And the couple is an outstanding surgeon of the Renaissance. Renaissance medicine

In the Middle Ages in Western Europe, there was a distinction between doctors who received medical education at universities and were engaged only in the treatment of internal diseases, and surgeons who did not have a scientific education were not considered doctors and were not allowed into the class of doctors.
According to the guild organization of the medieval city, surgeons were considered artisans and were united in their own professional corporations. So, for example, in Paris, where the antagonism between doctors and surgeons was most pronounced, surgeons united in the “Brotherhood of St. Kosma,” while the doctors were part of the medical corporation at the University of Paris and very zealously guarded their rights and interests.

There was a constant struggle between doctors and surgeons. Doctors represented official medicine of that time, which still continued to follow blind memorization of texts and behind verbal disputes was still far from clinical observations and understanding of the processes occurring in a healthy or sick body.

Craftsman surgeons, on the contrary, had rich practical experience. Their profession required specific knowledge and vigorous action in the treatment of fractures and dislocations, extraction foreign bodies or treating the wounded on the battlefields during numerous wars and crusades.

"long-" and "short-sleeved" surgeons

There was a professional gradation among surgeons. A higher position was occupied by the so-called “long-skirted” surgeons, who were distinguished by their long clothes.
They had the right to perform the most complex operations, such as stone cutting or hernia repair. Surgeons of the second category (“short-skinned”) were mainly barbers and were engaged in “minor” surgery: bloodletting, tooth extraction, etc.

The lowest position was occupied by representatives of the third category of surgeons - bathhouse attendants, who performed simple manipulations, such as removing calluses. There was also a constant struggle between different categories of surgeons.

Official medicine stubbornly resisted recognizing the equal rights of surgeons: they were forbidden to cross the boundaries of their craft, perform medical procedures and write prescriptions.
Surgeons were not allowed into universities. Surgery training took place within the workshop, initially on the principles of apprenticeship. Then surgical schools began to open.
Their reputation grew, and in 1731, already during the period of modern history, in Paris, despite the desperate resistance of the medical faculty of the University of Paris, the first surgical academy was opened by the decision of the king.

In 1743 it was equated to the Faculty of Medicine. At the end of the 18th century, when the reactionary University of Paris was closed as a result of the French bourgeois revolution, it was surgical schools that became the basis on which higher medical schools of a new type were created.

Thus ended in Western Europe the centuries-long struggle between scholastic medicine and innovative surgery, which grew out of practical experience.

Surgery Western Europe Did not have scientific methods pain relief until the middle of the 19th century, all operations in the Middle Ages caused severe suffering to patients. There were also no correct ideas about wound infection and methods of wound disinfection. Therefore, most operations in medieval Europe (up to 90%) ended in the death of the patient as a result of sepsis.

With the advent firearms in Europe in the 14th century. the nature of the wounds has changed greatly: the open wound surface has increased (especially with artillery wounds), the suppuration of wounds has increased, and general complications have become more frequent.
All this began to be associated with the penetration of “gunpowder poison” into the wounded body. An Italian surgeon wrote about this Johannes de Vigo(Vigo, Johannes de, 1450-1545) in his book "The Art of Surgery" ("Arte Chirurgica", 1514), which went through more than 50 editions in various languages ​​of the world.

De Vigo believed that in the best possible way Treatment of gunshot wounds is the destruction of gunpowder residues by cauterizing the wound surface with a hot iron or a boiling composition of resinous substances (to avoid the spread of “gunpowder poison” throughout the body). In the absence of pain relief, such a cruel method of treating wounds caused much more suffering than the wound itself.

Ambroise Pare and the revolution in medieval surgery

The revolution of these and many other established ideas in surgery is associated with the name of the French surgeon and obstetrician Ambroise Paré(Pare, Ambroise, 1510-1590).
He did not have a medical education. He studied surgery at the Hoteluieu hospital in Paris, where he was an apprentice barber. In 1536, A. Pare began serving in the army as a barber-surgeon.

A. Pare's first work on military surgery “A way to treat gunshot wounds, as well as wounds inflicted by arrows, spears, etc.” was published in 1545 in colloquial French (he did not know Latin) and was republished in 1552.

In 1549 Paré published "A Guide to Removing Babies, Both Living and Dead, from the Womb". Being one of the most famous surgeons of his time, Ambroise Paré was the first surgeon and obstetrician at the court of Kings Henry VI, Francis II, Charles IX, Henry III and the chief surgeon of the Hotel Dieu, where he once studied the surgical craft.

Paré's outstanding merit is his contribution to the teaching of the treatment of gunshot wounds.
In 1536, during a campaign in Northern Italy, the young army barber Ambroise Paré did not have enough hot resinous substances with which to fill his wounds.
Having nothing else at hand, he applied a digestive of egg yolk, rose oil and turpentine oil to the wounds and covered them with clean bandages.
"I couldn't sleep all night, - Paré wrote in his diary, - I was afraid to find my wounded, whom I had not cauterized, dying from poisoning. To my amazement, early in the morning I found these wounded cheerful, well-slept, with wounds not inflamed and not swollen.
At the same time, others, whose wounds were filled with boiling oil, I found feverish, with severe pain and with swollen edges of the wounds. Then I decided never to burn the unfortunate wounded so cruelly again.”.
This was the beginning of a new, humane method of treating wounds.

At the same time, along with brilliant works on orthopedics, surgery, and obstetrics, Paré wrote an essay "About Freaks and Monsters", in which he cited many medieval legends about the existence of animal people, fish people, sea devils, etc. This indicates contradictions in the views of outstanding figures of the most complex transitional era of the Renaissance.

The activities of Ambroise Paré largely determined the development of surgery as a science and contributed to the transformation of an artisan surgeon into a full-fledged medical specialist. The transformation of surgery associated with his name was continued by his numerous followers and successors in different countries.

Compilation based on the book: T.S. Sorokina, “History of Medicine”

The Renaissance was a decisive stage for the development of surgery. Initially, those who dealt with it were looked upon as charlatans and bloodletters. But gradually, thanks to advances in anatomy, as well as the work of such outstanding surgeons as Pare, Foshan, Gilden, Magati, surgery was recognized as a full-fledged branch of medicine.

Confrontation between university doctors and surgeons

By the 15th-16th centuries, many universities already had medical faculties where anatomy was studied. However, university doctors still tried to stay away from surgeons and barbers. Surgery in those days was considered quackery, and most often it was. The people who dealt with it had no education and did not study medicine. It was believed that working with hands in the age of the triumph of reason was low and unpromising.

It was not until 1515 that the university took control of the surgeons. The barbers became part of the brotherhood of St. Kosma, which was later transformed into a surgical college, and the teachers of surgery there began to be called professors. Despite this, the opinion that surgeons are charlatans persisted for a long time.

Scientific achievements of the Renaissance

Improved knowledge of anatomy contributed to the development of surgery. A great contribution to this process was made by Leonardo da Vinci’s drawings depicting the structure human body and its parts. A huge breakthrough in the development of science was the discoveries of Andrei Vesalius, who became one of the first professors of surgery. He studied the structure of the heart, blood vessels, muscles, skeleton and many organs. Vesalius's main work, “On the Structure of the Human Body,” was presented in seven books.

A large number of anatomical works appeared in the second half of the 16th century. Most famous authors- R. Colombo, C. Etienne, R. Eustachius, I. Fabricius, G. Fallopius, V. Harvey.

The formation of surgery: the merits of Ambroise Pare

The first most famous surgeon was the Frenchman Ambroise Pare. He was descended from barbers and received his education in a Paris hospital. At that time it was a large number of wars and firearms have already appeared. Since the wounds inflicted by him were very different from ordinary ones, new ways of treating them were required. Initially, they were burned with boiling oil or a hot iron, which caused even more pain to the patient.

Paré enlisted in the army as a barber-surgeon, and his work “A Method for Treating Gunshot Wounds, as well as Wounds Inflicted by Arrows, Spears, etc.” became a real revolution in medicine. According to his method, the wounds were treated with a special ointment, and a clean bandage was applied on top. Later he was admitted to the medical college at the university and became the first surgeon and obstetrician at court. The couple also improved amputation methods, invented many surgical instruments, orthopedic devices, including artificial joints, limbs and teeth.

Renaissance Dentistry

At the very end of the Renaissance, surgical dentistry began to develop. The impetus for this was Fauchard’s work “The Dentist Surgeon”, in which he described dental diseases and oral cavity, as well as prosthetics. Later he invented a drill, dental pins, and metal-ceramic dentures, which became the prototype of modern models.

Gradually, views on surgery in general began to be revised. Barbers and surgeons were no longer looked upon as bloodletting artisans. Pare Gilden, Magati and many other outstanding scientists continued to develop the ideas.

In the Middle Ages in Western Europe, surgeons did not have a scientific education, were not considered doctors and were not allowed into the class of doctors. They were considered artisans and united in their own professional corporations (in Paris, surgeons united in the “Brotherhood of St. Cosmas”, and doctors who received medical education at universities and were engaged only in the treatment of internal diseases were part of the medical corporation at the University of Paris).

There was a tireless struggle between doctors and artisan surgeons. Doctors represented official medicine of that time; they continued to memorize texts and were far from understanding clinical observations and understanding the processes occurring in a healthy or sick body. Surgeons, on the contrary, had rich practical experience. There was a professional gradation among them. The highest position was occupied by “long-haired” surgeons (distinguished by long clothes). They had the right to perform the most complex operations, for example, hernia repair or stone cutting. Surgeons of the second category - “short-skinned” (barbers) were engaged in “minor” surgery: Bloodletting, tooth extraction, etc. The lowest position was occupied by bathhouse attendants, who performed simple manipulations, for example, removing calluses. There was a constant struggle between different categories of surgeons.

Official medicine stubbornly resisted the recognition of surgeons. They were not allowed into universities. Surgery training took place within the workshop, initially on the principles of apprenticeship. Then surgical schools began to open. In 1731, in Paris, by decision of the king, the first Surgical Academy was opened. In 1743 it was equated to the Faculty of Medicine. Thus, in Western Europe, the centuries-long struggle between scholastic medicine and innovative surgery, which grew out of practical experience, ended.

Surgery did not have scientific methods of pain relief until the middle of the 19th century, so all operations caused severe suffering to patients. There were no correct ideas about wound infection and methods of wound disinfection. Therefore, 90% of operations in medieval Europe ended in the death of the patient as a result of sepsis.

With the advent of firearms in Europe in the 14th century. the nature of the wounds has changed greatly: the open wound surface has increased (especially with artillery wounds), the suppuration of wounds has increased, and general complications have become more frequent. All this began to be associated with the penetration of “gunpowder poison” into the wounded body. The Italian surgeon Johannes de Vigo (1450-1545) wrote about this in his book “The Art of Surgery” (“Arte Chirurgica”, 1514), which went through more than 50 editions in various languages ​​of the world. De Vigo believed that the best way to treat gunshot wounds was to destroy gunpowder residues by cauterizing the wound surface with a hot iron or a boiling composition of resinous substances (to avoid the spread of “gunpowder poison” throughout the body). In the absence of pain relief, such a cruel method of treating wounds caused much more suffering than the wound itself.

The revolution of these and many other established ideas in surgery is associated with the name of the French surgeon and obstetrician Ambroise Paré (1510-1590). He did not have a medical education. He studied surgery at a Paris hospital, where he was an apprentice barber. In 1536, A. Pare began serving in the army as a barber-surgeon. His first work on military surgery was “A Method for Treating Gunshot Wounds, as well as Wounds Inflicted by Arrows, Spears, etc.” was published in 1545 in colloquial French (he did not know Latin) and was republished in 1552. In 1549, Paré published “A Manual for the Extraction of Infants, Both Living and Dead, from the Womb.” Being one of the most famous surgeons of his time, Ambroise Paré was the first surgeon and obstetrician at the court of Kings Henry II, Francis II, Charles IX, Henry III and the chief surgeon of the Hotel Dieu, where he once studied the surgical craft.

Paré's outstanding merit is his contribution to the teaching of the treatment of gunshot wounds. In 1536, during a campaign in Northern Italy, the young army barber Ambroise Paré did not have enough hot resinous substances with which to fill his wounds. Having nothing else at hand, he applied a digestive of egg yolk, rose oil and turpentine oil to the wounds and covered them with clean bandages. “I couldn’t sleep all night,” Paré wrote in his diary, “I was afraid to find my wounded, whom I had not cauterized, dying from poisoning. To my amazement, early in the morning I found these wounded cheerful, well-slept, with wounds not inflamed and not swollen. At the same time, others, whose wounds were filled with boiling oil, I found feverish, with severe pain and with swollen edges of the wounds. Then I decided never to burn the unfortunate wounded so cruelly again.” This was the beginning of a new, humane method of treating wounds.

At the same time, along with brilliant works on orthopedics, surgery, and obstetrics, Pare wrote the essay “On Freaks and Monsters,” in which he cited many medieval legends about the existence of animal people, fish people, sea devils, etc. This indicates contradictions in the views of outstanding figures of the most complex transitional era of the Renaissance.

The activities of Ambroise Paré largely determined the development of surgery as a science and contributed to the transformation of an artisan surgeon into a full-fledged medical specialist. The transformation of surgery associated with his name was continued by his numerous followers and successors in different countries.

Chapter 7 Renaissance Medicine

The final stage of feudalism (from the 15th to the 17th centuries) is the time of its decline and decay, the gradual formation of elements of a capitalist economy in the bowels of the still dominant feudal society. This was a transition to the next, historically higher socio-economic formation - capitalism (to its early stage - the stage of manufacture).

The search for new markets and colonial conquests are associated with the growth of production. These same circumstances caused long journeys from Europe to the east and west, major geographical discoveries, the journey of Marco Polo to Indochina and China, Vasco da Gama to India, Magellan through Pacific Ocean, Christopher Columbus and Amerigo Vespucci (discovery of America). “In search of goods on Russian soil” was carried out in 1466-1472. Tver merchant Afanasy Nikitin made his “walk across three seas.”

In addition to its great influence on economic and cultural development European countries, these geographical discoveries contributed to the enrichment of the arsenal of medicinal medicine: the penetration into Europe of opium, camphor from Asia, quinine, ipecac, coffee, bacauta (guaiac wood) from the Middle and South America and etc.

Introduction from the middle of the 15th century. printing, instead of the previous rewriting of books, significantly accelerated the spread of literature, making it accessible to a much wider circle of readers.

The developing class - the young bourgeoisie, which consisted of artisans and traders, mastering the productive forces, needed knowledge of nature, was interested in the development of various branches of natural science. In the field of culture and ideology, traditional medieval scholasticism and official theology (studia divina), on the one hand, and a new worldview, humanism (studia humana), on the other, opposed each other.

Progressive figures of the transition period, fighting against the omnipotent official church, used the cultural heritage of ancient antiquity, especially Ancient Greece. Hence the term “Renaissance” (Renaissance) - a very inaccurate designation that has survived to this day.

Western Europe adopted the classical heritage of ancient medicine, as well as the advanced medicine of the peoples of the East. “It was the greatest progressive revolution... an era that needed titans and which gave birth to titans in the power of thought... in versatility and learning... But what is especially characteristic of them is that they almost all live in the very midst of the interests of their time, accept active participation in practical struggle... Armchair scientists were then an exception..."

“The period, not without reason called the Renaissance, breathes with bursting passion, the period of the beginning of free art and free research thought in the modern history of mankind... Artistic and scientific works of this period should be constantly before the eyes of present generations.”

Earlier than in Western Europe, the characteristic features of the new era found expression in the medicine of the peoples of Transcaucasia - in Georgia (Ioane Petritsi, Kananeli), Armenia (Mkhitar Heratsi, Grigoris), Azerbaijan, as well as Bulgaria and other Balkan countries.

Mass movements of the enslaved peasantry against the feudal lords were an expression of the social demands of modern times. In conditions when the only form of ideology was religion and theology, these social liberation movements took the form of “heresies” directed against the dominant church. Such is the movement of the “Tondrakians” in Armenia, the “Bogomils” in Bulgaria (among the founders of the Bogomil movement were the doctor Jeremiah - 10th century, the doctor Vasily, executed in the 12th century), later in Central and Western Europe the movement of the Hussites - followers of Jan Hus in the Czech Republic , “Moravian brothers”, “rebaptized”, “Albigensian heresy”, etc.

IN social utopias During the Renaissance, in “Utopia” by Thomas More (1478-1535), in “The City of the Sun” by Tomaso Campenella (1568-1639), “New Atlantis” by Francis Bacon (1561-1626) and a number of other books, issues of medical affairs were raised, and the doctor was given a large, often decisive place in matters of personal and public life.

By the 15th century There were about 40 universities in Europe, most of them small. Many of them, especially large ones (Paris, Bologna, Oxford, etc.), included medical faculties. However, the state of medical sciences and its teaching at universities in most cases did not meet the needs and spirit of the new time. They preserved medieval scholastic traditions; official science lagged behind the advanced ones. Centers for the study of practical medicine without the influence of scholasticism were exceptions. Such a center was Salerno (Italy), where from the 9th century. a practical medical school was formed.

The most progressive in scientific activity and the restructuring of teaching turned out to be universities associated with the leading centers of social life of that time: Padua in Northern Italy, Leiden in Holland (the Netherlands). In these centers, the new, progressive medicine of the Renaissance received the greatest development.

Experimental method in science. Physics (mechanics). Beginning of microscopy. Progressive thinkers of the Renaissance strove primarily to understand reality on the basis of their own experience, abandoning their previous blind submission to the authority of the church and official science.

A characteristic figure for the Renaissance was the physician Theophrastus Paracelsus (1493-1541), a native of Switzerland who was educated in Ferrara (Northern Italy). “The physician’s theory is experience,” taught Paracelsus. He demanded that a doctor-scientist work in a chemical laboratory, considering the processes occurring in the body to be chemical. Paracelsus described the harmfulness of the work of foundries and miners. In the field of medicinal science, he developed a new idea of ​​the dose, believing that everything is poison and nothing is devoid of poisonousness, that only the dose makes a substance a poison or a medicine. In surgery, Paracelsus demanded that wounds be “protected from external enemies” with clean bandages, insisted on a close connection between surgery and therapy (internal diseases), which at that time were sharply separated: both, he believed, “come from the same knowledge.” Paracelsus fought against “Galenism” in medicine; he demonstratively burned Galen’s books in the courtyard of the University of Basel. At the same time, Paracelsus could not completely overcome the legacy of medieval mysticism, which had a strong influence on him in his youth. In the doctrine of “archaea,” the regulating spiritual principle of the body, etc., Paracelsus reflected the internal contradictions of the people of the transitional era. These contradictions are, to one degree or another, characteristic of all figures of the Renaissance.

The experimental method characterized the work of the outstanding English philosopher and naturalist Francis Bacon (1561-1626). K. Marx wrote: “The real founder of English materialism and all modern experimental science is Bacon.” Science, Bacon demanded, “must be active and serve man,” must master the largest possible number of secrets of nature that are still hidden from man. Not being a doctor by profession, Bacon showed great interest in medicine. He demanded that “doctors, leaving general views, let's go towards nature." Bacon sharply condemned the medicine that preceded him (to a large extent contemporary with him): “We find in medicine many repetitions, but few truly new discoveries.” In his classification, he divided medicine into three parts, according to its three tasks: maintaining health, curing diseases, longevity. He considered achieving healthy longevity “the noblest goal of medicine.” In his work “On the Dignity and Power of the Sciences” (De dignitate et augmentate scientiarum), Bacon set a number of specific tasks for medicine. Thus, considering descriptive anatomy insufficient, he insisted on the development of comparative anatomy and pathological anatomy: “In anatomical studies, one should carefully observe the traces and results of diseases, the lesions and damage they cause in the internal parts. Meanwhile, this is being neglected.”

In the field of therapy, Bacon considered it necessary to carefully “record everything that happens to the patient” - to keep medical histories and combine them into “medical descriptions, carefully compiled and properly discussed,” i.e., to draw up clinical guidelines. Bacon considered it necessary to develop balneology. At the same time, he demanded not to be limited to the study of natural mineral waters, but to synthesize and use artificial ones. Outraged by operations that were painful for patients, he demanded the introduction of pain relief. In these demands, succinctly formulated in a short chapter of the book, Bacon gave a program scientific work in medicine for the coming centuries. In his utopian voyage, The New Atlantis, Bacon outlined a society of scientists (“philosophers”) conducting experiments with the goal of “extending the power of man over nature.” He described “health rooms,” where physical conditions are created that are favorable for recovery from various illnesses and the prevention of diseases, as well as the preparation and application of new means of rational nutrition, in particular for sailors against scurvy.

Rene Descartes (1596-1650), a Frenchman, forced to move to the relatively more tolerant Holland due to the persecution of Catholic fanatics in his homeland, left a major mark in various fields of knowledge - mathematics, physics, philosophy, as well as in issues of anatomy and physiology related with medicine (“Description of the human body”, etc.). His philosophical views were distinguished by duality (dualism). However, like Bacon, he set before science the task of making people “lords and masters of nature.” In the field of physiology, Descartes approached the concept of a reflex: the transmission of nervous excitation, according to Descartes, occurs “similar to how, by pulling a rope at one end, we make a bell ring at the other end.”

The teachings of Descartes and especially Bacon had a significant influence on the development of natural science and medicine.

The development of natural sciences was stimulated by the demands of military affairs, manufacturing, and shipping. The most developed branch was mechanics, somewhat less so - optics. In the form of the laws of mechanics (this included “celestial mechanics” - astronomy), the human mind first learned the laws of nature. Chemistry received relatively less development.

In medicine of the 16th-17th centuries. there were followers, on the one hand, of iatrophysical (medico-physical) or iatromechanical, and on the other, of iatrochemical (medico-chemical) currents. Among the iatrochemists there were some prominent scientists who made remarkable discoveries. Among them, following Paracelsus, was van Helmont (1577-1644), a Flemish scientist who discovered carbon dioxide, gastric juice, who described chemical processes"fermentation". But iatrochemists, associated with the remnants of medieval alchemy, paid great tribute to unscientific ideas. In particular, van Helmont, like Paracelsus, developed the doctrine of “archaea”, otherworldly principles that inspire the activity of the organism, only in contrast to him he defended the existence of not a single archaea - for the whole organism, but many - for each organ separately.

Iatrophysicists (iatromechanics) sought to explain all processes in the body from the point of view of mechanics.

Then it had a progressive meaning - it expressed the desire to replace the arbitrariness of the deity with the knowledge of the laws of nature. In the fight against theology, this concept played a historically progressive role. According to the current definition, “mechanics transforms a person from a servant of God into a citizen of the universe.” The anatomist Vesalius joined the iatrophysicists (see below). In his classic work, he likened joints, bones and muscles to hinges, blocks and levers, the heart to a pump, glands to sieves, etc. The same thing characterized the physiologist Santorio, the doctor Borelli, and others.

The positive significance of physics (mechanics) in medicine was most convincingly reflected in the use of magnifying instruments - telescopes and microscopes, in the discovery of the structure of the smallest parts of the body (for example, the research of M. Malpighi; see below). The mechanic and astronomer Galileo, together with the physiologist Santorio, designed thermoscopes that served as the basis for the future thermometer, hygroscopes, pulsometers, devices for improving hearing and other devices. Later, in the 17th century. Using a homemade primitive combination of lenses, the Dutch optician, self-taught Antony Leeuwenhoek, studied the structure of bones, muscles, blood cells, sperm, etc., giving beautiful sketches of them.

Study of the structure of the body and life processes.

The culture of the Renaissance placed man at the center of attention. In the field of medicine, the study of the structure of his body began. Position ancient philosophy“know thyself” (gnothi se auton) was interpreted anatomically as knowledge of the physical nature of man. Anatomy was studied not only by doctors, but also by many people whose activities were far from medicine. Thus, the artist Leonardo da Vinci, an outstanding representative of Renaissance culture, worked a lot in the field of anatomy. Numerous anatomical sketches of Leonardo from his own anatomical preparations are available in a number of art repositories around the world, including the Leningrad Hermitage.

The University of Padua had an anatomical theater - one of the best in Europe at that time. Here in the 16th century. An anatomical and physiological school emerged, the famous representative of which was Andrei Vesalius (1514-1564).

A Vesalius (1514-1564).

A native of Brussels (now Belgium), Vesalius (real name Wittings) studied at the University of Paris, one of the main centers of medieval scholasticism. Deprived of the opportunity to study anatomy by dissecting corpses, he began to obtain corpses secretly, stealing them from gallows, hiding from guards, fighting hungry dogs, as can be judged from the sketches he left behind. There are descriptions in the literature of how medical students sometimes, in order to study corpses, collectively tore up the graves of recently buried people. Arriving in Padua, Vesalius was given the opportunity to freely dissect and at the age of 25 became a professor. He taught at the University of Padua for several years. Having become convinced during numerous autopsies of a number of errors made by Galen, the indisputable authority of medieval medicine, he criticized them, first cautiously, in the form of respectful “comments”, and then more boldly, in the form of direct refutations (for example, regarding the structure of the pelvic girdle, chest, hands; hearts). Vesalius created the basic prerequisites for the subsequent discovery of pulmonary circulation. In 1543, Vesalius published in Basel (Switzerland) his major work “On the structure of the human body” (De humani corporis fabrica) in 7 parts (“Books”), which was an open statement against Galen’s anatomy (Fig. 11).

Rice. 11. Human muscles (from the book A of Vesalius).

While Vesalius spoke on certain particular issues of body structure, his activity in the relatively free-thinking environment of the University of Padua was possible. But the publication of a major work, where criticism of Galen’s anatomy was given in the system, was the same open challenge to medieval scholasticism as the work of the Polish scientist, astronomer and practical physician Nicolaus Copernicus, “On the rotation of the celestial spheres” (De revolutionibus orbium coelestium), published simultaneously in Frankfurt. Besalia's book was met with ridicule and hostility. He was showered with abuse and accused of performing autopsies on living people. His Parisian anatomy teacher, the prominent anatomist Jacob Silvius, declared his student crazy and a slanderer against Galen. The end of Vesalius' life was sad. He was forced to leave the pulpit in Padua and travel to Jerusalem for “repentance at the Holy Sepulcher.” On the way back, he was shipwrecked and found himself on a sparsely inhabited rocky island off the coast of Greece, where he died of hunger and disease.

Vesalius's work remains a classic to this day. It is illustrated by the best artists of Titian's school - Kalkar and others. The human body is nowhere depicted in Vesalius motionless, lying down, but everywhere dynamically, in motion. The drawings indicate that Vesalius' lectures were accompanied by comparative demonstrations of a corpse, a living sitter, a skeleton, and sometimes animals. Vesalius was an innovator not only in the study, but also in the teaching of anatomy.

Rice. 12. Experimental chamber S. Santorio.

A number of Vesalius's successors, step by step, found new confirmations and justifications for his guess about the existence of blood circulation. Realdo Colombo, his closest successor (1516-1559), following the Spanish scientist M. Servetus, who was burned in Switzerland in 1553, traced the pulmonary circulation - the path of blood movement through the lungs; Gabriel Fallopius (1523-1562) introduced clarifications and corrections into Vesalius's studies. Gerolamo Fabricius (1530-1619) described venous valves. Thus, the ground was gradually prepared for the study of the entire circulatory system - a scientific work that was completed by William Harvey - an English liar, a student of the same Paduan school.

Knowledge of the structure of the body led to the study of processes occurring in the body. At the University of Padua, Santorio (1561-1636) studied body functions. He worked closely with Galileo, a great mathematician, mechanic and astronomer. The first thermometer, which they called a “thermoscope,” in the form of a graduated, spiral-shaped curved tube, a hygrometer (humidity meter), a pulse monitor, devices for improving hearing and other instruments were the fruit of the joint work of Galileo and Santorio. In a specially designed chamber, Santorio patiently studied his metabolism for several years, weighed himself, the food he took, his excretions, and tried to express in weight terms even the air released by evaporation. Santorio is one of the early predecessors of experimental physiology (Fig. 12).

A huge leap in the development of physiological knowledge was the activity of William Harvey (1578-1657), an English physician who studied blood circulation, at the University of Padua. He had predecessors in this work. In Europe, they did not know about the discoveries of the Arab physician Ibn an-Nafis, who described it in the 13th century. pulmonary circulation. Harvey could not have known this either. But he was familiar with the works of European scientists, primarily the Paduan school, and continued the research begun by Vesalius, Colombo, Fallopius, and Fabricius. Fabricius was his direct teacher in Padua. In 1553, in Switzerland, Miguel Servetus, a Spanish scientist and “heretic,” was burned along with his work “Restoration of Christianity” (“Christianismi restitutio”), directed against the official church. In the final chapter of the book, devoted to some questions of physiology, Servetus described the transition of blood from the right ventricle to the left “through a long and wonderful bypass” through the lungs, noting that “its color changes.” “Calvin burned Servetus when he came close to opening the blood circulation, and at the same time forced him to roast him alive for two hours...” The outstanding Renaissance thinker Giordano Bruno, who was condemned by the Inquisition and burned in 1600, wrote about blood circulation. Roman professor Andreus Caesalpinus (1519-1603) and others mentioned blood circulation. However, none of Harvey’s predecessors gave a picture of blood circulation as a whole and its scientific explanation.

Harvey's main historical merit was the use of a new method in the study of life phenomena. Blood circulation had been described before, but Harvey was the first to experimentally prove its existence.

W. Harvey (1578-1657).

The book “On the Movement of the Heart and Blood in Animals” (De motu cordis et sanguinis in animalibus), after many years of work on it, was published in 1628. Harvey was the first to use, in addition to experimentation, the method of calculation in the study of the life processes of an organism. He proved that the mass of blood contained in the body returns back to the heart, and is not absorbed without a trace by the tissues of the body, as previously assumed, that the pulsation of the arteries is associated with the contraction of the heart, and is not the result of the action of a special “force” - vis pulsitiva. He explained the true meaning of systole and diastole, previously misunderstood, in particular by Galen. Thus, Galen considered systole not as an active contraction of the heart, but as a passive decline. Diastole, on the contrary, was considered an active expansion of the heart to draw air into the blood flow, etc. Sharing the views of Francis Bacon on the importance of experience in the study of nature, Harvey wrote in the preface: “Anatomy should learn and teach not from books, but from dissection, not from dogmas of learning, but in the workshop of nature."

The discovery of blood circulation was met by official science with distrust and hostility. The long struggle around this discovery is one example of how thorny the path of development of advanced science was. Leading French writers Boileau and Molière, using the example of the University of Paris, ridiculed the attempts of the scholastics to slow down and ignore the discoveries of science. In Russia, from the very beginning of the systematic training of doctors, there were no protests against the opening of blood circulation.

The circulatory system presented by Harvey was missing an important step - capillaries, because Harvey did not use a microscope. After microscopic studies carried out by Marcello Malpighi (1628-1694), and his descriptions of capillaries and capillary circulation, a complete understanding of the circular movement of blood in the body was scientifically recognized. In addition to capillaries, Malpighi described the structure of glands, skin, lungs, kidneys, etc.

While studying blood circulation, Harvey also dissected animals at different stages of fetal development to trace the formation vascular system and hearts. Together with Fallopio, Malpighi and others, he was one of the founders of a new science - embryology. In his work “On the Birth of Animals” (De generatione animalium), Harvey refuted the ideas that had been preserved since ancient times about the spontaneous generation of animals from silt, dirt, sand, etc.: “Every living thing comes from an egg” (Ochae vivum ex ovo).

In connection with the expansion of anatomical and physiological knowledge, in accordance with the general direction of the worldview and culture of the Renaissance, the appearance of medical medicine was also transformed. Memorizing medical texts and verbal disputes about them was replaced by careful observation of patients, collecting and systematizing the manifestations of the disease, and establishing the sequence of their development. These features, reminiscent of the teachings of ancient Hippocrates, but based on greater knowledge of the structure and life of the body, characterized the clinical direction in medicine. Its exponent in Padua was Giovanni Batista Montano (da Monte) (1489-1552). He taught at the hospital. Montano's students continued to apply the clinical method in Padua and other centers. Subsequently, the main center of clinical medicine, continuing the traditions of Padua, became the University of Leiden in Holland (Fig. 13).

Particularly large place in therapeutic medicine focused on describing widespread epidemic infectious diseases. In the Middle Ages, there were numerous destructive epidemics that devastated large settlements and entire countries (“Black Death”, etc.). Naturally, therefore, the predominance of “epidemiographic” literature is descriptions of epidemics. The science of their etiology, routes of spread, and justified measures to combat them - epidemiology - did not yet exist.

Rice. 13. Anatomy lesson of Doctor Tulpius (painting by Rembrandt).

A major role in the study of infectious diseases was played by the work of G. Fracastoro (1478-1553) “On infection, contagious diseases and their treatment” (De contagione, de morbis contagiosis et eorum curatione) (1546). A student and teacher at the University of Padua, Fracastoro witnessed many epidemics, in particular typhus, as well as a significant spread of syphilis from the end of the 15th century. He was one of the first to describe syphilis in an unpublished, unfinished treatise “On Syphilis, or the Gallic Disease”, 1525 (in Russian translation published in Moscow in 1954) and in a poem under the same title (Syphilis seu de morbo gallico, 1530 G.).

Rice. 14. Monument to G. Fracastoro.

In the book “On Contagion, Contagious Diseases and Their Treatment,” Fracastoro outlined his teaching about the essence and ways of spreading infectious (contagious) diseases, the characteristics of individual diseases and their treatment. Fracastoro (Fig. 14) distinguished three routes of infection: through direct contact, through intermediary objects and at a distance. In all cases, Fracastoro believed, infection occurs through the smallest invisible “seeds” or “embryos” of the disease – seminaria morbi, and the infection is a material principle (“the source of the infection is corporeal”). Speaking about the transmission of infection through objects, he noted the influence of temperature: the infection is retained at a temperature that is not too high and not too low; high and low temperatures are unfavorable for infection. Among the infectious diseases, Fracastoro described smallpox, measles, consumption, leprosy, syphilis, different kinds fevers (according to the terminology of that time), etc. The description of typhus is interesting. He correctly regarded rashes as minor hemorrhages and therefore believed that “the infection of this disease has a special affinity for blood.” Fracastoro's book is a summary of human knowledge in the field of infectious diseases. At the same time, it played a significant role in the subsequent emergence of infectious diseases clinics and epidemiology.

Developing “contagionist” views on the transmission of infectious diseases, Fracastoro partially preserved the ideas of the “miasmatics” about the direct occurrence of infection in the air under the special “constitution” of the latter. Thus, in particular, he explained the outbreak and spread of syphilis in the eastern hemisphere at the end of the 15th - beginning of the 16th centuries.

Development of surgery. Surgery throughout the Middle Ages developed in special ways, which significantly differed from other branches, primarily from general therapy - the treatment of internal diseases. Medical scientists and doctors of medical faculties, as a rule, did not practice surgery, with some exceptions, for example in Bologna (Italy). Connected both in everyday life and in professional activity with the dominant Catholic Church, they were guided by the rule “the church fears blood” (“ecclesia abhorret sanguinem”). Following the same rule, the body of church persecution of freethinkers, the Inquisition, hypocritically preferred the burning of “heretics” to other types of execution. Those engaged in surgery were not accepted into the corporation of medical scientists and university faculties; were in the position of performers, almost servants. This division, which was a reflection of the class-guild system, reached its most complete development in France, where different categories surgeons were required to wear different clothes. Some surgeons, long-haired (chirurgiens de robe longue), had the right to perform stone cutting and some other operations. In some cases, they achieved great skill in these operations, especially in the speed of their implementation. They were united and led by the “brotherhood of St. Cosmas" (Fraternite Saint-Comes). The second, lower category of surgeons – short-sex surgeons (chirurgiens de robe courte) – had a more limited range of permitted surgical interventions. The largest group were barbers. A very common method of treatment at that time - bloodletting - was primarily their business. At the lowest level of this hierarchical ladder stood the callus operators in the baths, who were part of the same workshop of surgeons.

The doctors, united in the faculty corporation at the university, were a privileged group, jealously ensuring that surgeons did not exceed the limited rights granted to them, in particular, they did not prescribe prescriptions or administer enemas, which were the privilege of faculty doctors. Among surgeons, in turn, each higher category protected its “rights,” i.e., material interests, from attacks on them by a lower category. Constant and lengthy litigation on this basis - characteristic medieval medical life.

However, despite these conditions of life and activity of various groups of surgeons, far from scientific interests, during the Middle Ages the prerequisites were created for subsequent major achievements in the field of surgery.

Official university medicine, closely connected with theology and permeated with scholasticism, in practice was limited to the prescription of laxatives, enemas and bloodletting. She was, as a rule, powerless to provide effective assistance to the sick. Surgeons who did not have academic titles accumulated a wealth of practical experience and could, in some cases, help the sick and wounded the help you need. Surgery emerged from the numerous wars of the Middle Ages (crusades, etc.) significantly enriched. On the battlefield, the advantage of surgeons was especially evident.

Subsequently, on the basis of vast surgical practice, surgery developed as a science.

In different countries during the Renaissance, you can meet surgeon-scientists who grew out of artisans and practicing surgeons. The most characteristic figure among them is Ambroise Pare (1517-1590), in his youth a modest French barber who later became a scientist and reformer of surgery. In his notes in vernacular French, Paré described an incident during a campaign when he, a very young barber, the only medic at a French military unit, after a bloody battle, did not have enough “balm” - a resinous composition that should have been poured into boiling wounds. Gunshot wounds were considered to be poisoned by “gunpowder poison” (Vigo’s teaching), and they were either cauterized with a hot iron or poured with a boiling solution of resinous substances. In the absence of pain relief, this method of treating wounds caused severe suffering. Due to the lack of “balm,” A. Pare covered the wounds with a clean cloth, after filling them with egg yolks, turpentine and rose oil. Having discovered, to his great surprise, a much greater effect of such treatment, he then refused to pour the “balm” into the wounds. It has now been established that approximately in the same years or slightly earlier, other surgeons in Switzerland, Germany, Italy, and Spain proposed similar rational treatment of wounds. Like many other discoveries and innovations, new method treatment of wounds was the merit of more than one person and more than one country.

A. Pare made many new proposals in surgery. He replaced the compression and twisting of the vessels with their ligation. This method reliably protected against bleeding (often fatal) during amputation of limbs. Used back in the 3rd century. BC e. in Hellenistic Egypt, ligation of blood vessels was forgotten in the Middle Ages. A. Pare described a fracture of the femoral neck and the operation involved, which is still considered far from easy. He made detailed drawings of a number of complex orthopedic devices (artificial joints with gears, artificial limbs, etc.). He personally failed to implement these orthopedic improvements, but his proposals and drawings contributed to the further development of scientific thought in surgery. In obstetrics, they were offered a turn on the leg - a technique used in Ancient India, but also forgotten.

The barber A. Pare, who did not receive an academic education, did not speak the language of scientists - Latin; he wrote only in colloquial French. As a result, enormous difficulties arose in awarding him an academic degree towards the end of his life. By this time, A. Pare was a famous surgeon and court obstetrician, but the use of a language understandable to everyone made the achievements of surgery publicly available. This is precisely what representatives of official science feared.