Adam was the “first master and teacher of philosophy (primus philosophiae magister et doctor)”. […] Adam received wisdom from God and transmitted it to his descendants; the Holy Fathers, exiled in Egypt, taught it to the Armenians and Egyptians, and numerous Greeks poured […] attracted by the desire for knowledge; finally it came “through all parts of the earth and corners of the world and places dispersed far and wide…”[1]

In the words of the seventeenth-century churchman Enricus Gislonis Spinerus (1624-1671), Armenia was one of the first countries to be ‘enlightened’ by divine knowledge, which included medical knowledge. The roots of Armenian medicine can be traced back more than 3,000 years, branching out from indigenous practices and the collective expertise of generations of physicians who studied the healing properties of the local flora, fauna and minerals.

Mkhitar Heratsi, a 12th-century Armenian physician [Fig. 1], is generally regarded as the father of Armenian medicine, where he holds the same position as Hippocrates for the Greeks, Galen for the Romans, and Ibn Sina for the Islamic world at large.

He wrote several medical works including On the Structure and the Creation of the Eye, On Hernia, On Precious Stones, Predictions of Storms and Earthquakes. Of particular importance is the work On the Structure and the Creation of the Eye wherein Heratsi describes seven membranes of the eye, six muscles, and a pair of optic nerves. Like Galen, he believed that the lens played an important role in the process of seeing. His works on pharmacology and pathology were long thought to be lost. Recently, however, scholars have proved that important parts of them were included in works that have survived in full, such as the Gagik-Hetumian Medical Book [2] and Relief of Fevers, the latter of which, written in 1184 and addressed specifically to physicians, is considered Heratsi’s masterpiece.

Relief of Fevers is an encyclopaedic work dealing with surgery, diet and psychotherapy. It was the first work to indicate moulds as a living factor responsible for the onset of fever. Because of this, in traditional historical accounts of medicine, the work has been seen as anticipating similar theories by Girolamo Fracastoro (1478-1553), if not the discovery of microorganisms in the nineteenth century. The theory had many followers and, in keeping with Heratsi’s legacy, Armenian physicians included in the group of fevers caused by moulds (also known as moldy fevers) the so-called six-day fever, now identified as familial Mediterranean fever or Armenian disease.[3]

Heratsi proposed a classification of fevers into three categories: one-day fevers, mouldy fevers and wasting or consumptive fevers. Since one-day fevers do not easily fit within the boundaries of traditional humoral pathology, the classification seems to be suggested by intuitive or practical criteria. To explain their genesis, Heratsi referred to ancient theories such as the pneumatic theory, according to which changes in the ambient air can act as a pathogenic cause, either facilitating or directly causing the spread of a particular disease. Experienced physicians – Heratsi argued – should not overlook the unusual features that manifest themselves in patients affected by one-day fevers, and some scholars suggest that Heratsi may have had in mind several types of allergies caused by physical, “chemical” and dietary factors that can manifest themselves in one-day fevers.

Among the mouldy fevers, Heratsi seems to have included a number of infectious diseases that were common in the Middle Ages, such as malaria, typhoid, septicemia, plague, smallpox and measles. He identified at least three types of malaria, which he classified as quotidian (one day), tertian (alternate days, i.e. every three days) and quartan (three days apart) fevers.

The third group, the wasting or consumptive fevers, included various forms of tuberculosis. According to Heratsi, these fevers could be triggered by three types of causes, namely:

1. 1. 1. emotional stress and anxiety;
      2. exhaustion, overwork, and malnutrition;
      3. unfavourable climatic conditions.

To diagnose wasting or consumptive fevers, Heratsi used methods such as ‘observation’ (looking), ‘palpation’ (feeling with the hands), ‘percussion’ (tapping with a finger) and ‘auscultation’ (listening), together with uroscopy and organoleptic inspection of mucous and other discharges. Anamnesis, or the recollection of the patient’s past medical history, also figured prominently in Heratsi’s methods. Therapy included the use of plant extracts, regulation of diet, physical exercise, hydrotherapy and psychotherapy, especially listening to music.^[4]

Hydrotherapy included showers and baths, as well as the use of cold sponges and gymnastics. Since one-day fevers were caused by ‘sorrow and bitter anxiety’, Heratsi strongly recommended to:

[a]muse <the patient> with games and jokes and in every way possible, make him happy. The patient should <thus> listen to the songs of minstrels (gusans) as much as he can, to the sounds of strings and delightful melodies.[5]

Echoing Hippocrates, he advised physicians to consider the patient as an individual, taking into account the course of the disease, which he divided into four stages of intensity, used especially in prognosis to assess the severity of diseases. The prognosis is a key element in Heratsi’s approach, not only in deciding the appropriate treatment, but also in saving the patient’s life. Treatment, on the other hand, followed the Hippocratic motto contraria contrariis curantur – diseases are cured by that which opposes them.

It is noteworthy that in the treatment of infectious-allergic diseases, herbs with antibacterial, anti-inflammatory and anti-allergic properties seem to be preferred. As an example, in Relief of Fevers we find the following herbs used in compound preparations: water lily, violet, iris mullein, hyssop, inula, mugwort, plantain, liquorice root, meadow saffron, caper, mint, caltrops and thyme. In addition to herbs, these recipes also contain animal drugs (e.g. castoreum, ox bile) and mineral ingredients (e.g. Armenian clay, sulphur, zinc, boric acid) with tonic, antisclerotic and antitoxic properties.

Long-term patients, on the other hand, were advised to eat easily digestible food such as fresh fish, chicken, meat broth, egg yolk, milk (goat and donkey milk were recommended for tuberculosis patients), seasoned with coriander, basil, celery, okra, purslane and supplemented with fruits such as pomegranate, quince, grapes, oleaster, figs and jujube plums.

Following in the footsteps of Albert the Great’s Compendium theologicae veritatis, Grigor of Tatev dealt with physiognomy and offered a critical examination. In response to the question Are external features true? <that is>, Do they really express a person’s character? he stated: