Appendix 3 | The Mystery Illness

One of the most enduring myths about Theodore Laskaris is that he was an
epileptic. His epilepsy is thought to have been chronic (that is, he suffered
from it throughout his life оr a large part of his life) and hereditary (he
inherited the illness from his father), and to have led to his premature
death.1 Historians of disease have been sufficiently intrigued to explore the
issue, although they have reached opposite conclusions. In 1995 Georgios
Makris examined cases of Byzantine emperors alleged to have been epilep-
tics and concluded that neither Theodore Laskaris nor his father John
Vatatzes suffered from the disorder.2 In 1998, however, John Laskaratos
and Panagiotis Zis argued on the basis of the History of Pachymeres that
Theodore was afflicted with chronic epilepsy of the tonic-clonic (grand
mal) type, which the emperor developed possibly before his thirties.3
Retrospective diagnosis of a famous historical figure based solely on
written sources – in the absence of skeletal remains to be analyzed by
bioarchaeologists – is notoriously difficult. The only contemporary author
to diagnose Theodore with epilepsy is George Pachymeres, whose testi-
mony is not confirmed by any other Byzantine historian and contradicts
Theodore’s own description of the symptoms of his lethal disease. We will
begin, therefore, with a critical analysis of Pachymeres’ description and will
address the question as to whether Theodore Laskaris was affected by a
chronic illness. The discussion of the evidence on his health leads us to
assess the possible causes of his early death.
The historian Pachymeres, who was born and raised in Nicaea, was
sixteen years of age (and thus still a student pursuing secondary education
following the curriculum of enkyklios paideia) at the time of Theodore’s
death. Later in life, when he was employed in the patriarchal bureaucracy, he

1
William Miller (1923:506) spoke of “a hereditary malady” and Donald Nicol (1966:321) wrote
that Theodore “was an epileptic, and his affliction made him vacillate between the extremes of
nervous diffidence and blind self-confidence.”
2
Makris 1995:390–92.
3
Laskaratos and Zis 1998. A similar argument was made by Jeanselme (1924:267–73), who took
Pachymeres’ report at face value. He also did so with earlier reports by Byzantine historians
attributing the disease to emperors. 381

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 382 Appendix 3

became close to the metropolitan of Mytilene, Gregory, the confessor of the

dying emperor, and may have well derived some information from him.
Notably, a relative of George Pachymeres by the name of Theophylaktos was
a secretary to the regent George Mouzalon and was assassinated in the
Sosandra monastery, together with his patron, in August 1258 within days
of the emperor’s passing.4 The account of the disease is found in Chapter 12
of the first book of his History, entitled “How the ailing emperor was
suspecting everyone of magic, and concerning Martha (Michael Palaiologos’
sister).”5 The description is inserted here to explain the use of ordeals and
torture at the imperial tribunal; it anticipates the commentary on the
extraordinary intellectual and literary abilities of Theodore Laskaris in the
following chapter, Chapter 13 of the first book. The afflicted emperor is said
to have suffered fits or loss of consciousness and to have often fallen to the
ground (ἐπείληπτο γὰρ καταπίπτων συχνάκις). A learned digression follows.
According to Pachymeres, the reason for Theodore’s disease lay in the
excessive heat of his heart, which produced a “natural intelligence” (τὸ
εὐφυές) above the usual one. Herein is rooted, as we have seen, the influential
modern opinion that Theodore Laskaris was a sick genius. Theodore’s hot
heart is said also to have had an unbeneficial effect, because the heart was the
source of one’s thoughts. Pachymeres qualified the latter theory by adding
that philosophers disagreed on this rather vexed question.6 As Makris has
already detected, Pachymeres borrowed heavily from philosophical and
medical literature.7 According to the medical work of Stephanos the Phil-
osopher (c. AD 600), for example, excess heat in the body caused by a full
moon led to epilepsy.8 According to Aristotle, Problems, 30,1 (954a31–34),
people who have hot black bile in their bodies are naturally intelligent
(εὐφυεῖς) as well as erotically fixated, mad, and predisposed to anger, passion,
and loquaciousness.9 Elsewhere in his History Pachymeres lays out an
ethnographic climate theory based on the effects of heat and cold on the
human body. In a section devoted to the Mamluk state of Egypt, he digresses
to point out that people from hot, southern climates closer to the sun are

4
On his connection with Gregory of Mytilene, see Pach. II, 347.26–349.4. On Theophylaktos, see
Pach. I, 85.14–20.
5 6
Pach. I, 53.11–57.29. Pach. I, 53.14–21.
7
Makris 1995:391–92. I agree with Makris’ interpretation of τὸ εὐφυές as “sharpness of mind”
rather than “air of very good health” in Failler’s French translation.
8
Stephanus the Philosopher, Commentary on the Prognosticon of Hippocrates, I, 17 in Duffy
1983:56–57.
9
Problemata, 954a31–38, where emotions like love and anger as well as madness are connected
with body heat.

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 Appendix 3 383

naturally intelligent (εὐφυεῖς), clever, and excel in political organization,

skills, and learning, but are otherwise slothful, passive and weak in battle
in contrast to the warlike Cumans from the north (that is, the northern
Black Sea region).10
In contrast to Pachymeres, other Byzantine historians omit any detail
about the epilepsy of Theodore Laskaris. George Akropolites and Synopsis
chronike speak of “a terrible disease” that struck the emperor who, in a very
short time, drastically lost weight and was reduced to a skeleton. The
doctors were unable to cure him. Gregoras briefly mentions a “grave illness”
that consumed him and caused his death.11 Blemmydes, who witnessed
Theodore’s disease firsthand and was called upon to help in his capacity as a
highly trained physician and spiritual father, gives disappointingly little
clinical detail in his autobiography. He writes that “a scourge and a strange
disease” fell on Theodore, causing depression and confinement in the
palace.12 Two letters by Theodore Laskaris to Blemmydes (Epp. 45 and
48) during the period of the emperor’s terminal illness describe the symp-
toms and complain about the incompetence of the doctors. This is not the
first time that Theodore wrote Blemmydes about his health. We see him in
earlier letters (Epp. 9 and 11) expressing his hope that Blemmydes’ “holy
prayers” would lead to recovery from illness and thanking Blemmydes for
his beneficial effect on his health (Epp. 16, 17, and 20). No medical cures are
ever mentioned in the correspondence. The emphasis, rather, is on spiritual
healing.13 The beneficial effect attributed to Blemmydes could not be
achieved by other physicians, including the head court physician, a man
who can be identified with the famous thirteenth-century medical author
Nicholas Myrepsos.14 The first letter (Ep. 45) to Blemmydes dealing with
his fatal illness, datable to the autumn of 1257 or 1258, refers briefly to pain

10
Pach. I, 237.1–24.
11
Akrop. I, §74 (p. 153.4–9: note the powerful word κατασκελετευθείς); Synopsis chronike,
533.27–30; Greg. I, 61.19. The fourteenth-century versified chronicle of Ephraim is likewise
laconic and refers to a “gravest disease” without providing any detail. See Lampsides
1990:327.9270–74.
12
Blem., Autobiographia, I, 85 (p. 42).
13
In Ep. 16.19–20 (p. 22), Theodore writes rhetorically that the mental image of the fragrance of
Blemmydes’ robes, something which the letter carrier evoked, had a salubrious effect on him.
A similar statement is found in Ep. 17.5–10 (pp. 22–23), where reading a letter by Blemmydes is
said to have alleviated his pain.
14
In Ep. 20.28–34 (p. 27), Theodore complains that the doctors who were examining him and
testing medicines rebelled against “every medical knowledge” and disobeyed Galen. They are
contrasted to the effect of the “holy prayers” of Blemmydes. The physician who was their
superior is described as “the best human plague” (ἄριστος βροτολοιγός). According to Festa
1909:217, n. 1, he was the court physician (aktourarios) Nicholas, described by Akrop. I, §39

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 384 Appendix 3

in his arm. The second letter (Ep. 48) to Blemmydes, datable to 1258,
describes in detail the pain and numbness in his arm. The emperor pins
his hope on Blemmydes’ prayers and, evidently, his medical knowledge:
We are afflicted with bodily pain which no one has ever seen or heard.
A pain in the arm around the point of the shoulder moves down, as it
were, until the elbow, presses the arm, and goes throughout the length of
the arm and the forearm. There is no redness or swelling of any size. The
aching is so insufferable, and the numbness and paralysis are more
painful than the aching. Many times this hand was moved toward
inappropriate deeds; now it is receiving punishment, even though one
incommensurate with past events (for we are worthy of many terrible
things), but a punishment that is painful, grievous, and above human
faint-heartedness. A swelling does not show and the pressure is so great.
There is no doctor. The ones who are here are stupid. Based on the
establishment of the diagnosis and the treatment, one could suppose that
they are common peddlers or healers by accident. There is no fever
generally. The poor health condition results from the pain or rather from
an aggravation due to lack of use of the hand. The hand moves, but not in
all directions; in its upward swing it is very much constrained and does
not consent to move more.15

The symptom described by the patient (radiating pain from his arm and
arm numbness) and those mentioned by Akropolites and Synopsis chronike
(drastic loss of weight) do not support the view that Theodore passed away
from epilepsy. What, then, to make of Pachymeres’ account? The Nicaea-
born historian probably learned from eyewitnesses that the dying emperor
suffered from fits and could not maintain his balance, and he overheard,
too, that his condition was attributed to epilepsy. Pachymeres himself
could not provide any further clinical detail, and his solution was to engage
in a learned discussion on the effects of the disease. His diagnosis, there-
fore, has no historical value beyond its insight into some (but not all) of the
symptoms.

(p. 63.12–16) as being particularly close to the imperial family. The court physician Nicholas
has been identified with Nicholas Myrepsos, the author of the Dynameron (a collection of 2,656
medical recipes), who was highly influential both in Byzantium and the West. See Macrides
2007:212–13, n. 8 (with further bibliography). The letter suggests that the doctors supervised by
the court physician (“the best human plague”) were trying new pharmaceutical recipes and
therefore backs the identification with the medical author. The statement in Ep. 70.22 (p. 97)
addressed to Akropolites that “the chief human plague has an Alexandrian inspiration” adds
further support, for Nicholas Myrepsos, known in Latin as Alexandrinus, was believed to have
spent time in Alexandria in Egypt.
15
Ep. 48.22–37 (p. 65).

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 Appendix 3 385

Was Theodore Laskaris a chronically ill man? Here, again, the evidence
points in a direction different than chronic epilepsy that could have led to a
sudden death during a seizure. The majority of the sources refer to a
disease that developed in the last year of his life. Akropolites places the
onset of Theodore’s fatal medical condition after the change of government
in Bulgaria (that is, the accession of Constantine Tikh), which took place
sometime in 1257.16 Nikephoros Gregoras notes that Theodore fell ill when
he was in the thirty-sixth year of his life – that is, at the earliest in late
1257 or early 1258.17 A remarkably precise indication of the beginning of
the illness can be found in the polemical letter that Rabbi Jacob ben Elia of
Carcassonne wrote around ten years after the emperor’s death, in about
1270, in Valencia.18 Addressed to Pablo Christiani, a famous Jewish con-
vert to Christianity who had entered the Dominican order, the letter
provides historical examples, both ancient and relatively recent, of divine
wrath against persecutors of the Jews. Thus, the blinding of Theodore
Komnenos Doukas when he fell under Bulgarian captivity in 1230 is
blamed on his confiscation of Jewish wealth. The death of John Vatatzes
from an illness is attributed to an edict on the conversion of the Jews
allegedly issued in the last year of his reign. While such legislation is highly
doubtful, the proselytization of the Jews in the empire of Nicaea through
preaching and economic incentives is well attested.19 Divine punishment is
said to have fallen on Vatatzes’ son and grandson. Theodore Laskaris
reportedly died after nine months of illness, a duration that agrees with
Akropolites’ and Gregoras’ estimate that the emperor fell ill at the earliest
in late 1257. According to Jacob ben Elia’s letter, the first signs of his illness
would have manifested themselves in November 1257. The close corres-
pondence of this detail with the descriptions by Byzantine historians can be
explained by reports that trickled through Mediterranean medical net-
works, in which Jews traditionally played a prominent role.20
The circumstance that Theodore Laskaris contracted a fatal disease
during the last year of his life does not mean, of course, that he was
continually healthy before this time. Indeed, the theme of illness runs
through many of his writings and deserves close attention for any insights

16 17
Akrop. I, §73 (pp. 152–53). Greg. I, 61.18–20.
18
English translation of the section on Byzantium in Bowman 1985:228–30. For the context of
composition and a summary of the content of the letter, see Mann 1926.
19
See 253, n. 106 and the well-founded doubts of Prinzing 1998b (cited in the note) on the
existence of such a piece of legislation.
20
See the twelfth-century example discussed by Goitein (1964) based on a letter from the archive
of the Cairo Geniza.

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 386 Appendix 3

it can give us regarding the state of his health. More than ten letters
(Epp. 9, 10, 11, 13, 14, 16, 17, 20, 70, 98, 118, and 134) written before
November 1254 – most of them addressed to Blemmydes – speak or allude
to medical conditions and thank correspondents for their prayers. Account
needs to be taken of the requirements of the epistolographic genre. Illness
was a common subject in Byzantine epistolography and Theodore Laskaris
is just one letter writer among many to speak both about his own health
and that of his correspondents.21 In one letter to Blemmydes (Ep. 13),
Theodore responds to the news he has received that his teacher was ill with
a terrible disease and sympathetically describes his own illness. As we have
seen in Appendix 2, more than thirty of Theodore’s letters to Mouzalon are
united by the theme of Mouzalon’s recovery from illness. In other words,
Theodore Laskaris’ epistolary circle displayed the hypochondriac tenden-
cies of other Byzantine letter writers.
The pre-1254 letters sometimes bring up specific medical symptoms, and
so does Theodore’s oration in gratitude to Jesus Christ composed after his
recovery from illness, likewise composed before 1254.22 Ep. 9, addressed to
Blemmydes, refers to a throat and a tongue ache.23 Ep. 13 (the letter
responding compassionately to the news of Blemmydes’ sickness) speaks
of a rash on his head causing pain, sleeplessness, and discomfort.24 The
complaint of a headache reappears in Ep. 134, addressed to the monk
Akakios.25 The oration of gratitude to Jesus Christ mentions fever and
nausea.26 The symptoms are diverse and do not point to one single illness.
In 1909 Nicola Festa attempted to explore the diagnosis behind these
symptoms with the help of a young doctor from Rome and immediately
encountered an obstacle: the chronological uncertainty of the letters that
refer to medical conditions.27 The chronology of the letters (see Appendix 2)
suggests that some, in fact, were written over a considerable amount of time.

21
Karlsson 1959:138–39; Mullett 1981:78.
22
Similar words of gratitude to saints and holy figures are found in his encomium on the healing
saints Cosmas and Damian composed in 1252 and in his invocatory hymns composed after
November 1254.
23
Ep. 9.11–15 (p. 13). According to Festa (1909:216), the references in Ep. 9 to πύκνωσις and
καταπύκνωσις τῶν σωματικῶν πόρων point to a gastric-rheumatic disease. The same term is
found also in Ep. 118.
24 25
Ep. 13.21–27 (p. 18). Ep. 134 (p. 189).
26
Oration of Gratitude to Our Lord Jesus Christ Composed upon Recovery from a Terrible Illness,
A, f. 15r, P, f. 27r. The work provides additional information on Theodore’s attitudes to doctors
and disease.
27
Festa 1909:216. Festa made this observation in his review of Pappadopoulos’ book, which he
criticized for insufficient attention to the medical information in the letters.

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 Appendix 3 387

Ep. 9 is among the early letters to Blemmydes, and one can agree with Festa
that the disease is the same one to which Ep. 10 alludes at its abrupt end.28
Ep. 10 (datable to 1243–44) refers to the imminent arrival of the new
metropolitan bishop of Ephesos, Nikephoros, at the city to take up his
position. However, Ep. 118, addressed to the metropolitan bishop of Phila-
delphia, Phokas – a letter in which Theodore complains of disease and
expresses his hope for Christ’s supernatural intervention – dates to 1252,
because it mentions the return of Andronikos of Sardis from an embassy to
the papacy.29 The two letters (Ep. 9 and Ep. 118) are separated by at least
eight years and are unlikely to refer to the same disease. This impression is
enhanced by the oration to Jesus Christ and by letters (Epp. 16, 17, and 20),
in which Theodore speaks about recovering from illness and regaining his
health. He appears to have contracted contagious illnesses with flu-like
symptoms, but these illnesses proved not to be life-threatening and caused
nothing resembling a medical disorder. The prolific evidence for his active
lifestyle at times of peace and war, evidence examined above in Chapters 5
and 8, militates strongly against this interpretation.
There are two other things to learn from the medical focus of the letters.
The first is that the court physicians were extremely attentive to the health
of the only child in the ruling family and designated successor. Physicians
were continually in close proximity to the coemperor, even though he
expressed to Blemmydes and Akropolites distrust in their expertise and
dislike for these “human plagues.” Ep. 70 mentions two physicians, Koites
and Mauroeides, and as we have seen, alludes to the head physician
(aktouarios), Nicholas Myrepsos. These doctors belonged to a world of
shared medical knowledge in the Mediterranean. Theodore Laskaris com-
ments on the “Alexandrian inspiration” of Nicholas Myrepsos.30 The
second thing to learn is that Theodore himself acquired some medical

28
Ep. 10.27 (p. 14) ends enigmatically with the phrase περὶ δὲ τῆς νόσου ἡμῶν followed by a
missing text. It is reasonable to assume that the missing text, containing clinical or medical
details, was dropped at the time of preparation of the Laurentian epistolary collection, in
accordance with the editorial principle of de-concretization noted in Appendix II. Festa
(1909:216) suggests that the disease mentioned in Epp. 9 and 10 is the same as the one in
Epp. 13 and 14, which is entirely possible. However, it is unlikely that Ep. 118 is a description of
the disease, given that the letter dates to 1252.
29
Ep. 118.29–33 (p. 165). The letter has to be taken into consideration in the editing and analysis
of his Oration of Gratitude to Our Lord Jesus Christ Composed upon Recovery from a Terrible
Illness.
30
Mauroeides is not necessarily a nickname (“the swarthy one”), because it is attested as a family
name. See PLP 17435–36. Festa (Ep., Index, 406) thought that Mauroeides stood for Avicenna,
but this seems farfetched. On the puzzling name Koites, see 283, n. 43. On Myrepsos, see 383,
n. 14.

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 388 Appendix 3

knowledge, whether through his studies with Blemmydes, the presence of

court physicians or in another way. He mentions the theory of the four
humors in philosophical treatises, but also in letters in which he refers to
the unnatural flow of the humors during illnesses.31 He uses the vocabulary
of Galenic medicine – terms such as “tightening of the pores” (πύκνωσις)
and “confluence of the humors” (σύρροια).32 He speaks of feeling pain in
the union of his soul and body, which accords with the traditional view
that illnesses were psychosomatic and affected both one’s body and soul.33
He knew medical recipes and wrote in passing that heated mulled wine
alleviated stomachache.34
None of the symptoms of Theodore’s illnesses before November
1254 corresponds to those of the lethal disease that manifested itself less
than one year before his death: pain and numbness of the hand; great loss
of weight; fits and inability to maintain balance; and depression. What,
then, might have been the cause of Theodore’s death? Following Festa’s
attempt to bring a modern medical perspective to bear on the information
found in Theodore’s letters, my consultation with psychologists and gen-
eticists has opened some possibilities, even though the information on the
clinical picture of our medieval patient is not sufficiently detailed to permit
a definitive answer.35
The background of consanguinity is a risk for an autosomal recessive
disease. His father, John Vatatzes, was blood-related to Theodore’s mother,
Irene: Vatatzes was the second cousin of Irene’s mother. Most autosomal
recessive diseases manifest themselves in childhood. The probability of an

31
Natural Communion, PG, vol. 140, col. 1313A; KD, I, 106.5–6; Ep. 13.24–25 (p. 18);
Sat., 192.923. In light of Theodore’s interest in the effects of humors on the body, it is unlikely
that the mention of blood flow (Ep. 16:19–20 [p. 22], 17.8 [p. 23]) means that he suffered from
hemorrhage, as suggested by Pappadopoulos 1908:22.
32
On πύκνωσις, see Ep. 9.15 (p. 13), 118.29 (p. 165); Stephanus of Athens, Commentary on
Hippocrates’ Aphorisms, V–VI, in Westerink 1995:84.24, 88.34–35. On σύρροια, see Ep. 118. 29
(p. 165).
33
Encomium on the Holy Anargyroi (the healing saints Cosmas and Damian), in A, f. 35r, P,
f. 56v: ψυχικὰ καὶ σωματικὰ νοσήματα; Α, f. 39r, P, f. 60r: πᾶσαν νόσον ἰᾶται ψυχικὴν ὁμοῦ καὶ
σωματικήν; Α, f. 40v, P, f. 61r–ν: Ἀλλ’ ἐγὼ μὲν ὁ νῦν καὶ σῶμα καὶ νοῦν νοσῶν ἄμφω τε καὶ ψυχὴν
τὰς αὐτῶν ποικίλας ἐνεργείας αἰτῶ, ἵνα καὶ τῆς ψυχικῆς ἐκτροπῆς τέλεον λυτρωθῶ καὶ τὴν
στοιχειακὴν πῆξιν ἀλλοιωθῶ πρὸς τὸ βέλτιστον; Oration of Gratitude to Our Lord Jesus Christ
Composed upon Recovery from a Terrible Illness, Α f. 21ν, P f. 37r–v ; Ep. 13.18–20 (p. 18),
27.26–28 (p. 37), 98.5 (p. 132): ἀλγοῦντες τὸ σωματικὸν καὶ ψυχικὸν ξυμφυές.
34
Ep. 54.72–73 (p. 81).
35
I have benefited from participating in a medical study group at the University of Birmingham
(members: Femi Oyebode, professor of psychology, Dr. Lenia Constantine, and Dr. Sandy
Robertson) and from discussions with Jordan Smoller, professor of psychiatry at the Harvard
Medical School and director of the psychiatric genetics unit.

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 Appendix 3 389

autosomal genetic disease is diminished, however, because the symptoms

of Theodore’s fatal illness are different from those reported in texts com-
posed before November 1254.36 An obstacle to identifying an autosomal or
a dominant genetic disease is that the causes of death of his grandparents,
parents, and children are not known. On the other hand, the symptoms of
Theodore’s lethal disease are consistent with an acquired condition and
particularly with tumor processes in the brain, the lungs, and the spine. All
these tumors can cause, at an initial stage of their progress, arm numbness,
which is followed by drastic loss of weight and sometimes seizures. Brain,
pulmonary, and spinal cancer can all lead to death within a year of first
manifestation of the symptoms, which was the case with the emperor. The
possibility that Theodore Laskaris died from cancer – it ought to be
stressed – is only a best guess. What can be stated with confidence is that
the Nicaean emperor and philosopher was neither a chronically sick man
nor a disturbed genius, something for which he acquired a reputation not
long after his death.

36
Laskaratos and Zis (1998) preferred to see in the radiating arm pain a neuralgic amyotrophy
that may have resulted from a trauma and argued that Theodore Laskaris concealed his epilepsy
for a long time. Not only is such a concealment an argument from silence, but it is reasonable to
suppose that the emperor’s tutor and high official Akropolites would have known about the
disease and would have reported it.

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