Vittorio Volpi, incomparable librarian in Iseo-Brescia, for tracking down those Pepagomenos PDFs for me.