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Strucni rad

UDK 616. 89 - 008 (495.02)616. 89 (091)

LlKANTROPIJA U RADOVIMA VIZANTIJSKIH LEKARA

Vasitis P. Kontaksakis' , tDzon G. Laskaratos", Panajotis P. Ferentinos',Maria-Irini V. Kontaksaki', Dzordz N. HristoduJu I

lKatedra za psihijatriju, Univerzitet u Atini, Grcka2Istorija medicine, Univerzitet u Atini, Grcka

Apst rakt : Svrha ovog rada je da napravi preg led tekstova 0 Iikantropiji iz vizantijskemedicinske literature i da proeeni njihov utieaj na medicin u od tog perioda do danas . Proucavanisu original ni tekstovi na grckorn jeziku vizant ijskih lekara, kao sto su Oribas ijc (IV vek n.c.), Ecije(VI vek n.e.), Pavle Eginjan in (VII vek n.e.), Pavle iz Nikeje (VII vek n.e.), Mihajlo Pse l (XI vekn.e.) i Jovan Aktuarije (XIV vek n.e.). Autori su, takode, preglcdali i sacuvane lekstovc antickihgrckih i rimskih lekara. Vizantijski lekari su pruzi li detaljne opise klinicke slike Iikantropije, kao ipredlogc za njcno leccnjc. Smatrali su da likantropija predstavlja oblik rnelanholicne iii psihoticnedepresije, a ne da je demonskog porekla, sto je u skladu sa misljcnjcm rimskog lekara MarsilijaSiditskog (II vek n.e.), koji je prvi opisao ovaj sindrom . Stavovi vizantijskih lckara 0 likantropij isu neposredno iii posredno utica li na nacin na koji se arapska iii zapadnoevro pska medic ina kasni­jc bavila tim problemom.

Kljucne re ci: vizantijska medicina, istorija medicine. likantropija, depre sija , melanholi­ja. ps ih oza

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UvodLikantropija je sumanuto uverenje bolesnika da se preobrazava u zi­

votinju, pO tradiciji, u vuka [1,2]. Terminje nastao od grckih reci lyeos = vuki anthropo s = covek. Najraniji opisi ovog sindroma mogu se naci u grckojmitologiji . Poluboga Likaona Zevs je za kaznu pretvorio u vuka, jer je poku­sao da posluzi Zevsa mcsom zrtvovanog mladica [3]. Jedan kasniji opis ovogsindroma nalazi se i u Bibliji. U Prvoj knjizi Danilovoj , Bog je kaznio vavi­lonskog kralja Nabukodonosora tako sto ga je na sedam godina pretvorio uvola [4,5].

Pocetkom XIX veka likantropija je smatrana dusevnim poremecajem[6]. U svetskoj literaturi je tokom XX veka objavljeno nekoliko prikaza slu­cajeva likantropije . Vecina se odnosila na pacijente koji su patili od afektiv­nih iIi psihoticnih poremecaja. Ostali slucajevi preobrazaja coveka u zivoti­nju javili su se kod pacijenata sa drugim mentalnim poremecajima, medu ko­jima su bili poremecaji licnosti , histerija, zloupotreba alkoho1a iii droga, or­ganski mozdani sindromi, demencija i epilepsija [7-11].

Ovaj rad ima za cilj da pokaze da su radovi vizantijskih lekara 0 li­kantropiji obezbedili nove podatke i ponudili jasnija tumacenja ovog stanja;stavi se, oni pruzaju dokaze da je likantropija od antickih vremena smatranadusevnorn bolescu,

Vizantijska medicina, u stvari, predstav1ja nastavak anticke grcke,helenisticke i rimske tradicije u medicini , kao i vaznu kariku koja je povezujesa zapadnoevropskom medicinom na koju je uticala neposredno iii posredno,preko tekstova arapskih lekara. Proucavanje tckstova vizantijskih lekara je odvelikog znacaj a jer vccina nj ih reprodukuje sustinu radova starogrckih lekara,od kojih jc veci deo danas izgubljen, a u isto vreme, daje i svoj licni doprinostemi [12]. Veliki vizantijski doktori, od Posejdonija i Oribasija (IV vek n.e.)do Jovana Aktuarija (XIV vek n.e.), ostavili su za sobom mnostvo klinickihopi sa od znacaja za psihijatriju, koje su preuzeli iz dela antickih lekara, po­sebno Hipokrata (V vek p.n.e.), Galena (II vek n.e.), Areteja (I-II vek n.e.) ,Sorana iz Efe sa (I-II vek n.e.) i drugih. U njihovim delima je, osim likantro­pije , opisan i veliki broj drugih mentalnih porernecaja, kao sto su manija, me­lanholija, katafora (duboka depresija) , frenitis, Ijubavna bolest, inkubus (no­cna mora), letargija, nesanica, senilna atrofija mozga (vrsta demencije) , tro­vanje alkoholom i epilepsija [13] .

MatcrijalPrvi vizantij ski lekar koji se bavio 1ikantropijom nije bio Ecije, kako

tvrde neki autori [14] , vee Oribasije (IV vek n.e .), koji je napisao prvo po­glavlje u vizantijskoj medicinskoj literaturi na ovu temu, pod naslovom "0likantropiji" [15]. Oribasije je pisao da likantropi izlaze nocu, uglavnom sezadrzavaju u blizini grobnica do zore, a njihovo ponasanje je nalik vucjern,Ovakvi bolesnici su mogli da se prepoznaju uz pomoc sledecih znaka i simp­toma: bledi SU, pogled im je prazan, oci suve i duboko usadene i bez suza.

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Jezik im je suv i ne mogu da luce pljuvacku, Uvek su zedni, a potkoleniee suim obicno po vredene jer se cesto saplicu 0 stvari. Prema Oribasiju, ova bolestj e dijagnostikovana kao vrsta melanholije. Lecenje u toku hronicne faze jeukljucivalo smirivanje pacijenta, dugotrajno pustanje krvi dok bolesnik ne biizgubio svest, kupanje u svezoj (ne i morskoj) vodi, a preporucivalo se uno­senje tecnosti, Nakon toga, pacijent je tokom tri dana moran da se pridrzavaishrane zasnovane na obranom mleku i da uzima biljni purgativ sueur, sto jeponavljano tri puta (ukupno devet dana). Korisceno je i bilje pornesano samedom, sto je u to vreme bio uobicajen lek za melanholiju. U akutnoj fazibolesti, u usi i nozdrve bolesnika ukapavana su uspavljujuca ulja koja su naj­ceSce sadrzavala opijum.

los jedan cuveni vizantijski lekar bavio se likantropijom - Ecije (VIvek n.e .), koji je napisao poglavlje pod naslovom "0 likantropiji, odnosnokinantropij i, prema Marsiliju" [16] , opisao je ponasanje bolesnika na isti na­cin kao Oribasije, dodavsi da likantropi lutaju nocu u februaru, oponasajucivukove iii pse. Dao je istu klinicku sliku kao Oribasije, dod ajuci da su ranena potkolenicama nastale kao rezultat cestih padova i ujeda pasa , i da se nemogu zaleciti . On je, takode, smatrao da je ova bolest jedan oblik melanholi­je i predlagao je slican nacin lecenja kao Oribasije. Pridodao je neke novepurgative, kao sto su "sveti lekovi" Rufusa, Arhigena i Justusa. Neposrednopre vecernje krize, on je, takode, preporucivao uspavljujuce i slicne supstan­ee , posebno opijum, koji se davao iii u obliku ulja kroz nozdrve, iii u nekimretkim slucaj evima per os.

Pavle Eginjanin (VII vek n.e.) bio je saglasan sa dva prethodna auto ­ra. Jedno znacajno poglavlje koje je napisao naslovio je "0 likantropiji iliLikaonu" , sto je sa sobom nosilo konotaeije inspirisane grckorn mitologijom[17].

Anonimni pisac [18] jednog poglavlja 0 likantropiji slagao se sa sta­vovima Oribasija i Ecija, i dodao da su likantropi neuobicajeno mrsavi, sto jekarakteristicno za melanholiju. Njihova melanholicna konstitueija je iii mo­dena iii stecena, nastala kao posledica nesanice, stresnih zivotnih situaeija,lose ishrane ili skrivenih hemoroida, a kod zena zbog prestanka menstrual­nog ciklusa. Nacin lecenja ove bolesti se, prema ovom autoru, poklapa saonim za koji su se zalagali raniji vizantijski autori. Takode je preporucivaouopsten o lecenje melanholije, i posebne simptomatske tretmane u slucajuhemoroida (operacija) i menstrualnih anomalija. Na kraju, autor je preporu­civao diuretike i per spirante. Novija istrazivanja [19,20] pruzaju dokaze da jeovaj anonimni pisac verovatno bio Pavle iz Nikeje, cuveni vizantijski lekar izVII veka n.e.

Mihajlo Psel, lekar i cuveni filozof kasnijeg doba (XI vek n.e.), usvoj u pesmu "Carmen de re medica" ukljucio je i opis u to vremc poznatihbolesti [21]. Kratko je primetio da je likantropija ne sarno oblik melanholije,vee i mizantropije, posto je pacijent izolovan od drustva, Bolesnika je opisaokao bledog , potistenog, sparusenog i zapustenog izgleda.

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Poslednji cuveni vizantijski lekar, Jovan Aktuarije (XIV vek n.c .),koji je objedinio znanja svih lekara dugog vizantijskog perioda, bavio se me­lanholijom u poglavlju "0 melanholicnim bolestima" [18]. U opis je uklju­cio i slucajeve pojedinaca koji Sll vcrovali da poseduju bozji dar predvidanjabuducnosti, iii su se plasili bezopasnih svakodnevnih dogadaja, iii bezrazloz­no izbegavali drustvo ljudi iii razgovor sa njima, cutljivi, tuzni i povuceni.Opisao je i druge, koji su se iii plasili smrti iii je prizeljkivali, uz misli 0 sa­moubistvu. Klinicka slika koju je pruzio ista je kao kod ranijih lekara, po­sebno u slucajevima likantropije, Tvrdio je da bolesnici nocu lutaju po grob­Ijima i usamljenim mestima, poput vukova, a preko dana se vracaju svojimdomovima, gde je njihova ponasanje naizgled normalno.

DiskusijaPrvi opis likantropije dao je lekar Marsilije Siditski (tj. iz Sidije,

grada u Maloj Aziji) , koji je bio sledbenik aleksandrijske pneumatske skole iziveo u Rimu (II vek n.e.). Verina Marsilijevih dela je izgubljena. Meduonima koja su sacuvana, moze se izdvojiti njegovo delo 0 likantropiji iii ki­nantropiji. U svojoj knjizi koja je sadrzala razna medicinska misljenja 0 me­lanholiji, Galen je citirao znacajan izvod iz dela svog savremenika Marsilija[22]. Sam Marsilije je likantropiju smatrao jednim oblikom melanholije.

Ova bolest je kasnije smatrana zooantropskim delirijumom, posto jepacijent bio uveren da se pretvorio u vuka [3]. Ovu vrstu transformacije veeje opisao Hipokrat [3]. Bila je poznata i u vizantijsko doba , i veliki vizantij­ski lekar, Aleksandar Tralski (VI vek n.e.), iako nije opisao likantropiju perse, predstavio je nekoliko slucajeva melanholije komplikovane raznim vrs­tama cudnih fantazija [23]. Konkretno, opisao je pacijente koji veruju da sucrepo vi, iii zivotinjske koze , iii petlovi, i imitiraju njihovo kukurikanje. Nekidrugi pacijenti su imali fantazije inspirisane grckorn mitologijom; verovali suda su slavuji koji placu jer su izgubili Itija (rnitoloska licnost) iii da su Atlaskoji podupire nebeski svod, i plasili se da bi on mogao da padne i unisti i njihsame i ceo svet.

Oribasije, koji je sastavio prvi medicinski opis likantropije u vizantij­sko doba, bio je paganin i prihvatio je Marsilijev pristup. Klinicki opis i na­cin lecenja koji su predlozili bili su prilicno slicni, mada su se razlikovali unekim tackama. Medutim, uticaj starih naroda jos uvek je bio ocigledan dvaveka kasnije , kada je hriscanin Ecije gotovo od reci do reci usvojio Marsili­jeve koncepte i etioloski pristup. Marsilije je isticao da je likantropija men­talna bolest, a ne stvarni fenornen, posto je nemoguce da se Ijudsko bice fi­zicki preobrazi u vuka. Bolesnik veruje da se u njemu odigrala rnagicna pro­mena [3]. Prema tome, Marsilije je ocigledno pokusao da obuzda magijskaverovanja svog vremena u korist medicinske realnosti , zastupajuci stay da jelikantropija psihoza, a ne magijski preobrazaj,

Koncept likantropije su kasnije usvojili islamski doktori; prema 001­su [14], iz Ecijevih tekstova. Moguce je, medutirn, da su arapski lekari bili

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upoznati sa ovom temom preko radova Galena, Oribasija, Pavla iz Nikeje, iiicak Pavla Eginjanina, koji su opi sali slicne klinicke slike i cija su dela bilapoznata u islamskoj literaturi. Rad kasnijih vizantijskih lekara imao je snaza nuticaj na medicinske koncepte kod Arapa [24] . Razes je doslovce prihvatiomisljenj a Vizantinaca; drugi su, kao Abulkasis, dodavali neke elemente tera­pije kao sto jc kauterizacija glave , metod koji se nije naIazio u vizantijskimiii Galenovim tekstovima. Drugi arapski lekari smatrali su da jc ova bole stnasledna i tesko izleciva [14J.

Prcma Doisu [14], likantropija predstavlja dobar primer sindroma izovog pcri oda koji su iskljucivo teorijski. Ne postoji nijedan slican opis usrednj ovckovnoj islam skoj literaturi . Prema tome, rnoguce jc da je klinickaslika likantropije izvedena iz grcke medicine [13]. Kasnijc je ovu klinickusliku prih vatila i zapadnoevropska medicina, i to iIi direktno iz vizantijskihmcdicinskih tek stova iii, sto je cesci slucaj , posrcdno, preko prevoda arap­skih tekstova na latinski [13J.

Cini se da je ova bolest, koju karakterisu Iutanje oko grobnica prekonoci i vracanje u svakodnevnu rutinu preko dana, slicna mitu 0 vampirima,koji se moze naci u mnogim kulturama sirorn sveta [25].

Da zakljucimo: mnogi vizantijski Iekari detaIjno su opisali klinickusliku likantropije. Neki osnovni simptomi ovog porernecaja, kao sto je drus­tvena izolacija, rnizantropija, potisteno st i nemar prema spoljasnjem izgledu,ubrzo su ih naveIi da ovo stanje klasifikuju kao mentalni poremecaj , u skla­du sa shvatanjem Marsilija, koji ga je prvi opisao. Preciznije, vizantijski Ie­kari kIasifikovali su likantropiju kao oblik depresije (melanholicni tip, ilipsihoticna depresija). Treba napomenuti da ni Marsilije, iako je bio paganin,ni hriscanski vizantijski doktori, nisu verovali da je ovaj poremecaj magij­skog iii demonskog porekla, vee su smatrali da je rec 0 dusevnoj bolesti.Njihovi stav ovi su neposredno ili posredno utical i na arapsku i zapadnoev­ropsku medicinu.

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General art icle

UDK: 616. 89 - 008 (495.02)616. 89 (091)

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LYCANTHROPY ACCORDING TO BYZANTINEPHYSICIANS

tVassilis P. Kontaxakis', 'J ohn G. Lascaratos", Panayotis P. Ferentinos',

Maria-Irini V. Kontaxaki' , George N. Christodoulou'

IDepartment of Psychiatry, University of Athens, Greece2History of Medicine, University of Athens, Greece

Abstract: The purpose of this paper is to review texts about lycanthropy in Byzantinemedical literature and to appreciate their impact on medicine thenceforth. The original Greeklanguage texts of the Byzantine physicians, such as Oribasius (4th century A.D.), Aetius (6th

century A.D.), Paul of Aegina (7th century AD.), Paul of Nicea (7th century A.D.), Micha elPsellus (II th century AD.) and Joannes Actuarius (14th century AD.), were examined . Theexisting texts of ancient Greek and Roman physicians were also reviewed . Byzantine physi­cians provided detailed descriptions of the clinical picture of lycanthropy as well as sugges­tions about its treatment. They believed lycanthropy to be a form of melancholic or psychoticdepression and not demonic in origin, being in line with the Roman physician Marcellus Sid­ites (2nd century A.D.), who first described the syndrome. The views of Byzantine physic iansabout lycanthropy have directly or indirectly influenced the way Arabic and Western Europeanmedicine have later dealt with it.

Key words : Byzantine medicine, history ofmedicine, lycanthropy, depression, melan­choly, psychosis

IntroductionLycanthropy is the delu sional belief of having been transformed into

an animal, traditionally a wolf [1,2]. The term lycanthropy originated fromthe Greek words lycos = wolf and anthropo s = man. The first descripti ons ofthe syndrome can be found in Greek mythology. Demigod Lycaon was trans­formed by Zeus into a wolf as a punishment for his attempt to feed Zeus withthe t1esh of a young boy he had sacrified [3]. A later description of the syn­drome is found in the Bible. In the Book of Daniel a divine punishment wasinflicted upon the Babylonian King Nebuchadnezzar; he was transformed intoan ox for seven years [4,5].

In the beginning of the 19th century lycanthropy was considered as amental disorder [6]. During the 20 th century, several case reports o f lycan­thropy were publi shed in the international literature. Most of them concernedpatients su fferin g from affective or psychotic disorders. Further cases ofman-animal metamorphoses were reported in patients with other mental dis­orders, including personality disorders , hysteria, alcohol or drug abu se, or­ganic brain syndromes, dem entia, and epil epsy [7-11].

The purpose of this study is to show that the works of Byzantine physi­cians on lycanthrop y provided new data and offered clearer interpretations ofthis condition ; moreover, they prov ide evidence that since ancient timeslycanthrop y had been thought to be a mental diseas e.

Byzantine medicine is, in fact , the continuation of anci ent Greek,Hellenistic and Roman medical tradition, as well as the vital link to WesternEuro pean medi cine , which it influenced directly or indirectly, via the worksof Arab physicians. The investigation of the writings of Byzantine physici ans isof significant interest because most of them reproduce the essence of the writ­ings of ancient Greek physicians, many of which are now lost , without failin gto supply their own contribution at the same time [12] . The great Byzant inedoctors , from Possidonius and Oribasius (4th century A.D.) to Joannes Actu­arius (14th century A.D.), provided many clinical descriptions of psychiatric in­terest, which they compiled from the works of ancient physicians, espec iallyHippocrates (5th century B.C.), Galen (2nd century AD.), Aretaeus (l sl_ 2nd cen­tury AD.), Soranus from Ephesus (1 st _ 2nd century A.D.) and others. Apart fromlycanthropy, a series of other mental disorders were described in their works,such as mania, melancholy, cataphora (profound depression), phrenitis, love­sicknes s, incubus (nightmare), lethargy , insomnia, senile cerebral atro­phy (a type of dementia) , alcoholic intoxication and epilepsy [13].

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MaterialThe first Byzantine physician to deal with lycanthropy was not Aetius,

as referred to by some authors [14] , but Oribasius (4 th century A.D .), whowrote the first chapter of Byzantine medical literature on this topic, entitled"On Lyc anthropy" [15]. Oribasius wrote that lycanthropes circul ate at night ,usually stay around tombs until dawn, and behave exactly like wolves. The

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recognition of these sufferers was achieved by notin g the following signs andsymptoms. They are pale and gaze vacantly with dry eyes deep in theirsockets, without producing tears. Their tongue is dry and they do not producesaliva at all. They are always thirsty and their shins are usually injured be­cause they often stumble against objects . According to Oribasius the dis­ease was diagnosed as a form of melancholy. The treatment during thechronic phase included calming the patient, extended venesection until thesufferer fainted , baths in fresh (non-salt) water, while fluid-intake was encour­aged. Later on, a fat-free milk diet and holy marrow herb purgatives wereadministered for three days. This was repeated three times (a total of ninedays). Then, theriac-containing snakes, the usual remedy for melancholy inthat time, were administered. In the acute phase of the disease , somniferousinunctions into the ears and nostrils, most often containing opium, were used.

The second eminent Byzantine physician dealing with lycanthropywas Aetius (6th century A.D. ), who wrote a chapter entitled "On Lycan­thropy , that is cynanthropy, according to Marcellus" [16]. Aetius describedthe behavior of sufferers in the same way as Oribasius and added that lycan­thropes wander at night in February, imitating wolves or dogs. He provided thesame clinical picture as Oribasius, adding that the wounds of the shins aredue to repeated falls and dog bites and are incurable. He also considered thedisease as a form of melancholy and suggested a similar treatment asOribasius. He went on to add some new purgatives, such as the "ho ly drugs"of Rufu s, Archigenes and Justus. Before an imminent evening crisis, healso rec ommended soporifics and similar substances , in particular opium,administered either as inunctions into the nostrils or in some rare cases per os.

Paul of Aegina (7th century A.D.) was in line with the two previousauthors. He entitled his relevant chapter "On Lycanthropy or Lycaon", implyingconnotations inspired from Greek mythology [17].

Another anonymous writer [18] of a chapter on lycanthropy agreedwith the ideas of Oribasius and Aetius and added that lycanthropes are un­usually slim , which is a characteristic of melancholy. Their melancholic con­stitution is either congenital or acquired, resulting from insomnia , life stressors ,bad diet or blind hemorrhoids and, in women , a cessation of the menstrual cy­cle. According to the author, the treatment of the disease coincided with thatadvocated by earlier Byzantine writers . He further recommended generaltreatments of melancholia and special causative treatments in cases of hemor­rhoids (surgery) and menstrual anomalies. Finally, the author suggested diu­retics and perspirants. Recent researches [19,20] have provided evidencethat the anonymous writer was probably Paul of Nicea, an eminent Byzantinephysician of the 7thcentury A.D.

A later physician and eminent philosopher, Michael Psellus (11th

century A.D.), included in his poem "Carmen de re medica" a description ofthe known diseases in that time [21]. He noted briefly that lycanthropy is notonly a form of melancholy but also misanthropy, since the patient is isolated

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from society. He de scribed the sufferer as pale, dejected, dry , and care­less of his appearance .

The last famous Byzantine physician, Joannes Actuarius (l4th centuryA.D.), who summarized the knowledge of all the physicians of the extensiveByzantine period, dealt with melancholy in his chapter "On Melancholic Dis­eases" [18]. He included cases of individuals believing that they had the di­vine gift of forecasting the future, or fearing harmless everyday events, or un­reasonably avoiding the company of or conversation with people, remainingsilent, sad and withdrawn from society. Finally, he described others whoeither feared death or desired it, having suicidal thoughts. In lycanthropycases, in particular, he provided the same clinical picture as earlier physicians.He argued that at night sufferers wander around cemeteries and lonelyplaces like wolves; while during daytime they return to their homes,where their behavior is apparently normal.

DiscussionThe first description of lycanthropy was given by the physician Mar­

cellus Sidites (i.e. from Sydia , a town in Asia Minor), who was a follower ofthe Pneumatic School of Alexandria and lived in Rome (2nd century A.D.). Mostof Marcellus' works have been lost. Among the remaining ones, his workon lycanthropy or cynanthropy can be singled out. Galen quotes a relevantextract of his contemporary Marcellus ' work in his bo ok containingvarious medical opinions on melancholy [22] . Marcellus himself consid­ered lycanthropy to be a form of melancholy.

The disease was later considered to be zooanthropic delirium, as thepatient thought he had been transformed into a wolf [3]. Thi s kind of trans­form ation had already been described by Hippocrates [3]. It was also knownin Byzantine times, as a great Byzantine physician , Alexander of Tralles (6th

century A.D.) , presented several cases of melancholy complicated with dif­ferent kinds of strange fantasies , although he did not describe lycanthropyp er se [23]. In specific, he described patients who believed they were roof­tiles , or animal skins, or cockerels, imitating their crowing. Some other pa­tients had fantasies inspired from Greek mythology; they believed they werenightingales crying because they had lost Itis (a mythological figure) or theybelieved they were Atlas supporting the globe, fearing that it might fall and de­stroy themsel ves and the whole world.

Oribasius, who compiled the first medical description of lycanthropyin Byzantine times , was a pagan and he adopted Marcellus ' approach. Theclinical description and treatments they proposed were quite similar, althoughdifferent in some points. However, the influence of the ancients was still evi­dent two centuries later, when the Christian Aetius adopted, almost verba­tim, Marcellu s' concepts and etiological approach. Marcellus pointed out thatlycanthropy was a mental disease and not a real phenomenon, as it is impossi­ble for a human being to be transformed physically into a wolf. The sufferer

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believes that a magical change has taken place within him [3]. Thus, Marcellusobviously harnessed the magical beliefs of his time to the medical reality, ad­vocating that lycanthropy is a psychosis and not a magical transformation.

The concept of lycanthropy was later adopted by Islamic doc­tors; according to Dols [14], from the work of Aetius. It is, however, possi­ble that Arab physicians could have known this from the works of Galen,Oribasius, Paul of Nicea or even Paul of Aegina, who described similar clinicalpictures and whose works were known in the Islamic literature. The work ofthe later Byzantine physician s deeply influenced the medical concepts ofthe Arabs [24]. Razes adopted verbatim the opinions of the Byzantines; otherslike A bulc asis added some therapeutic elements such as cauterizationof the head, a method not included in Byzantine or Galenic texts. Other Arabphysicians considered the illness inherited and hardly curable [14].

According to Dols [14], lycanthropy represents a good example of thepurely notional syndromes of this period. No similar description in the medievalIslamic literature exists . Thus, it is possible that the clinical picture of lycan­thropy was derived from Greek medicine [13]. Later, this clinical picture wasadopted by Western European medicine either directly from the Byzantinemedical texts or, mainly, indirectly from translations of the Arabic works intoLatin [13] .

It seems that the disease, characteri zed by wandering aroundtombs at night and returning to everyday routine during daytime, resemblesthe myth of vampires, which can be found in many cultures worldwide [25] .

In conclusion, many Byzantine physicians have described the clini­cal picture of lycanthropy in detail. Some main symptoms of the disorder,such as social isolation, misanthropy, dejection and carelessness of one's ap­pearance , have led them to early classify this condition as a mental disorder, inline with the concepts of Marcellu s, who first described it. In specific, Byzan­tine physicians have classified lycanthropy as a form of depression (melan­chol ic type or psychotic depression). It is worth noting that neither Marcel­lus, though a pagan, nor Christian Byzantine doctors thought that the disor­der was magical or demonic in origin, and they believed it to be a mental ill­ness. Their views have directly or indirectly influenced Arabic and WesternEuropean medicine.

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Doc. dr Vasilis P. KONTAKSAKlS, Univerzitet u Atini , Psihijatrijsko ode­Ijenje bolnice "Eginition", Grcka

Vassilis P. KONTAXAKlS, MD, PhD, Associate Professor of Psychiatry,University of Athens, Greece

E-mail: bkont@cc.uoa.gr