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The meaning of the nursing in Byzantium.


History, which is a guide to the future, reminds us that ancient Greek civilization influenced medical care according to the prevailing mode of living, and remained unchanged until the time of Christianity. Greece, having accepted the Christian religion, urged women to follow the teachings of St. Paul and faithfully practice his doctrine. Married women, widows, and virgins offered their services in palaces which they changed into hostels, abandoning their luxurious life and the social customs of that period (Hellenic-Roman) for the simple life of a deaconess [1].

The Byzantine era began with the transfer of the capital of the Roman Empire from Rome to the site of ancient Byzantium on the Bosphorus in the year A.D. 330. The new capital was called Constantinople, after its founder the Emperor Constantine, I (324-337) [2].

Despite the transfer of the capital from Rome to Constantinople, Greek Christian civilization preserved its focus on care for the needy in the monasteries of the Byzantine period [3]. Deaconesses also cultivated the spiritual legacy of the Byzantine Empire, copying on papyrus the teachings of the Fathers of the Church, and the teachings of Hippocrates, leading a rich and calm life [4]. Empresses like St. Helen and Theodora, as well as humble deaconesses, gave care to the needy in the monasteries of the Eastern Orthodox Church and tended those who entered their hostels, homes for the poor or aged, maternity homes, and orphanages, demonstrating interest in community and social welfare [5].

The purpose of this study is to describe the meaning of nursing care in Byzantine times. Historical research was used in this report. A special sorting system was developed for the recording of the gathered material, and the elements were placed in special dossiers based on chronology and the source of origin.

The meaning of nursing care in Byzantium

Byzantine care constitutes a unique example not only for the medieval period but also for the whole of human history and civilization. The Byzantine period is specifically of interest for its approach to social welfare and organized care for the sick, the elderly, mothers, and children [6]. There were innumerable hostelries, Xenones (hospitals), nursing homes, leper homes, maternity hospitals, and infant and children's centers that not only cared for the sick and the suffering but also taught medicine and health care [1, 7].

Nursing care was administered mostly by nuns and monks as a form of prayer and as an expression of love and worship of God. On this basis, nursing developed into a calling and a sacred service. Nursing was practiced as a form of contemplation; nurses were expected to see God in the person of the patient [6, 8].


Selected writings from the 8th and 12th century A.D. show the philosophy of patient care in Byzantine period. A passage from the writings of Theodore Stoudites describes nursing in this perspective. Theodore Stoudites, born in 759, in Constantinople, which included a hospital, dedicated the following iambus, "To the Nurse": It is a sacred thing to bear the load of the sick. Since you are honored with this sacred privilege, my son, do struggle warmly and eagerly in the accomplishment of your duty. Early in the morning, first, visit and care for your bedridden patients, heat them mainly by your words, later serve them their appropriate diet in good manner and kind talking. Don't neglect the patient, because he is a member of Christ. If you care for your patient with zest and promptitude, you will be greatly rewarded by receiving the divine light, and heaven's inheritance [9].

Writings by Anna Comnena are representative of the care the sick and disabled received at that time. Anna Comnena (1083-1148), daughter of the Emperor Alexius I Comnenos, was a famous historian who had "an unusual interest and gift for medical matters." Anna Comnena is considered "the first woman historian," and has been characterized as a "great historian." She gives a picture of patient care, likely using a metaphor from the Book of Job, during her father's dynasty: I, myself have seen an old woman, being served by a young lady, a blind man directed by a man with healthy sight, a crippled person transported by a healthy person, an armless man guided by other men, orphan babies carried in the arms of others unrelated to them, mothers, and paralytics being cared by robust people [10].

Professional nurses were employed beginning at the end of the 4th century AD. Men were called hypourgoi and women, hypourgisses. Nurses were also called nosokomoi, and their assistants, paranosokomoi. The term Nosokomos was also used for the administrative director of the hospital. These were people with high social status [11].


In addition, Gregorios Theologos, in his sixth letter, provides a detailed description of the duties of a nurse [12]. St. Basil the Great refers to penances (Epitimia) and Theodore Stoudites described various punishments (poines) that were imposed on nurses if they failed in their duties. Thus, a nurse who did not offer what she should received the punishment of 50 kneelings. She had to eat only dry bread, and was excommunicated for one day [9, 13].

Nursing care in Byzantine hospitals

The fact that nursing evolved as a form of loving care during the Byzantium is easy to explain. Philanthropy and the duty to care for the sick, the poor, and the needy were features of Christianity. Jesus Christ was referred to as "Christus Medicus" (Christ the physician, who, taking pity, heals us through his own body and blood with the medicine of life) [14]. Bishops were healers of the soul as well as of the body [15].


Byzantine hospitals and other philanthropic institutions were mostly annexed to monasteries, and they were kept up by donations from emperors and other eminent persons [16]. Hospitals were so well organized that they can be compared with contemporary ones. Major hospitals of Byzantium included the following: Sampson's hostelry, the Basilicas in Cappadocia, established by St. Basil, which included a number of hospitals, leper homes, poor houses, and other institutions, Pantocrator's Monastery hostelry, and St. Irene's hostelry [17]. Byzantine hospitals were mainly for the poor. There were, however, some exceptions. The Emperor Justinian was hospitalized in the Samson Xenon (6th c. AD), and the Emperor Alexios in the Xenon of Magana (12th c. AD) [18].

In Byzantine hospitals, patients were cared for with humanity. The Typikon of the Xenon of Theotokou of the Evergetidos in Constantinople (7th c AD) notes: "We must care about the food, the drinking and the other needs of the patients ... the doctors should visit the patients every day and look after them wholeheartedly" [1,19].

In the Typikon of Theotokou Eleousas in Stroubitsa of Skopia (11th c AD), the following words are found: "You should console the needy and treat the patients at your best. You should behave to all with kindness. You should also treat the invalid at your best. You should not make fun of the feeble-minded. And kick out the fear from your soul." [1, 19].


During the Byzantines times, there was a great action concerning the health care. The main factors of the welfare development were the Greek Education, as well as the Christian values. Under this prism, it is obvious that there was a great respect for the patients, and the institutions for them were the main point of the welfare for the patients. The main purpose of the homes for the sick people was the health care, and nurses provided systematic patient care. Since the nursing has expanded and developed, into a science and into a profession for making a living, practiced by nurses who are not necessarily religion-oriented. However, there are also religious orders practicing nursing as a way of dedication to God. Modern nursing continues to draw much of its spirit, its philosophy, and its leading values from the Christian religion.

Conflicts of interest

We declare that we have no conflicts of interest.


[1.] Kourkouta LI. Nursing in Byzantium. PhD Thesis. Athens University, 1993.

[2.] The Cambridge Medieval History. The Byzantine Empire. Cambridge University Press. Cambridge, 1996. (Greek translation). Melissa, Athens, 1979.

[3.] Baynes NH, Moss H.St.L.B. Byzantium. An Introduction to East Roman Civilization. Oxford University Press. Oxford, 1961.

[4.] Konstantellos DJ. Byzantine Philanthropy and Social Welfare. Fos, The Social Action Council. Athens,1986.

[5.] Messolora AJ. A brief history of the evolution of Nursing in Greece. Hellenic Red Cross. Athens, 1967.

[6.] Lanara V.A. Heroism as a Nursing Value--A Philosophical Perspective. 2nd reprint. Athens, 1991.

[7.] Runciman S. Byzantine Civilization. The World Publishing Company. Cleveland, 1967.

[8.] Pournaropoulos G.C.A Brief History of Hospitals in Greece in Ancient Times and the Middle Ages. Atti Del Primo Congreso Europeo Di Storia Ospitaliera, 6-12 Giuno 1960.

[9.] Studites Th. Patrologiae Cursus Completus. Series Graeca. J.-P. Migne, Paris, 1860; 99, 1741.

[10.] Comnenae A. Alexiadis. Ludonicus Schopenus. Bonnae, MDCCCLXXVIII, 347-8.

[11.] Kourkouta L. Working conditions and duties of nurses in Byzantium. Int Hist Nurs J. 1998 Autumn; 4(1): 32-4.

[12.] Theologos G. Patrologiae Cursus Completus. Series Graeca. J.-P. Migne, Paris,1860, 221, 252.

[13.] Basil the Grate. Library of Greek Fathers and Religious Writings. Apostolic Deaconate. Athens, 1976.

[14.] Allan N. Hospice to hospital in the near east. Bull Hist Med. 1990 Fall; 64(3): 446-62.

[15.] Kourkouta L. Some details of the administration and functioning of the Byzantine hospitals. Int Hist Nurs J. 1997 Autumn; 3(1):79-85.

[16.] Kourkouta L, Lanara VA. Terms used in Byzantium for nursing personnel. Int Hist Nurs J. 1996 Autumn; 2(1): 46-57.

[17.] Miller TS. The birth of the Hospital in the Byzantine Empire. Johns Hopkins University Press. Baltimore, 1984.

[18.] Miller TS. Byzantine Hospitals. Dumbarton Oaks Papers. 1984; 38: 53-63.

[19.] Volk R. Gesundheitswesen und Wohltatigkeit im Spiegel der Byzantinischen Klostertypika. Munchen, 1983; 39-225.

Kourkouta L. (1)*, Plati P. (2), Ouzounakis P. (3)

(1) Nursing Department, Alexander Technological Education, Institution of Thessaloniki, Greece

(2) Department of History and Archaeology, University of Ioannina, Greece

(3) Universtity Hospital of Alexandroupolis, Greece

* Corresponding author:

17 Diocharous Street

16121 Athens, Greece

Tel: 2114018603

E-mail: Laku1964@Yahoo.Gr (Kourkouta Lambrini)

Received: 26.05.2012

Accepted: 25.06. 2012
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Author:Kourkouta, L.; Plati, P.; Ouzounakis, P.
Publication:Progress in Health Sciences
Article Type:Report
Geographic Code:4EUGR
Date:Jun 1, 2012
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