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)
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.