The first case of pagophagia: the Byzantine Emperor Theophilus

The first case of pagophagia: the Byzantine Emperor Theophilus

By Effie Poulakou-Rebelakou, Costas Tsiamis and Dimitrios Ploumpidis

Acta Medico-Historica Adriatica, Vol.13:1 (2015)

Emperor Theophilus, in the Chronicle of John Skylitzes

Abstract: The Byzantine Emperor Theophilus (829-842 AD) died from dysentery, the exact nature of which is unknown. However, based on the original Greek texts of the Byzantine historians and chroniclers of that era, the possible cause of death may be connected to Theophilus’ pagophagia (snow eating), in order to relieve the symptoms of gastric inflammation.

Additionally to the symptoms from the gastro-intestinal system, the Emperor seemed suffering from depress after the defeat of his army and the loss of territories, among whom his native town, Amorion. The current study supports the theoretical possibility that the case of pagophagia in the 9th century AD, so well described by a great number of historians because of the sufferer’s royal identity, extends in the past the knowledge on pica, still attracting the medical interest.

Introduction: Pagophagia is the excessive or exclusive consumption of ice, snow or iced water, broadly regarded as a manifestation of pica. Pica is defined as a form of appetite disorder, presenting as the persistent eating of non-nutritive substances and has been described since antiquity. Some researchers extend the narrow definition to include the eating of both food and non-food items, while others classify the picas into food, non-food and mixed types. As a kind of inappropriate behaviour, pica is frequently associated with mental retardation, but it has been observed in all ages and both sexes, and particularly in young children and pregnant women. The most common types of substances ingested are earth (geophagia), ice (pagophagia), chalk, grass, cloth, paper; the eating patterns are referred to as “-phagias”. This paper describes a unique case of snow consumption by the Byzantine Emperor Theophilus (829-842 AD), who according to the narrations of the historians and chroniclers of those times was an ice eater, developing a pathologic craving for iced water and snow. Theophilus’ health problems are commented in accordance with this habit and an explanation for the causes of his death is attempted.

The term pica derives from the Latin word for magpie (kissa in Greek), named after the bird’s peculiar eating behaviour and indiscriminate selection of edible and non-edible items. The terms geophagia and pagophagia derive from the Greek verb phagein (to eat) and the words Gaia (earth) and pagos (ice) respectively. Pica of earth and clay was a well-known entity and the first description of geophagia in connection with pregnancy is traced in the Hippocratic Collection: If a pregnant woman feels the desire to eat earth or charcoal and then eats them, the child’s head will show signs of these things. Soranus (1st-2nd centuries AD) the most famous gynaecologist of antiquity also described pica during pregnancy: Some people say that pica (kissa) has been thus termed from a certain bird but others, however, say that it has been termed this from the ivy (kissos), for it twines around in a way that also varies. It usually sets around the 40th day and then persists for about four months. Women are affected by the following: appetite for things not customary like earth, charcoal, tendrils of the vine, unripe and acid fruit.