Учебное пособие (Методичка) по Истории Медицины. И.Ю.Худоногов

27.When the oath of ancient Greek doctors (the Hippocratic Oath) appeared, what provisions does it contain, and what reasons contributed to its emergence?

28.What is Hellenistic culture and Hellenistic medicine, how did they have a mutual influence, and what connected them?

29.What is the "Museion of Alexandria", and what is its role in the development of world medicine?

30.What achievements are proud of the anatomy and surgery of the Hellenistic era, who were the largest representatives of the medicine of Ancient Greece of this period?

31.What contradictions arose between anatomy and surgery on the one hand and medical ethics on the other in the Hellenistic era, and how did these contradictions have been resolved?

The development of healing in ancient Rome

Three main stages stand out in the history of the Roman state: 1) the royal period (8-6 centuries

2) the period of the republic - 31 years BC); 3) the period of the empire BC - 476 AD).

The Roman state had a regular army, waged constant aggressive wars on seizure of foreign territories. By the beginning of the period of the Empire, it was the largest state in the world, having the greatest opportunities for development. In the Roman army there were posts of camp doctors, doctors of legions, cohorts. Junior doctors (capsaria) provided first aid to the wounded directly on the battlefield, transportation of the wounded from the battlefield to military hospitals (valetudinariums) was well organized. Military doctors were in the public service, received salaries, enjoyed respect and various benefits. An important feature of the Roman state was the construction of sanitary facilities from the 6th century BC At first, the famous sewage system was built, along which city runoff merged into the Tiber River. Since the Tiber River was polluted by sewage, and there were not enough underground sources, an acute need for clean water arose. At the beginning

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of the 4th century BC the Romans began to build aqueducts. Water was taken from mountain lakes and rivers. The aqueducts were arched bridges with a height of 20 meters or more. Their length was tens of kilometers. Through the aqueducts, water was supplied to administrative, government buildings, baths, valetudinariums and fountains. Residents took water from fountains or bought from water carriers. Elements of improvement in most private homes were absent. Garbage was thrown out into the street, there were some public toilets. The famous Roman baths (“Terms”) were monuments of improvement. These were the most luxurious buildings in the city with pools, sculptures. In the baths, the Romans not only washed, but also spent their free time. Facilities for recreation, eating, sports fields, libraries, etc. were at the baths. Items relating to sanitary measures were reflected in the main document of Roman law “Law of 12 Tables” (a ban on burial within the city, taking water for drinking from the River, a fine for spoiling the aqueduct, etc.). Control over the implementation of sanitary requirements was entrusted to city officials (aediles). post of archiatrist (supreme doctor) was first introduced in the Roman Empire. Galen (129-204 CE) was Rome's most famous physician and naturalist He was born in Pergamum (today it is Turkey) in the family of a mathematician and architect, studied medicine in Pergamum and Alexandria, traveled a lot, worked at a gladiator school, then moved to Rome, where he was engaged in private practice, was a court archiatrist of Roman emperors. Together with practical activities, Galen studied anatomy, physiology in animals, a number of serious discoveries were the result of his research. He described organs, muscles (back and spine, ophthalmic, larynx, chewing), arteries, examined the brain, showed participation in the breathing of cervical and intercostal muscles and the diaphragm, determined that there are nerves in all organs and parts of the body. Galen is the author of more than 400 works on anatomy, physiology, pathology, therapy, surgery, pharmacy, philosophy of which about 80 have survived. The most important of them are: “On the purpose of the parts of the human body”, “On the anatomy”, “On the composition of drugs”, “Therapeutic methods” and others. His work for 14 centuries was the main source

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of medical knowledge in Western Europe. Galen correctly described the structure of the heart, coronary vessels and Botallo duct, but mistakenly considered the septum of the heart as permeable to blood (as in a fetus). In his opinion, the blood passed from the right heart to the left, bypassing the peripheral vessels and circles of blood circulation. He believed that the pulsation of blood vessels is the result of some “pulsating force” of the arteries, and not the heart. This incorrect point of view was considered absolutely true and not subject to criticism until the XVI century, when the Spanish theologian M. Servet risked for the first time to describe a small circle of blood circulation. In addition, he had errors in anatomy, as Galen studied the body structure of animals. Later in Western Europe, especially when the church would be dominate in all spheres of life and in science, such a thing as “galenism” will arise. It denoted one-sided, distorted by the church and Middle Ages scholastics Galen’s teachings, turned into dogma. In the royal period of the history of the Roman state, medical schools were absent, and only folk healers (empiricists) were engaged in healing. During the period of the republic, when the war of aggression began, the Romans began to take a lot of prisoner-slaves (including doctors, most often from Greece). Slave doctors appeared in almost every estate, but the Empire demanded more doctors. It was during the period of the Empire that new medical schools appeared: they were public or private. In public schools, future military doctors were trained for free. After graduating from such a school, they were sent to the public service (in the Army).

Training in medicine was practical (students investigated animal anatomy, collected herbaria, visited patients at home or wounded in valetudinariums). Civilians doctors in Rome were respected also, exempted from taxes, conscription, had various benefits.

Questions for self-control:

1.When and why did the main sanitary facilities appear in Ancient Rome?

2.Who was the largest physician in the Roman Empire, and how did he achieve this?

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3.What types of medical schools were used in ancient Rome to train physicians, and why were there so many of them?

4.What features of the development of medicine were there in the Roman state?

5.What did the sanitary measures of the Roman state include?

6.How was military medicine organized in the Roman Empire?

7.What works, belonging to the pen of Galen, are considered the main, what is written in them?

8.What is “Galenism”, why did the attitude to the works of the great thinker change in the Middle Ages?

9.What periods are customary to highlight in the history of Ancient Rome and its medicine?

10.What sources of information about the development of medicine in Ancient

Rome exist?

11. What is written in the "Laws of the Twelve Tables" about sanitary norms, rules

and requirements?

12.What sanitary facilities existed the possessions of Ancient Rome at different stages of its history (cloacas, aqueducts, baths, etc.)?

13.When and why did the medical professionals appear in Rome?

14.How did the position of a doctor in ancient Rome change at different stages of history (slave doctors, freelance doctors, free doctors)?

15.How and why was the formation of medical practice in the cities and provinces of the Roman Empire?

16.In connection with what was the formation of military medicine in ancient Rome?

17.What philosophical foundations did medicine have in ancient Rome, why did the materialistic direction receive the greatest development, and who can be named among the outstanding representatives of this direction?

18.What facts from the life of Galen determined his fame and successful professional destiny?

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19.What were the philosophical views of Galen, and with what was the dualism of his teaching?

20.How can you assess the contribution of Galen to the development of anatomy, physiology, pharmacotherapy?

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Theme 5. The development of medicine in the Middle Ages.

The development of medicine in Byzantium

At the beginning of the 4th century, Emperor Constantine the 1st Great Equal-to- the-Apostles transferred the capital from Rome to the small city of Byzantium (later Constantinople, now Istanbul), and in 395 the Roman Empire fell into two parts: eastern and western. The western part lasted until 476, and the eastern one gave rise to a new state – the Byzantine Empire, which lasted until 1453. Byzantium was a multinational state, it preserved and continued the traditions of Rome (urban planning, gardens, circuses, luxurious decoration of palaces, thermae, sewage systems, Latin, secular education). The Byzantine Empire borrowed from its predecessors the technology of building aqueducts, which were more complex – two-tier and four-tier. Underground water storages (tanks – cisterns) were available in Constantinople for storing clean water during long sieges. Attitude to baths (Terms) for 10 centuries of the existence of the Empire was different. At first the Terms were used for their intended ose, but later they began to seem too luxurious and were converted into Christian churches, as religion has become increasingly important in the of the state. Monastic charters recommended

swimming from two times month to one – two times a year. Sciences, including medical ones, developed those only that had a practical need: botany, which studies the healing properties of plants, alchemy (phytotherapy, pharmacy), surgery (usually military). Medical schools were mostly secular. For the science works were used borrowed from Ancient Greece (“Hippocratic collection”, the work of Alexandrian doctors), Galen, Dioscorides (“On medical matter”), Theophrastus on botany, early byzantine doctors. Hospitals attached to the monasteries first appeared as houses for visitors and then they were transformed into shelters for the poor, crippled and sick. Byzantine doctors Oribasiy, Aetius, Alexander and Pavel copied the works of their predecessors, supplemented it with their own knowledge and passed them on to the next generation in the form of multi-volume works (encyclopedias). Medicine in Byzantium was considered a theoretical discipline and was studied according to the works of ancient scientists.

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For ten centuries, the Byzantine Empire has preserved a huge number of works by

ancient authors, systematized and transferred them to Western Europe.

Questions for self-control:

1.When and why did the separation of the eastern part of the Roman Empire take place and Romania (Byzantium) began to develop independently?

2.What events shook Ancient Rome in 395 AD?

3.What traditions of Rome did the Byzantine civilization inherit?

4.How was the city planning of the Byzantine Empire different from the city planning of Ancient Rome?

5.What features of the development of culture of Byzantium influenced the development of medicine?

6.What features distinguished the Byzantine plumbing and sewage systems from

the Roman ones?

7.What physicians were considered the largest in Byzantium and why?

8.What contribution to medicine Oribasius of Pergamum make?

9.What are the medical achievements of Alexander of Thrall?

10.What is the famous healer Aetius of Amedia?

11.What is the famous physician Paul from the island of Aegina?

12.What was remembered by the inhabitants of Romania in 1453 AD?

13.When and why did the Byzantine Empire cease to exist?

14.What sources studied for mastering of medicine and natural science in Byzantium?

15.What information did the medical students receive from the “shestodnev”s (“six-day” books described creation of the world in six days)?

16.What sections of medical knowledge developed most actively in Byzantium and why?

17.What are the features of the development of medicinal treatment in Byzantium, how and why is it related to herbal medicine?

18.What are the achievements of Byzantine alchemy based on?

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19.Why was the surgery of the Byzantine Empire considered one of the best in the world?

20.What new types of hospitals appeared in Byzantium and why?

21.What structure and functions were typical for the first monastery hospitals?

22.Why were shelters built in the first monasteries, how did their structure and functions change in the future?

23.What types of medical schools were most common in Byzantium?

24.What contribution did Byzantine medicine make to the development of world medicine?

25.How and why did the use of Terms change in the Byzantine Empire?

Medicine of the peoples of the medieval East.

Caliphate Medicine

Medicine has been significantly developed in Muslim feudal states - Arabicspeaking caliphates. Arabs began major wars from the middle of the 7th century and conquered Byzantium, Iran, Armenia, Georgia and other countries. The result was a multinational state – the caliphate, where the main religion was represented by Islam, and the main language was Arabic. The heyday of the caliphate came in the 8-9 centuries. In the 12-13 centuries. The caliphate broke up into a number of small caliphates (Kazan, Astrakhan, etc.). Together with philosophy, mathematics, and natural sciences, medicine was part of the general education of scientists. Islam forbade autopsy to study anatomy, and even more so vivisection. Nevertheless, knowledge in this area was very much in demand and came from the conquered regions, because along with other trophies, the Arabs brought home in the caliphates books from different countries, translated them into Arabic and stored in their libraries. Knowledge of anatomy was borrowed from India and Egypt, and the representation about the role of fluids in the body came from Greece, as well as from the East. Surgery developed very well in caliphates, especially military surgery. More than 150 surgical instruments were invented by the Arabs, they were the first to use catgut during operations, improved the

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technique of operations (a suture with a thread with two needles), introduced a lying position during operations on the pelvis, used anesthesia from the mandrake root, cauterization for treatment wounds. These were innovations in the field of alchemy: methods were found for producing acids, alkalis, salts, a laboratory water bath was used, filtration was carried out, and alcohol was distilled for the first time. Arabs successfully developed ophthalmology. They studied the structure and gave names to parts of the eye (cornea, lens, iris, vitreous body, etc.), examined the refraction of light by the liquid media of the eye and created lenses for correcting vision in old age, wrote multivolume memorandums on eye diseases, improved the removal operation cataracts by aspirating fluid from the lens using a cannula. Pharmacy and therapy have also developed; the arsenal of medicines of plant, animal, mineral and chemical origin has expanded. To prepare medicines consisting of a large number of components, Arab doctors began to open pharmacies. The first pharmacy appeared in Baghdad in 754. Such doctors as alRazi and al-Zahravi gained fame in the caliphate. Al-Razi was a therapist, alchemist and philosopher. He founded and headed a hospital in Baghdad, first used cotton wool for dressings, created a tool for extracting foreign bodies from the larynx, and studied the effect of mercury salts on monkeys. There are known to more than 200 works of this scientist (“Comprehensive book on medicine” in 25 volumes, “Medical book” in 10 volumes, etc.). In his treatise “On Smallpox and Measles” he first outlined the differential diagnosis of these diseases. Al-Zahrawi was a brilliant surgeon, invented many new surgical instruments and improved old ones. He was first used catgut for hypodermic sutures, cauterization, etc. Medical schools during the existence of the Caliphate did not open. Knowledge (theoretical principles of medicine) could be obtained from books, because libraries were everywhere, and practical skills were acquired from relatives or other practitioners. Medical schools began to appear only during the collapse of the Caliphate from the 12th century. Three types of hospitals were in the Caliphate:

1) large multidisciplinary hospitals were created in the capitals financed from the caliph's treasury and were available to the entire population;

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2)small private hospitals for rich people were supported by sponsors and patient fees;

3)military hospitals, which were mobile and moved with the army.

For more than five centuries, Arabic-speaking medicine has occupied a leading position in the Mediterranean region. The Caliphate’s doctors preserved the knowledge of their predecessors, supplemented, edited, systematized it and transferred it to Western Europe when this knowledge had been begging to need by Europeans which brought the Renaissance closer.

Medicine in Central Asia

The encyclopedic scientist Abu Ali ibn Sina (980-1037) was the most outstanding scientist, philosopher, and physician of Central Asia. He was born near Bukhara in a small village. During this period, the Caliphate in this territory disintegrated and the state of the Samanids arose. The main language was Arabic, the religion was Muslim. Before the death of his parents, ibn Sina moved to Bukhara, where he read all the books of the famous Bukhara library. Then he lived in Khorezm, but most of his life was spent in wandering, and he died on the way to Hamadan (Iranian territory). In the twentieth century, grateful Hamadans built a mausoleum where the remains of the great scientist rest. 12 stellas are installed over the mausoleum, they symbolize 12 sciences, to which this outstanding scientist made a significant contribution (there are philosophy, linguistics, medicine, astronomy, mathematics, chemistry, etc.). Ibn Sina wrote about 500 scientific works. 238 have survived to this day. The 5-volume work of the medical scientist “Canon of Medicine” is the most famous. More than 800 medicines of plant, animal, mineral origin, their effect, the rules of collection and preparation were described in the "Canon". Ibn Sina summarized the experience of ancient doctors and anticipated the emergence of a number of disciplines (psychiatry, pediatrics, oncology, dietetics, etc.), pointed out the role of mineral waters, suggested the existence of invisible alive particles that cause infectious diseases, substantiated in detail the influence of natural factors, physical exercises and emotional state on human health.

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