How do you wash your hands without antibacterial soap? How do you maintain your teeth without a
dentist? The Byzantines found a way, with wave after wave of Black Death and Leprosy — all of
which spread through the empire with no cure to be found. In a society like that, you can bet there
were all sorts of ideas on what constituted “good” hygiene and what could help someone stay healthy.
Welcome back to Nutty History. Today, we’ll be going back to the ancient world
and looking at the hygienic practices of the Byzantine Empire. Like what you see?
The Byzantines believed that to stay healthy you had to keep the body’s “humors” in balance.
Now, in the first century, this didn’t mean being able to laugh at Constantine The Great’s
jokes. The Byzantines believed in the Hippocratic Theory, first developed by the Greeks. The theory
was that the body consisted of four “humors'': blood, phlegm, yellow bile, and black bile. If
you were ill, that meant that one of your humors was out of balance. Let’s talk about blood first.
Anything wrong with your blood was considered the fault of your diet and what your body did with it.
Blood was also considered to be affected by the other three humors. Essentially, if your blood
was out of whack for any reason, the physicians would prescribe a better diet of some sort,
in conjunction with trying to fix anything out of sorts with your other humors. They would encourage
the washing of fruits and vegetables, in order to prevent any actual bugs or microscopic bugs,
as we know them today from entering the system. In order to access blood, physicians would have
to wash their hands before each procedure. Today, that seems like common sense, but in the Byzantine
empire, it was a new concept. The fact that their advanced hospitals also provided private rooms
meant sanitation standards could be preserved. Each room was cleaned before and after each
patient, for extra hygienic measures. Now, if they found yellow bile, that would be a completely
different matter. Yellow bile would be found in your vomit or…other excrements, or possibly in
the gallbladder (So they say). It was believed that an excess of yellow bile would result in
emotional issues, such as super villain-style anger or asylum-worthy irregularities. To the
physicians at the time, bile showing up like this would mean that they needed to work with someone’s
mind and spirit more than their body. Now, when it comes to hygiene, there are a few ways to deal
with yellow bile. Below, we will discuss how the Byzantine people kept their teeth clear,
perhaps after yellow bile exiting their mouth. They were some of the leaders in oral hygiene.
If it came out the other end, they had that covered as well. They had public latrines, one
of the first in the world to do so, which meant that they did not have to deal with as many issues
regarding excrement in the street. They also had toilet paper, and there are several museums today
that showcase Byzantine toilet paper holders, to keep everything neat and clean. Despite the fact
that there was no electricity or running water, this is a society who was very concerned with
the hygiene of their people, when they were ill or healthy. Phlegm is the third humor, and they
associated it with problems in the brain or lungs. It was thought that phlegm would mean a tumor,
or lesion. The brain is well connected to the rest of the body and physicians at the time would see
this as the worst of the humors. It was associated with wintertime, cold and wet, as well as old age.
While there were many treatments for phlegm, what is interesting is the hygienic measures taken when
it was produced. Patients were encouraged not to cough without covering their mouths,
and to regularly wash their hands when phlegm was produced. Although the empire did not have
the science we know today, they clearly knew enough to know that microscopic particles (or
large bouts of phlegm) could be contagious if the patient was not hygienic about it.
Finally, we have black bile. While not quite as outwardly frightening as a brain tumor,
those with black bile would be possibly diagnosed with a problem with their spleen,
or with cancer, which seems quite a leap. Black bile was treated the same way as yellow bile,
and when in the hospital being examined, these patients were given extra hygienic measures, such
as cloths to cough into or cover their mouths with when around others. All of these humors came with
character traits as well. Those who had red blood were considered friendly, whereas those with black
bile were melancholy. Phlegm made one forgetful and those with yellow bile were bitter tempered.
When you consider what diseases (Even a bad cold!) could go along with these secretions or issues,
the character traits certainly make sense. However, the theory of the humors has been
disproven. The Empire, though, took many hygienic measures, on top of diagnosing what exited their
bodies. Good hygiene meant keeping the four in balance. One of the ways you could keep the
humors in balance was with a sort of aromatherapy. The Byzantines connected the different humors to
elements in daily life like temperature and scent, so to stay hygienic Byzantine gardens would have
specific aromatic flowers that they would distill into fragrant oils. Combinations of these oils
would be dabbed on parts of the body as perfume so that the scents would keep the humors in balance.
Water was an extremely important cure, and was often a part of a physician's
prescription for ailments — as well as for common hygiene! Like the Greeks and the Romans,
public bathhouses were a big part of Byzantine life, with separate areas for men and women.
The key difference between the Byzantines and earlier Greek and Roman civilizations is that
the Byzantines incorporated faith and superstition into these common hygienic practices. While the
Greeks and Romans used perfumed oils to mask bad smells, the Byzantines would distribute
oils that had come in contact with sacred relics and medicinal oils often came in vials with saints
depicted on them to ward away evil spirits and demons, along with any unwanted smells.
Public health became increasingly important to the Byzantines, and throughout the medieval world;
plague after plague will do that to a society. Keeping hygienic during medical practice seemed to
be at the top of their mind. As such, unlike many societies who performed medical services anywhere,
that was convenient such as the patient’s home on the kitchen table, the Byzantines
were actually the first to build functional hospitals throughout the city. At first,
the hospitals were built for the poor to have access to basic amenities such as baths.
The Byzantines understood that in order for general public health to increase,
they needed to provide washing-up access to those that were living without any.
Eventually, these institutions grew to facilities that housed different departments,
outpatient clinics, even small schoolhouses for the children of doctors! For the benefit of the
patients and the poor, each hospital had its own bathhouse, and those who were being treated or
resided there were expected — just like everyone else — to bathe at least twice per week. With more
than just patients having the ability to clean themselves twice a week, those who worked or came
to these hospitals maintained better health than those who did not have access to such facilities.
But to diagnose a patient once they were clean? They’d use a good ol’ urine test. Theophilus
Protospatharius is credited with assigning 20 different urine colors with different ailments.
His development was furthered by John Zacharias Aktouarios who created a urinal vial divided into
eleven different areas. Each area was assigned to a different part of the body, so when diagnosing
a patient he would know which part of the body held an imbalance in the humors. For example,
if the urine was cloudy closer to the top of the vial, he knew the patient was having trouble with
his head. Perhaps a headache? Or a toothache that could be cured with a bath and a gargle
of white wine? With the division of the urinals, hygiene could be maintained between departments.
There is a misconceived idea that the medieval times were somehow a free for all in terms of
personal hygiene. But there is one thing that the Byzantines did that you still do twice a day,
every day, and that is — brush your teeth. Byzantine physicians agreed with the Greeks when
it came to diet influencing your overall health and they recommended milk and cheese to improve
overall health and hygiene. Back then the average Byzantine citizen did not have access to Crest or
Colgate, so 4 out of 5 physicians recommended brushing with dill, and white wine! The most
popular teeth cleaners of the day were white wine, rose water, and lilac tree leaves. A mixture
of egg yolk with olive oil, myrtle, and honey was also recommended as an effective cleaner.
Physicians recommended cleaning the teeth and gums from the internal and external side just
after meals. It makes you wonder if Byzantines were also forgetting to floss after meals as well!
While they did not have any teeth whitening trays in the first century,
people were still striving for pearly whites. Lilac tree leaves mixed with white wine was a
common whitener but for those really stubborn stains, people would use baked and powdered
seashells or bones from large Mediterranean squid. As far as preventing root canals and cavities go,
physicians were more concerned with preventing the toothache that was associated with these ailments.
For that it was — you guessed it — wine gargles; this time combined with horse beans, myrrh, and
cypress leaves. However, physicians warned against swallowing this particular wine-based cocktail.
Unfortunately, all that brushing with white wine still didn’t help the most offensive
element of dental hygiene — bad breath. For this, physicians recommended perfumed essences combined
with more wine gargling. Just as nowadays you would gargle with a minty-flavored mouthwash,
in the Byzantine Empire you would combine Arabian gum or saffron with white wine and rinse with that
for a more pleasant breath. Now, records of this time warn that the combination may cause your
tongue to change color. The alternative to these bitter wine-based mouthwashes were pine needles or
juniper leaves that had been boiled in vinegar, I think I’ll stick with classic mint for now.
As we mentioned before, water was very important to the citizens of the Byzantine Empire.
In addition to being a healing cure, Constantine the Great found a way that
made it key to a relatively clean city, helping Constantinople to flourish in the medieval world.
When Constantine founded the new capital city, he made sure to install a feature that would be
key to preventing disease — sewers. Since Constantinople was founded by the water,
all the sewer drains ended up in the Mediterranean Sea, and Constantine made sure that the city had
a sprawling infrastructure of sewer drains. Some were so deep, you could ride a horse
through them! Not that you would want to. Not only that but according to city records,
there was a distinction between private and public sewer drains, and citizens could
connect their household drainage to the central public ducts — pretty much the same system that
is in place in most major cities today. Legal documents of the city mention the hazards from
organic waste and that it could contaminate the air and was a threat to public health.
There are many ways that the Byzantine empire set in stone hygienic and medical practices that are
still used today. From extensive sewer drains, to keeping disease from infecting an entire city;
to basic dental hygiene it set out a blueprint for preventative medicine
and hygiene that is still used in the 21st century. Did anything surprise you about
the Byzantine’s hygiene? Let us know in the comments below. We hope you enjoyed
learning about the Byzantines, and we’ll see you next time for another Nutty History video!