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

3.Common above private.

4.Justice is above the law.

5.The spiritual is higher than the material.

The initial stage of building the power vertical inside Yi-Go (several years) was accompanied by military losses on sides (center and periphery), devastation, and refugee flows in Rus. It negatively affected the sanitary condition and contributed to the development and spread of epidemics. Material reasons hindered the development of medical care (charity), which began to revive from the second half of the XIV century.

During the Yi-Go period, medicine in Russia continued to develop mainly at monasteries. The Mongol khans left the monasteries all the rights that they enjoyed before the conquest of Rus (worshipers, doctors, and deceased body washers were exempted from all taxes). For more than 200 years (1240-1480), there were no conditions for the development of state medicine. Help for the sick was provided by traditional healers and monks the monasteries. Therefore, monastery medicine of that time representscertain stage in the development of domestic medicine. Widely practicing “treatment” with prayers, she was forced to use the rich experience of the Magi the treatment of herbs, ointments, and waters.

The construction of hospital chambers at monasteries and the provision of outpatient care was a progressive phenomenon of the time. However, monastery medicine turned out to be helpless in the event of epidemics. The monasteries attracted a lot of people (pilgrims), but hospital and outpatient care were very limited and could not satisfy the needs of the whole people.

Nonetheless, monasteries played an important role in creating the spiritual foundations and strengthening the Russian state, supporting the princely power. From the 14th century, monasteries, being fortresses, occupied and controlled significant areas of empty land, and, having a powerful system of defensive structures, were often used as military defensive points in the event of an enemy invasion and as hospital bases for treating the wounded. Thus, in Ancient Rus,

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monastery medicine played a positive role in organizing inpatient care in the form of monastery hospitals.

Despite the fact that the Russian people were in Yi-Go under double oppression (of the central and local elite), by the end of the XIII - beginning of the XIV century. all destroyed infrastructure was restored. Through the efforts of the people, the burnt down cities were rebuilt, the construction of new churches and monasteries was underway. It was made the tanneries, tar production was established, soap, soda, oil, fish glue and another goods.

Gradually, the Russian state gained strength to such a level that in 1380, Russian troops led by Prince Dmitry Donskoy defeated the forces of the Khan of the Golden Horde of Mamaia. This battle is known in history as the Battle of Kulikovo pole (field). The heroic struggle of the Russian people against Yi-Go (separate centers of resistance were noted from the 13th the 15th centuries) did not allow the Mongol-Tatars to advance to the to the Atlantic. It was the most important condition for the independent development of Western European culture and civilization. According to A. Herzen: “From this ill-fated time, which lasted about two centuries, Rus has allowed Europe to overtake itself.”

The fourth stage. The development of trade and crafts in the United State (Yi-Go) strengthened ties between individual Russian principalities, it served as a prerequisite for the formation of a United centralized mono-national state, led by Moscow. Its power greatly increased during the reign of Ivan Kalita (1325–1340) and Dmitry Donskoy (1363–1389).

The liberation struggle of the Russian people ended in the 15th century with the unification of Russian lands into a United national Moscow state. In time, this historical stage coincided with the decline of the power of the Golden Horde, its disintegration into individual khanates (Kazan, Astrakhan, Siberian and Crimean, etc.).

Medicine in the Moscow state (XV-XVII centuries)

The Moscow state became one of the significant European powers already at the end of the 15th – first half of the 16th centuries and continued the policy of

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unification of Russian lands. Pskov (1510), Smolensk (1514), Ryazan (1521), Kazan and Astrakhan (1552-1557), Polotsk (1562), Veliky Novgorod (1578) were annexed to Moscow. In the late 80s of the XVI century, Siberia was annexed to Rus. According to K. Marx: “Amazed Europe, at the beginning of the reign of Ivan III, barely noticing the existence of Muscovy, squeezed between the Tatars and Lithuanians, was struck by the sudden appearance of a huge state on its eastern borders”. The centralization of public administration and the transformation of Muscovite Russia from a mono-ethnic to a multinational state in the 16th century led to a significant development of culture, art, as well as medical practice. In 1485, the construction of the entire ensemble of the Moscow Kremlin was completed. Unique architectural monuments (Trinity-Sergius Lavra, KievPechersk Lavra, Donskoy, Novodevichy Convents) were built. At the monasteries began to keep annals. In 1563, in Moscow, Ivan Fedorov opened the first printing house in Russia. Together with his assistant, Mstislavets, he published the book Apostle, published the first ABC in Russia with grammar. In the middle of the XVI century, a manual on household hygiene – “Domostroy” was written. It contained tips for housekeeping in a boyar house, culinary, pedagogical advice. In “Domostroy”, instructions for the diseases treatment were contained, about keeping food clean, thoroughly washing dishes, changing clothes, wiping feet at the entrance to the house, etc. In connection with the growth and strengthening of the Moscow state in the XVI – XVII centuries, transformations and innovations in the medicine field arose. In the sixteenth century, in Moscow Russia, medical professions were divided: they were vrachi (whisperers-casters), healers, herbalists, nurses, zeleyniki (potion sellers), rudomety (bloodletters, phlebotomists), zubovoloki (dental surgeons), ochnye masters (glasses manufacturers), kostopravy (bonesetters, chiropractors), midwives. Folk healers and pharmacists provided medical assistance to the people. The practice transmitted over the centuries, as well as the books “herbalists” and “healers” were their science. Zeleyniks made potions (decoctions and tinctures) from herbs, roots, and other potions for treatment. They had shops in the malls where they sold collected herbs, seeds,

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flowers, roots and imported medicines. Shop owners at the same time studied the quality and healing properties of the materials they sold. The healers-physicians were few in number. They lived mainly in cities. Payment for treatment was made depending on the knowledge of the physician and the cost of drugs. Wealthy segments of the urban population primarily used the services of physicians. Peasants who carried feudal duties could not pay for the expensive services of

physicians. Guardianships existed in churches and city blocks. Medical

guardianship consisted of organizing shelters and almshouses for crippled, orphans, and other chronic patients. Almshouses in Muscovite Russia were maintained mainly by the population itself; the role of the church was less than in Western Europe. Almshouses were in Novgorod, Kolomna, Toropets. Almshouses also provided medical assistance to the population. Patients had to being come here to get assistance, and here the same familyless lonely dead persons were delivered

•burning infected houses and neighborhoods;

•burial of the dead away housing;

•organization of bonfires, outposts on the roads.

In 1581, in Moscow, the first pharmacy was opened under Tsar Ivan the Terrible, which was located on the territory of the Kremlin. In the reforms undertaken in the 50s of the 16th century, during the reign of Ivan the Terrible, an attempt to entrust the state with some part of the concern for people's health, for the public charity of the sick and the weak was made. Awareness of the need for state organization of medical affairs has also matured under the influence of wars, economic and political conditions. From this period, a new stage in the history of domestic medicine begins – in the 17th century, state medicine occupies an important place, and folk and monastery medicine fade into the background. The danger of a military attack from outside existed throughout the seventeenth century. The question of providing troops and the population with constant medical care was

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raised before the government. For this purpose, at the end of the 16th century, the Aptekarskiy prikaz (Pharmaceutical order), the highest body of medical service in the Moscow state, which existed throughout the 17th century, was created. A special Aptekarskiy boyar – Prince Athanasius Vyazemsky – headed the first Aptekarskiy prikaz, which was placed in the Kremlin, opposite the Chudov Monastery and cathedrals – there was also a pharmacy. At the first stage of its activity, the Aptekarskiy prikaz was a court medical institution. He was led by close associates of the king (not doctors). Providing medical assistance to the king, his family and close associates was the responsibility of the personnel of the Aptekarskiy prikaz. The “bestqualified medical devices” made for the king were stored in a pharmacy in a special room under the control of the clerk of the Aptekarskiy prikaz. The medicine prepared for the palace was first tried by the doctor who prescribed it; then the pharmacist who prepared it, and finally the person who delivered the medicine to the or his family. After the king, the

remnants of the medicine had been drinking by the boyar, who oversaw this procedure from beginning to end.

At first, the staff of the Aptekarskiy prikaz was small: 2 doctors, 5 healers, 1 pharmacist, 1 optometrist, carriers and 1 clerk. Foreign doctors working in the Aptekarskiy prikaz received from the state an annual salary of 200-250 rubles; pharmacists and healers – 50-70 rubles; they enjoyed special benefits. Gradually, the functions of the Aptekarskiy prikaz expanded. In the middle of the 17th century, it was transformed from a court institution into a national institution. However, a large part of the Russian population would remain without organized medical care for a long time, right up to the formation of zemstvo medicine in the second half of the 19th century. The Aptekarskiy prikaz was in charge of the royal pharmacy, the collection and cultivation of medicinal plants, their purchase in other countries, he supervised the court doctors serving the royal family and the boyars close to the king, controlled the healing, invited foreign doctors, checked their knowledge upon admission to the service, appointed doctors to shelves, provided regimental pharmacies with medicines and conducted forensic and

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medical examinations. Under the jurisdiction of the Aptekarskiy prikaz were collectors of medicinal plants – pomyasy. The lists of plants to be collected were compiled by the Aptekarskiy prikaz. The collectors were managed by healers and medical students. Medicinal plants were bred by “znattsy” (experts) for sale to the Aptekarskiy prikaz, and the best “znattsy” were included in the lists of employees of the Aptekarskiy prikaz. By the second half of the XVII century, the staff of the Aptekarskiy prikaz increased significantly. Among the 80 persons there were 6 doctors, 4 pharmacists, 3 alchemists, 10 foreign physicians, 21 Russian physicians, 38 students of medicine and bonesettering. In addition, there were still clerk, gardeners and handymans. The location of the Aptekarskiy prikaz was not permanent. At first, this institution was located on the territory of the Kremlin in a stone building opposite the Chudov Monastery. Then the main services of the Aptekarskiy prikaz were moved to a new place. new pharmacy yard was built on Smolenskaya Street. Currently, one of the outbuildings of the Aptekarskiy prikaz has been preserved behind the building the Museum of Russian Architecture. In 1712, during a great fire in Moscow, the Aptekarskiy prikaz burned down, and in 1716, by Decree of Peter I, the Aptekarskiy prikaz was replaced by a new institution – the Aptekars (Pharmaceutical) Chancellery. In the 17th century, Russia waged lengthy wars with Turkey, Poland, and Sweden. Hence, the need for the treatment of wounded soldiers and sanitary measures in the army and among the population increased. Craft healers could not adequately meet these needs. The government was forced to decide on the wider training of healers. In order to have their own, Russian doctors, the students went to study with foreign doctors who served in Russia. The state also sent students abroad to study medical sciences. These were mainly children of foreigners living in Russia. However, this did not lead to a significant increase in the number of doctors. Therefore, the organization of a state medical school at the Aptekarskiy prikaz was inevitable. In 1654, the Russian healers’ school (Lekarskaya shkola) was opened. For 5-7 years, at the expense of the state, children of archers and clergy studied at the Russian healers’ school. Training began with the collection of herbs under the guidance of

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experienced herbalists and then continued at the pharmacy. From the fourth year of study, students were distributed among doctors to study surgery and dressing techniques. With healers, the students were having to going to the locations of the troops. Students who graduated from school were sent to the shelves with the rank of sub-healer. In the shelves, they were supposed to show their knowledge, after which the Aptekarskiy prikaz approved them with the title of “Russian healer”. Due to difficult living and studying conditions, some students had to left school and fled. In such cases, a letter confirming the search for the fugitive and his return to the Aptekarskiy prikaz to continue his studies was issued. In contrast to the scholastic, purely book-based teaching of medicine at the medical faculties of medieval universities in Western Europe, the training of Russian healers in the 17th century Moscow state was practical. In 1658, the monk of the Chudov Monastery Epiphanius Slavinetsky translated Latin into Russian the work of A. Vesaliy “On the structure of the human body”. Epiphanius Slavinetsky graduated from Krakow University and ught at the Kiev-Mohyla Academy, then at the Lekarskaya shkola at the Aptekarskiy prikaz. As a gifted and educated person, he knew medicine, astronomy, geography, pedagogy and philology. The Aptekarskiy prikaz had a medical library and a staff translator good enough for that time. His duties came down to translating those books that could be useful in mastering medicine. When translating foreign medical books, the translator made changes and additions to them, based on the experience of Russian medical practice. Russian translators accompanied the translation with their comments, gave the names of local medicinal plants, added whole chapters devoted to plants found in Russia. In the XVI century, and especially in the XVII century, in Moscow Russia, manuscript books of medical content were widely distributed: “Herbalists”, “Lechebniki (Healers)”, “Apteki (Pharmacies)”, “Vertogrady”. To our time, more than 200 such medical manuscript books have survived. Some of them were translations of the Hippocratic collection, works of Aristotle, Galen, etc. The dissemination of medical knowledge among literate people was the main task of herbalists. Over the 50 years of teaching the Russian healers’ school has trained

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more than 100 graduates which was certainly not enough for Russia. More serious transformations in the field of medical education will occur with the advent of Peter I. In the 17th century, civilian hospitals appeared in Moscow. So, boyar Rtishchev, partly with his own funds, partly with donations other citizens created the first civilian hospital in Moscow with 15 beds. In 1682, a decree: to build two almshouses in Moscow for charity of the wretched was issued. The organizers intended to use one of the hospitals as a medical school. This combination of treating patients and training future physicians was a progressive moment in the medical practice of that period. In Russia, the right to award the degree of Doctor of Medicine was legalized only in the XVIII century. However, even during the formation of the Moscow state, Russians traveled to Western Europe to receive not only a medical education, but also a doctorate in medicine. George from Drogobych and Francis Skorina from Polotsk became the first Russian doctors of medicine. It is known for the names of other first domestic doctors of medicine: Ivan Almanzenov, Andrey Kelderman, Stepan Kirillov, Roman Ryleev and others. Another Russian doctor, Pyotr Vasilievich Posnikov (1676-1716), graduated from the Slavic-Greek-Latin Academy in Moscow and was sent by Peter I abroad to continue studying medicine Padua, he received a doctorate in medicine (1696). But, since Posnikov was fluent in foreign languages, after returning to Russia, by decision of Peter I he was used in diplomatic work in the Netherlands, France and England. The formation of a centralized Moscow state contributed to the emergence of state medicine, the opening of a pharmacy, hospitals, and a medical school. Russian healers were able to recognize and treat diseases, to compose "dokhturskie skazki" (case histories). The fight against epidemics was conducted nationwide. In the XV-XVII centuries, the first domestic doctors of medicine appeared. In the XVI-XVII centuries, the Moscow state prepared the conditions for radical changes and transformations that would highly likely to take place in Russian medicine in the XVIII century.

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Questions for self-control:

1.How many forms of medical aids organization are known in history of medicine and what new one appeared in Russia at the end of the 16th century?

2.What functions did the Aptekarsky Prikaz perform in the first years of its existence?

3.How have the tasks of the Aptekarsky Prikaz changed after its expansion, which contributed to the emergence of new functions?

4.When and in connection with what was the first educational medical institution in Russia established, and what teaching methods were used there?

5.Who were the first doctors of medicine in Russia in the 16th-17th centuries, and how did their professional life develop in their homeland?

6.What types of medical assistance to various segments of the population were in

Russia before the 17th century?

7. Where was the assistance provided to th civilian population in Russia before

9.In what written sources and what medical information was there in Russia before the 17th century?

10.What was the organizational system for the procurement of medicinal herbs in Russia?

11.What medicines were used in Russia, and what were their therapeutic effects associated with?

12.Where and when was the first water supply system built in Russia, what material was used for the manufacture of pipes, and why this particular material?

13.When did Russians begin to pave the pavements in Russia, and what material were used to cover the streets?

14.Where and when the first monastic hospitals in Russia were opened, what quality of care was provided there, to what extent was the monastic medical care

available to the general population?

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15. When did the first civilian hospitals appear in Russia, who established them

and why?

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