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

Questions for self-control:

1.What are the most important features distinguish healing in Arabic-speaking countries from medical activities in other civilizations?

2.What was the main religion in the Arab Caliphate, its medical aspects?

3.What innovations of Arab doctors allowed them to take a leading position in the field of world surgery, and why?

4.Which Arab doctors were considered the largest in the caliphate and why?

5.What achievements of the alchemists of the Arab caliphates significantly accelerated the development of medicine, and why?

6.What is the name and what information is contained in the main work on medicine, penned by Ibn Sina?

7.Where and when was the first pharmacy in the Arab Caliphate opened, what

does this indicate?

8. What types of in-patient departments were built in the Arab Caliphates, and

why?

9.What are the merits of al-Razi in medicine?

10.Who is considered the largest scientist-encyclopedist of Central Asia, and why exactly he, what character traits that determined the fate of the scientist were laid in him from childhood?

11.What is the contribution of Ibn Sina to world culture, science and medicine?

12.What is the significance of Arab medicine for the medicine of Western Europe?

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Theme 6. Medicine in Western Europe.

Medicine in Western Europe during the Early and Advanced Middle Ages

The year 476 is conventionally considered the beginning of the Middle Ages history in Western Europe, then the western part of the Roman Empire ceased to exist. There are three periods of the Middle Ages:

1)the early Middle Ages (5-10 centuries);

2)the classical Middle Ages (11th – early 14th centuries);

3)the later Middle Ages or the Renaissance (15-17 centuries).

Medicine in Western Europe during the early Middle Ages had a theological character. It originated in monasteries, which, following the example of Byzantium, began to arise in Western Europe from the 4th century. At monasteries, monks built hospitals, and at hospitals they established monastery medical schools. In the 7-8 centuries, monastery hospitals schools appear in Paris and Montpellier. Teaching was based on the writings of Galen. In the 9th century in Salerno, the monastery school was transformed into the first secular medical school. Salerno School was one of best schools in Western Europe, it continued the traditions of antique medicine, the training was practical, and students underwent medical practice for a year at the monastery hospital. Then secular medical schools were opened in Paris, Padua, Bologna and other cities. From the beginning of the 12th century, legal, philosophical and medical schools began to be combined into one general school – the university. The undergraduates were called students (in lat. studere – to teach, to study), the rector (in lat. rector – ruler) led the university. Students and teachers had been united in faculties (in lat. facultas – ability, skill). Universities consisted of three main faculties: philosophical, legal, medical. Artistic faculty (or the seven liberal arts faculty) was a preparatory, at the beginning general cultural knowledge were given (such as grammar, rhetoric, dialectics, arithmetic, etc.). The faculty was headed by the dean (in lat. decanus - ten's manager), as ten students studied at the faculty. During training, the student could receive a bachelor's, master's or doctor's degree. Since 1600, the title “professor”, taken from Rome, where professors called public teachers of grammar

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and rhetoric, appeared. Medieval universities enjoyed great autonomy: they had their own laws, their own courts, and police. The basic principle of teaching was scholastic (in lat. schola – school, “school wisdom”), which consisted of the following provisions: 1) worship of the authority of ancient scholars; 2) the conviction of the impossibility of discovering new; 3) teaching is a theoretical process that excludes experience. Teaching students included recording lectures, memorizing material, and communicating with teachers in the form of disputes, discussions, mental battles. Autopsies for the study of anatomy were not performed at all universities and only once every 3-5 years. At the beginning of the 13th century, the Catholic Church began to wage a more active struggle against heresy. Two monastic orders were created: Franciscan and Dominican, among the Dominicans the idea of the Inquisition (in lat. inquisitione – inquiry, question, interrogation, investigation) arose. So the church gradually subjugated all spheres of society’s life: politics, science, art, medicine, etc. The church dictated which works of antiquity can be studied and which cannot. Ancient western scholars fell under the ban because they were pagans, eastern – because of they were from peoples of a different faith, a different religion. Galen arranged the church most of all, since he spoke of a higher mind, of God, and his works were taken under the protection of and became an indisputable authority. So galenism arose. This term refers to a distorted, one-sided interpretation of Galen’s teachings. The writings of other scholars were severely censored and supplied with detailed “commentaries” of the reverend fathers. For any dissent, people went to the bonfire of the Inquisition. The church imposed strict prohibitions on the autopsy of human corpses up to the death penalty and excommunication. The first anatomical theater opened in Padua only in 1490. The sanitary and hygienic condition of the medieval cities left much to be desired. Garbage and waste were thrown onto streets that were narrow and unpaved. Water pipes, sewers, sewage systems were absent. The first water supply system was built in Germany only in the 15th century, and paving began to appear at the end of the 14th century. Such unsanitary conditions entailed epidemics and pandemics of infectious diseases. Thus, a large part of the

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population of European cities died out from the pandemic of the 14th century plague. Attempts to resist the spread of infections included the following measures: in the port cities “quarantines” (isolation of visitors for 40 days) began to be established; those infected with plague were isolated, and the dead were burned along with property and housing. In the Middle Ages, leprosy spread widely. Lepers were driven out of cities. They wore black coats-hoodies, wide-brimmed hats with a white ribbon and a rattle announcing their approach. The authorities did not allow them to work, only to beg, and they let them into the city on certain days. Subsequently, leper colonies and infirmaries began to be built for lepers.

Medicine in Western Europe during the Renaissance

Big changes take place in the 14-15 centuries. in the social and cultural life of Western Europe: a new bourgeois system is emerging and requires the development of sciences, primarily the mechanics, mathematics, chemistry, which are necessary for the development of production, a transition from scholasticism to experimental knowledge is taking place, a humanistic worldview is being formed. The transition to experiments is also taking place in medicine, primarily in anatomy and physiology. Brilliant Italian artist Leonardo da Vinci (1452-1519) was one of the first experimenters to study anatomy in practice. Opening the corpses, he studied the structure of the human body, washed organs with running water, injected wax into the ventricles of the brain and blood vessels, and sawed bones and organs. Leonardo described and sketched many muscles, bones, nerves, organs, compiled 13 volumes of anatomical drawings, which became famous only in the 18th century.

Professor of Padua University A. Vesalius (1514-1564) went down in history as the founder of scientific human anatomy. Despite the prohibitions, he performed autopsies and discovered errors that Galen had made. He presented his results in the works “On the Structure of the Human Body” in 7 volumes, “Epitome” (“Extract”) and “Anatomical Tables”. Because A. Vesalius encroached on the authority of Galen, the scholastic doctors and the church met his research with a

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storm of indignation, he was expelled from the university. Other scientists (R. Colombo, I. Fabrice, B. Eustachius, etc.) confirmed the data of A. Vesalius and made new discoveries, which made it possible to lay a solid foundation for scientific anatomy. On its basis, physiology, therapy and surgery have been developed.

The birth of physiology as a science is connected with the name of the English doctor, researcher W. Harvey (1578-1657), who scientifically substantiated and experimentally confirmed the existence and inextricable connection of the large and small circles of blood circulation. The predecessor of W. Harvey, the Spanish theologian and philosopher M. Servet, tried to describe the small circle of blood circulation, but for all his works, both philosophical and natural-scientific, he was burned at the stake of the Inquisition. The smallest vessels - capillaries were discovered by M. Malpigi thanks to the invention of the microscope by A.

under the pseudonym Paracelsus (similar to Celsus). Paracelsus claimed the importance of chemistry medicine, laid the foundations of professional

pathology, developed a classification of factors that affect health. He believed that surgery should be taught at universities along with therapy, he was an opponent of medical participation in the Inquisition.

Bloody wars often occurred in Western Europe during the Renaissance, and this required the development of military surgery. Most of the universities did not allow surgeons to be admitted, so their training was conducted in the workshop associations of surgeons. The first Surgical Academy was opened in Paris in 1731. Changes in the nature of wars (the appearance of firearms in the 14th century) required other methods of surgical treatment. Disinfection was achieved using such barbaric methods as cauterizing wounds with hot iron, pouring boiling resins, oils and all this without pain relief. The wounded often died of pain shock. In the middle of the 16th c. French surgeon A. Pare (1510-1590) proposed a new gentle

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method for treating wounds by applying dressings soaked in balms, which alleviated the suffering of the wounded. He published a book on the treatment of gunshot wounds, wrote essays on anatomy, surgery, treatment of fractures, dislocations and obstetric care, improved the technique of amputations, applied the ligation of large vessels, created a number of new surgical instruments, and the construction of artificial limbs and joints. The activities of A. Pare contributed to the transformation of the artisan surgeon into a full-fledged specialist physician and determined the formation of surgery as a science.

Infectious diseases continued to spread in Europe at that time. The doctrine of infectious diseases was developed by the Italian scientist, doctor D. Fracastoro (1478-1553). His main work “On contagia, contagious diseases and their treatment” contained a summary of all known information about infectious diseases, routes of transmission, the clinical picture and treatment methods known

trade, crafts, culture, science, art and which gave impetus to the further development of all spheres society.

Questions for self-control:

1.What date is conventionally considered the beginning of the Middle Ages in Western Europe, what happened in that time and why?

2.What types of medicine are usually distinguished in the course "History of Medicine", and with what type does modern Western Europe medicine begin its development?

3.Where and when did the first monastic medical schools appear in Western Europe?

4.The works of which scientists were taken as a basis in the monastery medical schools?

5.When and where in the Western Europe was the first secular medical school opened, and why exactly there?

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6.What are the principles underlying scholastic teaching, and why?

7.How many faculties did Western European universities have, what were they called and why?

8.Why did teaching in medieval universities have the same methodological basis as monastic schools?

9.What elements of improvement were present in the medieval cities of Western Europe, and why?

10.The works of which ancient scientist were under the patronage of the church, and why were its turned into dogma for many centuries?

11.What features that characterize the era of the Renaissance underlie the rejection of Christian values?

12.Who were the founders of scientific anatomy during the Renaissance, and why

exactly are they?

13. Who were the founders of scientific physiology during the Renaissance, and why exactly they?

14. Who was the founder of iatrochemistry during the Renaissance, and how else did he become famous?

15.Who was the founder the doctrine of infectious diseases in the Renaissance, what advanced ideas were expressed in his work?

16.What are the main works written by A. Vesalius, how did they differ from the works of Galen?

17.What are the main scientific achievements of Paracelsus, how natural was their appearance?

18.Which Renaissance surgeon is considered the largest, and why?

19.What discoveries in medicine did Ambroise Paré make?

20.What is anatomical theater, where and when was it first opened in Europe?

21.What measures were taken to combat epidemics in Western Europe during the Renaissance?

22.When did Western Europeans start paving and cover the streets in cities, and why it was so late in comparison with Novgorod?

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23. When and where was the first water supply system built in Western Europe,

and why it was so late in comparison with Novgorod?

The development of medicine during the New Age (second half of the 18th

century – the beginning of the 20th century)

New Age is identified with the period of the establishment and development of capitalist relations. The expansion of capitalist production required the development of natural science knowledge (mechanics, physics and chemistry). The great influence on the development of dialectical views on nature and medicine of the New Age period was made by the great natural-science discoveries of the late 18th - first half of the 19th century. Among them, the most important are: 1) the law of conservation and transformation of energy (M.V. Lomonosov, A. Lavoisier, D. Joule, G. Helmholtz, J. Mayer); 2) the theory of the cellular structure of living organisms (F. Raspail, J. Purkinje, MF Bisha, PF Goryainov, M. Schleiden, T. Schwann); 3) Evolutionary doctrine (J. Lamarck, C. Wolf, P.F. Goryainov, N.A. Severtsev, A.N Beketov, L.S. Tsenkovsky). Medical sciences (both theoretical - anatomy, physiology, pathology, and practical - therapy, surgery) began to successfully develop on their basis. Experimental physiology arose on the basis of the achievements of physics and chemistry, the development of histology and the development of animal research methods. F. Mazhandi (French) was a representative of the experimental direction in physiology, he developed a methodology for a physiological experiment, which was used both for scientific purposes and in the teaching process. Merits in the field of normal and pathological physiology belong to the German naturalist I. Müller. Numerous discoveries in the field of biology, anatomy, physiology make it possible to consider him one of the founders of physiological chemistry (blood chemistry, lymph). C. Bernard (French) combined physiology, pathology and therapy and created experimental medicine. The most famous was the work of K. Bernard on the study of sugar metabolism in the body and liver function. The development of pathology in the mid 19th century was determined by the struggle of two

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directions: humoral teaching (K. Rokitansky and others) and the theory of cell (cellulary) pathology (R. Virkhov and others). The Virchow theory is prevailing in Western Europe unit now despite the fact that it contained a major flaw – the belief that the disease is a local process. In Russia, this theory did not receive the support of most scientists who believed that the disease affects not only the organ or part of it, but absolutely the whole organism. The development of the natural sciences has also influenced the development of clinical medicine. New diagnostic methods have appeared in the field of therapy: percussion (L. Auenbrugger, J.N. Corvisar), auscultation (R. Laenneck), thermometry, kimographs for recording heart rhythms, instruments for examining internal organs (gastroscope, esophagoscope, bronchoscope, cystoscope and other). The rapid pace of development of natural science contributed to the success of surgery and the solution of the most important problems that impeded its development: 1) improvement of pain relief methods; 2) solving the problems of aseptic and antiseptic; 3) blood transfusion.

substances in surgery, but more than 40 years passed before nitrous oxide (G. Wells, 1844) and then ether (W. Morton, 1846) were first used in dental practice. In 1846, the first successful surgery to remove a tumor on the neck in Boston by a surgeon J. Warren was performed. Anesthesia was given by dentist W. Morton, the concentration of ether was controlled by chemist C. Jackson. This date entered the history of medicine. In 1847, the English surgeon and obstetrician D. Simpson performed the first operation under chloroform anesthesia. In 1904 S.P. Fedorov and N.P. Kravkov laid the foundation for the development of non-inhalational (intravenous) anesthesia methods. With the discovery and development of anesthesia methods, a new era in surgery has begun.

2) Until the middle of the 19th century, more than 80% of patients have had to be died from purulent complications of surgical wounds. The onset of asepsis (Latin denial of rot) is associated with the name of the Vienna obstetrician I.

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Semmelweiss, who suggested washing the hands of an obstetrician before examining a woman in labor with a solution of bleach due to that the mortality from maternity fever of women in the maternity ward of the Vienna obstetric clinic was sharply reduced. But this discovery was not accepted during the life of I. Semmelweiss. In 1867, the English Surgeon J. Lister suggested using a carbolic acid solution as an aseptic. Thanks to the method of J. Lister, postoperative complications decreased several times. But doctors could completely solve this problem only in the late 80s. 19th century, when antiseptics were added to the aseptic method, German surgeons E. Bergman and C. Schimmelbusch became the founders of antiseptics. At the end of the 19th century surgeons began to carry out abdominal operations (J.E. Pean, T. Billroth, T. Kocher, N.V. Sklifosofsky and others).

3) The first information about experiments on blood transfusion on animals refers to 1638 (English K. Potter). In 1667, French scientists J. Denis and P. Emmerets successfully transfused the blood of a to a person. The following transfusions ended in death, and experiments blood transfusion to humans stopped for almost a century. The first successful transfusion of blood from person to person was performed in 1819 (English obstetrician J. Blundell). In Russia, the first successful transfusion of blood from person to person was carried out by G. Wolf (1832) and saved a woman who was dying from uterine bleeding. Scientifically based blood transfusion became possible after the establishment of blood groups according to the AB0 system (Austrian K. Landsteiner in 1900), for which in 1930 he was awarded the Nobel Prize. In 1907, the Czech doctor J. Jansky confirmed the presence of four blood groups in humans. The discovery of anesthesia, the development of antiseptic and aseptic methods and the discovery of blood groups allowed surgery to achieve practical results over several decades, which were not found in the entire centuries-old history of the development of surgery. In the second half of the 19th century medical microbiology takes shape in an independent scientific discipline. The French chemist L. Pasteur and the German physician R. Koch became the founders of this discipline. L. Pasteur denied the

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