"Dark Ages" - this is the definition given by many historians to the era of the Middle Ages in Europe. How well do we know the events connected with the political reality of this period? But many documents of that era are associated with propaganda or political intrigues, and therefore suffer from bias towards other realities of that time. Are we also well acquainted with other aspects of the life of this time?

How and under what conditions were people born? What diseases could a person of that period suffer from, how was treatment carried out, by what means was medical care provided? How advanced was medicine in that period? What did medieval medical instruments look like? When did hospitals and pharmacies appear? Where can you get medical education? These questions can be answered by studying the history of medicine in the Middle Ages, toxicology, epidemiology, and pharmacology. Consider the basic concepts that give an idea of ​​the subject of this article.

Term « the medicine » originated from the Latin word "medicari" - to prescribe a remedy.

Medicine is a practical activity and a system of scientific knowledge about the preservation and strengthening of people's health, the treatment of the sick and the prevention of diseases, the achievement of longevity by human society in terms of health and performance. Medicine has developed in close connection with the whole life of society, with the economy, culture, worldview of people. Like any other field of knowledge, medicine is not a combination of ready-made, once-for-all truths, but the result of a long and complex process of growth and enrichment.

The development of medicine is inseparable from the development of natural science and technical branches of knowledge, from the general history of all mankind at the dawn of its existence and in each subsequent period of its change and transformation.

It is necessary to understand the links between the development of individual medical branches. This is the task of the general history of medicine, which studies the main patterns and main, key problems in the development of medicine as a whole.

Medical practice and science develop historically in close interaction. Practice, accumulating material, enriches medical theory and at the same time sets new tasks for it, while medical science, developing, improves practice, raising it to an ever higher level.

The history of medicine is a scientific discipline that studies the development of medicine at all stages, from its origin in the form of primitive traditional medicine to the present state.

The following sources are used to study the history of medicine: manuscripts; published works of doctors, historians, government and military officials, philosophers; archival materials; linguistic materials, data of art, ethnography, folk epic and folklore; images that can be presented both in the form of ancient rock paintings, and in the form of photographic and film documents of our time; scientific information: numismatics, epigraphy, paleography. Of particular importance are the data obtained as a result of archaeological excavations, paleontological and paleopathological studies.

By studying the history of medicine, we can trace the entire path of the origin, development, improvement of medical instruments, methods of treatment, formulations of medicines and compare with the level of development of modern instruments and methods of treatment. To follow the whole thorny path of trial and error that doctors have gone through from century to century.

The medieval period is very interesting because we still do not know many of its aspects. And it would be exciting to know more about him. Let us consider in more detail the medicine of the Middle Ages.

How did hospitals, hospitals and pharmacies appear?

The development of the hospital business is associated with Christian charity, because every person who wants to quickly go to heaven after death donated part of his income and property to the maintenance of hospitals and hospitals.

At the dawn of the Middle Ages, the hospital was more of a shelter than a hospital: those who arrived here were given clean clothes, they were fed and monitored for compliance with Christian norms, the rooms in which the sick were, washed and ventilated. The medical fame of hospitals was determined by the popularity of individual monks who excelled in the art of healing.

In the 4th century, monastic life was born, its founder was Anthony the Great. The organization and discipline in the monasteries allowed them to remain a citadel of order in the difficult years of wars and epidemics and to take under their roof the elderly and children, the wounded and the sick. Thus, the first monastic shelters for crippled and sick travelers arose - xenodocia - prototypes of future monastic hospitals.

One of the most famous medical institutions of the early 9th century was the monastery in Saint-Gallen.

In the 10th - 11th centuries, many wanderers and pilgrims, and later crusader knights, could find medical assistance and shelter in the cloisters of the "mobile brotherhood", the so-called hospitallers.

In the 70s of the XI century. Hospitallers built many shelters and hospitals in European countries and in the Holy Land (in Jerusalem, Antioch). One of the first to be built was the Hospital of St. John the Merciful in Jerusalem, in which a specialized department of eye diseases had already been allocated. At the beginning of the XII century, this hospital could take up to 2000 patients.

The Hospitaller Order of Saint Lazarus of Jerusalem was founded by the crusaders in Palestine in 1098 on the basis of a hospital for lepers, which existed under the jurisdiction of the Greek Patriarchate. From the name of this order comes the concept of "Infirmary". The order accepted into its ranks knights who fell ill with leprosy, and was originally intended to care for lepers. His symbol was a green cross on a white cloak. The order followed the "Rite of St. Augustine", but until 1255 was not officially recognized by the Holy See, although it had certain privileges and received donations.

At the same time, women's spiritual communities were also created, whose members cared for the sick. For example, in the 13th century in Thuringia, St. Elizabeth created the Order of the Elizabethans.

In Medieval Western Europe, initially hospitals were founded at the monasteries only for the monks living in them. But due to the increase in the number of wanderers, the premises of the hospitals gradually expanded. On the territories of the monastery lands, the monks grew medicinal plants for the needs of their hospital.

It should be noted that during the Middle Ages and the Renaissance, monasteries not only cultivated medicinal plants, but also knew how to use them correctly, knowing numerous ancient recipes. The monks followed these recipes, preparing various herbal medicines that were used in the treatment. Many monk-healers compiled and invented new medicinal herbal infusions and elixirs. An example is the French herbal liqueur Benedictine, which became so named after the monks from the monastery of St. Benedict. This monastery was founded on the banks of the English Channel, in the city of Fecamp in 1001. .

This is how the first pharmacies appeared. Over time, they became of two types: monastic, which had places for the manufacture of medicines, and urban ("secular"), which were located in the city center and were maintained by professional pharmacists who were part of the guild organizations.

Each of these types of pharmacies had their own placement rules:

• monastic: in order not to disturb the routine of monastic life, they were located, as a rule, outside the walls of the monastery. Often the pharmacy had two entrances - external, for visitors, and internal, which was located on the monastery territory;
• city ​​ones were usually located in the center of the city, they were decorated with bright signs and emblems of pharmacists. The interiors of pharmacies were original, but their indispensable attribute was special cabinets - rows of glazed or open shelves with pharmacy raw materials and finished medicines.

Of particular interest is the ancient apothecary utensils, the production of which, with the development of a network of pharmacies, has become an independent industry, which is often closely linked with art.

The production and sale of medicines at the initial stages of the development of the pharmacy business were too unprofitable, and in order to make the enterprise more profitable, pharmacists sold alcoholic beverages, sweets and much more.

Tallinn Town Hall Pharmacy, one of the oldest operating in Europe, opened in the 15th century, was famous, for example, not only for good medicines, but also for claret, light dry red wine. Many diseases were treated with this pleasant remedy.

In the Middle Ages, the work of monastic pharmacies and hospitals was strongly influenced by the epidemics that struck Europe. They contributed to the emergence of both explanations for the spread of the disease and methods of dealing with it. First of all, quarantines began to be created: the sick were isolated from society, ships were not allowed into the ports.

In almost all European cities in the 12th century, medical institutions founded by secular citizens began to appear, but until the middle of the 13th century, these hospitals still continued to be under the leadership of monasticism. These asylums were usually located near the city wall, on the outskirts of the city or in front of the city gates, and in them one could always find clean beds and good food, as well as excellent care for the sick. Later doctors began to be assigned to hospitals who did not belong to a particular order.

At the end of the 13th and beginning of the 14th centuries, hospitals began to be considered secular institutions, but the church continued to provide them with its patronage, which benefited from the inviolability of the property of the hospital. This was very important for the organization of medical activities, since wealthy citizens willingly invested their money in hospitals, thereby ensuring their safety. Hospitals could purchase land, take stocks of grain if there was a crop failure, and make loans to people.

How did medicine develop? Where can you get medical education? Outstanding doctors

The worldview of the Middle Ages was predominantly theological, "and church dogma was the starting point and basis of all thinking."

In the Middle Ages, the church severely persecuted and tried to eradicate any attempts by scientists of that time to explain to people the nature of various phenomena from a scientific point of view. All scientific, philosophical and cultural research, research and experiments were strictly prohibited, and scientists were subjected to persecution, torture and execution. She [the church] fought against "heresy", i.e. attempts at a critical attitude to the "Holy Scripture" and church authorities. To this end, the Inquisition was created in the 13th century.

By the 8th century, interest in education had declined across much of Europe. This was largely facilitated by the church, which became the dominant force. In the era of the development of feudalism, the need for the development of medical education was acutely revealed, but the church prevented this. The exception was the Salerno Medical School, founded in the 9th century in an area with healing natural springs and a healthy climate. It differed significantly from the later scholastic medical faculties that arose later. In the 11th century, the school was transformed into a university with a term of study of 9 years, and for persons who specialized in surgery, 10 years.

In the 12th century, universities opened in Bologna (1156), Montpellier (1180), Paris (1180), Oxford (1226), Messina (1224), Prague (1347), Krakow ( 1364). All these educational institutions were completely controlled by the church.

In the XIII century, the Parisian High School received the status of a university. The future doctor successively went through the stages of a clerk, bachelor, licentiate, after which he received a master's degree in medicine.

Scholastic (“school wisdom”) medicine developed at the universities. Teachers read texts and commentaries on books by church-recognized authors; students were required to learn this by heart. Both those and others discussed a lot, argued about the methods of treating a particular disease. But there was no practice of treatment. The ideological basis of medical training was Aristotle's doctrine of entelechy: the expediency and purposeful activity of the "highest creator" in predetermining the forms and functions of the body, and his natural science views were distorted. Galen was recognized as another indisputable authority. His works "Small Science" ("Ars parva") and "On the affected places" ("De locis affectis") were widely used. The teachings of Hippocrates were presented to students in the form of Galen's comments on his writings.

Teachers and students were not familiar with the anatomy of the human body. Although autopsies have been performed since the 6th century, in the Middle Ages this practice was condemned and banned by the church. All information about the structure and functions of the human body, with all significant errors and inaccuracies, was drawn from the works of Galen and Ibn Sina. They also used an anatomy textbook compiled in 1316 by Mondino de Lucci. This author had only been able to dissect two corpses, and his textbook was a compilation of the writings of Galen. Only occasionally were autopsies allowed at universities. This was usually done by a barber. During the autopsy, the theoretical professor read aloud in Latin the anatomical work of Galen. Typically, dissection was limited to the abdominal and thoracic cavities.

Only in Italy at the end of the 15th - beginning of the 16th century did the dissection of human corpses for the teaching of anatomy become more frequent.

Pharmacy was associated with alchemy. The Middle Ages are characterized by complex medicinal registrations. The number of parts in one recipe often reached several tens. A special place among medicines was occupied by antidotes: the so-called theriac, which included 70 or more components (the main component is snake meat), as well as mithridates (opal). Theriac was also considered a remedy for all internal diseases, including "pestilence" fevers. These funds were highly valued. In some cities, especially famous for their theriaci and mitridates and selling them to other countries (Venice, Nuremberg), these funds were made publicly, with great solemnity, in the presence of authorities and invited persons.

After graduating from the university, doctors united in a corporation in which there were ranks. Court physicians had the highest status. One step below were the city doctors, who lived off the payment for the services rendered. Such a doctor periodically visited his patients at home. In the XII-XIII centuries, the status of city doctors increased significantly. They began to manage hospitals, testify in court (about the causes of death, injuries, etc.), in port cities they visited ships and checked if there was any danger of infection.

During outbreaks of epidemics of the sick, "plague doctors" were especially popular. Such a doctor had a special suit, which consisted of a cloak (it was tucked at the neck under a mask and stretched to the floor to hide as much of the body surface as possible); masks in the form of a bird's beak (the view repels the plague, red glasses - the doctor's invulnerability to the disease, odorous herbs in the beak - also protection from infection); leather gloves; caskets with garlic; canes (for examination of the patient).

At the lowest level were surgeons. The need for experienced surgeons was very great, but their legal status remained unenviable. Among them were wandering surgeons who performed operations in different cities right on the market square. Such doctors cured, in particular, skin diseases, external injuries and tumors.

Bath attendants-barbers also joined the corporation of doctors. In addition to their direct duties, they performed bloodletting, set joints, amputated limbs, treated teeth, and monitored brothels. Also, such duties were performed by blacksmiths and executioners (the latter could study human anatomy during torture and executions).

Outstanding doctors of the Middle Ages were:

Abu Ali Hussein ibn Sina (Avicenna) (c. 980-1037) was an encyclopedic scholar. As a result of long and painstaking work, he later created the world famous « Canon of Medicine » , which became one of the largest encyclopedic works in the history of medicine;

Pietro d'Abano (1250-1316) - an Italian doctor accused by the Inquisition of secret knowledge and practicing magic. He had a medical practice in Paris, where he became famous after publishing a work on the complex use of various medical systems;

Arnold de Villanova (c. 1245 - c. 1310) - theologian, physician and alchemist. Studied medicine in Paris for 20 years;

Nostradamus (1503 - 1566) - French physician and soothsayer, whose far-reaching prophecies for many centuries caused a contradictory attitude towards himself;

Paracelsus (1493 - 1541) – one of the greatest alchemists, philosophers and doctors. His methods of treatment have gained wide popularity. Paracelsus served as city doctor and professor of medicine. He argued that any substance can become a poison depending on the dose;

Razi (865 - 925) – Persian encyclopedic scientist, philosopher, alchemist, also made a great contribution to the development of medicine;

Michael Scott (about 1175 - 1235) – alchemist, mathematician, physician, astrologer and theologian;

Guy de Chauliac (XIV century) is a comprehensively educated doctor who inherited the ideas of Hippocrates, Galen, Paul of Eginsky, Ar-Razi, Abul-Kasim, surgeons of the Salerno school, and others.

What diseases and epidemics "devoured" the population of Europe during the Middle Ages?

In the Middle Ages, a wave of terrible epidemics swept through the countries of Western Europe, killing thousands of people. These diseases were previously unfamiliar to the population of Europe. Many epidemics were brought to this territory thanks to the return of the knights from the Crusades. The reason for the rapid spread was that after the fall of the Roman Empire, where much attention was paid to the protection of public health, the era of Christianity that came to Europe marked a general decline in knowledge gained by experience. Christianity took a sharp opposition to the pagan cult of a healthy and beautiful human body, which was now recognized as only a mortal, unworthy shell of care. Physical culture was often opposed to the mortification of the flesh. Diseases began to be regarded as God's punishment for sins, so their occurrence was no longer associated with a violation of elementary norms of sanitation and hygiene.

Epidemics were used by the clergy to strengthen the influence of religion on the masses and increase church income through donations for the construction of God's temples. Also, church customs and rituals themselves contributed to the spread of infection. When kissing icons, crosses, the Gospel, the shroud, applying to the relics of "holy saints", the causative agent of the disease could be transmitted to many people.

Plague

People have long noticed the connection of plague epidemics with the preceding unusually strong reproduction of rats, which was reflected in numerous legends and tales. One of the famous stained glass windows of the cathedral in the German city of Gammeln depicts a tall man in black clothes playing the flute. This is the legendary rat-catcher, who saved the inhabitants of the city from the invasion of vile creatures. Bewitched by his playing, they left their holes, followed the flutist into the water and drowned in the river. The greedy burgomaster deceived the savior and instead of the promised hundred ducats gave him only ten. The angry rat-catcher again played the flute, and all the boys living in the city followed him, and disappeared forever. This mystical character is found on the pages of many works of art.

Plague has two main forms: bubonic (lymph nodes are affected) and pulmonary (the plague bacterium enters the lungs, causing acute pneumonia with tissue necrosis). In both forms, untreated, fever, sepsis, and death occur. Since the most typical of the plague is the femoral bubo, on all engravings and relief sculptures of St. Roch, the patron saint of plague patients, the latter defiantly flaunts the bubo located in this very place.

According to the chronological table compiled by A.L. Chizhevsky, starting from 430 BC. and until the end of the XIX century, there are 85 plague epidemics. The most devastating was the epidemic of the XIV century, which swept through the countries of Europe and Asia in 1348-1351.

Lion Feuchtwanger's historical novel The Ugly Duchess vividly describes the pages of this distant past. “The plague came from the East. Now she raged on the sea coast, then penetrated deep into the country. She killed in a few days, sometimes in a few hours. In Naples, in Montpellier, two-thirds of the inhabitants died. In Marseilles, the bishop died with the entire chapter, all the Dominican friars and minorites. Entire areas were completely depopulated ... The plague was especially raging in Avignon. The slain cardinals fell to the ground, the pus from the crushed buboes stained their magnificent vestments. Papa locked himself in the most distant chambers, did not allow anyone to see him, maintained a big fire all day, burned herbs and roots that purify the air ... In Prague, in an underground treasury, among gold, rarities, relics, Charles, the German king, sat, he put on myself fasting, praying.

The plague spread in most cases with merchant ships. Here is her path: Cyprus - late summer 1347; in October 1347 she penetrated the Genoese fleet stationed in Messina; winter 1347 - Italy; January 1348 - Marseille; Paris - spring 1348; England - September 1348; moving along the Rhine, the plague reached Germany in 1348. The structure of the German kingdom included the present-day Switzerland and Austria. There have also been outbreaks in these regions.

The epidemic also raged in the Duchy of Burgundy, in the Kingdom of Bohemia. 1348 - was the most terrible of all the years of the plague. It went for a long time to the periphery of Europe (Scandinavia, etc.). Norway was hit by the Black Death in 1349.

The plague left depopulated cities, deserted villages, abandoned fields, vineyards and orchards, devastated farms and abandoned cemeteries. No one knew how to escape the black death. Fasting and prayer did not help. Then people rushed to seek salvation in fun. Processions of dancers, calling to the mercy of St. Wallibrod, the protector from the plague, stretched along the streets and roads. One of these processions was depicted on a canvas dated 1569 by the artist Pieter Brueghel the Elder (the painting is in the Amsterdam Rijksmuseum). This custom of organizing mass dances to fight the plague, despite its complete uselessness, long persisted among the Dutch and Belgian peasants.

The "Black Death" still exists on the planet, and people are still dying from it, especially in those countries where the epidemic service is poorly set up.

Leprosy (leprosy)

This disease is caused by Mycobacterium leprae, a bacterium related to tuberculosis. This disease proceeds very slowly - from three to forty years and inevitably leads to death, which is why in the Middle Ages it was called "lazy death."

With leprosy, or, as it is more commonly called, leprosy, one of the darkest pages in the history of infectious diseases is connected. This chronic, generalized infectious disease affects the skin, mucous membranes, internal organs and peripheral nervous system... Different peoples have very figurative names for leprosy: fox scab, rot, lazy death, mournful disease.

In Christianity, there are two saints who patronize leprosy patients: Job (especially revered in Venice, where there is the church of San Jobbe, and in Utrecht, where the St. Job hospital was built), covered with ulcers and scraping them out with a knife, and poor Lazarus, sitting at the door of the house an evil rich man with his dog that licks his scabs: an image where sickness and poverty are truly united.

Vintage engraving "Jesus and the leper"

Egypt is considered the birthplace of leprosy. In the time of the pharaohs, the only way to alleviate the disease was to take a bath of human blood. (Wow, doesn't it remind you of anything?! It can be assumed that this is how the legends about vampirism began to appear.) S. Zweig in the chronicle novel "Mary Stuart" mentions the ominous rumors that circulated about the French King Francis II. It was said that he was ill with leprosy and, in order to be healed, bathed in the blood of babies. Many considered leprosy even more terrible punishment than death.

During archaeological excavations in Egypt, bas-reliefs were discovered that convey a picture of mutilation - the rejection of limbs during leprosy. From here, the disease passed through Greece to the countries of Europe - to the West to Spain and to the east - to Byzantium. Its further spread was the result of the Crusades to Palestine, the participants of which were knights, merchants, monks and farmers. The first such campaign under the slogan of the liberation of the Holy Sepulcher took place in 1096. Crowds of thousands of motley rabble led by Pierre of Amiens moved to Palestine. Almost all the participants in this campaign laid down their lives in Asia Minor. Only a few lucky ones managed to return to their homeland. However, the European feudal lords needed new markets, and three years later a well-armed army of six hundred thousand knights and their servants took Jerusalem. Over the course of two centuries, seven crusades took place, during which huge masses of people rushed to Palestine through Asia Minor and Egypt, where leprosy was widespread. As a result, this disease became a social disaster in Medieval Europe. After the cruel massacre of the French king Philip IV over the knights of the Knights Templar in France, a difficult time of popular unrest began, which took bizarre forms of religious and mystical mass campaigns. During one of these outbreaks, a massacre of lepers began in the country, who were blamed for the misfortunes that befell the country.

M. Druon described these events in the novel “The French Wolf”: “Were these unfortunates with a body eaten away by a disease, with the faces of the dead and stumps instead of hands, these people imprisoned in infected leper colonies, where they bred and multiplied, from where they were allowed to leave? only with a rattle in their hands, were they really guilty of polluting the waters? For in the summer of 1321, springs, streams, wells and reservoirs in many places turned out to be poisoned. And the people of France this year choked with thirst on the banks of their full-flowing rivers, or drank this water, waiting with horror after every sip of inevitable death. Didn’t the same order of the Templars put their hand here, didn’t they make a strange poison, which included human blood, urine, witchcraft herbs, snake heads, crushed toad legs, blasphemously pierced prosphora and the hair of harlots, a poison that, as assured, and the waters were contaminated? Or, perhaps, the Templars pushed these God-damned people to revolt, suggesting to them, as some lepers admitted under torture, the desire to destroy all Christians or infect them with leprosy? ... Residents of cities and villages rushed to leper colonies to kill the sick, who suddenly became enemies of society. Only pregnant women and mothers were spared, and even then only while they were feeding their babies. Then they were burnt. The royal courts covered these massacres in their judgments, and the nobility even allocated their armed men to carry them out.

People with signs of leprosy were expelled from the settlements to special shelters - leper colonies (many of them were created on the initiative of the Order of St. Lazarus, established by the Crusaders, at the beginning they were called infirmaries, and later - leper colonies). As soon as the relatives of the sick person or neighbors discovered that someone was ill with leprosy, the patient was immediately put in chains and the church tribunal sentenced him to death. Then one of the cruel and sinister rituals to which the Catholic Church was prone during the Middle Ages was staged. The patient was taken to the temple, where the priest handed him special gray clothes. Then the unfortunate was forced to lie in a coffin, a funeral mass was served and the coffin was taken to the cemetery. The priest said over the grave: "You are dead to all of us." And after these words, a person forever became an outcast. From now on, the leper colony became his lifelong refuge.

If the patient left the territory of the leper colony, he had to announce his approach by ringing a bell or a rattle. He also had a begging bag with him, and a special sign was sewn on his gray cloak: crossed arms made of white linen or a goose paw made of red cloth - a symbol of the disease, often accompanied by the gradual death of the limbs (the bones inside the fingers rotted, crumbled, the sensitivity of the fingers disappeared, fingers withered). If a leper talked to anyone, he was obliged to cover his face with a cloak and stand against the wind.

Although there are drugs to treat leprosy today, it still affects people in India, Brazil, Indonesia and Tanzania.

Medical instruments and operations

It is important to note that in the Middle Ages, no painkillers were used, other than strangulation or a blow to the head, and the use of alcohol. Often, after operations, the wounds rotted and hurt terribly, and when a person tried to ask a doctor for painkillers, the latter answered that pain relief means cheating pain, a person was born to suffer and must endure. Only in rare cases was hemlock or henbane juice used, Paracelsus used laudanum, an opium tincture.

During this period of history, it was widely believed that diseases could most often be caused by an excess of fluid in the body, therefore the most common operation of that period was bloodletting. Bloodletting was usually carried out by two methods: hirudotherapy - a physician applied a leech to the patient, and exactly on the place that most worried the patient; or opening the veins - direct cutting of the veins on the inside of the arm. The doctor cut a vein with a thin lancet, and the blood flowed into a bowl.

Also, with a lancet or a thin needle, an operation was performed to remove the clouded lens of the eye (cataract). These operations were very painful and dangerous.

Amputation of limbs was also a popular operation. This was done with a sickle-shaped amputation knife and a saw. First, with a circular motion of the knife, the skin was cut to the bone, and then the bone was sawn.

Teeth were mostly pulled out with iron tongs, so for such an operation they turned to either a barber or a blacksmith.

The Middle Ages was a "dark" and unenlightened time of bloody battles, cruel conspiracies, inquisitorial torture and bonfires. Medieval methods of treatment were the same. Because of the unwillingness of the church to allow science into the life of society, diseases that can now be easily cured in that era led to massive epidemics and death. A sick person, instead of medical and moral assistance, received general contempt and became an outcast rejected by all. Even the process of giving birth to a child was not a cause for joy, but a source of endless torment, often ending in the death of both the child and the mother. “Prepare for death” - women in labor were admonished before childbirth.

Cruel times gave birth to cruel customs. But still, science tried to break through church dogmas and prohibitions and serve for the benefit of people even in the Middle Ages.

I chose this picture for me:

But it turned out that I had an urgent opportunity to write on this topic elsewhere, and in order not to duplicate information, this post, written back in February, had to be hidden from everyone ... Nevertheless, I always remembered it, and now I had the opportunity to show it to everyone, which I do with pleasure.

This post is dedicated to one of the most sinister outwardly and essentially fertile figures of medieval history - the plague doctor, who is depicted in the photo above. This photo was taken by me on July 19, 2005, while traveling in Estonia, in the Kiek in de Kök Tower Museum in Tallinn.

Thanks to films and historical books, it is known what horror people in the Middle Ages, for example, were inspired by the executioner's costume - this hoodie, a mask that hides the face and makes its owner anonymous ... But no less fear, although not without a share of hope, caused more one suit - the so-called. The plague doctor. Both of them, both the doctor and the executioner, dealt with Death, only one helped take lives, and the second tried to save them, although most often unsuccessfully ... The appearance on the streets of a medieval city of a terrible silhouette in a dark robe and with a beak under a wide-brimmed hat was ominous a sign that the Black Death - the plague - settled nearby. By the way, the plague in historical sources was called not only cases of bubonic or pneumonic plague, but also pestilence and other fatal epidemics.

Plague was a long-known disease - the first reliable pandemic of the plague, known as "Justinian", arose in the 6th century in the Eastern Roman Empire, during the reign of Emperor Justinian, who himself died from this disease. This was followed by an outbreak of bubonic plague in Europe in the 8th century, after which it made itself felt only sporadically for several centuries.

The pandemic, known as the "great pestilence" or "black death" in the 14th century (1348–51), was brought to Europe by Genoese sailors from the East. It must be said that it is difficult to find a more effective means of spreading the plague than medieval ships. The holds of the ships were infested with rats, spreading fleas on all decks.

The cycle of infection from flea to rat and from rat to flea could continue until the rats died out. Hungry fleas in search of a new host transferred the disease to humans. Here, for example, is a diagram showing the cycles of infection and mortality in one single unit of society. The infected rat, marked with a red dot in the "1st day" column, died from the disease on the 5th day. When a rat died, the fleas left it, carrying the plague to other rats. By day 10, these rats were also dead, and their fleas were transferred to humans, infecting about 75% of them. By the 15th day, about half the people on the ship or in the house will have died of the plague; a quarter will recover, and a quarter will avoid infection.

Not a single state of Western Europe escaped the wholesale pestilence, even Greenland. It is believed that the Netherlands, Czech, Polish, and Hungarian lands remained almost unaffected, but the geography of the spread of the plague has not yet been fully studied.

The plague "moved" at the speed of a horse - the main transport of that time. During the pandemic, according to various sources, from 25 to 40 million people died. The number of victims in different regions ranged from 1/8 to 2/3 of the total number of inhabitants. Entire families died. The map of Europe shows the ways in which this epidemic spread:

Unsanitary conditions, constant malnutrition and a decrease in the physical resistance of the human body, the lack of basic hygiene skills and overcrowding of the population contributed to the spread of the epidemic. No one was immune from the plague, neither a simple townsman nor a king. The list of the dead includes French King Louis IX (Saint), Jeanne of Bourbon - wife of Philip of Valois, Jeanne of Navarre - daughter of Louis X, Alphonse of Spain, German Emperor Gunther, brothers of the King of Sweden, artist Titian. As Russov's chronicle tells, the master of the powerful Livonian Order of the Crusaders Bryggene died in Livonia.

The name "bubonic plague" comes from one of the early signs of the disease: the appearance of large painful swellings of the lymph nodes called buboes in the neck, groin and under the arms. Three days after the appearance of buboes, people had a fever, delirium began, and the body was covered with black uneven spots as a result of subcutaneous hemorrhages. As the disease progressed, the buboes enlarged and became more painful, often bursting and opening.

Reconstruction of the appearance of such a patient from a museum in Holland:

About half of the patients died before this stage. Images of patients with buboes are frequent on old images of that time.

On this English miniature of 1360-75. monks are depicted covered with buboes and seeking salvation from the Pope himself:

Doctors of that time could not immediately recognize the disease. It was fixed too late, when it seemed impossible to do anything. The causative agents of the disease will remain unknown for several centuries, the treatment as such did not exist at all. Doctors believed that the plague was spreading as a result of the so-called. "infectious beginning" (contagion) - a certain toxic factor that. can be passed from the sick to the healthy. Person-to-person transmission was thought to be either through physical contact with the patient or through clothing and bedding.

Based on these ideas, the most infernal costume of the Middle Ages arose - the costume of the Plague Doctor. In order to visit the sick during the plague, doctors were required to wear this special dress, which was the result of a combination of both epidemiologically sound things and prejudice.

For example, it was believed that such designs of masks in the form of ravens and other creatures with beaks, giving the doctor the appearance of an ancient Egyptian deity, "scare away" the disease. At the same time, the beak also carried a functional load - it protected the doctor from the "morbid smell". The beak or its tip was filled with strong-smelling medicinal herbs. It was a kind of natural filter that simplifies breathing in conditions of constant stench. He also protected others from other "stench" - since the doctor constantly chewed garlic for preventive purposes, and also placed incense on a special sponge in the nostrils and ears. To prevent the doctor from suffocating from all this bouquet of smells, there were two small ventilation holes in the beak.

The mask also had glass inserts to protect the eyes. A long, wax-soaked cloak and thick leather or oiled clothing were needed to avoid contact with the infected. Often clothes were impregnated with a mixture of camphor, oil and wax. In reality, this made it possible to some extent to avoid the bite of the plague carrier - a flea, and protected from the disease transmitted by airborne droplets, although this was not even suspected in those days.

The doctor's costume was completed by a leather hat, under which they put on a hood with a cape, covering the joint between the mask and clothes. Variations of the costume depended on the area and the financial capabilities of the doctor. For example, in the museum of the Tallinn tower Kik-in-de-Kök, the image of a doctor without a hat is presented, but with a hood that fits around his beak. Wealthier doctors wore bronze beaks. The doctor's gloved hands often clutched two objects necessary in his practice: a stick to drive away hopelessly infected people and a scalpel to open buboes. Or it could be smoking incense. The wand also contained incense, which was supposed to protect against evil spirits. Even in the doctor's arsenal there was a pommander - a box for aromatic herbs and substances that were supposed to "scare away" the plague.

In more recent times, the plague doctor costume became this:

In addition to doctors, there were also so-called. Mortuses (special employees recruited from those who survived the plague, or from convicted criminals), whose duty it was to collect the bodies of the dead and take them to the burial place.

On old engravings from London, mortuses are seen bringing corpses on carts and wagons, digging graves and engaging in burial.

Burning braziers can be seen on the engravings of that time. Then it was believed that fire and smoke purify the contaminated air, so the fires were burning everywhere, not going out even at night, incense was smoked to help cleanse the air of infection. Residents of London in the 17th century, for example, were persuaded to smoke tobacco, equating it with healing incense. Fumigation of premises with tarry substances, washing with odorous compounds, inhalation of vapors of burned saltpeter or gunpowder was practiced. To disinfect the premises where the patients died, the doctors recommended, in particular, to put a saucer with milk, which allegedly absorbs poisoned air. During trade settlements during the plague and other epidemics, buyers lowered money on the market into a vessel with oxymel (honey vinegar) or just vinegar, which each seller had - it was believed that then the infection could not pass from hand to hand.

Leeches, dried toads and lizards were applied to abscesses. Pig fat and butter were put into open wounds. Opening of buboes and cauterization of open wounds with red-hot iron was used.

It is not surprising that with such treatment, the mortality among the sick often even at a later time was 77-97%. A tried and tested recipe, which was followed by the people, was, until the 17th century. and later, - cito, longe, tarde: to flee from the infected area as soon as possible, further and return later.

The fear induced by the plague is shown in the painting by Pieter Brueghel the Elder "The Triumph of Death", where death in the form of wandering skeletons destroys all life. Neither the king with his gold, nor the young revelers at the table can escape the invasion of the ruthless army of the dead. In the background, skeletons push their victims into a water-filled grave; nearby you can see a barren, lifeless landscape.

The writer Daniel Defoe, known as the author of "Robinson Crusoe" and also at the origins of British intelligence, wrote in his "Diary of a Plague Year": "If only it were possible to accurately depict that time for those who did not experience it, and give the reader the correct the idea of ​​the horror that seized the townspeople, it would still make a deep impression and fill people with surprise and awe. It can be said without exaggeration that all London was in tears; no mourners circled the streets, no one wore mourning and did not sew to honor the memory of the closest dead, but crying was everywhere.The cries of women and children at the windows and doors of the dwellings where their closest relatives were dying, or perhaps just died, were carried so often, it was only necessary to go out into the street, and the most stony heart.Crying and lamentations were heard in almost every house, especially at the beginning of pestilence, because later hearts hardened, since death was constantly before everyone’s eyes, and They have lost the ability to mourn the loss of loved ones and friends, hourly expecting that they themselves will suffer the same fate.

Giovanni Boccaccio, in his "Decameron", which takes place just during the plague epidemic in 1348 in Italy, wrote: "A person who died from the plague caused as much participation as a dead goat."

Boccaccio's description is tragic: "Glorious Florence, the best city in Italy, was visited by a destructive plague ... Neither doctors nor drugs helped or cured this disease ... Since for the great multitude of dead bodies that were brought to the churches every hour, no Enormous pits were dug in overcrowded church cemeteries and whole hundreds of corpses were lowered in. In Florence, as they say, 100,000 people died... How many noble families, rich inheritances, huge fortunes were left without legitimate heirs! How many strong men , beautiful women, charming young men, whom even Galen, Hippocrates and Aesculapius would recognize as completely healthy, had breakfast with relatives, comrades and friends in the morning, and in the evening they dined with their ancestors in the next world.

In those days, people sought salvation from epidemics in churches, prayed for healing all together - sick and healthy ... The feeling of panic horror that epidemics and diseases sowed in medieval society was reflected in the prayer for intercession: "Save us from plague, famine and war us, Lord!"

According to eyewitnesses, the panic was such that "people wrapped themselves in two sheets and arranged a funeral for themselves during their lifetime (which was simply unheard of!)".

Perhaps the most famous Plague Doctor today was Michel de Notre Dame, better known as the soothsayer Nostradamus. At the dawn of his career, Nostradamus became famous for his success in saving his fellow citizens from the plague. The secret of Nostradamus was simple - the observance of elementary hygiene. There were no other means in his arsenal, and therefore he was powerless to save his first family from this terrible disease, after which he went into exile. And only in 1545 (at the age of 42) he returned to Marseilles, and this time his new medicine was able to act on pneumonic plague, and then, in Provence in 1546, on the "black plague".

Scene from the exposition of the Nostradamus Museum in Provence:

Not much is known about Nostradamus' methods. Wherever the bubonic plague raged, he ordered black crosses to be painted on the houses of the doomed to warn the healthy and hinder the spread of the epidemic. It must be remembered that the rules of hygiene familiar to us in those days were not known to many, and therefore the methods of Nostradamus had some effect. He recommended drinking only boiled water, sleeping in a clean bed, in case of danger of the plague, leaving the dirty, stinking cities as soon as possible and breathing fresh air in the countryside.

In the city of Aix, the capital of Provence, Nostradamus first used his famous pills, mixed with rose petals and rich in vitamin C. He distributed them right on the streets of the infected cities, along the way explaining to fellow citizens the rules of elementary hygiene. "All who used them," he later wrote, "were saved, and vice versa."

Nostradamus devoted several chapters in one of his medical books to the description of the disinfectant powder from which he made the pills. The 1572 edition of this book is kept in the Parisian library of St. Genevieve under the unusual title for us "An excellent and very useful brochure on many excellent recipes, divided into two parts. The first part teaches us how to prepare various lipsticks and perfumes to decorate the face. The second part teaches us how to prepare jams of various varieties from honey, sugar and wine Compiled by Master Michel Nostradamus, M.D. from Chalons in Provence, Lyon, 1572." Particularly, the sections of this book were titled "How to make a powder, clean and whiten your teeth... and a way to give a pleasant smell to your breath. Another way, even more perfect, for cleansing teeth, even those that are badly rotten... A way to cook a kind of soap that whitens and softens hands and has a sweet and delicious smell... A way to prepare a kind of distilled water to best beautify and whiten the face... Another way to make beard hair blond or gold-colored, and also to destroy too greater fullness of the body.

Before the discovery of the plague bacterium and the use of antibiotics in the treatment of this disease, almost half a millennium remained ...

The painting "The Plague" by Arnold Böcklin (1898) shows all the horror of this disease - after all, even in his time, at the turn of the 19th and 20th centuries, they had not yet learned how to fight it!

And even in our time, individual outbreaks of this disease are still recorded:

Materials used in the preparation of the article:
from Colin McEvedy's article "Bubonic Plague" from IN THE WORLD OF SCIENCE. (Scientific American. Edition in Russian). 1988. No. 4,
Wikipedia and Encyclopedia Britannica
from the article "War against the "Black Death": from defense to offensive" V. S. Ganin, Ph.D. honey. Sciences, Irkutsk Research Anti-Plague Institute of Siberia and the Far East, in the journal "Science and Life" No. 7, 2006
Filippov B., Yastrebitskaya A. The European world of the X-XV centuries.
HISTORY OF PLAGUE EPIDEMICS IN RUSSIA

Kazakh-Russian Medical University

Department of Public Disciplines

On the topic: Philosophy of the 20th century - a change in the style of thinking of medicine in the 20th century

Completed by: Ruzanna Sadyrova

Group 203 A stom. faculty

Checked by: Bekbosynova Zh.B.

Almaty 2013

Introduction

Introduction

exceptions.

various problems.

specialties.

twentieth century.

Scientific medicine in the Middle Ages was poorly developed. Medical experience intersected with magic, religion. A significant role in medieval medicine was assigned to magical rites, the impact on the disease through symbolic gestures, "special" words, objects. From the XI-XII centuries. objects of Christian worship, Christian symbols appeared in healing magical rites, pagan spells were transposed in a Christian way, new Christian formulas appeared, the cult of saints and their relics flourished.

The most characteristic phenomenon of healing practice in the Middle Ages was the saints and their relics. The heyday of the cult of saints falls on the High and Late Middle Ages. In Europe, there were more than ten of the most popular burial places of saints, where thousands of pilgrims flocked to regain their health. Gifts were donated to the saints, the afflicted prayed to the saint for help, sought to touch some thing that belonged to the saint, scraped off stone chips from tombstones, etc. From the 13th century. the "specialization" of the saints took shape; about half of the entire pantheon of saints were considered patrons of certain diseases.

As for diseases, they were tuberculosis, malaria, dysentery, smallpox, whooping cough, scabies, various deformities, and nervous diseases. But the scourge of the Middle Ages was the bubonic plague. It first appeared in Europe in the 8th century. In 1347, the plague was brought by Genoese sailors from the East and within three years spread throughout the continent. The Netherlands, Czech, Polish, Hungarian lands and Russia remained unaffected. To recognize the plague, as, indeed, and other diseases, medieval doctors could not, the disease was recorded too late. The only recipe used by the population until the 17th century came down to the Latin advice cito, longe, targe, that is, to flee from the infected area sooner, further and return later.

Another scourge of the Middle Ages was leprosy (leprosy). The disease appeared, probably in the era of the Early Middle Ages, but the peak of the incidence falls on the XII-XIII centuries, coinciding with the strengthening of contacts between Europe and the East. Patients with leprosy were forbidden to appear in society. use public baths. For lepers, there were special hospitals - leper colonies, which were built outside the city limits, along important roads, so that the sick could beg for alms - the only source of their existence. The Lateran Cathedral (1214) allowed the construction of chapels and cemeteries on the territory of leper colonies to create a closed world, from which the patient could only come out with a ratchet, thus warning about his appearance. At the end of the XV century. syphilis appeared in Europe.

Under the influence of Arab learning, which began to penetrate Europe in the 11th and 12th centuries, the first timid interest in experimental knowledge appeared. So. R. Grossetest (circa 1168-1253) experimentally tested the refraction of lenses, he, along with Ibn al-Haytham (965-1039), is credited with introducing lenses for vision correction into practice; R. Lully (circa 1235-1315) - one of the creators of alchemy - was looking for the "elixir of life". The disputes and works of medieval scholastics contributed to the development of logic, alchemy prepared the emergence of scientific chemistry, and so on. At the same time, the intellectual life of medieval Europe did nothing for the development of the cardinal problems of natural science and even contributed to a certain regression in the field of natural science knowledge. R. Bacon (circa 1214-1292) was perhaps the first European medieval thinker who called on science to serve mankind and predicted the conquest of nature through its knowledge. However, it took almost two centuries of intellectual development before the "titans of the Renaissance" brought natural science out of oblivion and it turned out to be at the center of the interests of the educated circles of European society.

The dominance of the theological worldview, traditional thinking, and stagnation in the natural sciences severely hampered progress in the field of mathematics. However, the development of mathematics did not stop. During the period of the formation of feudalism, the most favorable conditions for the development of mathematics developed in the eastern regions.

Medicine and education in the Arab states of the Middle Ages - Surgery and anatomy - Outstanding personalities of Arab medicine - Hospitals and clinics of the Arab world

In the 7th century, when the Arabs conquered Iran, Syria and Egypt, Greek science and Greek philosophy developed in the scientific centers of these countries. The most famous at that time were Alexandria School in Egypt and the Christian Nestorian school in Gundishapur (Jundi-Shapur) in southern Iran. The court physician of Caliph al-Mansur (754-776) came out of this school. Jurjus ibn Bakhtish- the founder of the dynasty of court Christian doctors, who for two and a half centuries served impeccably at the court of the Baghdad caliphs. Realizing the importance of ancient science, the caliphs and other Muslim leaders contributed to the translation into Arabic of the most important Greek works.

The beginning of this activity was laid at the end of the 8th century, however, the main work of translators unfolded during the reign of Caliph al-Mamun (813-833), who specially organized for this in Baghdad "House of Wisdom"(Arab, bait al-hikma). During the 9th and 10th centuries almost all available literature of interest to the Arabs was translated into Arabic. Over time, translations into Arabic began to be made directly from Greek. Most researchers associate this transition with the activities of the most famous translator of the era of the Caliphates - a Nestorian Christian Hunayn ibn Ishaq(809-873) from Hira. He translated Plato and Aristotle, Soranus and Oribasius, Rufus from Ephesus, and Paul from Fr. Aegina. At that time, there were no original texts in Arabic on the topics of the works he translated, and Hunayn ibn Ishaq mastered medical terminology, introduced it into Arabic and laid the precious lexical foundation of medical texts in Arabic. Many texts were also translated from Persian. Through the Persians, the Arabs became acquainted with the achievements of Indian civilization, especially in the field of astronomy, medicine, and mathematics. From the Indians, they also borrowed numbers, which the Europeans called "Arabic". The translation activities of the Arabs played an invaluable role in preserving the heritage of the civilizations that preceded them - many ancient works reached medieval Europe - only in Arabic translations. However, scientists believe that no more than 1% of medieval Arabic manuscripts have survived to this day. Education in the Caliphate was largely influenced by Islam. In the medieval Muslim world, all knowledge was divided into two areas: "Arab"(or traditional, basically related to Islam) and "foreign"(or ancient, common to all peoples and all religions). The "Arab" humanities (grammar, lexicography, etc.) were formed in connection with the study of hadiths (traditions about the sayings and deeds of Muhammad) and the Koran, knowledge of which is extremely important for Muslims. The study of "foreign" sciences was dictated by the needs of a developing society and reflected its interests: geography was necessary to accurately describe the subject lands, history served as the basis for studying the life of the Prophet, astronomy and mathematics refined the sacred calendar. Interest in medicine also increased, which over time began to be defined as a profession worthy of praise and blessed by Allah: according to Islamic tradition, Allah will not allow a disease until he creates a remedy for it, the task of a doctor is to find this remedy.

Medicine and education in the Arab states of the Middle Ages As the main scientific manuscripts were translated into Arabic, Christians lost their monopoly on medicine, and the centers of science and higher education gradually moved to Baghdad, Basra, Cairo, Damascus, Cordova, Toledo, Bukhara, Samarkand. The library of Cordoba contained more than 250 thousand volumes. Large libraries were in Baghdad, Bukhara, Damascus, Cairo. Some rulers and rich people had their own libraries. So, in the library of the head of the Damascus doctors Ibn al-Mutran (Ibn al-Mutran, XIII century), who treated Caliph Salah ad-Din, there were about 10 thousand books. Head of Baghdad Doctors Ibn al-Talmid (Ibn al-Talmld, XII century)- the author of the best pharmacopeia of his time - collected more than 20 thousand volumes, many of which were rewritten by him personally. In the 12th century, when there were only two universities in Western Europe (in Salerno and Bologna), in Muslim Spain alone (the Caliphate of Cordoba) there were 70 libraries and 17 higher schools, in which, among other disciplines, medicine was also taught. Arabic-language medicine has dominated the Mediterranean region for eight centuries. It preserved, supplemented and returned to Europe in an improved form all the most important knowledge accumulated in the region by the early Middle Ages. In the field of the theory of disease, the Arabs adopted the ancient Greek teachings about the four elements and four bodily juices (arab. Ahlat), set out in the Hippocratic Collection and the works of Aristotle, and then commented on in the writings of Galen. According to the Arabs, each of the elements and liquids participates (in various proportions) in the creation of four qualities: heat, cold, dryness and moisture, which determine mizaj(Arabic, mizag - temperament) of each person. It can be normal, in case of balance of all components, or "unbalanced" (of various degrees of complexity). When the balance is disturbed, the doctor's task is to restore the original state. Mizaj is not something permanent and changes with age under the influence of the surrounding nature. In the treatment of internal diseases, the first attention was paid to establishing the correct regimen, and only then medicines were used, simple and complex, in the preparation of which the Arabs reached a high level of perfection. This is largely due to the development of alchemy. Having borrowed from the Syrians the idea of ​​using alchemy in the field of medicine, the Arabs played an important role in the formation and development of pharmacy and the creation of the pharmacopeia. Pharmacies began to open in the cities for the preparation and sale. Alchemists of the medieval Arabic-speaking East invented a water bath and an alembic, applied filtration, obtained nitric and hydrochloric acids, bleach and alcohol (which was given the name alco-hol). Having conquered the Iberian Peninsula, they brought this knowledge to Western Europe.

Ar-Razi (850-923), an outstanding philosopher, physician and chemist of the early Middle Ages, compiled the first encyclopedic work on medicine in Arabic literature "The Comprehensive Book of Medicine" ("Kitab al Hawi") in 25 volumes. Describing each disease, he analyzed it from the standpoint of Greek, Syrian, Indian, Persian and Arabic authors, after which he presented his observations and conclusions. In the XIII century. "Kitab al-Hawi" was translated into Latin and then into many European languages, was constantly republished in medieval Europe and, together with Ibn Sina's "Canon of Medicine", was one of the main sources of medical knowledge for several centuries. Another encyclopedic work of Ar-Razi "Medical Book" in 10 volumes ( "Al-Kitab al-Mansuri"), dedicated to the ruler of Khorasan Abu Salih Mansur ibn Ishak, summarized the knowledge of that time in the field of the theory of medicine, pathology, medicinal medicine, dietetics, hygiene and cosmetics, surgery, toxicology and infectious diseases. In the XII century .. it was translated into Latin, and in 1497 published in Venice. Among and numerous works of Ar-Razi, a small treatise is of particular value "About smallpox and measles", which is recognized by many authors as the most original work of medieval Arabic-language medical literature. In essence, this is the first detailed presentation of the clinic and treatment of two dangerous infectious diseases that claimed many human lives at that time. Even today, it could be a great study tool for students!

Surgery and anatomy Surgery in the medieval Arabic-speaking world was more of a craft than a science, unlike in the ancient world. This was explained by the Muslim tradition, which forbade both autopsy and vivisection. It is clear that in the caliphates, surgery developed to a lesser extent than medicinal medicine. Nevertheless, Muslim doctors have made a significant contribution to the development of certain areas of anatomy and surgery. This is especially evident in ophthalmology.

Exploring the structure of the eye of animals, the famous Egyptian astronomer and physician Ibn al-Haytham(965-1039, known in Europe as Alhazen) was the first to explain the refraction of rays in the media of the eye and gave names to its parts (cornea, lens, vitreous body, etc.). Having made models of the lens from crystal and glass, he put forward the idea of ​​vision correction using biconvex lenses and suggested using them when reading in old age. Capital work of Ibn al-Khaytham "Treatise on Optics" ("Kitab al-Manazir") glorified his name in the countries of the East and Western Europe. Unfortunately, the Arabic original of this book has not been preserved. It has survived to this day in Latin translation - "Opticae thesaurus Alhazeni arabis" ("Treasures of the optics of the Arab Alhazen"). The galaxy of remarkable Arab oculists also includes Ammar ibn Ali al-Mausili (Ammar ihn Ali al-Mausili, X c.), one of the most famous eye doctors in Cairo. The cataract removal operation developed by him by suction of the lens with the help of a hollow needle invented by him was a great success and was called "Ammar's operation". The treatment of eye diseases was an area of ​​medicine in which the influence of the Arab school was felt in Western Europe until the 17th century. The outstanding achievements of the Arabs in the field of anatomy include a description of the pulmonary circulation, which was made in the XIII century. Syrian doctor from Damascus Ibn an-Nafis (Ibn an Nafis), i.e. three centuries earlier than Miguel Serveta. Ibn al-Nafis was revered as a great scientist of his time, famous for his comments on the section of anatomy in Ibn Sina's Canon. The most prominent surgeon of the medieval Arabic-speaking world is considered Abul-Qasim Khalaf ibn Abbas al-Zahrawi (lat. Abulcasis c. 936-1013). He was born near Cordoba in Muslim Spain and thus belongs to the Arab-Spanish culture. Al-Zahrawi lived in the "golden period" of its development (the second half of the 10th century), when the Arab-Spanish culture was the most advanced in Western Europe, and along with the Byzantine one, in all of Europe as a whole. The main scientific centers of Muslim Spain were universities in Cordoba, Seville, Grenada, Malaga. In the chain of the historical development of surgery, al-Zahrawi became a link between ancient medicine and the medicine of the European Renaissance. He considered knowledge of anatomy absolutely necessary for a surgeon and recommended studying it according to the works of Galen. The criterion of truth for him was his own observations and his own surgical practice. This partly explains the fact that his writings contain few references to other people's work. Compared with the surgery of antiquity, al-Zahrawi made a big step forward. He described what is today called tuberculosis of the bones and introduced the operation of cataract removal (az-Zahrawi's term) into the eye surgery of the West. He was the author of new surgical instruments (more than 150) and the only author of antiquity and the early Middle Ages who described them and presented them in drawings. Often he was accused of replacing the knife with red-hot iron. However, we should not forget that at that time they did not yet know the nature of inflammation and the infectious process and did not know how to deal with them. Al-Zahrawi highly appreciated the method of cauterization (remember the centuries-old experience of traditional Chinese medicine) and successfully used it to treat local skin lesions and other diseases. Abu al-Zahrawi gained fame as the largest surgeon of the medieval Muslim world - no one in that era surpassed him in the art of surgery and innovation in it. Hospitals and clinics in the Arab world The organization of the hospital business received significant development in the caliphates. Initially, the establishment of hospitals was a secular affair. Hospital name - bimaristan (bimaristan)-Persian, this once again confirms that the hospital business in the caliphates experienced a significant influence of Iranian and Byzantine traditions. According to the historian al-Maqrizi (1364-1442), the first known hospital in the Muslim world was built during the time of the Umayyads under Caliph al-Walid (705-715). A hospital in the modern sense of the word appeared in Baghdad around 800. At the initiative of Caliph Harun ar-Rashid, it was organized by an Armenian Christian doctor from Gundishapur - Jibrail ibn Bakhtishi (Gibra "il ibn Bahtisu), the third in the famous Bakhtishu dynasty. His grandfather Jurjus ibn Jibrail ibn Bakhtishu (Girgis ibn Bahtisu)- the founder of the dynasty and the head of the doctors of the medical school in Gundishapur - in 765 he cured the seriously ill caliph al-Mansur, whom no one could cure. And despite the fact that Jurjus ibn Bakhtisha was a Christian and did not convert to Islam, the caliph appointed him head of the doctors of the capital of the Caliphate-Baghdad. He and all his descendants successfully served as court physicians to the caliphs for six generations, were known in the Muslim world and highly revered by the rulers until the beginning of the 11th century. The hospitals founded by the Muslims were of three kinds. The first type included hospitals established by caliphs or famous Muslim figures and designed for the general population. They were funded by the state, had a staff of doctors and non-medical attendants. Libraries and medical schools were created at hospitals. The training was theoretical and practical: the students accompanied the teacher during his rounds in the hospital and visited patients at home with him. The hospital was one of the largest "al-Mansuri" in Cairo. Opened in 1284 in the premises of the former palace, it, according to historians, was designed for 8 thousand patients who were placed in accordance with their diseases in the male and female departments. The physicians of both sexes serving her specialized in various fields of medical knowledge. Hospitals of the second kind were funded by famous doctors and religious figures and were small. The third type of hospitals were military medical institutions. They moved along with the army and were placed in tents, castles, citadels. During military campaigns, along with male doctors, the soldiers were accompanied by female doctors who cared for the wounded. Some Muslim women who practiced medicine have earned wide recognition. So, under the Umayyads, a woman oculist became famous Zainab from the tribe of Avd. The sister of Al-Hafida ibn Zuhr and her daughters (their names are not known to us) had high knowledge in the treatment of women's diseases, they were the only doctors who were allowed treatment in the harem of Caliph al-Mansur. The high level of organization of medical affairs in the medieval East is closely connected with the development of hygiene and disease prevention. The ban on autopsies, on the one hand, limited the study of the structure of the body and its functions, and on the other hand, directed the efforts of doctors to find other ways: to maintain health and led to the development of rational hygienic measures. Many of them are enshrined in the "Quran" (five ablutions and cleanliness of the body, the ban on drinking wine and eating pork, the norms of behavior in society, the family. According to legend, the Prophet Muhammad received his knowledge in the field of medicine from a doctor al-Harith ibn Kaladaha (al-Harit ibri Kalada), who was born in Mecca in the middle of the 6th century, and studied medicine at the Gundishapur Medical School. If this fact took place, the hygienic recommendations of the Koran go back to the traditions of Gundishapur, which absorbed the traditions of ancient Greek and Indian medicine.

Medicine of the Middle Ages

Russian State Medical University. N.I. Pirogov

Department of History of Medicine

Essay on the history of medicine

"Medicine of the Middle Ages"

Moscow Medical Faculty, stream "B"

performed by a student of group No. 117

Kiryanov M.A.

Scientific adviser Dorofeeva E.S.

Moscow 2002

Introduction 3

Chapter 1 Medicine in Medieval Western Europe 5

Chapter 2. About the history of the Western European hospital in the Middle Ages 23

Chapter 3. On the clinical training of doctors in medieval universities 35

Conclusion 41

References 42

Introduction

The Middle Ages are usually regarded as a dark age of ignorance.

or perfect barbarism, as a period of history, which is characterized in

in two words: ignorance and superstition.

As proof of this, they cite that for philosophers and doctors during

throughout the medieval period, nature remained a closed book, and

indicate the prevailing dominance at this time of astrology, alchemy,

magic, sorcery, miracles, scholasticism and gullible ignorance.

As proof of the insignificance of medieval medicine, they cite

the complete lack of hygiene in the Middle Ages, both in private dwellings and

in general in cities, as well as rampant throughout this period

deadly epidemics of plague, leprosy, various kinds of skin diseases and

Contrary to this view, there is an opinion that the Middle Ages

because it is above antiquity, because they follow it. Nothing to prove that and then

and the other is without foundation; at least as far as medicine is concerned, already one

common sense speaks in favor of the fact that there was not and could not be a break in

medical tradition, and just as the history of all other fields

culture will show that the barbarians were the direct successors of the Romans,

in the same way, medicine cannot, and could not, in this respect,

exceptions.

It is known, on the one hand, that in the Roman Empire, and especially in

Italy was dominated by Greek medicine, so that Greek writings served

these guides for mentors and students, and on the other hand,

that the invasion of the barbarians did not at all have such all-destroying

consequences for science and the arts, as was usually supposed.

This topic seemed interesting to me because the era of the Middle Ages

is an intermediate link between ancient and modern times, when science

began to develop rapidly, discoveries began to be made, including in medicine.

But nothing happens and does not happen in an empty place ...

In my abstract, I showed in the first chapter a general picture of this era,

since it is impossible to consider separately any branches, whether

art, economics or, in our case, medicine, since to create

objectivity, it is necessary to consider this section of science in relation to its

period of time, taking into account all its specifics and considering from this position

various problems.

It was interesting for me to consider in the second chapter a more specific topic

the history of the medieval hospital, its way of becoming from a simple monastery

charities for the poor and places of caratative activity of the church before the formation

social institution of medical care, although even a semblance of a modern

hospitals with doctors, nurses, wards and some

Specialization of the hospital begins to resemble only that from the 15th century.

The clinical training of doctors in the Middle Ages is also interesting,

to which the third chapter is devoted, their process of training in medical

faculties of universities of that time, since education was mainly

theoretical, moreover, scholastic, when students had to

just rewrite the works of the ancients in lectures, and not even themselves

works of ancient scientists, and comments on them by the holy fathers. Science itself

was within the strict limits dictated by the church, the leading slogan that gave

Dominican Thomas Aquinas (1224-1274): "All knowledge is a sin if it

does not aim at the knowledge of God ”and therefore any free-thinking, digressions,

a different point of view - was regarded as heresy, and quickly and mercilessly

punished by the "holy" inquisition.

As reference literature in the abstract were used

the following sources, such as - a large medical encyclopedia,

reference book that formed the basis of this work. And which is probably

most fully covers the most relevant issues related to medicine and,

interesting, both for students and for practicing doctors of any

specialties.

As periodical literature, I took magazines: “Problems

social hygiene and the history of medicine”, where

"Clinical Medicine" and "Russian Medical Journal", which have

The books “History of Medicine” by L. Meunier turned out to be an important help,

"History of Medieval Medicine" Kovner, "History of Medicine. Favorites

lectures” F.B. Borodulin, where the entire period of the history of medicine is described in detail,

starting with primitive society and ending with the beginning and middle

The main diseases of the Middle Ages were: tuberculosis, malaria, smallpox, whooping cough, scabies, various deformities, nervous diseases, abscesses, gangrenes, ulcers, tumors, chancres, eczema (the fire of St. Lawrence), erysipelas (the fire of St. Sylvian) - everything is exhibited paraded in miniatures and pious texts. The usual companions of all wars were dysentery, typhus and cholera, from which, until the middle of the 19th century, significantly more soldiers died than from battles. The Middle Ages are characterized by a new phenomenon - epidemics.
The 14th century is known for the "black death", it was a plague combined with other diseases. The development of epidemics was facilitated by the growth of cities that were distinguished by dullness, dirt and crowding, the mass migration of a large number of people (the so-called great migration of peoples, the crusades). Poor nutrition and the miserable state of medicine, which did not find a place for itself between the recipes of the healer and the theories of learned pedants, gave rise to terrible physical suffering and high mortality. Life expectancy was low, even if you try to define it without taking into account the horrendous infant mortality and frequent miscarriages in women who were malnourished and forced to work hard.

Epidemic was called "pestilence" (loimos), literally "plague", but this word meant not only the plague, but also typhus (mostly typhus), smallpox, dysentery. Often there were mixed epidemics.
The medieval world was on the verge of eternal famine, malnourished and consuming bad food ... From here a series of epidemics caused by the consumption of unfit food began. First of all, this is the most impressive epidemic of "fever" (mal des ardents), which was caused by ergot (perhaps other cereals as well); this disease appeared in Europe at the end of the 10th century, and tuberculosis was also widespread.
As the chronicler Sigebert of Gemblouse relates, 1090 “was a year of epidemic, especially in Western Lorraine. Many rotted alive under the influence of the "sacred fire" that devoured their guts, and the burnt members turned black as coal. People died a miserable death, and those whom she spared were doomed to an even more miserable life with amputated arms and legs, from which a stench emanated.
By 1109, many chroniclers note that the "fiery plague", "pestilentia ignearia", "devours human flesh again." In 1235, according to Vincent of Beauvais, “a great famine reigned in France, especially in Aquitaine, so that people, like animals, ate the grass of the field. In Poitou, the price of a network of grain rose to a hundred sous. And there was a strong epidemic: the "sacred fire" devoured the poor in such a large number that the church of Saint-Maxin was full of the sick.
The medieval world, even leaving aside periods of extreme disaster, was doomed in general to a host of diseases that combined physical misfortune with economic difficulties, as well as mental and behavioral disorders.

Physical defects were found even among the nobility, especially in the Early Middle Ages. On the skeletons of Merovingian warriors, severe caries were found - a consequence of poor nutrition; infant and child mortality did not spare even the royal families. Saint Louis lost several children who died in childhood and youth. But ill health and early death were primarily the lot of the poor classes, so that one bad harvest plunged into an abyss of starvation, the less endurable the more vulnerable the organisms were.
One of the most widespread and deadly of the epidemic diseases of the Middle Ages was tuberculosis, probably corresponding to that "exhaustion", "languor", which is mentioned in many texts. The next place was occupied by skin diseases - first of all, terrible leprosy, to which we will return.
Two pitiful figures are constantly present in medieval iconography: Job (especially revered in Venice, where there is the church of San Giobbe, and in Utrecht, where the hospital of St. Job was built), covered with ulcers and scraping them with a knife, and poor Lazarus, sitting at the door of the house of the evil a rich man with his dog that licks his scabs: an image where sickness and poverty are truly united. Scrofula, often of tuberculous origin, was so characteristic of medieval diseases that tradition endowed French kings with the gift of curing it.
No less numerous were diseases caused by beriberi, as well as deformities. In medieval Europe there were a great many blind people with eyesores or holes, which would later wander in the terrible picture of Brueghel, cripples, hunchbacks, patients with Graves' disease, lame, paralyzed.

Another impressive category were nervous diseases: epilepsy (or the disease of St. John), the dance of St. Guy; here comes to mind St. Willibrod, who was in Echternach in the 13th century. patron of the Springprozession, a dancing procession on the verge of witchcraft, folklore and perverted religiosity. With a fever, we penetrate deeper into the world of mental disorder and insanity.
The quiet and furious madness of lunatics, violently mad, idiots towards them The Middle Ages oscillated between disgust, which they tried to suppress through some kind of ritual therapy (exorcism from the possessed), and sympathetic tolerance, which broke free in the world of courtiers (jesters of lords and kings) , games and theater.

None of the wars claimed so many human lives as the plague epidemic. Now many people think that this is just one of the diseases that can be treated. But imagine the 14-15th century, on the faces of people the horror that appeared after the word "plague". The Black Death that came from Asia in Europe claimed a third of the population. In 1346-1348, the bubonic plague raged in Western Europe, 25 million people died. Listen to how the writer Maurice Druon describes this event in the book “When the King Ruins France”: “When trouble spreads its wings over a country, everything mixes up and natural disasters are associated with human mistakes ...

The plague, the great plague that came from the depths of Asia, brought down its scourge on France more viciously than on all other states of Europe. The city streets have turned into deadly suburbs - into a slaughterhouse. A fourth of the inhabitants were carried off here, and a third there. Entire villages were deserted, and among the uncultivated fields only huts, abandoned to the mercy of fate, remained from them.
The peoples of Asia had a hard time enduring the epidemic. In China, for example, the population decreased from 125 million to 90 million during the 14th century. The plague moved to the West along the path of caravans.
The plague reached Cyprus in the late summer of 1347. In October 1347, the infection entered the Genoese fleet stationed in Messina, and by winter it was in Italy. In January 1348, the plague was in Marseille. It reached Paris in the spring of 1348 and England in September 1348. Moving along the Rhine trade routes, the plague reached Germany in 1348. The epidemic also raged in the Duchy of Burgundy, in the Kingdom of Bohemia. (It should be noted that the present-day Switzerland and Austria were part of the German kingdom. The plague raged in these regions too.). The year 1348 was the most terrible of all the years of the plague. She walked for a long time to the periphery of Europe (Scandinavia, etc.). Norway was hit by the Black Death in 1349. Why so? Because the disease was concentrated near trade routes: the Middle East, the Western Mediterranean, then Northern Europe, and finally returned to Russia again. The development of the plague is very clearly shown in the geography of medieval trade. How does the Black Death proceed? Let's turn to medicine.” The Plague causative agent, getting into the human body, does not cause clinical manifestations of the disease from several hours to 3-6 days. The disease begins suddenly with a rise in temperature to 39-40 degrees. There is severe headache, dizziness, often nausea and vomiting. Patients are disturbed by insomnia, hallucinations appear. Black spots on the body, rotting ulcers around the neck. It's a plague. Did medieval medicine know how to treat it?

2. Methods of treatment

Practical medicine

In the Middle Ages, practical medicine was mainly developed, which was carried out by bathhouse barbers. They did bloodletting, set joints, amputated. The profession of a bath attendant in the public mind was associated with "unclean" professions associated with a sick human body, blood, and corpses; for a long time the stamp of rejection lay on them. In the Late Middle Ages, the authority of the bath attendant-barber as a practical doctor began to increase, and it was to them that patients most often turned. High demands were placed on the skill of a bath attendant-healer: he had to complete an apprenticeship within eight years, pass an exam in the presence of the elders of the bath attendant guild, a representative of the city council and doctors of medicine. In some European cities at the end of the XV century. from among the attendants, shops of surgeons were established (for example, in Cologne).

The Saints

Scientific medicine in the Middle Ages was poorly developed. Medical experience intersected with magic. A significant role in medieval medicine was assigned to magical rites, the impact on the disease through symbolic gestures, "special" words, objects. From the XI-XII centuries. objects of Christian worship, Christian symbols appeared in healing magical rites, pagan spells were transposed in a Christian way, new Christian formulas appeared, the cult of saints and their most popular burial places of saints flourished, where thousands of pilgrims flocked to regain their health. Gifts were donated to the saints, the afflicted prayed to the saint for help, sought to touch some thing that belonged to the saint, scraped off stone chips from tombstones, etc. From the 13th century. the "specialization" of the saints took shape; about half of the entire pantheon of saints were considered patrons of certain diseases.
Do not underestimate the help of God and the saints in healing. And in modern times there is medical evidence of a miracle, and at a time when faith was stronger, God helped more (“The Lord said: if you had faith the size of a mustard seed and said to this fig tree: uproot and transplant into the sea, then she would obey you." Gospel of Luke, chapter 17). And then it was not in vain that people turned to the saints for help (although in some cases it was the wrong magic, that is, “I give you a candle / a hundred bows, and you heal me.” Do not forget that according to Christian teaching: diseases from sins ( from actions that are not characteristic of human nature from creation; it can be compared that when we use devices for other purposes, not according to the instructions, they can break or deteriorate), by effectively changing their lives accordingly, people could be healed with the help of God.
“Why do you cry about your wounds, about the cruelty of your illness? according to the multitude of your iniquities I have done this to you, because your sins have multiplied.” Jeremiah 30:15
“2 And when Jesus saw their faith, he said to the paralytic, Be of good cheer, child! your sins are forgiven you.
….
6 But that you may know that the Son of Man has power on earth to forgive sins, then he says to the paralytic, Arise, take up your bed, and go into the house.” The Gospel of Matthew, chapter 9

amulets

In addition to healing by saints, amulets were common, which were considered an important prophylactic. Christian amulets were in circulation: copper or iron plates with lines from prayers, with the names of angels, amulets with holy relics, bottles of water from the sacred Jordan River, etc. They also used medicinal herbs, collecting them at a certain time, in a certain place, accompanying them with a certain ritual and spells. Often, the collection of herbs was timed to coincide with Christian holidays. In addition, it was believed that baptism and communion also affect human health. In the Middle Ages, there was no such disease against which there would be no special blessings, spells, etc. Water, bread, salt, milk, honey, Easter eggs were also considered healing.
It is necessary to separate the concept of a Christian shrine and an amulet.
According to Dahl's dictionary: AMULET m. and amulet f. mascot; both words are distorted Arabic; pendant, incense; protection from spoilage, protective potion, amulet, zachur; love and lapel root; conspiracy, slander potion, root, etc.
Means a magical item that works by itself (whether we believe in it or not), while the concept of a shrine in Christianity is completely different, and this may not be noticed by secular historians, or incorrect parallels may be drawn.
The concept of a Christian shrine does not imply a magical property, but rather the miraculous help of God through a certain object, the glorification of God by a certain saint, through the manifestation of miracles from his relics, while if a person does not have faith, it means that he does not hope for help, it is given to him and will not be. But if a person believes and is ready to accept Christ (which does not always lead to healing, and maybe even vice versa, depending on what is more useful for this person, what he can bear), then healing can occur.

Hospitals

The development of the hospital business is connected with Christian charity. At the dawn of the Middle Ages, the hospital was more of an orphanage than a clinic. The medical fame of hospitals, as a rule, was determined by the popularity of individual monks who excelled in the art of healing.
In the 4th century, monastic life was born, its founder was Anthony the Great. Egyptian anchorites appear, then they unite in monasteries. The organization and discipline in the monasteries allowed them to remain a citadel of order in the difficult years of wars and epidemics and to take under their roof the elderly and children, the wounded and the sick. Thus, the first monastic shelters for crippled and sick travelers arose - xenodocia - prototypes of future monastic hospitals. Subsequently, this was enshrined in the charter of the Cenobitic communities.
The first large Christian hospital (nosocomium)_ was built in Kesari in 370 by St. Basil the Great. It looked like a small city, its structure corresponded to one of the types of diseases that were then distinguished. There was also a colony for lepers.
The first hospital in the territory of the Roman Empire was established in Rome in 390 at the expense of the penitent Roman woman Fabiola, who gave all her funds to the construction of charitable institutions. At the same time, the first deaconesses appeared - ministers of the Christian church, who devoted themselves to caring for the sick, infirm and weak.
Already in the 4th century, the Church allocated 1/4 of its income for the charity of the sick. Moreover, not only the materially poor were considered poor, but also widows, orphans, defenseless and helpless people, pilgrims.
The first Christian hospitals (from hospes - a foreigner) appeared in Western Europe at the turn of the 5th-6th century at cathedrals and monasteries, later established on donations from private individuals.
Following the first hospitals in the east, hospitals began to spring up in the west as well. Among the first hospitals, or rather almshouses, can be attributed the "Hotel Dieu" - the House of God. Lyons and Paris (6.7 centuries), then the hospital of Vortholomew in London (12th century), and others. Most often, hospitals were arranged at monasteries.
In the High Middle Ages, from the end of the 12th century, hospitals appeared, founded by secular persons - seigneurs and wealthy citizens. From the second half of the XIII century. in a number of cities, a process of so-called communalization of hospitals began: city authorities sought to participate in the management of hospitals or completely take them into their own hands. Access to such hospitals was open to burghers, as well as to those who would make a special contribution.
Hospitals increasingly approached the appearance of modern ones and became medical institutions where doctors worked and there were attendants.
The oldest are hospitals in Lyon, Monte Casino, Paris.

The growth of cities led to the emergence of urban hospitals, carrying the functions of a hospital and an orphanage, however, care for spiritual health remained in the foreground.
Patients were placed in a general ward. Men and women together. The beds were separated by screens or curtains. Entering the hospital, everyone made a vow of abstinence and obedience to the authorities (for many, the shelter was the only way to have a roof over their heads).
At first, hospitals were not built according to a specific plan and could be placed in ordinary residential buildings adapted for this purpose. Gradually, a special type of hospital buildings appears. In addition to rooms for the sick, there were outbuildings, a room for those who cared for the sick, a pharmacy, and a garden where the most commonly used medicinal plants grew.
Sometimes patients were accommodated in small wards (two beds each), more often in a large common room: each bed was in a separate niche, and in the middle there was an empty space where hospital employees could move freely. So that the sick, even those who are bedridden, could attend Mass, a chapel was placed in the corner of the hall for the sick. In some hospitals, the most seriously ill patients were isolated from others.
When the patient came to the hospital, his clothes were washed and hidden in a safe place, along with all the valuables that he had with him. The rooms were kept clean. The Paris hospital used 1,300 brooms annually. The walls were washed once a year. In winter, a big fire was kindled in every room. In summer, a complex system of blocks and ropes allowed patients to open and close windows, depending on the temperature. Stained glass was inserted into the windows to soften the heat of the sun's rays. The number of beds in each hospital depended on the size of the room, with a minimum of two, and more often three people, in each bed.
The hospital played the role of not only a medical institution, but also an almshouse. The sick lay side by side with the elderly and the poor, who, as a rule, willingly settled in the hospital: after all, they were provided with shelter and food there. Among the inhabitants there were those who, being neither sick nor infirm, for personal reasons wished to end their days in the hospital, and they were looked after as if they were sick.

Leprosy and Lepresoria (Infirmaries)

In the era of the Crusades, spiritual and knightly orders and brotherhoods developed. Some of them were created specifically to care for certain categories of the sick and infirm. Thus, in 1070, the first hospice for pilgrims was opened in the Jerusalem state. In 1113, the Order of St. John (Hospitallers) was founded; in 1119, the Order of St. Lazarus. All spiritual and knightly orders and brotherhoods provided assistance to the sick and poor in the world, that is, outside the church fence, which contributed to the gradual exit of the hospital business from the control of the church.
One of the most serious diseases of the Middle Ages was considered leprosy (leprosy), an infectious disease that was brought to Europe from the East and especially spread during the era of the Crusades. The fear of contracting leprosy was so strong that special measures were taken to isolate leprosy in places where, due to crowding, the disease was transmitted more quickly. All known means were powerless against leprosy: neither diet, nor stomach cleansing, nor even an infusion of viper meat, which was considered the most effective medicine for this disease, helped. Practically ill was considered doomed.

The Military and Hospitaller Order of Saint Lazarus of Jerusalem was founded by the crusaders in Palestine in 1098 on the basis of a leper hospital that existed under the jurisdiction of the Greek Patriarchate. The order accepted into its ranks knights who fell ill with leprosy. The symbol of the order was a green cross on a white cloak. The order followed the "Rite of St. Augustine", but until 1255 was not officially recognized by the Holy See, although it had certain privileges and received donations. The order exists to our time.
Initially, the order was founded to care for lepers. The brethren of the order also consisted of knights infected with leprosy (but not only). The name "Lazaret" comes from this order.
When the first signs of leprosy appeared, a person was buried in the church, as if he were already dead, after which he was given special clothes, as well as a horn, rattle or bell to warn the healthy about the approach of the patient. At the sound of such a bell, people fled in fear. A leper was forbidden to enter a church or a tavern, attend markets and fairs, bathe in running water or drink it, eat with the uninfected, touch other people's things or goods when buying them, talk to people standing against the wind. If the patient complied with all these rules, he was given freedom.
But there were also special institutions where patients with leprosy were kept - leper colonies. The first leper colony has been known in Western Europe since 570. During the period of the Crusades, their number increases sharply. There were strict rules in the leper colonies. Most often they were placed on the outskirts of the city or outside the city limits in order to reduce the contacts of lepers with the inhabitants of the city. But sometimes relatives were allowed to visit the sick. The main methods of treatment were fasting and prayer. Each leprosarium had its own charter and its own special clothes, which served as an identification mark ..

Doctors

Doctors in a medieval city united in a corporation, within which there were certain ranks. The court physicians enjoyed the greatest advantages. A step below were the doctors who treated the population of the city and the district and lived off the fees received from patients. The doctor visited patients at home. Patients were sent to the hospital in case of an infectious disease or when there was no one to care for them; in other cases, patients, as a rule, were treated at home, and the doctor periodically visited them.
In the XII-XIII centuries. the status of the so-called city doctors is significantly increased. This was the name of doctors who were appointed for a certain period of time to treat officials and poor citizens free of charge at the expense of the city government.

City doctors were in charge of hospitals, testified in court (about the causes of death, injuries, etc.). In port cities, they had to visit ships and check if there were anything in the cargo that could pose a risk of infection (for example, rats). In Venice, Modena, Ragusa (Dubrovnik) and other cities, merchants and travelers, along with the delivered goods, were isolated for 40 days (quarantine), and they were allowed to go ashore only if no infectious disease was detected during this time. In some cities, special bodies were created to carry out sanitary control ("health trustees", and in Venice - a special sanitary council).
During epidemics, the population was assisted by special "plague doctors". They also monitored the observance of strict isolation of the areas affected by the epidemic. Plague doctors wore special clothes: a long and wide cloak and a special headdress that covered their faces. This mask was supposed to protect the doctor from inhaling "contaminated air". Since during epidemics "plague doctors" had long-term contacts with infectious patients, at other times they were considered dangerous to others, and their communication with the population was limited.
"Scholarly doctors" were educated at universities or medical schools. The doctor had to be able to diagnose the patient, based on the examination data and the study of urine and pulse. It is believed that the main methods of treatment were bloodletting and cleansing the stomach. But medieval doctors also successfully applied medical treatment. The healing properties of various metals, minerals, and most importantly, medicinal herbs were known. In the treatise Odo from Men "On the properties of herbs" (XI century), more than 100 medicinal plants are mentioned, including wormwood, nettle, garlic, juniper, mint, celandine and others. From herbs and minerals, with careful observance of proportions, medicines were composed. At the same time, the number of components included in a particular drug could reach several tens - the more healing agents were used, the more effective the drug should have been.
Of all the branches of medicine, surgery has achieved the greatest success. The need for surgeons was very great because of the numerous wars, because no one else was involved in the treatment of wounds, fractures and bruises, amputation of limbs, and so on. Doctors even avoided bloodletting, and bachelors of medicine made promises that they would not perform surgical operations. But although surgeons were in great need, their legal status remained unenviable. Surgeons formed a separate corporation, which was much lower than the group of learned doctors.
Among the surgeons were wandering doctors (dental pullers, stone and hernia cutters, etc.). They traveled around the fairs and performed operations right on the squares, leaving then the sick in the care of their Relatives. Such surgeons cured, in particular, skin diseases, external injuries and tumors.
Throughout the Middle Ages, surgeons fought for equality with learned doctors. In some countries they have made significant progress. So it was in France, where a closed class of surgeons formed early, and in 1260 the College of St. Cosmas. Entering it was both difficult and honorable. To do this, surgeons had to know Latin, take a course in philosophy and medicine at the university, practice surgery for two years and receive a master's degree. Such surgeons of the highest rank (chirurgiens de robe longue), who received the same solid education as learned doctors, had certain privileges and enjoyed great respect. But the practice of medicine was by no means limited to those who had a university degree.

Bathhouse attendants and barbers adjoined the corporation of physicians, who could supply banks, bleed, correct dislocations and fractures, and treat a wound. Where there was a shortage of doctors, barbers were charged with the duty of supervising brothels, isolating lepers, and curing plague patients.
Executioners also practiced medicine, taking advantage of those who were being tortured or punished.
Sometimes pharmacists also provided medical assistance, although they were officially forbidden to practice medicine. In the early Middle Ages in Europe (except for Arab Spain) there were no pharmacists at all, the doctors themselves produced the necessary medicines. The first pharmacies appeared in Italy at the beginning of the 11th century. (Rome, 1016, Monte Cassino, 1022). In Paris and London, pharmacies arose much later - only at the beginning of the 14th century. Until the 16th century doctors did not write prescriptions, but visited the pharmacist themselves and told him what medicine should be prepared.

Universities as centers of medicine

Universities were the centers of medieval medicine. The prototypes of Western universities were the schools that existed in the Arab countries and the school in Salerno (Italy). In the beginning, universities were private associations of teachers and students, similar to workshops. In the 11th century, a university arose in Sarelno (Italy), formed from the Salerno Medical School near Naples.
In the 11th-12th centuries, Salerno was the true medical center of Europe. Universities appeared in Paris, Bologna, Oxford, Padua, and Cambridge in the 12th and 13th centuries, and in Prague, Krakow, Vienna, and Heidelberg in the 14th century. The number of students did not exceed a few dozen in all faculties. Charters and curricula were controlled by the Church. The order of life was copied from the order of life of church institutions. Many doctors belonged to monastic orders. Secular doctors, entering medical positions, took an oath similar to the oath of priests.
In Western European medicine, along with drugs obtained by medical practice, there were those whose action was based on distant comparison, astrology, alchemy.
A special place was occupied by antidotes. Pharmacy was associated with alchemy. The Middle Ages are characterized by complex medicinal recipes, the number of ingredients could reach several dozen.
The main antidote (as well as a means of treating internal diseases) is theriac, up to 70 components, the main of which was snake meat. The funds were valued very dearly, and in cities that were especially famous for their tiriacs and mitridates (Venice, Nuremberg), these funds were made publicly, with great solemnity, in the presence of authorities and invited persons.
The autopsy of corpses was already carried out in the 6th century, but contributed little to the development of medicine, Emperor Frederick 2 allowed the autopsy of a human corpse once every 5 years, but in 1300 the Pope established a severe punishment for autopsy, or digestion of a corpse to obtain a skeleton. From time to time, some universities were allowed to perform an autopsy, usually done by a barber. Usually the autopsy was limited to the abdominal and chest cavities.
In 1316, Mondino de Luci compiled an anatomy textbook. Mondino himself opened only 2 corpses, and his textbook became a compilation, and the main knowledge was from Galen. For more than two centuries, Mondino's books have been the main anatomy textbook. Only in Italy at the end of the 15th century were autopsies performed to teach anatomy.
In large port cities (Venice, Genoa, etc.), where epidemics were brought on merchant ships, special anti-epidemic institutions and measures arose: in direct connection with the interests of trade, quarantines were created (literally “forty days” - a period of isolation and observation of the crew of arriving ships) , there were special port guards - "health trustees". Later, “city doctors” or “urban physicists”, as they were called in a number of European countries, appeared, these doctors performed mainly anti-epidemic functions. In a number of cities, special regulations were issued to prevent the introduction and spread of contagious diseases. At the gates of the city, gatekeepers examined those who entered and detained those who were suspected of being ill with leprosy.
The fight against infectious diseases has contributed to some measures, such as providing cities with clean drinking water. Ancient Russian water pipes can be attributed to the number of ancient sanitary facilities.
In Salerno, there was a corporation of doctors who not only treated, but also taught. The school was secular, continued the traditions of antiquity and practiced in teaching. The deans were not ecclesiastics, funded by the city and tuition fees. By order of Frederick 2 (Holy Roman Emperor 1212-1250), the Salerno School was given the exclusive privilege of conferring the title of doctor and issuing licenses for medical practice. It was impossible to practice medicine on the territory of the empire without a license.
The training was according to such a plan: the first three years a preparatory course, then 5 years medicine, and then a year of compulsory medical education. practices.

military medicine

The first centuries after the collapse of the slave system - the period of pre-feudal relations (VI-IX centuries) - was marked by a deep economic and cultural decline in the West of the Eastern Roman Empire. Byzantium managed to defend itself from the invasion of the barbarians and preserve “the howling economy and culture, which was a reflection of the Western. At the same time, Byzantine medicine, which was the direct successor of Greek medicine, was acquiring ever greater features of decline and clogging with theological mysticism.
Military medicine in Byzantium retained in general terms the same elementary organization as in the Roman imperial army. Under Emperor Mauritius (582-602), for the first time, special sanitary teams were organized in the cavalry, designed to carry the seriously wounded from the battlefield, provide them with elementary first aid and evacuate them to valetudinariums or to nearby settlements. A riding horse under a saddle served as a means of evacuation, on the left side of which there were two stirrups to facilitate the landing of the wounded. Sanitary teams of 8-10 unarmed men (despotati) were attached to squads of 200-400 men and followed in battle at a distance of 100 feet from them. Each warrior of this team had a flask of water with him to "revive" the unconscious. Weak soldiers from each section were assigned to the medical teams; each soldier of the team had two “saddle ladders” with him, “so that they and the wounded could sit on horses” (Works on the tactics of the emperors Leo-886-912 and Constantine of the 7th-10th centuries). The soldiers of the medical teams received a reward for each soldier they saved.

During the period of pre-feudal relations in Europe (VI-IX centuries), when the peasants in the mass were not yet enslaved, political power in large barbarian states was centralized, and the decisive force on the battlefields was the militia of free peasants and urban artisans, there was still an elementary organization of medical care for the wounded. At the end of the ninth century in the Frankish barbarian state, during the long wars of Louis the Pious with the Hungarians, Bulgarians and Saracens, each cohort had 8-10 people who were responsible for carrying the wounded from the battlefield and caring for them. For every soldier they rescued, they received a reward.

At the same time, during this period (IX-XIV centuries), a significant role in the spread of science and culture belongs to the Arabs, who in their numerous wars of conquest established lively trade relations between Africa, Asia and Europe; they absorbed and preserved Greek scientific medicine, littered, it is true, with a significant admixture of superstition and mysticism. The development of surgery was affected by the influence of the Koran, the prohibition of autopsy and the fear of blood; along with this, the Arabs created chemistry and pharmacy, enriched hygiene and dietetics, etc. This served as an impetus for the development of natural science and medicine. The Arabs do not have any information about the presence of a military medical organization, if we do not take into account the completely unfounded statements of Fröhlich that “It may very well be that the military organization of the Moors previously had military hospitals” or that “it is only possible to assume that the Arabs in their numerous campaigns were accompanied by field infirmaries. Along with this, Fröhlich cites interesting data of a military-hygienic nature, taken from the Arab Ratses (approximately from 850 to 932 or 923) and concerning sanitary requirements for the arrangement and location of camps, the destruction of harmful animals in the disposition of troops, food supervision, etc.

Gaberling, having studied the heroic songs of the Middle Ages (mainly the 12th and 13th centuries), draws the following conclusions about the organization of medical care during this period. Doctors were extremely rare on the battlefield; as a rule, first aid was provided by the knights themselves in the order of self-help or mutual assistance. Knights received knowledge on rendering assistance from their mothers or from mentors, usually clerics. Particularly distinguished by their knowledge were persons brought up from childhood in monasteries. Monks could be found in those days sometimes on the battlefields, and more often in a monastery near a wounded soldier, until in 1228 the famous phrase was heard at the episcopal cathedral in Würzburg: “ecclesia abhorret sanguinem” (The Church does not tolerate blood), which put an end to help of the monks to the wounded and forbidding the clergy even to be present at any surgical operation.
A large role in helping the wounded knights belonged to women, who at that time mastered the technique of dressing and knew how to use medicinal herbs.

The doctors mentioned in the heroic songs of the Middle Ages were, as a rule, laymen; the title of doctor (physician) applied to both surgeons and internists, they had a scientific education, usually received in Salerno. Arab and Armenian doctors also enjoyed great fame. In view of the very small number of scientifically educated doctors, they were usually invited from afar; the opportunity to use their services was available only to the feudal nobility. Only occasionally did scientifically educated doctors meet in the retinue of kings and dukes.
Assistance to the wounded was provided at the end of the battle, when the victorious army settled down to rest, on the battlefield or nearby in the camp; in rare cases, the wounded were carried out during the battle. Sometimes monks and women appeared on the battlefield, carrying out the wounded and helping them. Usually, the wounded knights were carried by their squires and servants to the distance of an arrow from the battlefield, after which they were helped. As a rule, there were no doctors. From here, the wounded were transferred to nearby tents, sometimes to castles or monasteries. If the troops continued the campaign and it was not possible to ensure the safety of the wounded in the area of ​​the former battle, they were taken with them.

The removal of the wounded from the battlefield was carried out on the hands or on the shield. For carrying over a long distance, stretchers were used, improvised as needed from spears, sticks, branches. The main means of transportation: were horses and mules, most often harnessed to a double-horse stretcher. Sometimes the stretcher was hung between two horses walking side by side, or mounted on the back of one horse. There were no wagons to transport the wounded. Often a wounded knight left the battlefield on his own on his horse, sometimes supported by a squire sitting behind him.

There were no medical institutions at that time; wounded knights most often ended up in castles, sometimes in monasteries. Any treatment began with the inscription of a cross on the forehead of the wounded with a balm, in order to drive the devil away from him; it was accompanied by conspiracies. After removing equipment and clothing, the wounds were washed with water or wine and bandaged. The doctor, when examining the wounded, felt the chest, pulse, examined the urine. The arrows were removed with fingers or iron (bronze) tongs; with a deep penetration of the arrow into the tissues, it had to be surgically excised; sometimes stitches were applied to the wound. The suction of blood from the wound was used. With a good general condition of the wounded and shallow wounds, a general bath was made for him to cleanse from blood; in case of contraindications, baths were limited to washing with warm water, heated oil, white wine or honey mixed with spices. The wound was dried with tampons. Dead tissue was excised. Herbs and plant roots, almond and olive juice, turpentine and "healing waters" were used as medicines; the blood of bats, which was considered a good remedy for wound healing, was held in special esteem. The wound itself was covered with ointment and plaster (the ointment and plaster was usually carried by each knight along with the material for the initial dressing; he kept all this in his “Waffen ruck”, which he wore over his equipment). The main dressing material was the canvas. Sometimes a metal drainage tube was inserted into the wound. Fractures were immobilized with a splint. At the same time, sleeping pills and general treatment were prescribed, mainly medicinal drinks made up of medicinal herbs or roots, pounded and crushed in wine.

All this applies only to the upper class: the feudal knights. The medieval infantry, recruited from the feudal servants and partly from the peasantry, did not receive any medical care and was left to itself; the helpless wounded bled to death on the battlefield or, at best, fell into the hands of self-taught artisans who followed the troops; they traded in all sorts of secret potions and amulets, and for the most part had no medical training,
The situation was the same during the crusades, the only major operations of the medieval period. The troops leaving for the crusades were accompanied by doctors, but there were few of them and they served the commanders who hired them.

The calamities suffered by the sick and wounded during the Crusades defy description. Hundreds of the wounded rushed to the battlefields without: any help, often became victims of enemies, sought, subjected to all sorts of abuse, sold into slavery. Hospitals founded during this period by knightly orders (St. John, templars, knights of St. Lazarus, etc.) had neither military nor medical significance. In essence, these were almshouses, hospices for the sick, the poor and the crippled, where treatment was replaced by prayer and fasting.
It goes without saying that during this period the warring armies were completely defenseless against epidemics that snatched hundreds and thousands of lives from their midst.
With widespread poverty and untidiness, with the complete absence of the most elementary rules of hygiene, pestilence, leprosy, various epidemics, acclimatized in the combat area, as at home.

3. Literature

1. "History of Medicine" M.P. Multanovsky, ed. "Medicine" M. 1967
2. "History of Medicine" T.S. Sorokin. ed. Center "Academy" M. 2008
3. http://en.wikipedia.org
4. http://velizariy.kiev.ua/
5. Article by Berger E. from the collection "Medieval City" (M., 2000, Vol. 4)
6. Books of the Holy Scriptures of the Old and New Testaments (Bible).
7. Dahl's Explanatory Dictionary.

Kempen Historical Club (formerly St. Demetrius Club) 2010, copying or partial use of materials without attribution is prohibited.
Nikitin Dimitri

Medieval Medicine

Renaissance period, which began in the 14th century. and lasted almost 200 years, was one of the most revolutionary and fruitful in the history of mankind. The invention of printing and gunpowder, the discovery of America, the new cosmology of Copernicus, the Reformation, the great geographical discoveries - all these new influences contributed to the liberation of science and medicine from the dogmatic shackles of medieval scholasticism. The fall of Constantinople in 1453 scattered Greek scholars with their priceless manuscripts throughout Europe. Now Aristotle and Hippocrates could be studied in the original, and not in translations into Latin from Hebrew translations of Arabic translations of Syriac translations from Greek.

The medicine of the late Middle Ages is called "scholastic", referring to its detachment from real life. The decisive factor for the development of medicine was the fact that the lecture was the basis of teaching in universities.

Medical scholastics were engaged in the study and interpretation of the texts of ancient and some Arabic authors, mainly Hippocrates, Galen and Avicenna. Their works were memorized. As a rule, there were no practical classes: religion forbade the "shedding of blood" and the opening of human corpses. Physicians at consultations often argued over quotes instead of bringing practical benefit to the patient. The scholastic nature of medicine in the late Middle Ages was especially pronounced in the attitude of university doctors to surgeons: in the vast majority of medieval universities, surgery was not taught. In the era of the late Middle Ages and the Renaissance, surgeons were considered artisans and united in their professional corporations. Bath attendants and barbers practiced in the baths, who were engaged in surgery, the treatment of wounds and bruises, the reduction of joints and bloodletting. Their activities contributed to the bad reputation of the baths and brought the profession of a surgeon closer to other "unclean" professions (executioners and gravediggers) associated with blood and corpses. The Faculty of Medicine in Paris, around 1300, directly expressed its negative attitude towards surgery.

Anatomy was taught along with physiology and practical medicine. If the lecturer did not have the opportunity to illustrate his lectures on anatomy and surgery by experience, he supplemented them with anatomical drawings of his own making, which sometimes represented elegant miniatures.

Only in the XIII century. general medicine began to be taught at universities in close connection with surgery. This was facilitated by the efforts of the great doctors, who were also talented surgeons. Medical manuals of the 13th and 14th centuries. contain images of skeletal bones and anatomical drawings. The first anatomy textbook in Europe was compiled in 1316 by Mondino de Luzzi (1275-1326), master of the University of Boloi. His writings were also successful in the Renaissance, the great Leonardo argued with him in the field of anatomy. Much of de Luzzi's work is borrowed from Galen's work "On the Appointment of the Parts of the Human Body" due to the fact that anatomy was carried out extremely rarely.

Historical parallels: The first public dissections of corpses, performed at the end of the Middle Ages, were so rare and unusual that they often became a sensation. It was in those days that the tradition of organizing "anatomical theaters" arose. Emperor Frederick II (1194-1250) was interested in medicine and in many ways contributed to the prosperity of the school in Salerno, he founded the University of Naples and opened an anatomy department in it - one of the first in Europe. In 1225, he invited the doctors of Salerno to study anatomy, and in 1238 he issued a decree on the public autopsy of the bodies of executed criminals in Salerno once every five years.

In Bologna, teaching anatomy using autopsy began at the end of the 13th century. Mondino de Luzzi at the beginning of the XIV century. could dissect corpses about once a year. Let us note for comparison that the Faculty of Medicine in Montpellier received permission to open the corpses of the executed only in 1376. In the presence of 20-30 spectators, the sequential opening of different parts of the body (stomach, chest, head and limbs) lasted four days, respectively. For this, wooden pavilions were erected - anatomical theaters. Posters invited the public to the performance, sometimes the opening of this spectacle was accompanied by the ringing of bells, the closing - by the performance of musicians. Honorary persons of the city were invited. In the XVI-XVII centuries. anatomical theaters often turned into solemn demonstrations, which were held with the permission of the authorities in the presence of colleagues and students. In Russia, the establishment of anatomical theaters is associated with the name of Peter I, by whose decree in 1699 the teaching of anatomy for the boyars began in Moscow with demonstrations on corpses.

Surgical encyclopedia of the late Middle Ages and the most common textbook of surgery until the 17th century. was the "Review of the Surgical Art of Medicine" by Guy de Chauliac (1300-1368). He studied in Montpellier and Bologna; spent most of his life in Avignon, where he was the doctor of Pope Clement VI. Among his teachers, he names Hippocrates, Galen, Paul of Aegina, Razes, Albukasis, Roger Frugardi and other doctors of the Salerno school.

Guy de Chauliac was a well-educated man and a talented writer. His fascinating and lively writings contributed to the fact that long-forgotten techniques were restored in surgical practice, in particular, narcotic inhalation during operations.

However, one should not think that the old medical theories and methods of treatment immediately gave way to scientific medicine. Dogmatic attitudes were too deeply rooted; in Renaissance medicine, the original Greek texts simply replaced inaccurate and distorted translations. But in the related disciplines, physiology and anatomy, which form the basis of scientific medicine, there have been truly grandiose changes.

Anatomy did not lag behind physiology. Almost half of the anatomical names are associated with the names of researchers of the 17th century, such as Bartholin, Steno, De Graaf, Brunner, Wirzung, Wharton, Pakhioni. A powerful impetus to the development of microscopy and anatomy was given by the great medical school of Leiden, which became in the 17th century. center of medical science. The school was open to people of all nationalities and creeds, while in Italy a papal edict kept non-Catholics out of the universities; as has always been the case in science and medicine, intolerance led to decline.

The largest medical luminaries of that time worked in Leiden. Among them was Francis Silvius (1614–1672), who discovered the Sylvian sulcus of the brain, the true founder of biochemical physiology and a remarkable clinician; it is believed that it was he who introduced clinical practice into Leiden teaching. Famous Hermann Boerhaave(1668-1738) also worked at the Faculty of Medicine in Leiden, but his scientific biography belongs to the 18th century.

Clinical medicine also reached in the 17th century. great success. But superstition still reigned, hundreds of witches and sorcerers were burned; flourished inquisition, and Galileo was forced to renounce his doctrine of the motion of the Earth. The king's touch was still considered a sure remedy for scrofula, which was called the "royal disease". Surgery was still below the dignity of the doctor, but the recognition of diseases had advanced considerably. T.Villiziy differentiated diabetes and diabetes insipidus. Rickets and beriberi have been described, and the possibility of non-sexual transmission of syphilis has been proven. J. Floyer began to count the pulse using a watch. T.Sydenham(1624-1689) described hysteria and chorea, as well as the differences between acute rheumatism and gout and scarlet fever from measles.

Sydenham is generally recognized as the most outstanding clinician of the 17th century, he is called the "English Hippocrates". Indeed, his approach to medicine was truly Hippocratic: Sydenham distrusted purely theoretical knowledge and insisted on direct clinical observation. His methods of treatment were still characterized - as a tribute to the times - by excessive prescribing of enemas, laxatives, bloodletting, but the approach as a whole was rational, and the medicines were simple. Sydenham recommended the use of quinine for malaria, iron for anemia, mercury for syphilis, and prescribed large doses of opium. His insistence on clinical experience was extremely important in an era when too much attention in medicine was still given to pure theorizing.

The emergence of hospitals and their constant growth, the training of certified doctors, whose number was also constantly growing, contributed to the solution of public health problems. There are beginnings of health legislation. So, in 1140, King Roger of Sicily issued a law, according to which it was allowed to practice doctors who had passed the state exam. Later, an order appears regarding the provision of cities with food products and their protection from falsification. From ancient times, such hygienic establishments as public baths pass.

In the cities, which were marked by dense buildings, narrow streets and outer walls (because the feudal lords had to pay for the land), epidemics spread. Apart from the plague, leprosy was a huge problem. Cities are introducing the positions of city doctors, whose main task was to combat the introduction of infections. Quarantine (40 days) is introduced in port cities, during which the ship is in the roadstead, and its crew is not allowed into the city.

Plague epidemic in a medieval city.

Costume of a medieval doctor during a plague epidemic.

The first attempts to create ideal systems of human communities appear, which also provide for a number of public medical events. Thomas More wrote a work called "Utopia", in which he substantiates the way of the state for all time. He recommends that the state always have a supply of grain for two years in order to prevent the occurrence of famine. He describes how the sick should be treated, but pays most attention to the canons of family morality, in particular, he sees great harm in premarital sexual relations, justifies the need to prohibit divorce and the need for severe punishment, up to the death penalty, adultery. Tomaso Campanella in his work "The State of the Sun" also pays special attention to the reproduction of offspring; from his position, everything that concerns the interests of posterity should be in the primary care of the state.

Should be remembered B. Ramazzini. In 1696, he summarized his observations of the labor of people in various professions in a book called Discourses on Diseases from Occupation. In this work, he describes in detail various diseases that are associated with various kinds of activities. B. Ramazzini is called the father of professional hygiene.

In the 17th century a statistical approach to the analysis of social phenomena arose, which was of great importance for the development of public medicine. In 1662, D. Graunt handed over to the Royal Scientific Society a work in which he outlined his observations on mortality and fertility in London (from 1603). He was the first to compile tables of mortality and calculate the average life expectancy of each generation. This work was extended by his friend and physician W. Patty, who called his observations on the natural movement of the population "political arithmetic", which better reflects the influence of social phenomena on these processes than even the current name - demographic statistics. Mortality tables soon began to be used as the basis for life insurance.

Pharmacies operated like chemical laboratories. In these laboratories, the method of chemical analysis of inorganic substances originated. The results obtained were used both for the search for drugs and directly for chemical science. Pharmacies became centers of science, and pharmacists occupied the main place among the scientists of the Middle Ages.

New drugs are emerging. In 1640, cinchona bark was brought to Spain from South America, which proved to be effective in the treatment of malaria. Iatrochemists explained its action by the ability to stop the fermentation of febrile substances, iatrophysicists - by the physical improvement of thick or very thin blood. The effect of using cinchona bark was compared with the consequences of the introduction of gunpowder in military affairs. The therapeutic arsenal was replenished with the root of ipecac as a vomit and expectorant, brought in 1672 from Brazil. Arsene is used for cauterization, as well as internal administration in small doses. Veratrin, strychnine, caffeine, ethyl ether, magnesium sulfate were discovered.

The process of drug preparation is being improved. During the Middle Ages, complex prescriptions for medicines reached their climax, the number of components in one prescription grew to several dozen. A special place was occupied by antidotes. So, the book of the Salerno school was called "Antidotarium" and contained many new prescriptions for medicines. However, teriyaki (honey porridge of 57 ingredients, which necessarily included snake meat, opium, and the like) remained a panacea for all diseases. These medicines were prepared publicly, solemnly, in the presence of government officials and invited persons.

Alchemist in the laboratory

In Florence, in 1498, the first city “registry of medicines” (pharmacopoeia) was issued, which contained a description of medicines and the rules for their manufacture, and became a model for adoption in other cities and countries of their own registries. The name "Pharmacopoea" was first written on the title of his book by the French physician Jacques Dubois (1548). In 1560, the first edition of the Augsburg Pharmacopoeia appeared, which was most valued in Europe. The first edition of the London Pharmacopoeia is dated in 1618. The first pharmacopoeia in Poland appeared in Gdansk in 1665. Of the pharmaceutical works, the most widespread in the late 16th and early 17th centuries. purchased the book by M. Haras "Pharmacopoea Royale et Galenique". In 1671, Daniel Ludwig summarizes the available treatments and issues his pharmacopoeia.

Of great interest is the development of medicine in Ukraine during the Renaissance.

In 1578, Prince Konstantin Ostrozhsky, a Ukrainian magnate and philanthropist, founded the Ostroh Academy in Volhynia - the Greek-Slovenian-Latin collegium - the first school of the highest type in Ukraine, which was called "Ostrog Athens". The first rector was Gerasim Smotrytsky. A hospital with a medical class (a prototype of the faculty) was opened at the academy, where they studied medicine. Ostrog became a cultural cell, it had a printing house in which the Bible was printed for the first time on the territory of Ukraine. Poetic literature first arose in the academy. Quite a lot of educated people of Ukraine came out of here, in particular doctors. Existed until 1624.

From the 15th century the training of scientific doctors began in Poland, at the Jagiellonian (Krakow) University. Later, doctors were trained at the Zamoysk Academy in the city of Zamość (near Lvov).

The Academy in Zamość was founded on the initiative of Count Jan Zamoyski in 1593. Jan Zamoyski, who himself was educated at the University of Padua, decided to open a school in his homeland, modeled after this university. Pope Clement VIII approved the charter of the academy, giving it the right to award degrees of Ph.D., law and medicine. However, King Stefan Batory, in order not to create a competitor for the University of Krakow, refused to confirm this papal privilege. It was only in 1669 that King Michael Korybut gave the Zamoysk Academy all the privileges of universities and granted noble rights to the professors of the academy. A separate medical class (faculty) at the beginning of the 17th century. organized by a native of Lviv, doctor of medicine Jan Ursin. The Medical Faculty of the Academy was weaker than Krakow. One or two professors laid out all the medicine in it. Of the 17 professors of medicine at the Zamoyansk Academy, 12 received their doctoral degrees in Padua, 2 in Rome, and only three were not students of Italian universities.

The relationship of the Zamoj Academy with the University of Padua was so close that it could be considered the successor of this university. It is worth recalling the fact that the rector of the Zamoysk Academy, on behalf of the Faculty of Medicine, addressed the Faculty of Medicine in Padua with a request to express his opinion on the causes of the occurrence and treatment of koltun, a disease common in those days in Poland and Galicia, especially among the inhabitants of the mountainous regions of the Carpathians. The question was considered at a special conference of professors of the medical faculty. The main reason was the unsatisfactory sanitary level, unfavorable living conditions and low culture of population.

The students of the Zamoysk Academy united in the community: Polish, Lithuanian, Ruska, etc. The Ruska (Ukrainian) group consisted of graduates of the fraternal schools of Lvov, Kiev, Lutsk. At the Faculty of Medicine, the number of students did not exceed 45. There was a hospital with 40 beds at the academy. The Zamoysk Academy existed for 190 years. Despite the modest capabilities of the medical faculties of Krakow and Zamost, they played a significant positive role in the dissemination of scientific medical knowledge in the then Ukraine.

Individual graduates, having received the title of licentiates of medicine in Krakow or Zamost, continued their studies at the universities of Italy, where they obtained the degree of doctor of medicine. Of these doctors of medicine, Georgy Drogobych and Philip Lyashkovsky are known.

George Drohobych-Kotermak (1450-1494) under the name of George-Michael, son of Donat from Drohobych, was recorded in 1468 as a student at the University of Krakow; received a bachelor's degree in 1470, a master's degree - in 1473. Not satisfied with this education, he went to distant Italy and joined the University of Bologna. In 1478, G. Drogobych received the title of Doctor of Philosophy, and in 1482 - Doctor of Medicine. Already in these years he laid out astronomy, and in 1480-1482. elected as one of the rectors of the university for the faculties of medicine and free institutions. On holidays he gives honorary lectures in medicine. A book printed in Rome by Kotermak under the title: “Prognostic assessment in the current 1483 of Master Georgy Drogobych from Russia, doctor of arts and medicine of the University of Bologna, happily completed” has survived to our times (one copy each in the Krakow library and in the library of Tübingen). This is the first ever printed book of our compatriot; she came into the world on February 7, 1483. G. Drogobych believed in the power of the human mind: "Although far from the eyes of the space of the sky, and not so far from the human mind."

From 1488 Kotermak publishes medicine at the University of Krakow. Studied by Mikolaus Copernicus. I visited home several times, visited Lvov.

Georgy Drogobich-kotermak (1450–1494).

In 1586, the first fraternal school was founded in Lvov. Brotherhoods are organizations of the Orthodox philistinism that existed during the 15th-17th centuries. and played a big role in the life of the Ukrainian people, in their struggle against national and religious oppression. The brotherhoods were engaged in a variety of work: charity and educational activities, helped the impoverished members of their parish, and the like. Later, such schools were created in Lutsk, Berest, Peremishli, Kam'yantsi-podilsky.

On October 15, 1615, with the help of Galshka Gulevichivni (Elizaveta Gulevich), the Kiev Brotherhood was opened, and a school was opened under it. in 1632, Archimandrite Peter Mogila, who was elected Metropolitan of Kiev and Galicia that year, united the Kiev fraternal school with the Lavra school founded by him at the Kiev-Pechersk Lavra and established the Kiev fraternal collegium. From 1633 it received the name of Kiev-Mohyla. In 1701, through the efforts of the Hetman of Ukraine Ivan Mazepa, the collegium was granted the official title and right of the Academy by royal decree.

Kyiv-Mohyla Academy is the first higher school in Ukraine, one of the oldest in Europe, the main cultural and educational center of all Eastern Europe in the 17th–18th centuries. It stood at the level of the leading universities of that time, played an extremely important role in the dissemination of culture both in Ukraine and in Eastern European spaces. The Kiev Academy had a large book depository, where manuscripts from various branches of knowledge, including medicine, were kept.

Kiev professors created in Moscow in 1687 the Slavic-Greek-Latin Academy. A lot of preparatory work for this was done, in particular, by Epiphanius Slavinetsky and Arseniy Satanovsky. After graduating from the Kiev fraternal school, they studied abroad, then worked as teachers at the Kiev-Mohyla Collegium. At the request of Tsar Alexei Mikhailovich, they moved to Moscow to correct the primary sources of religious books. E. Slavinetsky owns the translation (1658) of an abridged textbook of anatomy by Andreas Vesalius under the title: “Vrachevskaya anatomy from Latin, from the book of Andrea Vessalius Brukselenska”. Until now, the translation has not been preserved. Epiphanius Slavinetsky, together with Arseniy Satanovsky and the monk Isai, also translated another cosmography, which explained the systems of Ptolemy and Copernicus. In addition, Epiphanius Slavinetsky taught "free sciences" at the school at the Andreevsky Monastery. He died in Moscow in 1675.

The first secular hospital was opened in Ukraine in Lvov in the 13th century. In the city acts of Lvov for 1377 we find information about the foundation of a hospital for the sick and the poor in the city. In the tax list of the city for 1405, the doctor of medicine, Benedict, is listed. In 1407, water was brought to the city by clay pipes, sewer pipes were laid 70 years later. The main streets of the city were paved with stone, covered with boards along the outskirts. From 1408, the duty of the city executioner included the removal of garbage from the streets. In 1444, a school was founded "for the science of noble and simple children." In 1447, city acts recall an invitation to meet public needs of a doctor with a fee of 10 kip (600) money. In 1522, the Lvov Brotherhood arranged a haven for the poor and infirm at the Onufrievsky Monastery and kept it financially. In 1550, Egrenius, doctor of medicine from Spain, worked as a city doctor with a salary of 103 zlotys per year. In those days there were three city hospitals in Lvov and two at the monasteries. There was also a bathhouse in the city, which was “as usual and right” exempted from any taxes. Schoolchildren and teachers had the right to use it free of charge once every two weeks.

In the Middle Ages, the main people were served not by certified doctors, but by medical artisans, who we called them, as in European countries, barbers. They treated, based on the age-old experience of traditional medicine. In large cities, performing various medical handicraft activities as prescribed by doctors of medicine, having generally close business relations with certified doctors, barbers replenished their knowledge. This combination of the experience of household medicine with the data of science contributed to some extent to the increase in the volume of medical knowledge of barbers. Some of them have achieved great skill in the treatment of wounds, carrying out amputations, operations of carving stones, pulling out teeth, and especially in a very common means of treatment - bloodletting.

Craftsmen of medieval cities, for economic and legal reasons, united in workshops. We find documentary information about craftsmen-healers, or barbers, in the archives from the end of the 14th century, when self-government was established in the cities of Ukraine, known in history as the Magdeburg Law. In the XV century. 16 craft workshops of various specialties were subordinate to the Kiev magistrate, among them there was also a barbers' workshop.

Seal of the Kiev barber shop depicting a razor, scissors, a comb with a scythe, a jar of leeches and dental tongs (Kiev Historical Museum).

A model for barber shops in Ukraine was the Lvov shop, founded in 1512.

The statutes of the barbers' shops distinguished such members of their association: 1) students, who in Ukraine were called "guys"; 2) apprentices - they were called "youngsters", "servants"; 3) masters. Pupils were accepted at the age of 12, literacy was not mandatory for them. Before joining, each student made a certain contribution to the workshop box (from 6 groszy to 6 złoty). The student's studies lasted three years. One master should not have more than 3-4 students. They were taught to put jars, dry and with notches (bloody), cut purulent wounds, pull out teeth, bandage wounds, apply a vise for fractures, set dislocations, and make various plasters for healing wounds. The students studied the signs of certain diseases and, of course, hairdressing.

Surgical instruments of barbers (XVІ-XVIII centuries).

Members of the workshop competed with each other. In addition to guild barbers, in large cities many barbers were engaged in medical practice, who, for one reason or another, were not included in the guilds. They were called "partachs" (private traders). There was a fierce struggle between the two groups. The owners of the estates had their barbers from the serfs, who were sent to science to doctors or city barbers.

The most common method of treatment used by barbers was bloodletting. It was widely practiced in workshops, baths and at home. Before the beginning of the spring field work, mass bloodletting was done to free people from the winter “worked out” blood. It was believed that bloodletting enhances strength and performance.

Large craft workshops had their own hospitals. Smaller workshops united and had one hospital. In some cities, hospitals were kept with money that they received for using city scales, for crossing bridges, and ferry crossing. In addition to hospitals that were maintained at public expense, there were hospitals in Ukraine, the existence of which was ensured by the wills of wealthy people who signed off villages, mills, taverns and the like for this.

The main harm to public health was carried by pestilence, or pestilence. The most devastating were the epidemics of plague, smallpox, typhus. A special place in the history of medicine was occupied by the plague pandemic - the "Black Death" - in the middle of the 14th century, when it bypassed all the countries known at that time, destroying a quarter of humanity.

Large epidemics arose in the following years. Yes, the plague epidemic in 1623 took 20 thousand people in Lvov, the streets of the city were littered with corpses. The fight against the plague was led by Dr. Martin Kampian, who remained one of the authorities in the city; a portrait of this courageous man is preserved in the historical museum of Lviv.

Ukraine experienced exceptionally severe poverty during the War of Independence. The fields were empty. In Podillya in 1650, the people ate the leaves of trees and roots. According to the testimony of contemporaries, crowds of hungry, swollen people moved to Zadniprovya, looking for salvation there. At the same time, from noon, a plague spread through Moldavia to Ukraine, from which "people fell and lay along the roads like firewood." in 1652, the army of Bohdan Khmelnitsky, after the victory on the Batoz field, began the siege of Kamenetz-Podolsk, but through the "sea air" they were forced to remove it. The following year, “there was a great pestilence all over Ukraine, a lot of people died,” as we read in the Chernigov Chronicle.

The plague passed through Ukraine during 1661-1664, then - in 1673. This year, the population of Lviv and Zaporozhye suffered especially. The Cossack Council decided to separate the infected kurens, but the epidemic spread and left many victims behind.

For centuries in Ukraine there was a custom in the event of an invasion to build a church by the whole society in one day.

The doctor of medicine Slezhkovsky in his book “On the Prevention of Plague Air and its Treatment” (1623) recommended rubbing the body with rue juice, camphor and taking a mixture of Mithridates teriyaki, alcohol, and the boy’s urine in equal amounts in order to prevent plague. In case of bubonic plague, he advised applying the warm breast of a freshly killed dog or a dove or a frog spread alive to the tumors.

Medical support in the Zaporizhzhya Sich was interesting. The life of the Zaporizhzhya Cossacks for the most part took place in campaigns and military clashes. They provided assistance with various injuries and diseases according to the rules and means of traditional medicine. The Cossacks knew how to bleed, pull out teeth, make plasters for healing wounds, apply a vise for fractures. Going on a campaign, they took medicines along with stocks of weapons and food.

Fragment of a diorama Medical care in the army of Bogdan Khmelnitsky

(Artist G. Khmelko, Central Museum of Medicine of Ukraine).

We find more or less detailed information about the healing customs of the Zaporozhian Cossacks in the manuscripts of the French engineer Beauplan, who lived in Ukraine for 17 years and outlined his observations in a separate book published in 1650. He writes: “I saw Cossacks who, in order to lose their fever, diluted half a load of gunpowder in a glass of vodka, drank this mixture, went to bed and woke up in the morning in a good condition. Often I saw how the Cossacks, wounded by arrows, when there were no barbers, themselves covered their wounds with a small amount of earth, which they had previously rubbed with saliva on their palms. Cossacks almost do not know diseases. Most of them die in clashes with the enemy or from old age... By nature, they are endowed with strength and high growth...”. Beauplan also notes that during the winter campaigns among the Cossacks there were no great losses from the cold, since they ate hot soup from beer three times a day, which was seasoned with oil and pepper.

Of course, Beauplan's information is not always reliable. Sometimes they are based on legends and conjectures, not fully reflecting the actual state of medical care.

Zaporizhzhya Cossacks returned from campaigns with a large number of wounded, some of whom remained crippled forever. For these reasons, the Cossacks were forced to mother their hospitals.

The first such hospital was founded in the Oak Forest on an island between the rivers Staraya and Novaya Samara. Houses and a church were built there, surrounded by protective moats.

“ ZaporizhzhyaSpas” is the main Cossack hospital in Mizhhiria near Kiev.

At the end of the XVI century. the main hospital of the Cossacks becomes the hospital in the Trakhtemirivsky monastery on the Dnieper below Kanev.

Trakhtemirovsky hospital monastery on the Dnieper.

In the future, the main Cossack hospital was located in the Mezhyhirsky monastery near Kiev. The monastery had a large book depository, including medical books, which the monks of the monastery got acquainted with. Later, hetman Bogdan Khmelnitsky presented the Mezhyhirsky Monastery with the town of Vyshgorod with the surrounding villages for the help that the monastery provided to the wounded Cossacks.

There were also military hospitals in the Lebedinsky monastery near Chigirin and in Levkivsky near Ovruch. The monasteries willingly took care of the Cossacks, and had material profit from this. In Cossack hospitals, as opposed to civilian ones in cities and villages, not only the crippled found shelter, but the wounded and sick were also treated here. These were the original first military medical institutions in Ukraine. Barbers treated the wounded and sick in the Zaporozhian Sich itself.

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