History of medicine

Middle Ages


MEDICINE IN THE BYZANTINE EMPIRE (395-1453). The development of medical knowledge. Hospital case


The term “Middle Ages”, more precisely “Middle Ages” (Latin medium aevum), originated in Italy in the 15th and 16th centuries. among the humanists who thus separated their time from the history of the ancient world.

The Middle Ages were the time of formation, development and decline of feudalism. In different regions of the globe, the feudal system originated and developed at the same time, therefore the chronological framework of the Middle Ages (as well as other periods of history) is very conditional. Thus, in Western Europe, the beginning of the Middle Ages and feudalism is considered to be 476, the year of the fall of the Western Roman Empire. In the countries of the East, feudalism originated much earlier. In China, it was strengthened in the 3rd century, in the countries of the Transcaucasus - in the 4th century, in Byzantium and the states of Central Asia - in the 7th century. In Russia, the feudal system began to form in the IX century.

In Europe, the era of the Middle Ages is conventionally divided into three periods: the early Middle Ages (5th-11th centuries), the developed Middle Ages (11th-15th centuries) and the late Middle Ages (15th-17th centuries).

The end of the Middle Ages, modern historical science determines the time of the first bourgeois revolutions, among which the British bourgeois revolution of 1640–1649 was of general European importance. The year of its beginning is conditionally considered the border between the history of the Middle Ages and the new time.





In the history of world culture, the Byzantine civilization was the immediate successor of the Greco-Roman heritage. For 10 centuries of its existence, it was the center of a unique and truly brilliant culture.

Its prehistory begins during the reign of the emperor of the Great Roman Empire, Constantine (306–337), who is known, inter alia, for the introduction of Christianity as the state religion and the creation of a new capital, which he transferred from Rome, which was raided by barbarian tribes, into the small ancient Greek town of Byzantium on the western shore of the Bosphorus. During his reign, in the city of Byzantium, 30 palaces and temples were built, more than 4 thousand buildings for nobles, two theaters, a circus, a hippodrome, more than 150 baths and 8 aqueducts. In May 330, the ceremonial opening of the new capital took place, which was later called K'nstan: tinopol, i.e., “the city of Constantine” (now Istanbul).

At the end of the 4th century, under the onslaught of the “Great Migration of Peoples”, the Roman Empire, shaken by constant crises, weakened even more. Its eastern provinces (including Greece, the Central and Eastern Balkans, Asia Minor, Syria, Palestine and Egypt) already under Diocletian (284–305) received independent control, and in 395 they finally separated from Rome as the Eastern Roman (Byzantine) empire.

The Western Roman Empire, leading incessant bloody wars and weakened by slave uprisings, did not exist for long: in 476, the tribes of the Rugia. under the leadership of Odoakra, they overthrew the last Western emperor Romulus. Av— "thick, and the Western Roman Empire ceased to exist.

. A different fate was the Eastern Roman Empire, with its capital Constantinople. The economic strength of its more developed provinces was ensured. highly developed handicraft production, (especially art products) and agriculture, brisk by foreign trade. with Arabia, Black Sea, Persia,

^ the countries of Central Asia, India and China. The leading cities of the empire Constantinople, Bibl, Caesarea, Beirut, Thessaloniki, Ephesus, Smyrna, and others were major centers of handicrafts and international trade.

During its existence, the Eastern Roman Empire was called the Empire of Romeis. or romania. "Byzantium", or "Byzantine Empire" - the conditional scientific name, introduced by historians after the Empire of Rome, conquered by the Turks, ceased to exist. It comes from the original name of the capital of the empire, the city of Byzantium, and is now generally accepted in world literature.

Being the direct heir of ancient culture, the Byzantine Empire for a long time maintained the traditions of ancient Rome: urban planning, baths, large gardens around buildings, the luxury of the interior decoration of palaces, clothing, harness, hunting, sports, theater, circus, court ceremonies and Latin - the language of politics, Church and literature (in the 5th century it changed to Greek).

The Byzantine Empire reached its highest power during the time of Justinian I (527-565). In the VI. In the composition of Byzantium included. Balkans and. Asia Minor, Aegean islands and some, areas of the Northern Black Sea region, Syria, Palestine, Egypt and North Africa. Even after in VII. Byzantium lost Syria, Palestine and Egypt, conquered by the Arabs, it continued to remain a major power, the era of the early middle ages (Fig. 62). Up to the XII century. it was the most K5'ltur country in Europe and had a great influence on the development of neighboring countries. The merchant navy of Byzantium dominated the Mediterranean until the eleventh century. Its capital, Constantinople, was the “golden bridge between East and West”, “the king of cities” and “Rome. East.

One of the outstanding achievements of multinational Byzantine culture was an invention in the 9th century. brothers Cyril (Constantine) and Methodius of the Slavic alphabet - Cyrillic, which laid the foundation for Slavic writing. In the IX century. Close ties of Byzantium with Kievan Rus were established, mutual enrichment of cultures began.

Due to the characteristics of its economic and state development, the Byzantine Empire existed for a millennium longer than the Western Roman Empire. In 1453, after the Turks conquered Constantinople, the last Byzantine territories became part of the Ottoman Empire — Byzantium ceased to exist. However, the influence of Byzantine culture on the countries of the East and the West has been felt for centuries. It was Byzantium that preserved those ancient traditions, the continuity of which in Western Europe was broken.


Sanitary facilities


The early Byzantine civilization inherited the device and way of life of cities from the antiquity: water pipes, sewage systems, baths. This was most clearly manifested in the construction of Constantinople.

The stony soil on which the ancient city of Byzantium was located did not give the population the necessary amount of water. The construction of wells was difficult. The water that filled them had a bitter-salty taste and was unfit for drinking. Therefore, one of the most important tasks in creating a new capital, which lasted for many centuries, was the construction of aqueducts (aqueducts), constantly replenishing water supplies in wells, fountains and underground reservoirs — tanks. The largest number of hydraulic structures of Constantinople was built under Constantine the Great, Valente (364-378) and Justinian I.

The two-tier aqueduct of Valenta (Fig. 63) is one of the oldest among the Byzantine structures of Constantinople to be preserved. Its construction began in the II century. under the emperor Adrian and ended in the IV. under the emperor Valey. The 23-meter-high aqueduct arcades stretch for 625 meters, crossing the city from end to end and passing over rooftops and streets. The aqueduct built in the times of Justinian is also one of the outstanding hydraulic structures of this period. Its four-tiered arches with a height of 36 m were thrown over a stream 140 m wide.

By virtue of its geographical position and historical significance in deciding the fate of the East and West, Constantinople often underwent lengthy sieges and successfully withstood them, partly due to the considerable supplies of drinking water that have always been (and still are) in the city’s underground tanks. The architectural and technical solution of these underground reservoirs made them unique monuments of Byzantine architecture. Some tanks have survived to our days, in particular the Basilica tank, or Yerebatan-Saray (translated from Turkish - the Palace, which fell through the ground, Fig. 64). Its dimensions are enormous: length 1! 2 m, width 61 m, height 13.5 m. The vaults spiral into 336 columns. To this day, the private water tank / (Currently Yerebatan-shed is a branch of the museum of the church of St. Sophia, next to which it is located.)




In the early Byzantine cities "there were baths everywhere, and in such large centers as Constantinople and Antioch, there were a great many. However, over time, the bath in Byzantium ceased to be the center of social life, as was the case in ancient Rome. Old terms seemed too luxurious and were converted to Christian churches. The capital baths consisted of several rooms that were heated. Hot water was supplied to them. The provincial baths had a very poor appearance and were fueled “blackly.” “The smoke goes into the room,” wrote the monk Mikhail Khoniat, - such a wind blows through the cracks, that the local bishop always washes his cap so as not to catch his head. ”At the monasteries small bathhouses were built. It was difficult to say how often they washed them: two times a month, up to several times a year, and sometimes “from Easter to Easter.”) At the same time, the bath remained a place of healing: the doctors prescribed a bath 1-2 times a week (depending on the disease).


Byzantine science and religion


Throughout its history, Byzantium has been a multi-ethnic state. Byzantine culture united the achievements of many peoples inhabiting it (Greeks, Syrians, Romans, Copts, Armenians, Georgians, Cilians, Thracians, Kappados, Dacs, Slavs, Polovtsians, Arabs, etc.). However, the Byzantines were not limited to the simple assimilation of knowledge acquired in previous centuries, and in a number of industries made certain steps forward.

Special attention was paid to those areas of knowledge that were closely associated with practice, primarily with medicine, agricultural production, construction, and navigation. At the same time, the foundation of all the sciences was not the ancient philosophy, but theology. Established on the ruins of the ancient world, Christianity in Byzantium ousted the life-affirming pagan religion of the Greeks.

For a long time paganism existed along with Christianity. Many major church leaders of Byzantium IV — V centuries. studied in pagan schools and subsequently actively fought with some prejudices of Christians against Greco-Roman ancient literature. Thus, a prominent theologian and bishop of Caesarea Cappadocia, Basil the Great (c. 330-379), was educated at the highest pagan school in Athens. In his writings, he spoke with great respect about the ancient cultural heritage, and convincingly argued that ancient literature in many ways anticipated the emergence of Christianity. Moreover, Basil the Great and other early Christian writers pointed to the need for Christians to get a secular education: in their opinion, it would contribute to a better understanding of the Scriptures and to interpret it with the help of the methods and means of ancient scholarship. Calling themselves the Romais, and their empire, the Romeysk, the Byzantine Christians were proud of the fact that they preserve the cultural heritage of Hellas and Rome, so powerful was the historical inertia of the ancient world. However, only that which contributed to the consolidation of Christianity was selected from the ancient heritage. In the field of natural science, the main data were drawn from the works of Aristotle ("Physics", "The History of Animals", "On the Parts of Animals", "On the Movement of Animals", "On the Soul", etc.). All of them were repeatedly commented on by the early Byzantine authors in order to make them accessible to the reading public.

The so-called “Six Days”, based on the biblical legend about the creation of the world in six days, became peculiar encyclopedias of natural science in the early Byzantine period. The main goal of “Talks on the Six Days” was to present a Christian doctrine on the structure of the Universe and to refute the physical theories of antiquity. The Six Days of Basil the Great and George Pisida enjoyed the greatest popularity. Being engaged in the development of philosophical and theological problems and arguing with the ancient writers, they borrowed from antiquity various information on natural science, both real (about plants, birds, fish, reptiles, land animals, etc.) and fantastic (about sacred geese, about the virgin birth of the offspring of the kite and the silkworm caterpillar - the thesis of the immaculate conception, etc.).

Valuable information about the fauna of Egypt, Ethiopia, Arabia, Ceylon and India is contained in the XI book "Christian Topography" (c. 549) by Cosmas Indykoplov (i.e. "Plavatel-la India"). Along with this, it stated that the Earth is a plane surrounded by the ocean and covered with the firmament, where paradise is located.

Becoming the ideology of the Middle Ages, Christianity had a decisive influence on social and political processes. The state doctrine of glorifying the Christian monarchy and the cult of the Byzantine emperor as the head of the entire Christian world had a great influence on the whole social and ideological life of Byzantium (ideology, culture, philosophy, history, literature, art and various fields of knowledge, including medicine).


The development of medical knowledge


The main source and basis of medical knowledge in the Byzantine Empire was the Hippocrats Collection and the works of Galen, extracts from which served as the basis for compilations consistent with the spirit of Christianity. The search for a natural scientific explanation of the nature of the disease has stopped, and the study of the practical methods of treatment developed in previous centuries has come to the fore.

As practitioners, Byzantine doctors also described their own observations, often clarifying the descriptions of individual practices and their healing properties. The interest in medicinal plants in the empire was so great that botany gradually evolved into a practical area of ​​medicine that deals almost exclusively with the healing properties of plants.

The main sources of knowledge about the plant world were the works of “the father of botany” Theophrastus. (Theophrastus, 372–287 BC. E.) And the Roman physician (Greek by birth.) Dios Coris (see p. 127). His essay "On medical, matter" for nearly sixteen centuries was an unsurpassed textbook on. medicinal medicine.

Over time, artisans-chemists became interested in the preparation of drugs. In the period of the Middle Ages, chemistry as a science did not yet exist: quantitative and qualitative accumulation of practical information took place, and special guidelines were drawn up for the production of various substances, mainly dyes and drugs.

The accumulation of certain chemical knowledge was also facilitated by alchemy, which arose in the first centuries of our era and reached its greatest survival in the Middle Ages. Alchemists believed in the transmutation of metals and the possibility of obtaining chemically gold, silver and precious stones, were engaged in the search for the philosopher's stone and the elixir of longevity, which (as they thought) would save a person from diseases and ensure a long life (and even immortality). .

Despite the fact that the original premise of the alchemists was false, their practice contributed to the expansion of knowledge about chemical-technical processes and methods of their study.

The twin brothers Kosma and Damian were considered the first Christian doctors. At the time of Diocletian (284-305), they were martyred, subsequently consecrated as saints, and revered in the Christian world as patrons of doctors and pharmacists.

The turbulent era of IV — VII centuries. left. much more written medical sources than the entire subsequent history of Byzantium (Figure 5). This was the period of the creation of multi-volume encyclopedic arches, summarizing the heritage of the ancient and the experience of Byzantine doctors. Drawing on their knowledge from the treatises of the eminent scientists of antiquity, Byzantine physicians saved them from oblivion and passed on to subsequent generations.

One of the most prominent impostors of Byzantium was Oribas from Pergamum (Greek: Oreibasios, Latin: Oribasius, 325–403), a Greek by origin. He studied medicine in Alexandria, which at that time preserved the glory of the largest medical center in the Mediterranean .. His teacher was the famous doctor at the time Zeno from Fr. Cyprus.

Subsequently, Oribasiy became a friend and physician to Emperor Julian the Apostate. Highly educated Julian did not accept the Christian religion and in every way sought to preserve the heritage of the ancient Greek-linguistic civilization (in the field of medicine in particular). At his suggestion (361), Oribasius compiled his main encyclopedic work “Collecta medi-cinalia” (“Medical meeting”) in 72 books, of which only 27 survived.

He is in it. summarized and systematized the medical heritage from Hippocrates to Galen, including the works of Herodotus, Dioscorides, Diokles, and other ancient authors. On many of the writings, we know only what Oribasii has managed to communicate.

At the request of his son Eustache, who studied medicine, Oribasiy compiled a shortened version of his extensive collection, the so-called “Synopsis” (“Review”) in 9 books, which became a tool for medical science students. An even more concise extract from Synopsis was another well-known work by Oribasia, Euporista (“Public Medicines”). It was intended for people who did not have medical education and were engaged in preparing medicines at home. Both works in the V century. were translated into Latin and reached us in full.

Oribasiy was persecuted by the church for his scientific views and adherence to the ancient traditions and after the death of Julian (in the Persian campaign in 363) was temporarily expelled from Constantinople.

After Oribasius, there were several outstanding medical encyclopaedists in Byzantium. Among them is Aetius from Amida (Greek: Aecios, Latin: Aetius Amide nus, 502-572), who is considered the first Byzantine Christian doctor. He also studied in Alexandria, then served as chief of the imperial suite and a doctor at the court of Justinian. The main; The Ae-tion - a manual on medicine "Tet-rabiblos" ("The Four Book") in 16 books is a compilation of works by Oribasia, Galen, Soran and other authors, and also contains prescriptions for Egyptian and Ethiopian medicine, thus covering almost all practical medicine of the Mediterranean region of the time.

Aetius's famous contemporary was Alexander of Thrall (Latin Alexander Trallianus, ca. 525-605) - the son of a doctor and brother of the architect Anfimy, the builder of the church of St.. Sofia in Constantinople. Alexander's 12-volume work on internal diseases and their treatment was popular throughout the Middle Ages. He was translated into Latin (“Lib-ri duodecim de re medica”), Syriac, Arabic, and Hebrew, and was widely known both in the West and in the East, where Alexander was called the “Healer” during his lifetime. The main material for this work was Alexander's own medical practice. Accuracy in the diagnosis and the desire to find out the causes of diseases favorably distinguished him from other colleagues. Based on his own experience, he allowed himself to disagree with some of the conclusions of Galen and criticized them. Alexander considered prevention as the main task of the doctor. He traveled a lot. He lived in Greece, Italy, Galia, Africa. He died in Rome, where he was invited to be the city’s archiect by Pope Gregory the Great (590-604) during the plague epidemic. It was the terrible “Plague of Justinian”, which, having left Egypt, devastated almost all the countries of the Mediterranean (see diagram 5) and lasted for about 60 years. In Constantinople alone, at the height of the epidemic in 542, several thousand people died daily.

The prominent doctor of Byzantium was Paul from Fr. Aegina (Greek Paulos, Lat . Ra -ulus Aegineta, 625-690). His work is inextricably linked with Alexandria, where he studied and worked, when Alexandria was part of the Byzantine Empire, and after its conquest by the Arabs (who highly appreciated him as a surgeon, obstetrician and teacher). Pavel composed two large works: a work on women's diseases (which has not come down to us) and a medical-surgical collection in 7 books “Compendii medici libri septem” "Paul's tpyji is distinguished by originality of thought, clarity of presentation and clear knowledge of the subject. The Greek East learned and appreciated early it, the Latin West used it throughout all the Middle Ages. Of particular value is the sixth book of this work - a thorough outcome of the development of surgery by the 7th century (minor surgery, the study of fractures, dislocations and amputations, cavitary, military and plastic surgeon and I)". During the Renaissance, many medical faculties, such as the University of Paris, prescribed to teach surgery only from this book. The radical operations described in it were considered classic until the 17th century, and Paul himself from Egina was revered as the most courageous surgeon of his time.

Byzantine doctors used not only the ancient heritage, but also the experience of Arabic-speaking medicine. Medical Arabic manuscripts were also translated into Greek. Arabic drugs are widely known. The influence of Arabic medicine is more pronounced in the writings of late Byzantine authors. Among them is the work on the food properties of Simeon Seth (Seth Simeon, IX cent.) And the book on pharmacology (Opus medicamentorum) by Nikolai Mireps (Myrepsus, Nicolaus, XIII cent.), Used for teaching in Europe until the 17th century.


Hospital case


The emergence and development of monastic hospitals and hospital work is closely connected with the history of Byzantium. Its roots go back to the beginning of the 4th century, when desert-breeding was born in Egypt - the first form of monasticism. Its founder, Anthony the Great, protesting against the injustices of the human world, distributed his property, went into the desert and became an example for many imitators. The first deserts (anchorites) wandered hermits one by one. Then the difficulties of life forced the hermit monks to unite. So the monasteries arose. The first "hostel monastery" '(Kinovia) was founded in Egypt in 320. Subsequently, monasteries began to appear in Palestine, Syria and other areas of the Byzantine Empire.

In time, the initial content of monasticism — departure from life — has expanded: the monks began to take part in public affairs. Gradually, monasteries became a place where, far from worldly concerns, monks (among other things) read, copied and wrote books. The business organization and discipline of the monasteries allowed them to remain in the difficult years of wars and epidemics a stronghold of order and take old people and children, wounded and sick, under their roof. Thus arose the first xeno-dohii (i.e., monastic shelters for disabled and sick travelers) - types of future monastic hospitals. Basil the Great enshrined this in the Charter of the Cinovite communities he drafted, which retained its importance in all ages of Orthodox monasticism, in that. including in Russia.

Monasteries also made a hard selection of that minimum of church and secular literature, which from the church’s position needed to be preserved, rewritten and commented. The results of this selection determined the future fate of medieval scholarship, which subsequently inextricably linked itself with scholasticism (see p. 171).

Compared with the Latin West, the hospital case in Byzantium stood at a higher level. The first large Christian hospital was built in Caesarea in 370 by Basil the Great. She looked like a small town and had as many buildings as there were types of diseases then distinguished. There was also a colony for lepers — a prototype of the future European leper colony.

In the Byzantine Empire, hospitals were widespread. Thus, in the territory of Western Armenia in Sebastia, already in the 4th century, a hospital for the poor, foreigners, cripples and the infirm was famous.

The description of one of the hospitals in Constantinople, founded by John II at the monastery of Pantokrator in the 12th century, testifies to the high organization of the hospital business in Byzantium. It had five departments, including the department of female diseases. The total number of beds reached 50. The hospital had a permanent staff of medical specialists (surgeons, midwives) and their assistants, who worked in two shifts, alternating a month later. In each department there were two doctors who were receiving and coming patients. Doctors received a salary in money and food, used free housing and monastic horses, but did not have the right to private practice without the special permission of the emperor. At the hospital there was a school for teaching medical skills.


Education and Medicine


Education in the Byzantine Empire was secular. In IV — VII centuries. its main centers remained the ancient cities. Alexandria was famous for its medical school, which functioned even after the Arabs conquered it (until the beginning of the 8th century). As already noted, Oryba Sius, Aetius, Paul, and many other distinguished Byzantine physicians left the Alexandrian medical school. In Athens - the capital of rhetoric and philosophy - the Athenian Academy founded by Plato (closed under Justinian) continued to work. Beirut was the center of legal education. Gaaz was famous for its rhetoric school, which for a long time maintained Hellenic traditions. Teaching was conducted in Greek.

Despite the religiosity of the Byzantine society, the basis of education was not the monuments of the Christian literature, but the works of ancient authors, supplemented by numerous interpretations. Even in the “Auditorium” of Constantinople (“Auditorium specialiter nostrum”), the only Byzantine university founded by Theodosius II in 425 (that is, almost a century after the recognition of Christianity as the state religion), theology was not taught. It was not among the disciplines of higher education and was studied in the family and in the churches.

The training system was designed to acquire purely secular education. The most prominent figures of the church, Basil the Great, Gregory the Theologian, Gregory of Nyssa, received brilliant secular education in the best grammar, rhetorical, and philosophical schools of the empire.

The attitude of the clergy to the philosophical education was twofold: an excessive passion for philosophy, in their opinion, could lead to heresy and at the same time philosophy was necessary in the preparation of educated ministers of the church. As a result, philosophy was viewed as a preliminary step to the study of theology and was thus, as it were, the “official tool” of theology, which was defined as the crown and goal of all sciences.

Monastic schools in Byzantium were relatively few. Only future monks had the right to visit them. The education received in monasteries was purely religious (rather spiritual and ascetic, rather than intellectual).

Medicine was part of the Byzantine education program and was taught in close connection with the four main subjects of the higher Late Anti-school, mathematics, geometry, astronomy and music, which were combined under the name “Quadri-vium” (Latin - four ways). In addition to them, the full course of Byzantine higher education included the study of grammar, dialectics and rhetoric (from the 9th century onwards they were called Trivium). The seven “liberal arts” (Latin - artes liberates, Greek equivalent - enkiklios paideia) were the main contents of higher general education already in the period of late antiquity; they persisted for almost a whole millennium, and in the Middle Ages they formed the basis of the faculties of liberal arts in the universities of Western Europe.

Despite its practical nature, medicine in Byzantium continued to be considered a theoretical discipline and was studied from the writings of the great physicians of antiquity (the Christian religion forbade the shedding of blood and the anatomy of corpses). Particular attention was paid to treatment techniques developed in previous centuries, and the study of drugs.

In the early Byzantine period, the Alexandrian school was the most famous: everybody who wanted to become a doctor wanted to study there. In late Byzantium, schools in Constantinople and Ohrid (Macedonia) became major medical education centers.

According to contemporaries, teaching medicine was in the nature of discussion. Upon graduation, passing examinations of a specially appointed college of doctors and obtaining relevant certificates, graduated from medical schools could receive public office and the title of archiatrist. However, in most cases they were engaged in private practice.

In the history of science, the heritage of Byzantium cannot be regarded as the wealth of one country — Greece and Bulgaria, Yugoslavia and Romania, Turkey and Hungary, Italy and Egypt and many other Mediterranean countries are now located in its vast territory. For 10 centuries of its history, Byzantium was able to preserve and systematize the ancient heritage, and also created the original medieval culture, which had a great influence on the development of the culture and medicine of many peoples of the world.



History of medicine