Lectures on history of medicine

Medicine of Ancient Rome
Ancient Rome was a civilization that grew from a small agricultural community founded on the Italian Peninsula in the IX B.C. to a large empire straddling the Mediterranean Sea. In its twelve centuries of existence, Roman civilization shifted from a monarchy, to a republic based on a combination of oligarchy and democracy, to an increasingly autocratic empire. It came to dominate Western Europe and the area surrounding the Mediterranean Sea through conquest and assimilation.

To the end of III B.C. Ancient Rome became strong centralistic slave-owning state of Western Mediterranean. Ancient Rome in I B.C. – was gigantic empire, which includes territories of Western and South-Eastern Europe, Northern Africa, and Asia Fore (Front). Period from II c. B.C. to II A.D. was the high blossom of slave-owning social-economic structure and slave-owning production way.

Roman civilization is often grouped into "classical antiquity" with ancient Greece, a civilization that inspired much of the culture of ancient Rome. Ancient Rome contributed greatly to the development of law, war, art, architecture, rhetoric, agriculture, philology, literature, technology, language and medicine in the Western world.

Significant part of ancient Roman written monuments was lost. Some sources (from III B.C.) have special interest, such as poem of T. Lucrecius Car “About nature of things”, treatise “About medicine” by Cornelius Celsus, Galen’s work “About aim of human body organs”. Information about medicine is also Greek and Latin epigrams, devoted to doctor activity.

The healing profession was in the hands of priests, magicians, and elders of the family. At first it was just the herbs that Romans used to cure their illnesses. Diggings of ancient Rome cities allowed becoming the common property of the history the life and medicine development. There were found set of medical instruments, first in archeological history, in Pompey which was buried because of volcano Vesuvius in 79 A.D. Second set consisted of 150 antique medical instruments was discovered in 1893 in Baden, and third one was discovered in 1925 in Bingham.

Ancient roman hygienic constructions – therms or bath houses, aqueducts or water-pipe, sewage are of big interest for medicine.

The Romans made fine roads throughout their empire, brought pure water to all their cities through aqueducts, drained marshes to combat malaria, built sewerage systems and established hospitals for the sick.

The Law of the Twelve Tables (about 450 B.C.) was the ancient legislation that stood at the foundation of Roman law. The Law of the Twelve Tables formed the centerpiece of the constitution of the Roman Republic. They were post up behind Rome Senate. Official - edibles saw to realization of these laws. Also they watched building and improvement in towns.

The Romans knew that dirt encourages disease and they appreciated the importance of cleanliness. They built aqueducts to bring clean water into towns since IV B.C. There were 11 aqueducts in Rome in I B.C. total length which was 436 kilometers. Aqueducts had state protection.

They also knew that sewage encourages disease. The Romans built public lavatories in their towns. Streams running underneath them carried away sewage. The famous underground channel - cloaca maхima – functions to present day.

Therms were wide spread in Roman Empire. Therms’ capacity allowed washing 10 -100 thousand persons simultaneously. Splendid decoration had to bear similarities to museums. There were checkrooms, rooms for physical activities, rooms for oil rubbing, hot bath and basins in therms. Pictures of Asclepios and Hygie were in honor place. Therms were centers of public and cultural life in Roman Empire. Libraries, halls for banquet and meetings were attached to therms.

By the historians’ opinion therms were the best gift of Roman emperors to population.

There were not doctors- professionals in Ancient Rome. The Romans conquered Greece and afterwards doctors in the Roman Empire were often Greeks. Many of them were slaves - prisoners of war. Every rich Roman wanted to have slave-doctor. High cultural and professional levels of slave-doctor raise him and he became free person. But he must treat his ex-master and his family free of charge. Doctors had low status in Rome. However the state paid public doctors to treat them poor.

Ancient Rome made contribution into military medicine. Constant roman army waged war and needed in doctors-professionals. Each cohort consisted from 1000 soldiers and 4 surgeons. The Romans also had hospitals called valetudinarian for their wounded soldiers.

Medical business was developed together with military medicine. Authority established places of profit of doctors – arkhiatrs. Their duties were teaching medicine in special schools in Rome, Alexandria and other towns. Besides state schools there were private schools. Great one was school founded by Asclepiad. With time doctor‘s position became consolidate. They had many rights and privileges. During the war doctors and their sons were excused from compulsory military service, and that attracted many foreign doctors. To the end of II B.C. there were doctors of eyes, tooth, and surgeries in Ancient Rome. They made herniotomy and lithotomy.

The Romans borrowed their medicine largely from the Greeks whom they had conquered. While the politics of the world became Roman, medicine remained Greek.

Philosophy of Lucrecius. Medical system of Asclepiad
World outlook of ancient Romans had influence of Greek philosophy. Atomistic teaching, created by Greek philosophers – materialists Levkipius, Democritus and Epicure, found their expression in poem of Titus Lucrecius Car “About things’ nature”, there he gave characteristics of some illnesses, described infectious diseases, etc.

He paid attention on spread infection from water, food and other things; he outlined first ways of contagious concepts of transmission of infection.

Epicure teaching and Lucrecius looks had influence on Asclepiad from Bithynia. His rule was: “treat safely, quickly and pleasantly”. His treating methods were: diet, hygiene, massage, water treatment and moving.

From school of Lucrecius was Soran from Effess (II B.C.). He wrote the biggest work on obstetrics, gynecology and pediatrics in ancient medicine.

Celsus (about 25-30 B.C. to 45-50 A.D.) is the only Roman who worked with distinction in the medical field, but it is doubtful whether he was a physician. His work, “About medicine” "De re medica libri viii", which is written in classical Latin, and for which he used seventy-two works lost to posterity, gives a survey of medical science from Hippocrates to imperial times. Very famous is his description lithotomy. He wrote about hygiene, dyetetics, pathology, therapy and surgery. Celsus was altogether forgotten until the fifteenth century, when Pope Nicholas V (1447-1455) is said to have discovered a manuscript of his works.
Galen - doctor and naturalist

One of the most influential people of ancient medicine was Galen. Departure from the Hippocratic observation of nature led physicians to form numerous mutually opposing sects. A man of great industry and comprehensive knowledge, Galen of Pergamum (130-200 A.D.), tried to rescue medical science from this labyrinth. He was from family of architect. Since 17 years he devoted himself to medicine. He knew many languages (Greek, Latin, Persian and others), and traveled a lot.

Galen- was an author of 125 medicine works, only 80 retained till our time. There were “About purposes of human body parts”, “Therapeutic ways”, “About anatomy”, etc.

Dualism of Galen displayed in his hesitation between materialism and idealism.

Materialistic position was in his researches in anatomy and physiology. Dissection of dead bodies was forbidden by religion in Alexandria, so Galen anatomized monkeys, pigs, dogs, etc. He described bones, muscles, chords, internal organs, and his great contribution to research of nervous system.

He correctly described structures of heart, vessels. But he thought heart partition was permeable.

Galen had drug store; there was laboratory (officina) for preparing medicines. He introduced into practice regulation for preparing medicine from plants: weight and volume of materials, proportions and extragents.

Galen took the entire anatomical knowledge of his time, and out of it produced a work the substance of which was for centuries regarded as inviolable. His anatomy was to a large extent based upon the dissection of mammals, especially of monkeys, and, like his physiology, was under teleological influence. Instead of explaining the functions of organs on the basis of their structure, Galen chose this reverse method. His anatomy and physiology were the most vulnerable part of his system, and an earnest re-examination of these fields must necessarily have shaken his entire scheme of teaching. Galen expressed the greatest respect for Hippocrates, published his most important works with explanatory notes, but never entered into the spirit of the school of Cos, although he adopted many of its doctrines.

Galen is the culminating point and end of ancient Greek medical science. He produced the concepts of anatomy, physiology, therapeutics, and philosophy. He distinguished seven pairs of cranial nerves, described the valves of the heart, and observed the structural differences between arteries and veins. One of his most important demonstrations was that the arteries carry blood, not air, as had been taught for 400 years. His vivisection experiments were also very notable. Such experiments included performing a series of transactions of the spinal cord to establish the functions of the spinal nerves, and tying off the ureters to demonstrate kidney and bladder functions.

Galen and many other physicians used many tools in their practice. The most interesting thing about these tools and procedures is that many of them have the same names and uses today. His merits were either in making new medicinal preparations, as in their theoretical substantiations. In the The Middle Ages prominent scientists Paracelsus called whole group of medicinal preparations and institutions in honor of Galen.

Galen correctly described that he saw, but he wrong interpreted getting results. This was a dualism of Galen.

Galen was a prominent doctor of world; he was in one row with Hippocrates and Abu Ali Ibn Sina.

BIBLIOGRAPHY

1. Афоризмы Гиппократа // Твое здоровье. - 1996. - N4. -С.130 – 143.

2. Гиппократ. Избранные книги /пер. с греч. Под ред. В.П. Карпова.- М.: Биомедгиз, 1936. -736с.

3. Георгадзе В.И. Эмблемы медицины / В.И. Георгадзе, Э.Д. Грибанов. - Тбили­си, 1979. - 112с.

4. Грибанов Э.Д. Источники изучения истории медицины и здра­воохранения /ЭД Грибанов. -М., 1980. - 19с.

5. История Древней Греции: Учеб.для вузов по спец. "История"

/ Под ред.В.И. Кузищина: - М.: Высш. шк., 1986. - 381с.

6. 
   История медицины / П.Е. Заблудовский, Г.Р. Крючок, М.К. Кузьмин, М.М. Левит. - М.: Медицина, 1987. - 352 с.
   

7. Лисицын Ю.П. История медицины /Ю.П. Лисицын. - М.: ГЭОТАР-МЕД, 2004. -393 с.

8. Медицина в поэзии греков и римлян/Сост.Ю.Ф.Шульц. - М.:Медицина, 1987. - 128с.

9. Мультановский М.П. История медицины / М.П. Мультановский. - М.: Медицина, 1967. - 272 с.

10.Сорокина Т.С. Медицина в рабовладельческих государствах Средиземноморья /Т.С. Сорокина. - М., 1987. - 97с.

11. Сорокина Т.С. История медицины: Учебник для студ. высш. мед. учеб. заведений / Т.С. Сорокина. – 4-е изд., стер.- М.: «Академия», 2005.-560с.

12. Семенченко В.Ф. История фармации: Учебное пособие / В.Ф. Семенченко.- М.:«МарТ»; Ростов н/Д: «МарТ», 2003.- 640 с.

4. MEDICINE DURING THE PERIOD OF FEUDALISM IN THE COUNTRIES OF EAST AND WESTERN EUROPE
Epoch’s characteristics

Materialistic notion about history includes obligatory consistent historism that is to study of social phenomena in the process of its development. Feudal system had been established in different time in different countries. In 476 Western Roman Empire fall down by rush of barbarian German tribes. This date is considered de bene esse as beginning of the Middle Ages and feudalism in Europe.

Feudal system was formed earlier in East countries: China – in IIIc., Caucasian countries – in IVc. , Byzantine and countries of Middle Asia - in VIIc. , Russia – in IXc.

Feudal epoch had division into three periods. First period (V – XI) was early The Middle Ages, economics was concentrated in villages. Second period (XI – XV) was period of developed feudalism, significance of towns – centers of trade and handicraft. Third period (XV - XVII) was period of feudal decomposition and origin of capitalistic elements. The end of The Middle Ages was a time of first bourgeois revolutions and the main one was in England (1640 – 1649) That is why 1640 year was symbolized the beginning of new time and epoch of capitalism in Europe.

Making of world religions – Christianity and Islam - had grave consequences. Church influenced on all sphere of life.

With the fall of the Roman Empire, the medical schools established in Roman times also disappeared. Europe was ravaged by disease and pestilence: plague, smallpox, leprosy and tuberculosis. The practice of medicine reverted back to primitive medicine dominated by superstition and dogma. Rejection of the body and glorification of the spirit became the accepted pattern of behavior. It was regarded as immoral to see one's body; consequently, people seldom bathed. Dissection of the human body was prohibited. Medicine developed in difficult and contradictory conditions.

Medicine in Byzantine Empire
Byzantine medicine is the medicine practiced in the Byzantine Empire from about 400 A.D. to 1453 A.D. It drew largely on Ancient Greek and Roman knowledge. However, Medicine was also one of the few sciences in which the Byzantines improved on their Greco-Roman predecessors. The Byzantine civilization has significant place in world history. It was the center of bright culture within ten centuries. The history of Byzantine Empire began from the reign of Constantine I the Great, (306 – 337); he was revered under the title "The Great" for his contributions to Christianity. Emperor Constantine proclaimed Christianity the state religion. In 324, Constantine announced his decision to transform Byzantium into Nova Roma and on May 11, 330, he officially proclaimed the city the new capital of the Roman Empire. The city was renamed Constantinople (modern Stambul), The City of Constantine, after Constantine's death in 337. It would remain the capital of the Byzantine Empire for over a thousand years, a reign interrupted only briefly by its 1204 sacking and occupation in the Fourth Crusade, until it finally fell to the Ottoman Empire in 1453.

30 palaces and temples, more than 4 thousand buildings for nobility, two theatres, a circus, a hippodrome, more than 150 bath-houses and 8 aqueducts have been constructed during the reign of Constantine I.

Byzantine culture united cultural achievements of all people. One of achievement was creation of Slavic alphabet – Cyrillic alphabet in IX. Alphabet’s authors were brothers Cyril and Mefody.

An important contribution of Byzantium is arguably the fact that it was the first Empire in which dedicated medical establishments - usually set up by individual Churches or the State, which parallel modern Hospitals in many way, flourished. Although similar establishments existed in Ancient Greece and Rome, they differed in that they were usually either institutions for Military use, or places were citizens went to die in a more peaceful way. Medical Institutions of this sort were common in Imperial Cities such as Constantinople and later Thessaloniki.

The first hospital was built by Basil of Caesarea in the 370, and although these Institutions flourished, it was only throughout the VIII - IX c.c. that they began to appear in Provincial Towns as well as Cities, (although Justinian's subsidization of private physicians to work publicly for six months of the year can be seen as the real breakthrough point). Byzantine Medicine was entirely based around Hospitals or walk-in dispensaries which formed part of the Hospital complex, there was a dedicated hierarchy including the Chief Physician (archiatroi), professional nurses (hypourgoi) and the orderlies (hyperetai).

Doctors themselves were well trained and most likely attended the University of Constantinople as Medicine had become a truly scholarly subject by the period of Byzantium (despite the prominence of the great physicians of antiquity, its status as a Science was greatly improved through its application in formal education (particularly in the University of Constantinople. Thus, we know that in the twelfth century, Constantinople had two well organized hospitals staffed by medical specialists (including women doctors), with special wards for various types of diseases and systematic methods of treatment. Drug-stores also were appeared in Byzantine Empire.

Byzantine physicians often compiled and standardized medical knowledge into textbooks. These books tended to be elaborately decorated with many fine illustrations, highlighting the particular ailment. Oribasius (325 – 403) perhaps the greatest Byzantine compiler of medical knowledge, frequently made revisions noting where older methods had been incorrect. Several of his works, along with many other Byzantine physicians, were translated into Latin. His famous medical encyclopedic work was “Sinopsis” in 70 volumes. Doctors Aetius and Alexander of Tralles as well as Paul of Aegina were encyclopedists and they gathered and systematized the heritage of ancient medicine. The Medical Compendium in Seven Books, written by the leading physician Paul of Aegina, is of particular importance. The compendium was written in the late seventh century and remained in use as a standard textbook for 800 years.

Bizantine stopped its existence as state when Turkish army captured Constantinople and came into the territory of the Ottoman Empire in 1453.

For 10 centuries of the history Byzantium not only has kept and systematized the antique heritage, but also has created original medieval culture which rendered big influence on development of culture of many world nations.

Medicine in Arabian caliphates

The political structure of the Islamic states in the Middle East, North Africa, and Spain was called the caliphate; the term is from the Arabic word for "successor." The caliphs were successors of Muhammad, the founder of Islam, who died in 632 A.D. Arab conquests that began soon after Muhammad's death incorporated vast territories into the realm of Islam within a few decades.

In the beginning of VII c. Arabs populated in west part of Arabian Peninsula, had formed religion Islam, had organized Islamic state, which became great feudal empire – Caliphate because of Arabian conquests.

First stage of conquest was in VIIc. States- Syria, Palestine, Iran, Egypt, Cyprus and territories of Armenia and Georgia were included into part of Caliphate.

In the outcome of second conquest (end of VII c. и 30^th years of VIII c.) there were conquered North Africa, the biggest part of Pyrenean Peninsula, Asia Minor and Caucasus. Borders of caliphates were from Atlantic Ocean to Hind, from Asia Minor to North Africa. The armies of Islam set out from the Arabian Peninsula to make conquests in nearly every direction. At its height the Muslim empire stretched across North Africa and up into Spain, while eastward it incorporated the entire Near East and extended into India. Caliphate exceeded in its size Empire of Alexander Macedonian and Great Roman Empire.

Arabian culture influenced other countries of Asia, Africa, Europe and made great contribution into world culture.

Medicine had got high development, according to prophet, knowledge consisted from two parts: knowledge of religion and knowledge of body, i.e. medicine.

During the eight centuries Arabian medicine hold a main place in Mediterranean region. It kept and returned in improved type to Europe all important knowledge of that time.

The greatest contribution of Arabs, in general, was in the field of pharmacology. Seeking the "elixir of life", they developed pharmaceutical chemistry, introducing a large number of drugs, herbal and chemical. Pioneers in pharmacology, they invented the art of writing prescriptions, an art inherited by our modern pharmacists.

They introduced a wide range of syrups, oils, poultices, plasters, pills, powders, alcoholates and aromatic waters. The words drug, alcohol, syrup and sugar

are all Arabian.

Muslim physicians set up the earliest dedicated hospitals in the modern sense, known as Bimaristans, which were establishments where the ill were welcomed and cared for by qualified staff, and which were clearly distinguished from the ancient healing temples, sleep temples, hospices, assylums, lazarets and leper-houses which were more concerned with isolating the sick and the mad from society "rather than to offer them any way to a true cure." The Bimaristan hospitals later functioned as the first public hospitals, psychiatric hospitals and diploma-granting medical universities.

Hospitals in the Islamic world featured competency tests for doctors, drug purity regulations, nurses and interns, and advanced surgical procedures. Hospitals were also created with separate wards for specific illnesses, so that people with contagious diseases could be kept away from other patients. One of the features in medieval Muslim hospitals that distinguished them from their contemporaries and predecessors was their significantly higher standards of medical ethics. Hospitals in the Islamic world treated patients of all religions, ethnicities, and backgrounds, while the hospitals themselves often employed staff from Christian, Jewish and other minority backgrounds. Muslim doctors and physicians were expected to have obligations towards their patients, regardless of their wealth or backgrounds. The ethical standards of Muslim physicians was first laid down in the 9th century by Ishaq bin Ali Rahawi, who wrote the Adab al-Tabib (Conduct of a Physician), the first treatise dedicated to medical ethics. He regarded physicians as "guardians of souls and bodies", and wrote twenty chapters on various topics related to medical ethics.

Dissection was prohibited by religion, but doctors – Muslims contributed a lot of to anatomy and surgery development. Investigating of animals eye structure, Egyptian doctor Ibn- al-Haisam (965 – 1039), who was the first explained beam refraction in eyes and gave names to the parts (cornea, lens). Arabian school of ophthalmology influenced till the XVIIc.

Ibn Nafis (d. 1288) described human blood circulation. This discovery would be rediscovered, or perhaps merely demonstrated, by William Harvey in 1628, who generally receives the credit in Western history.

Big significance had questions on personal and general hygiene, rational nourishments and dietetics.