A short train ride from Bologna brings visitors to the historic town of Ravenna. A walk from the station past modest hotels leads to a shady park and a lively main street. At the far end, tourists find the sights they likely came for: the magnificent mosaics in the cathedral and the mausoleum of Galla Placida (389–450).
Often referred to simply as Placida, she was the daughter of the emperor Theodosius the Great, who in 395 divided the Roman Empire between his two sons. Arcadius, the older, received the east, which survived as the Byzantine Empire for about a thousand years. The younger son, Honorius, moved his western capital from Mediolanum (Milan) to the safer and more easily defended city of Ravenna. This became an important political and military center. The presence of emperors, soldiers, administrators, and clergy also created a need for physicians, surgeons, and medical attendants. Their Roman medical traditions, based largely on the teachings of Greek physicians such as Galen and Hippocrates, continued to be practiced there.
Ravenna’s marshy environment was unhealthy and fostered the spread of mosquito-borne diseases, especially malaria. Although its cause was unknown at the time, physicians linked marshlands with recurring fevers and supported drainage improvements around the city.
Moving to Ravenna rather than to Rome left the Eternal City undefended. For the first time in almost 800 years, Rome fell to a foreign invader, the Visigoth King Alaric, who in 410 sacked it mercilessly. He also captured young Placida and carried her off to Gaul, where he married her to his brother-in-law and chief general, Athaulf (414).
As a wedding gift, Athaulf gave his bride fifty young men dressed in silk as her personal guards, each carrying two plates, one piled with gold, the other with precious gems—all plundered from Rome. In 415, Athaulf was murdered by a domestic servant, and the new Visigoth king Sigeric, to consolidate his rule, killed all of Athaulf’s entourage and successors, and forced Placida to walk in front of his horse in a 12-mile funeral procession. Within one year, however, he was also assassinated. In 417, Placida was returned to the Romans in exchange for some critical grain shipments. In a series of events reminiscent of Lucrezia Borgia’s life, her half-brother, Emperor Honorius, forced her to marry the Roman general Constantius III, who became his co-emperor. Placidia had two offspring with him, but he died in 421. As the childless Honorius had divorced his second wife, she became Augusta or empress by default.
Palace intrigues flourished in the power vacuum that followed, with bizarre rumors spreading that Placida had become romantically involved with her half-brother. (One chronicler reported: “The absence of restraint in their love for one another and their constant kissing on the mouth caused many people to entertain infamous suspicions about them.”) Relations with Honorius went awry in 423 when he became convinced that she was dealing behind his back with the Visigoths, and he banished her from Ravenna. She fled with her two young children and hired a ship to travel back to her childhood home, Constantinople. It turned out to be a terrifying journey. The vessel nearly sank in an Aegean storm, and Placidia believed her family was saved only by a prayer promising to build a new church for St. John the Evangelist.
Not long after her escape from Ravenna, Honorius became edematous and died, leaving the throne to be seized by an upstart palace official named Joannes, who was capable and moderate but had no royal blood. Placidia convinced the reigning Eastern Emperor Theodosius II, her nephew, to dispatch an army to Italy, depose the usurper, and appoint Placidia’s six-year-old son, Valentinian, as emperor of the West. In 425, Placidia and her two children marched with the legions on Rome and then reoccupied Ravenna. Placidia regained her title of Augusta and took control of the Western Empire as her son’s all-powerful regent.
For the next decade, Placidia personally led the Western Empire, playing generals off one another, keeping the court’s deadly intrigues in check, and building alliances to stave off the new threat from the East, Attila the Hun. Even after Valentinian came of age in 437, Placidia, now 47, remained the power behind the throne. She legislated on the minutiae of daily life, took an active hand in Church affairs, and became close friends with bishops around the Mediterranean world. She weighed in on urgent theological debates, intervened in a dispute about the succession of the pope, and promoted worship of the Virgin Mary. She remained a devout patron of the arts, expanding her building program to edify the faithful. She died in 450 and was buried not in Ravenna but in Rome.
In 476 the Western Roman Empire collapsed, traditionally marked by the deposition of the last emperor, Romulus Augustulus. Italy was subsequently ruled first by the Germanic general Odoacer, and later by the Ostrogoths. It was reconquered in 535 by the Byzantine Emperor Justinian’s general Belisarius in Sicily (where 500 soldiers died after eating improperly prepared bread). The conquest was completed by his successor Narses, who defeated the king of the Ostrogoths, Totila (in 552). “Spare the king of the Ostrogoths,” Totila cried after being wounded on the battlefield, but they killed him anyway.
During the Byzantine period, Ravenna served as the capital of the Exarchate of Ravenna and became a bridge between the medical traditions of the Eastern and Western Roman worlds. Medical knowledge from Greek-speaking regions of the empire reached Italy through Ravenna, helping to preserve classical learning during an era when much ancient knowledge might otherwise have been lost.
The monasteries and churches in and around Ravenna also supported healthcare. Religious institutions cared for the sick, the poor, and travelers, while monks copied medical manuscripts that preserved texts later influential in European medicine. Although hospitals in the modern sense did not yet exist, charitable institutions offered shelter and nursing care to those in need.
In 568, the Lombards invaded Italy from the north. They took Ravenna in 751 but lost it to the Franks under the leadership of Pippin III the Short (Pepin le Bref) in 754. Pepin gave Ravenna to the pope in 757, but the local archbishops retained almost princely power. After a brief bid for independence in the mid-12th century, Ravenna came under the rule of the da Polenta family, a noble house of Romagna. In 1441, Venice established direct control over the city, but in 1509, Ravenna was returned to the Papal States. In 1512, the French seized the city, though it was soon recaptured. It remained under papal rule, with only minor interruptions, until 1859, when it was joined to the Kingdom of Sardinia, which became the Kingdom of Italy in 1861.
Today, Ravenna’s medical significance lies chiefly in its historical role as a center where Roman, Byzantine, and early medieval medical traditions intersected. The city illustrates how healthcare, public sanitation, and the transmission of medical knowledge continued despite the political upheavals that accompanied the decline of the Western Roman Empire. Thus, Ravenna occupies an important place in the history of medicine.
Further reading
Tony Perrottet, “The Misunderstood Roman Empress Who Willed Her Way to the Top,” Smithsonian Magazine, Jan/Feb 2023.