WORLD MEDICINE OF

MIDDLE AGES
(V – ХVІІ cent.)
In the end of IV century the Roman empire
disintegrated to Western and East parts. In 476
the Western Roman empire collapsed. At the
same time East Roman empire had different
manner of the development. Its capital was the
ancient Greek city Byzantium (later named as
Constantinople, and today it is Istanbul).

Byzantium is a heiress of ancient culture and to XII

century it was the cultural state of Europe.
Balkans, Little Asia, some districts of Northern
black sea Region, Syria, Egypt, Palestine, were as
Byzantium parts.
 Byzantiu
m
Medicine in the Byzantium empire was
considered as theoretical discipline and was
taught at higher schools together with algebra,
astronomy and music. The first Byzantium
university ”Auditorium" was founded in 425 in
Constantinople.

Typical features of the development of

Byzantium medicine:
-Refuges at christian monasteries for ill
travellers;
-activity of doctors-encyclopaedists;
-development of hospital business.
 Oribasius from Pergamo
(326–403)
Most prominent doctor-encyclopaedist of Byzantium,
personal physician of emperor Yulian. He collected
enormous collection of labours of Greek and Roman
scientists under the name "Synapsis", which he
saved for next generations; wrote "Popular
medications", "Curative collection" etc.

In his works he expounded modern for his time anatomic

presentations, he paid attention to internal diseases and
cautionary medicine, made feeding rations and life
standards for patients of different age, included his own
conclusions and generalizations.
 Aetius from Amida
(502-572)
Doctor-encyclopaedist of Byzantium. Wrote
work - nosography "Tetrabiblos”, which
consists of 16 books. It contains information
about works of Oribasius, Galen and other
famous doctors, also it includes recipes of
Egyptian and Ethiopian medicine.
Alexander Trallianus (525-605)
Wrote 12-volume work "About internal
diseases and their treatment", which was
translated to many languages. He believed that
a doctor "is under an obligation to open
everything for a benefit of humanity, basing on
his knowledge of experience".
 Paulus Aegineta
(625-690)
He was a famous surgeon,
accoucheur and teacher. Author of
two huge works: "About women
diseases" and ”Medico-surgical
collection" in 7 books.
In his sixth book he described the
results of development of surgery in VII
of century (small surgery, studies about
breaks, dislocations and amputation,
cavernous, military and plastic
surgery). Operations, described by him
were considered as classical until XVII
century.
 Simeon Sif
(2nd half XI –1 half XII cent.)
st

Byzantium scientist and writer. Author of medical

works. Simeon wrote a work "On properties of
meal”, which is based mainly on ancient
traditions. In less degree he alluded to everyday
practice of Byzantium society and Arabic
recipes. Also Sif wrote books on physics and
medicine, including refutation of principles of
ancient doctor Galen.
 Nicola Mireps
(1221-1254)
Chief physician of the Nicene emperor John III Vatats
in the 40’s years of XIII century. He was the author of
the well-known collection "Dinameron" ("The Book of
Treatments"), which containes 2,656 pharmacological
recipes, distributed into 48 classes based on
pharmacological properties: including 87 ophthalmic
ointments, 51 enema recipes, 98 general ontments, 12
somnifacients and 15 recipes for powders and
ointments against insects.
 Caliphate

At the beginning of the VII century Arabs the

religion of Islam (Arabic - obedience) was formed in
Arabs. Founder of islam was Mohammed of Mecca.
In Western Arabia, the huge state (the vast feudal
empire) - the Caliphate - was formed. The size of the
territory of the Caliphate exceeded the Empire of
Alexander the Great and the Great Roman Empire.
In the IX-X centuries Caliphate collapsed.
 Medicine of Arabic Caliphates
The Arabs made an outstanding contribution to the development
of culture and science, including medicine. They developed
chemistry, which was called al-chemistry, they received nitric,
hydrochloric acid, bleach and alcohol (al-kohol); invented the
pouring cube and water bath, applied filtration. Subsequently,
they transferred this knowledge to Western Europe.
Great success has been achieved in the field of medicine.
Medicine developed in private hospitals and medical schools.
The pharmacy, as an independent medical institution, has its
origins in the Arabian Caliphate.
The profession of a doctor began to be blessed by Allah; the
opening of libraries and the development of continuity between
states initiated as well.
 The development of pharmacology
in Caliphates
Arabs played an important role in the establishment and
development of pharmacy and the creation of
pharmacopoeia. In 754, the first pharmacy was
established in Baghdad.
Arabs were preparing alcoholic extractors from herbs,
used to improve the taste of cane sugar.
The development of ophthalmology
The greatest development
in the Arabian Caliphate
was ophthalmology.
Arabs:
-explained the refraction
of rays in the eye
environment;
-gave names to parts of
the eye (cornea, lens,
vitreous body);
-made biconvex lenses;
-have developed an
operation to remove
cataracts with a hollow
needle.
Consilium of doctors. (Arabic miniature of XI century
Vienna Library).
 Al-Razi (850-923)
Founder of Baghdad Hospital and Medical
School. Posted: "About smallpox and measles";
"For those who do not have a doctor";
"Medical book".
For the construction of the Hospital, Al-Razi
offered to hang out the meat in suitable places
and build it where it will last for a longer time.
Al-Razi has an interesting aphorism: "The one
who appeals to many doctors assumes many
mistakes."
Main achievements of Al-Razi:
•studied the effect of mercury salts on the monkey's body;
•created a classification of chemicals: earthy (mineral), vegetable,
animal;
•used cotton wool in medicine;
•created a tool for extracting foreign bodies from the larynx.
 The development of surgery
In surgery - more than 150 surgical instruments have been
described, cauterization waswidely used (caution), ketgut.
Al-Zahrawi (ca. 936-1013) is an outstanding surgeon in the Arab
world, a representative of Arab-Spanish culture. Wrote "The
Treatise on Surgery and Tools."
Main achievements of Al-Zahrawi:
•developed a seam technique with a
twin needle thread;
•applied a lower position in
operations on a small pelvis;
• modified operation of cataracts
removal - turbidity of the lens;
•described and graphically presented
surgical instruments.
Ibn Sina (Avicennа) (980-1037)
The most prominent doctor in not
only Arab world but also the
entire Middle Ages.
In Khorezm (999-1014), he wrote
the Canon of Medicine, which for
five centuries was the main tool
for future medical practitioners
not only for studying medicine in
Arab medical schools, but also in
European medical schools.
“Canon of Medicine”
 “Canon of Medicine”
This was the largest collection of medical knowledge. It
consists of five volumes.
The first is the general principles of medicine;
The second is the action of medicinal substances;
The third - treatment of internal diseases;
Fourth - surgery and general diseases;
Fifth - description of recipes and methods of preparation
of medicines.
Avicenna first diagnosed diabetes, noticing patients with high
appetite, thirst, polyuria and sweet urine, which he was tasting.
Started to apply urinotherapy. Described the clinic of gastric
ulcer, anthrax, developed a technique of tracheotomy,
lithotomy, extirpation of tumors, bloodletting. Introduced red
mercury and bismuth, offered a catheter and gout medicine.

Among the later doctors, Ibn al-Nafisa (1213-1288) should be

mentioned, who described a small circle of blood circulation
for the first time. He noticed that heart supplies coronary blood
vessels.
Arabs, like Byzantium, kept the scientific heritage of ancient
Greece and Rome and handed it over to Western Europe.
Being the ancestors of alchemy, they conveyed its
achievements to Europe together with many drugs on a
chemical basis.
Medicine of Ancient
Europe
In 476 the last Roman emperor Augustus was
deprived of power. This date is conditionally marked
as the collapse of the slavery era in Europe and the
beginning of a new era - feudalism.
The era of feudalism in Western Europe is divided
into 3 major periods:
-V-XI centuries - the early Middle Ages,
-XI-XV centuries - developed feudalism,
-XV-XVII centuries - the period of expansion of the
feudal system or the late Middle Ages.
Western-European feudalism had a long delay of
development comparing to the feudal East, where the
economic and cultural rise of the first millennium BC
was held on a solid foundation of East Roman and
Byzantine traditions.

Such a decline of the development of culture and science

is due to the fact that European civilization at that time
was in a state of establishment, also lack of states and
inhibitory influence of the Catholic Church have
influenced this process.
The Catholic Church had both negative and positive
impact on the development of medicine in Western
Europe during the Middle Ages.
Negative:
-scholasticism and the rule of church dogma;
-inquisition;
-prohibition of autopsy;
-spreading of false knowledge and prejudices.
Positive:
-Bible as a source of hygiene knowledge;
-priests engaged in alchemy;
-establishment of hospitals, pharmacies, shelters,
parishes;
-establishment of medical faculties at universities.
First hospital ("Noetl-Dieu") in Paris, built in 651 year.
Hospital in the Mediterranean. Engraving, 1496 year.
Visit to the patient. Giovanni del Robia. Frieze, 1525 year
 Scholasticism is a type of religious
philosophy in Medieval Europe.
The main features that characterize the scholastic
method of teaching in Western Europe:
-all the knowledge, which is necessary for a person, is
given in the writings of universally recognized
"authorities";
-science is the ability to deduce all the lower concepts
from the higher by means of arguments derived from the
writings of "authorities";
-complete and conscious neglect of experience.
 Scholastics and Medicine
Teaching in medieval universities was dogmatic.
The works of Hippocrates, Galen and Avicenna were
learned by heart.

Popular traditions were: cult of quotations;

mechanical learning of scientific texts; disregard for
practical experience.
Two scholastic doctors. Drawing by the French painter O. Domen
 Salerno Medical School in Italy
In the 9th century secular (non-monastic) medical education was
established. The oldest medical school in medieval Europe.
Salerno doctors collected and developed best knowledges, created
by the ancient and Arabic medicine. The training was conducted
on the works of Hippocrates, Galen and Avicenna. The school
wrote a number of treatises that were used for teaching.
The medical credo of the school was written in the "Salerno
Medical Code". The book "Passionaria" provided practical
recommendations for the diagnosis and treatment of various
diseases. Famous treatises: "On the treatment of diseases", which
discussed the treatment of all known diseases "from head to toe"
and "On the arrival of a physician to a patient”, written by
Archimedean.
The Salerno School had the right to confer the title of doctor and
grant a license for medical practice.
 Arnold of Villanova
(1235-1311)
He was teaching at the Salerno School. He
gained wide popularity, admired alchemy,
propagated his path for the preparation of many
medicines. He combined chemistry and medicine.
He was fond of toxicology and means of
prolonging life and fighting against old age.
He composed the poem "Salerno Code of
Health", devoted to the healthy lifestyle and
healing properties of individual plants.
 Crusades (1095-1270)

Crusades led to the widespread

spreading of many contagious
diseases.
The spreading of these diseases
was facilitated by:
-the lack of sewage and water
supply in the cities;
-lack of effective drugs;
-ignorance of the true causes of the
disease.
 Leprosy
Became a disease of the century. It was considered to be
incurable disease. The leper was expelled from society and
placed in leprozoria (shelter for lepers). He was given a
special dress of black material, a special hat with a white
ribbon and a rattle.
The idea of ​i solation lepers from society appeared in the sixth
century, when monks of the Order of St. Lazarus devoted
themselves to the care of the lepers.
After the Crusades there were 19 thousand leprozoria (only in
France - about 2 thousand).
Hospital for lepers
 Plague
3 large pandemics:
The first was the "plague of Justinian" (VI century). It occurred
in Egypt, devastated almost all the countries of the Mediterranean
and lasted for about 60 years.
The second - the most insignificant in the history of Western
Europe - "black death" (middle of the XIV century.). "Black
Death" was introduced in 1346-1348 through Genoa, Venice,
Naples; it devastated the entire Christian world. The death came
in a few hours after infection (nobody survived in Caesarea, 70%
died in Venice, 90% in London). Alive people did not have time
to bury the dead.
The third - the pandemic of the plague, which started in 1892 in
India (where more than 6 million people died), then passed in
other parts of the globe.
An epidemy of plague in a medieval city.
The costume of a medieval doctor during a plague epidemiv
For the fight against plague doctors
started to apply the detention of
people and goods at border
crossings for 40 days, hence the
term "quarantine" (Italian Quaranta
- 40). The first quarantine was
introduced in Italy in 1348. In
addition to the quarantine to
combat epidemics in Western
Europe, citizens started to apply:
paving of the streets; sewage
equipment, water sources;
fumigation of premises; burning of
goods; treatment with vinegar; use
of cleaning properties of fire.
In the Middle Ages, people, who were engaged
in operational activities, were called barbers.
They united in special workshops, by analogy
with other artisans. Barbers did not have
academic knowledge, book learning, but had a
wealth of practical experience. It was
indisputable that they had an advantage
comparing to doctors on the battlefield, where
they were treating wounds, removing arrows,
bullets, and helping with fractures.
Leg amputation by a barber under the supervision of a certified physician.
XVI century (Frankfurt Museum).
The King of England Henry VIII issues a certificate to the barber shop in London in
1540.
Anatomy Lesson at the Baroque School in the Eleventh
Century.
 Guy de Chauliac (1298-1368)

•French surgeon. Proved dental

instruments.
Main achievements of Guy de Chauliac:
-author of the compilation work "Great
Surgery";
-one of the first, who applied fracture
extraction;
-split the head wounds into 2 groups: with
loss of substance and without loss of
substance.
 The development of anatomy
Mondino de Luzzi (1275-1326) -
Master of Bologna University, made
the first textbook on anatomy in
Western Europe in 1316. His work
was based on the dissection of just
two corpses. He borrowed a huge
part from the translation of the
Galen’s work.
The development of scientific
anatomy in the Middle Ages
hampered the domination of
scholasticism and the prohibition of
the church to make autopsy of
corpses.
 Conclusions
The main features of the development of
medicine in the Middle Ages:
-the formation and development of alchemy,
pharmacy and pharmacopoeia;
-development of a medical case;
-distribution of medical care to all segments of the
population;
-creation of libraries and systematization of
scientific knowledge.
 Medicine
Of Renaissance
Renaissance created the true titans of human thought and spirit.
Among them, we should mention Leonardo da Vinci (1452-
1519), an outstanding anatto of the Renaissance, a scientist-
encyclopedic who left 13 volumes of drawings of the human
body after himself.
The founder of scientific anatomy. The work of "Anatomical
Notebooks".
Contribution of Leonardo da Vinci to the development of
medicine and anatomy:
-isolated 4 chambers in the heart;
-correctly described and painted a lot of muscles, bones, nerves and
internal organs;
-developed research method – wax injections of brain ventricles and
blood vessels;
-developed research method – body organs flushing in running
water.
Portrait of Leonardo da Vinci
Picture of a skull. Leonardo da Vinci. 1489 year
The main organs of the cardiovascular and reproductive system of a
woman. Leonardo da Vinci
Studying of the skeleton. Leonardo da Vinci
 Andreas Vesalius (1514–1564)
Outstanding Anatto of Renaissance, who was born
in Brussels. After graduation from the University
of Paris in 1537, he was invited to lead the
Department of Anatomy at the University of
Padua. Together with Da Vinci, he is the founder
of scientific anatomy. Wrote: The textbook on the
anatomy "Removal", works "Anatomical tables",
"On the structure of the human body”.
Andreas Vesalius (1514-1564)
Secretly, at night, during the light of the moon, he
analyzed the bodies of criminals, which were hanging
behind the city wall. At the lectures, he demonstrated
corpses. In 1543 he published his work "On the
structure of the human body".
In this book, A. Vesalius corrected more than 200
errors of Galen, who studied animals (mostly pigs).
This was the first normal human anatomy.
The greatest achievement of Vesalius is the discovery
of the absence of an intraventricular hole in human
heart, about which Galen previously wrote.
Illustration to the work "On the structure of the human body".
Engraving of I.S. Van Kalkar. 1543
Figure of the skeleton from the Vesalie’s atlas
Basing on the discoveries of Vesalieus, his student and
follower, Renaldo Colombo (1509-1553), discovered a small
circle of blood circulation: the right ventricle - the pulmonary
artery - the lungs - the pulmonary vein - the left atrium. The
works of Colombo are the "golden age" in the history of the
anatomy of the Renaissance. He created the work "On
anatomy".
Colombo made the assumption that there are small vessels
between the artery and the vein, which were later discovered
by Marcello Malpighi in 1661.
Independently from Colombo, before the discovery of a small
circle of blood, Miguel Servet (1511-1553), described it in his
theological book, "The Restoration of Christianity.”
Girolamo Fracastoro
(1478-1553)
 Girolamo Fracastoro
Italian doctor, astronomer, philosopher, physicist, poet. In 1546
he wrote the work "On Contagions, Contagious Diseases and
Their Treatment," in which he outlined the principles of his
developed doctrine of living contagious reproduction (contagion).
Describing 3 ways of transmitting of an infectious disease: 1)in
direct contact with a sick person, 2) through contaminated objects
and 3) by air at a distance.

For the first time introduced the term "infection" (Latin "inficere"
- to poison), which meant damage, penetration. Hence the name
"infectious diseases".
 Ambroise Pare
French surgeon, who improved amputation, using a
ligature of arteries. He constructed new surgical
instruments, orthopedic appliances, and improved the
technique of skull trepanation.
Pare is the founder of Gentle Surgery.
Also he applied blood vessels bandaging with clean
bandages soaked with a therapeutic balsam instead of
their distortion and baking with hot iron or boiled oil.
For the first time in Europe, he organized the obstetric
department and obstetric school. Described the turn of
the fetus to its leg and developed new operations and
tools in obstetrics.
Ambroise Pare
(1510 – 1590)
Prostheses, designed by A. Pare.
 Francis Bacon
English nature philosopher, philosopher, Lord Chancellor of Great Britain.
Bacon's classification of medicine
Bacon's medicine is divided into 3 parts according to its tasks.
The first part - should take care of health.
The second one is the treatment of diseases.
The third is a continuation of life span. He considered longevity to be the
noblest task of medicine.

The paths of the development of medicine by Bacon:

-studying the anatomy of the diseased organism (comparative anatomy and
anatomy of the human body after a severe course of the disease -
pathological anatomy);
-the invention of anesthesia methods;
-use of natural factors;
-the development of balneology (the use of healing water for the disease
treatment).
Francis Bacon
(1561–1626)
 Pharmacies worked as chemical laboratories. In these
laboratories the method of chemical analysis of
inorganic substances was established.
The results obtained were used both for the drug
search and for chemical science directly. Pharmacies
became centers of science, and pharmacists occupied a
prominent place among the scholars of the Middle
Ages.
Alchemy was an intermediate stage in the
development of modern scientific chemistry.
Alchemist in the laboratory
Doctor and pharmacist.
Woodcut. 1489 year
 Venetian pharmacist.
A copy of P. Longy's painting
A patient who escapes from pharmacist with enema
Paracelsus (1493-1541)
 The basic postulate of Paracelsus was as follows:
"Doctor's theory is an experience." He combined an
experienced method of knowledge of nature and the desire for
magic and understanding the influence of celestial bodies on
the fate of people and their health.
Founder of iatrochemistry: he believed that medicine
should rely on chemistry. Since a person is taken from the
earth, its basis is not blood, mucus and bile, as Hippocrates
considered, but mercury, sulfur and salt. They react with
each other in the body. That’s why chemistry must study
processes in the human body to find effective drugs.
Everything is a medicine, everything is a poison, depending
on the dose, according to Paracelsus.
He is considered as a forerunner of modern pharmacy.
Paracelsus is the author of the postulate
"Everything is a poison, and all is medicine.
One dose alone makes substance either
poison or medicine”.

Paracelsus introduced the term ”Galenicals”

in the pharmaceutical terminology.

In 1536, "Great Surgery" of Paracelsus was

published, it was a doctrine of wound
infections and the treatment of ulcers.
The doctor gives advice, examining the patient's urine. XV century
(National Library in Brussels).
Medieval diagnostics of diseases diagnosis on
the condition of urine
Childbirth process. Astrologers make a horoscope for
newborn baby. 15 century (Frankfurt Museum).
Iatrophysical and iatromechanical direction in medicine

Rene Descartes (1596-1650) – French

philosopher, physicist, mathematician and
physiologist. Developed the simplest form of
reflex arc scheme.

Giorgio Balvi (1668-1707) - an Italian doctor,

scientist. Famous representative of
iatromechanics. Compared the arteries and veins
with hydraulic tubes, the heart - with the injection
piston, the glands - with screens, muscles - with
levers.
Iatrophysical and iatromechanical direction in medicine
Giovanni Borelli (1608-1679) – Italian scientist. One of the founders of the
iatromechanical direction in medicine.
Wrote 2-volume work "On the movement of animals", in which he has put forward the
idea of ​the dependence of pressure in vessels from the area of ​their cross-section and
distance from the heart.
Showed that bones act as physical levers, and muscles act as driving forces.
Determined the process of walking - as a purposeful movement of the center of gravity,
accompanied by measures to restore equilibrium.

Musculoskeletal scheme
from Borelli's book
 Santorio

Italian doctor-anatomist, physiologist. The Renaissance

scientist, who for the first time proposed the use of a
water thermometer for measuring body temperature for
10 pulse strokes.

Santorio
(1561-1636)
Main achievements:
-created a thermoscope (a device for measuring body heat);
-invented sphygmometer (device for determining the speed of the
pulse);
-studied the metabolism on its own by weighing himself, food
intake and body excretion.
«Golden century» in history of anatomy
Francis Glisson (1597-1677) is a British
scientist-anatomist, professor at Cambridge. One
of the most prominent physicians of the first half
of the XVII century. In his work on rachitism
(London, 1650), he drew special attention to
doctors for childhood diseases.

Gabriel Fallopian (1523-1562) – Italian

anatomist. Described the facial nerve channel;
the structure and function of the fallopian tubes;
skeleton and fetal vessels. He studied the
structure of the liver, bile and urinary tract.

Bartolomeo Eustace (1510-1574) – Italian anatomist. Main

achievements: conducted pathoanatomy; described the auditory tube;
For the first time described the organ of hearing.
Nathaniel Gaymor (1613-1685) is an English doctor-anatomist.
He studied human descriptive anatomy. His great work on the
development of anatomy as a science was written in his work
"Anatomical study of the human body" (1651). Described the
maxillary sinus.

Nicolaas van Tyulp (1593-1674) – Dutch physician,

anthropologist, public figure. Has offered a burning candle and a
motto "Shining to others, I burn” as symbols of medicine.

Bernandino Ramazzini (1633-1714) – an Italian doctor. The

work "On the Diseases of Artists". The founder of occupational
pathology and occupational health as a branch of scientific
medicine.
Lesson of anatomy by Dr. Tyulp. Rembrandt, 1632
 Conclusion:

The main features of the development of

science in the Renaissance:
-humanism;
-anthropocentrism;
-metaphysical thinking;
-development of the experience method.
Thank you for
attention!