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The concept of "ancient Rome" has changed over the centuries: from Rome - the city-state to the Roman Republic, and then the Great Roman Empire, which, during its heyday, as if seized the Mediterranean Sea into its embrace and turned its huge water spaces into the "Inland Sea" of the empire - mare nostrum (our sea).

To the full extent, this will also be applied to the concept of “medicine of ancient Rome”, which in some cases means medicine of the ancient city of Rome, in others - medicine in the Roman Republic, and third - medicine in the Roman Empire.

Periodization of history and medicine

There are three main stages in the history of ancient Rome: 1) the tsarist period (VIII — VI centuries BC), when ancient Italy did not represent a single state, but was a combination of independent city-states, including Rome; 2) the period of the republic (510–31 BC), when the city of Rome subdued the territories of ancient Italy and began aggressive wars outside the Apennine peninsula; 3) the period of the empire (31 BC - 476 AD) - the heyday, and then the crisis of the slave-owning formation in the Mediterranean region, which was ruled by Rome.

The development of medicine and medical knowledge in each of these periods has its own characteristics and significant differences (Table 9). Sources on history and medicine: literary monuments (works of doctors, philosophers, poets), data of archeology, ethnography, material sources.

DOCTORS IN THE CZARIAN PERIOD (VIII — VI centuries BC.)

According to the tradition, initiated by Mark Terentius Varro (M. T. Varro, 116—26 BC. E.), The founding of the city of Rome is 753 BC. e. As a city-state, Rome was formed in the VI. before ya-e Legend has preserved the names of seven kings, of which the last three came from the Etruscan dynasty of Tarquinia.

The culture of the Etruscans had a significant impact on the culture of the Romans: the inhabitants of the city took from the Etruscans their writing and the so-called Roman numerals, clothing (lat. Toga - veil) and urban planning skills, customs and religious beliefs. Under Tsar Tarquinius the Ancients (6th century BC), the city began draining swampy areas through canals, a drainage system was built, and Cloaca maxima (which is still in operation today) was built, Fig. 49.

Further construction of sanitary facilities

Formation and development of military medicine Organization of military valletudarians and jacks, denarii in slave estates (for slaves)

Introduction of posts of archiatrists (palace provincial and city) (I-IV centuries). Creation of public and private medical schools

Further development of Roman law and regulation of the activity of doctors Development of encyclopedic knowledge

The Etruscans are considered the first builders of temples in Italy. The priests-fortune-tellers - haruspex (Latin haruspex), united in the collegiums of priests, occupied an important place in Etruscan society. They were supposed to be engaged in fortune-telling on the inside (mainly of the liver) of sacrificial animals (Fig. 50), to interpret the customs and phenomena of nature. Garuspiki were invited to the court, were in the retinue of the generals; their councils entered into force after the relevant decision of the Senate. The Etruscans achieved success in the processing of metals. Their dentures, made of animal bones and fastened with the help of a gold bridge, are known (Fig. 51).

In the royal period of history (and until the end of the 3rd century BC.) There were no professional healers in the city of Rome — they were treated at home with folk remedies: herbs, roots, fruits, their decoctions and infusions, often in conjunction with magic plots . According to the testimony of a prominent writer and statesman Marc Portia Cato (M.P. Cato Maior, 234-149 BC), for centuries cabbage was considered the most popular remedy: “Cabbage from all vegetables is the first,” wrote he is in the work "Agriculture." - Eat it boiled and raw ... It is a miracle how it helps digestion, sets the stomach, and the urine of the one who eats it serves as a cure for everything ... Naters, apply it to all wounds and boils. .. She will cure everything, expel the pain from the head and eyes ... "

In the imperial period, Greek medicine has not yet found its place in Roman soil.

MEDICINE OF THE PERIOD OF THE REPUBLIC (the end of the 6th century BC - 31 BC)

Conventional boundary between the royal and republican periods of the history of ancient Rome is 510 BC. e. — the year of the uprising of the Romans, the overthrow of the Etruscan king Tarquinius Proud and the approval of the republic (Latin res publica - a popular cause).

In the field of medicine, this period marks: the development of sanitary legislation and the construction of sanitary facilities; the emergence of professional doctors, the establishment and development of a medical case and elements of its state regulation; the formation of the materialist direction in medicine.

Sanitary business

The earliest written evidence of the attention of citizens of the city of Rome to sanitation measures were the “Laws of the XII tables” (Latin Leges XII Tabularum 451–450 BC), the brevity and simplicity of which to this day delight lawyers. Composed in the early republic period under pressure from the plebeians, they were a typical example of the code of laws of an early class society (protection of patriarchal traditions, a combination of the principle of talion and monetary fines, etc.). Thus, table VIII reads as follows: If it causes self-mutilation and does not reconcile (with the victim), then let him do the same thing himself.

3. If with a hand or a stick breaks a bone to a free person, let him pay a fine of 300 asss, if a slave is paid 150 asss.

According to the “Laws of XII Tables”, “a baby (distinguished) with exceptional deformity” must be deprived of life (Table IV. 1). Such cruelty at that time in the history of Pu-1 ma was, in all likelihood, determined by the harsh conditions of the transition period from primitive to early class society in a specific socio-economic situation.

A number of paragraphs of the “Laws of the XII tables” directly concern the protection of the sanitary condition of a city (Rome):

Supervision of the implementation of these and other laws was assigned to the city magistrates - edils (from the Latin. Aedes - the temple), who were not doctors. Edily monitored the construction, condition of streets, temples, markets and the term, were engaged in the distribution of grain, the organization of public games and the protection of the state treasury. The rights of the edils were enshrined in subsequent laws. So, the Heracle table containing (as scientists assume) the law of Julius Caesar (100-44 BC) on municipalities devotes a number of paragraphs to this. One of them says:

“Every owner of a building, in front of which there is a footpath, must contain this path throughout this building, which is well paved with no cracks, in accordance with the instructions of the aedila, who is in charge of monitoring roads in this part of the city”.

In the period of the early republic in Rome, the construction of aqueducts began (from the Latin aqua — water, ductus — conduction), since underground sources already could not provide all residents of the city with clean drinking water, and water of the r. The Tiber in connection with the flow of impurities into it through the cloaca system in the IV. BC e. was so polluted that it was prohibited by law to use it as drinking water. The first aqueduct in the capital of the Republic of Rome, 16.5 km long, was built in 312 BC. e. under the censor Appia Claudia. He was called so — Appiavia (Aqua Appia). He delivered drinking water from the keys located not far from the r. Anio. Forty years later, in 272 BC. A second aqueduct (Aqua Vetus), 70 "km long, was erected. In 144 BC, a third aqueduct (Aqua Marcia) was built, which is still in operation. Its length was 61 km, of which the last 10 km There were eleven aqueducts (fig. 52) with a total length of 436 km, of which 55 km - on arched bridges (two Roman aqueducts still supply the city with water). the city of 1.5 million cubic meters of clean drinking water from the Sabine Mountains. In terms of per capita in the capital of the Roman Republic, from 600 to 900 liters of water were consumed daily (for comparison, we note that in pre-revolutionary Petersburg, 200 liters of water per day were supplied per capita).

Aqueducts are not the invention of the Romans, who borrowed this idea in the East during the conquest. So, in the VII century. BC e. (three centuries before the first Roman aqueduct) in Assyria from the time of Sinanheriba, a majestic aqueduct was built (it went down in history under its name), which, crossing valleys and ravines, rested on arched bridges (see p. 51).

Under Roman rule, aqueducts began to be built in both the eastern and western provinces of the empire. As a result, about 100 cities were supplied with clean water using aqueducts.

Roman aqueducts were also found during excavations of ancient cities on the territory of our country. Thus, in Chersonesos, six lines of underground water supply from pottery pipes were opened. Built by the Romans 18 centuries ago, this water supply system for centuries supplied the city with clean drinking water from Balaklava heights for 6-10 km. It was used during the Crimean War of 1854–1855, and one of the lines of the ancient Khersones water supply system still supplies water to the city of Sevastopol.

The aqueducts of ancient Rome were protected by law. Control over the technical condition of this colossal water supply network was carried out by a special water authority - Curato-res aquarum. For deliberate damage to water pipes and water towers, a heavy fine was imposed on the guilty (100 thousand sesterces). If the damage was done without malicious intent, unintentionally, then the perpetrator should have immediately eliminated it.

The colossal amount of water that Rome consumed during its heyday was distributed between the imperial palace, public institutions (baths, markets, warehouses, gardens, amphitheatres, etc.) and numerous fountains, of which there were more than 600. as a rule, water was not supplied. She was either bought from water carriers ^ or went after her to the fountains. The lack of water in the house had its effect and the lack of sewage in residential areas: the Romans used public toilets, and carried out the garbage on the street. In this respect, the civilization of ancient India is favorably distinguished (see p. 69): as early as the middle of the 3rd millennium BC. e. in the city of Mohenjo-Daro, in each house there was not only a water supply system, but also pipes for drainage of sewage to main canals.

The first terms (Greek. Thermae - hot baths, from thermos - warm) of the city of Rome were built in the 3rd century. BC e. Mark Agrippa, who gave them free use of the population of the city. To ensure their maintenance, he singled out special estates, and to supply the thermal water with water, he conducted a new aqueduct to them.

Wishing to gain popularity among fellow citizens, many rich Romans (including emperors) built the terms of their name and bequeathed them in free use of the city’s population for all eternity (and also allocated special estates for which the baths were kept). Thus, in the city of Rome there were not only private terms (fee, in which was insignificant), but also public, which belonged to the city. Public terms could visit and the emperor. Their restoration or repair was a public matter, which is noted in special construction inscriptions and on sacrificial altars.

By the end of the period of the republic, in the city of Rome there were 170 public terms, and by the time of the decline of the empire (IV century) there were already about a thousand. The capacity of the capital's term allowed dozens and even hundreds of thousands of people to wash at the same time.

As a type of building, the terms were formed in their basic features already in the Republic-period (to the II century BC), but they received the greatest development in the period of the empire (p. 121).

The magnificent decoration of the term gave! they resemble museums. The walls of their voz-1 moved from the magnificent varieties of marble. Inside the walls and under the floor! special pipes were laid! for hot air heating or! heated water. This method of otap-1 casting of premises satisfies the highest sanitary and hygienic | skim requirements (lack of carbon monoxide smoke; maintaining a constant temperature; favorable conditions for maintaining wall pocrai-j si, which remained dry even in bathrooms).

There were numerous rooms in the baths: a sports hall (palaest-j ha), a dressing room (apodyterium), a tea-burning bath (caldarium), a warm bug (tepidarium), a cold bath (frigids rium), a swimming pool (natatio). In the imperial terms, there were also libraries, halls for feasts, meetings of meetings, where philosophers and scientists debated for hours. The inner rooms were decorated with paintings, columns and sculptures of white marble. Among them, the place of honor was occupied by the images of Asclepius and Hygiene. Many museums of the world decorate, today, works of ancient art found in Roman terms.

A vivid idea of ​​terms is given by the lines from the letter of the Roman statesman, philosopher and writer Lucius Anne Seneca (LA Seneca, 4–65):

“A man will be considered a poor and poor person if huge circles of precious marble do not sparkle in the walls of his bath ... if water does not flow out of silver taps ... now they will call a bath if it is not set so that the sun flooded it all day long through huge windows, if it is impossible to wash and sunbathe in it at the same time, if it is impossible to see the fields and the sea from the bath ... now the bath is heated to the temperature of the fire; a slave convicted of a crime should only be washed here. In my opinion, there is no difference between a heated bath and a fire. ”

According to the traditions of the then medicine, the bath was one of the most effective medical products and in the treatment of certain diseases it was not without it. In the work of an unknown poet the following words speak about the healing properties of the bath:

The gifts of many in the bathhouses we find: They can soften phlegm, take body moisture, Excess bile is being driven from the intestines, They soothe the itching, - it is pleasant and annoying, - And they sharpen vision; if someone began to hear poorly, they clean their ears with that. 1 Forgetfulness is carried away, but the memory is kept, For reason, the mind clarifies in a moment, By a lively conversation, the speech is directed, And the body shines from washing there

Translation by Yu. F. Schulz

Thus, the Roman terms were hygienic, medical, social and cultural centers. Erected by slave labor, they were a wonderful gift that emperors made to the Roman population.

Beginning of the organization of medical affairs

It was already noted above that in ancient Italy up to the 2nd c. BC e. dispensed with professional healers Greek medicine was considered an expression of effeminacy and luxury. This point of view in no small measure contributed to the stagnation in the development

Medicine in ancient Italy. The first doctors there were slaves from among prisoners of war, mainly the Greeks (from Greece, Asia Minor, Egypt). A whole series of “intelligent” professions were monopolized by the Greeks, as it were. The layer of the slave intelligentsia in Rome, especially in the last years of the republic’s existence, was especially numerous, and the contribution made by the slave Greeks to the creation of Roman culture was very tangible. Roman teachers, doctors, musicians were almost without exception Greeks. Every wealthy Roman citizen sought to acquire a slave doctor (servus medicus). A slave treated his master and his relatives.

The high cultural and professional level of the slave doctor gradually raised him in the eyes of the owner. The free practice of such a specialist seemed to the slave owner to be very profitable, therefore, for a fee, they began to let the slave specialists for free earnings.

The otpushchennik doctor was obliged to treat his former owner, his family, slaves and friends free of charge and give him a portion of the income. Legally, the release doctors remained dependent on the slave owners, and Roman society for a long time treated them with some contempt.

At the end of the III - the beginning of the II. BC e. Free doctors of Greek origin began to appear in the capital of the Roman Republic. The first free Greek physician in Rome is considered to be the Peloponnian Archagat (Greek Archagathos). He arrived in the capital in 219 BC. e. and was warmly received by the townspeople. He was granted the right of Roman citizenship and was allocated a state house for private practice. The beginning of activities brought great popularity to the Archagat. However, soon the cauterization and the surgical operations that he performed sharply changed the attitude of the Romans towards him: they called him the “Flayer” and stopped referring to him.

It took several centuries before Greek medicine gained recognition in the capital of the Roman Republic. An important milestone in this regard was the edict (decree) of Julius Caesar (100–44 BC), which in 46 BC. e. granted the honorary right of Roman citizenship both to visiting doctors — immigrants from Greece, Asia Minor, Egypt and other provinces of the state, and to local residents who studied medicine. Later, in the period of the empire, the decree of Emperor Constantine (337) established: 118

“Artisans living in cities are exempt from all duties, as leisure is required to study the craft, especially since they want to improve themselves and train their sons. The list is as follows: architects, doctors, veterinarians, painters, sculptors ... (33 more artisan professions are listed below) ”. It is important to note that doctors and veterinarians in this series are among the first. Thus, in the Roman Republic, elements of state regulation of the medical case began to manifest themselves, which were consolidated and approved during the period of the empire.

The philosophical foundations of medicine of ancient Rome

The worldview of the Romans was largely influenced by the culture and philosophy of the peoples that were part of the Roman Empire at certain stages of history. First of all, this is true of ancient Greek philosophy. Atomistic teaching, created by the eminent Greek philosophers Leucippus (c. 500-440 BC), Democritus (c. 460 - c. 371 BCE), and Epicurus (c. 342 - c. 270 BC, was included in the philosophy of the ancient Romans and was reflected in the works of the most prominent representative of the Roman Epicureanism - the philosopher and poet Titus Lucretius Cara (Lucretius Carus, Titus, circa 96-55 BC). ). His poem “On the nature of things” (“De rerum natura”) in six books (translated into Russian with detailed comments) was an encyclopedia of that time (fig. 53) and reflected the advanced views of the Romans in the fields of philosophy, natural science, medicine, psychology, history (the idea of ​​development, the denial of the immortality of the soul, the afterlife and the intervention of the gods in the life of the universe). “She was admired by Cicero and Virgil, the church fathers irritated her, rightly suspecting in Lucretia a terrible danger. This poem identified many features of the worldview of Newton and Lomonosov, delighted Herzen, deeply interested the young Marx ... "- wrote in the preface to the publication of the Russian translation of the poem S. I. Vavilov.

In the poem "On the nature of things," Lucretius approached the questions of natural science and medicine from the point of view of atomistic teaching. In a popular form, he talks about the complex structure of living organisms from the smallest moving particles - atoms, expresses the idea of ​​the gradual development of the plant and animal world, the differences in organisms and the transmission of signs by inheritance, the extinction of unsuitable and the survival of adapted organisms. It gives a description of some diseases and quite accurately describes the individual symptoms. In the sixth book of the poem Lucretius presents his ideas about contagious diseases:

Well, now, why do illnesses arise, from where Can suddenly come and blow with a fad on mortals • I will explain the Mora of unexpected power and strike people with herds and herds. There are a lot of seeds of all kinds As I have already indicated, of which there are only life-giving ones, but there are also quite a few of them that lead to illness and death to us. flown. When they come together by chance 'And the heavens will disturb, the air becomes infected. This whole disastrous sea, all these general diseases Or come from the outside and, like mists and clouds From above go through the sky, or from the earth itself arise Together gathering when the wet soil rots. "this hollow trouble and contagion, appearing suddenly May fall into the water of the mouth, or on the bread itself settles Or on other food for people and on the grazing of cattle" Ile continues to hang, remained in the air itself; INHALING Into this dismally mixed air It is necessary to inhale both the disease and the infection.

Speaking of "deadly mixed air", which, when inhaled: carries the seeds of "disease and death" into the human body, Lucretius gave an idea of ​​the miasmatic concept of the occurrence of diseases (the subsequent discovery of microbes will make this hypothesis untenable). At the same time, paying attention to the possibility of spreading infection through water, food and other objects, he outlined the first contours of the contagious concept of transmitting a contagious beginning (without realizing this in a clear report, as P. E. Zabludovsky noted). It will find its further, very deep development in the work of the outstanding Italian scholar of the Renaissance - Giro Lama Frakastoro (1478-1553) "On contagion, contagious diseases and treatment" (1546).

The teachings of Epicurus and the advanced views of Lucretius had a great influence on the Asklepiad from Prusa to Bethiam (Greek Asklepiades, Latin Asclepia-des, 128–56 BC) —the visible Greek physician in Rome. The development of the natural sciences in medicine of ancient Rome is closely connected with the methodical school founded by him. His system (tuto, celeriter et incunde curare - to heal safely, quickly and pleasantly) favorably differed from the methods of healing of the “flayer” of Archagat, the Greek doctor of the previous century.

Asclepiad was a student of erasist-ratori (i.e. followers of Erazist-rata, who moved away from the prevailing humoral theory and preferred solid particles). Hence, it is clear why Asklepiad considered the disease, firstly, as a result of stagnatio (stagnation of solid particles in the pores and channels of the body), and secondly, as a disorder in the movement of juices and pneuma. In his teaching, both ideas about the causes of diseases were united: humoral and nascent solidarity. According to these views, Aoklepiad attached great importance to proper sweating and respiration of the skin (perspiratio insensibilis). His treatment was aimed at restoring impaired functions and consisted of simple and natural measures: a sensible diet, keeping skin clean, hydrotherapy, massage, baths and movement in a variety of ways: Asklepiad advised his patients to walk and ride on-horse in a wheelchair and on a ship, in a word, to be in constant motion (today, in the “age of hypodynamia,” these recommendations sound particularly relevant). He advised paralyzed to be worn on carpets and to sway. According to Asklepiad, the main task of such treatment is to expand the pores and set the stagnant particles in motion; the success of the treatment was also facilitated by the detailed development of each method and its strictly individual application; medication was rarely prescribed. Asclepiad was firmly convinced that a person who has sufficient medical knowledge will never get sick. He himself was the first example of this, because he never got sick and died in old age as a result of an accident.

The Asklepiad methodical system had a positive effect on the subsequent development of medicine in the period of the empire and the natural science direction in medicine as a whole.

MEDICINE OF THE PERIOD OF THE EMPIRE (31 BC - 476 AD)

The history of the Roman Empire covers five centuries - from 31 BC. e. up to 476 y. e. —This is the heyday of the slave formation in the Mediterranean region (Fig. 54) and its fall. The period of the empire can be divided into two stages: the early empire (31 BC - 284 AD) and the late empire (III — V centuries).

The Roman science of this period, in general, kept emtshrichesko-descriptive, compilative nature and practicality peculiar to her. Proceeding from the aforesaid practice, agriculture, theory and. the practice of law, mathematics and related sciences, the construction of public buildings, including term and aqueducts, continued. During the period of the empire of Rome, the most famous baths were built: under the emperors Nero (Claudius Drusus of Germany Caesar Nero, 54-68), Marcus Aurelius North Antonina (nicknamed K'arakala) (211-217), and Alexander North ( 222-253). The terms of Caracalla are best preserved (their official name is Antoninov); they were famous for the beauty of their architecture and the splendor of the internal painting; in V c. n e. they were considered one of the miracles of Rome (fig. 55). A large number of works of ancient art were found in the terms of Caracalla: statues of Hercules and Flora, the Farnese bull, the torso of Apollo Belvedere.

The development of medical affairs during the empire was one of the manifestations of Roman practicality and was most clearly expressed in the development of military medicine.

The formation of military medicine

Beginning with the first dictator Sul-ly (Cornelius Sulla Lucius, 83-78 BC), the power of the Roman emperors had a pronounced military character and relied on the army. Long before the final fall of the republic, the Roman army, remaining de jure civilian militia, de facto turned into a professional army, the final formation of which was completed under the emperor Augustus (27 BC - 14 AD). His military reforms gave the army the form it has maintained for almost two centuries.

At the time of Augustus, the Roman army consisted of 27-28 legions (5-6 thousand people each), and by the end of his rule - out of 25; they stood in the provinces of the empire where martial law was the most uncertain (on the Rhine and Danube borders, in Egypt, north-west Spain, etc.). Legions and praetorian cohorts (emperor’s personal guards) were recruited only from Roman citizens; auxiliary troops (horse ala and foot cohorts, no more than a thousand people each) were accepted as provincials. The total number of soldiers during the time of Augustus ranged from 250 thousand to 300 thousand people; half of them served in the legions, half - in auxiliary troops. The service life in the Legion was 20 years, in auxiliary vy-skakh - up to 25 years; before the resignation of the soldiers had no right to marry.

The final formation of the army and the extensive aggressive campaigns required a large number of professional doctors. They were available in all divisions (legions, cohorts, alahs) and in all branches of the military (in earlier periods in the history of Rome there are no references to army doctors). Each cohort had four surgeons; in the fleet on each "warship, there was one doctor. Each soldier was supposed to have with him the necessary dressing material to give first aid to himself and wounded comrades. This is evidenced by the well-known relief (Fig. 56) on Trajan’s column (Mark Ulyshy Trayan, 98—117 BC.).

After the battle, the wounded were taken to the main cities or military camps, where (approximately from the second century) military institutions were set up for the wounded and sick - the valletudinarians of the Lat. valetudinarium) one for every 3-4 legions. The staff who served them consisted of doctors, housekeepers, instrumentation and junior staff. The tools were in charge of tools, drugs, dressings. Junior staff, mainly from among the Zab, were used to care for the Ash.

This system of rendering medical assistance to wounded soldiers was adopted subsequently in the Byzantine Empire and supplemented with a number of innovations. So, no later than the VI. in the Byzantine army, special sanitary teams began to be created, which consisted of civilian soldiers (they were called “deputati”), out of eight to 10 people for every 200—. Yuo warriors. Riding on horses behind the line "oy deputati picked up the wounded and brought the gh to the Valetudinarium. For this purpose, their saddles were two straps on the left side. De-putati carried jars of water with them, and possibly provided first aid. For each rescued, warrior they were paid in gold.

State (civil) hospitals in ancient Rome was not yet: doctors visited the sick, and the sick came to their home.

At that time, special valletodinarians were organized in slave estates for slaves who were served by medical slaves. Columella wrote about this (Lucius Junius Moderate Columella, 1st century) - a prominent Roman writer and agronomist, in his work “On Agriculture” (“De re rustica” in 12 books). However, as a rule, slaves were not treated. In the capital, the owner believed that he had the right not to provide any assistance to the sick slave: he was sent to Fr. Askle-epia (or St. Bartholomew) on r. Tiber and left there to die. In the event of recovery, such a slave became free and, according to the edict of the emperor Claudius (Tiberius Claudius Nero of Germany, 41-54), should not have returned to the slave owner. At the dawn of feudalism, the emperor. Byzantium, Justinian (527–565) went even further: the slave, abandoned by his master during his illness, freed from slavery, became a free citizen, not dependent on the former master. These tendencies were a reflection of the general crisis of the slave-owning mode of production and contributed to the formation of new feudal relations.

Medical development

Along with military medicine during the empire period, medical business developed in cities and individual provinces, where state authorities began to establish paid posts for doctors - arhiatry (Greek ag-chiatros - "supreme" doctor, from Greek arche - beginning, iatros - doctor) who were united in the collegiums (the heyday of the colleges falls on the period of the empire). At the emperor's court, archiatri palatini served; in the provinces — ag-chiatri provinciales; in the cities — archiatri populares (the title was introduced into the reign of Emperor Constantine, 306–337), 5–10 doctors depending on the number of population. The first imperial archiatrist in Rome is considered to be Xenophon (I century AD), the personal physician of the emperor Claudius, whom Claudius represented as a native of Fr. Kos and the descendant of the legendary Esculapius (as the Romans called the god of healing Asclepius).

Combined in the college, archi-atry were under the control of the city authorities and the central government, which strictly monitored their elections and appointments. The election procedure was like a rigorous exam; after that, the doctor received the title of “Medicus a Republica probatus” (“State-approved physician”). The arhiatry worked at the unions of artisans, in baths, theaters, circuses, etc. They had a permanent salary, but could also engage in private practice. An outstanding doctor of the ancient world, Galen, a Greek by birth, in his youth for a number of years worked as a doctor in the school of gladiators in Pergamum. There is information about the involvement of doctors as forensic physicians. Thus, in the "Biography of the Twelve Caesars" it is said that the doctor Antistius participated in the investigation of the murder of Julius Caesar:.

he was pierced by twenty-three blows, and only at the first he moaned ... And of so many injuries, the doctor Antistius acknowledged that only one — the second one — inflicted in

chest.

The duties of the head of the city ar-Hiatry included the teaching of medicine in special schools, which were established in the years. Rome, Athens, Alexandria, Antioch, Take and others. Anatomy was taught in animals, and sometimes in the wounded and sick. Practical medicine was studied at the bedside:

I was sick, but here to me, not a bit slow,

You appeared, Symmachus, with hundreds of your scholars.

They began to feel me a hundred hands, icy from the cold:

Without fever, Symmachus was me, and here she was.

Martial (43 — approx. 1.04). V. 9.

The law strictly defined the rights and duties of students. They had to give all their time to the teaching. They were forbidden to participate in feasts and make suspicious acquaintances.

Along with government medical schools in the Roman Empire, a small number of private schools for the training of doctors appeared. One of them (in all likelihood, the first one) founded Asklepiad.

By time, the position of the doctors in Rome has strengthened. They got big rights, exemption from burdensome duties and even benefits. During the war, doctors and their sons were exempt from common military service. Such privileges attracted foreign physicians in Rome, which led to their abundance, competition and, as a result, to narrow specialization. By the end of the II. in the capital of the empire there were eye and dentists, specialists who treated only diseases of the bladder, surgeons who performed only one operation (for example, hernia repair or stone-cutting). The position of the doctor in the Roman Empire was significantly different from the position of the doctor in ancient Greece, where the doctor was free from duties to the state (in ancient Greece, healers were employed only in the case of general diseases or during military campaigns, by their voluntary consent).

The development of medical knowledge

The Roman science of the empire period had an empirical-descriptive and applied character, typical of Roman practicality. Having absorbed the achievements of all the peoples of the Mediterranean, it was formed as a result of the transformation and mutual penetration of ancient Greek and Eastern cultures.

These tendencies were most clearly expressed in the multivolume (more than 20 volumes) encyclopedia “Artes” (“Arts”), 1 compiled by Avl Cornelius Celsus (Ce'sus, Aulus Cornelius, 30/25 BC - 45/50 N. e.) in Latin. Only eight volumes (VI-XIII) devoted to medicine have reached us (“De medicina”, fig. 57); They were discovered in the middle of the XV century. (ca. 1443) and first published in Florence in 1478. As a widely educated man and a wealthy slave owner, Celsus attracted a large staff of translators and copyists who translated numerous works on philosophy, rhetoric, law, medicine, agriculture and military affairs of the Greek Alexandrian, Indian and other authors; Many of these essays have not survived to our day, and we know about them only thanks to Celsus (for example, the writings of Herophile and Erazistratus - there would be a significant gap in the history of the Alexandrian school of medicine without the treatise of Celsus).

According to Galen, Celsus compiled his “practical guide by treating patients in his or her ward (for slaves)”. He described in detail the achievements of Roman medicine in the period of the early empire in the field of dietetics, hygiene, theory of disease, therapy, and especially surgery. The description given by him of four signs of inflammation (redness, swelling, fever and pain), as researchers believe, is borrowed from ancient Indian treatises; however, the samhites of Charaka and Sushruta could not be them, since modern science dates these works of the second and fourth centuries. n e., and Celsus compiled his encyclopedia during the times of the emperor Tiberius (Tiberius Caesar Augustus, 14—37 AD), that is, at the beginning of the first century. n e. Treatise Celsus made a significant contribution to the development of scientific Latin terminology (after T. Lucretia). His language, according to Pliny the Elder ,, classical - "golden Latin".

Pliny the Elder (Plinius Secun-dus, 23/24 - 79 AD) is another prominent representative of the encyclopedic direction, in Roman prose, a writer, scholar and statesman, distinguished by an exceptional inquisitiveness in nature’s observations (he died during eruption of the volcano of Vesuvius, which was observed from the ship, approaching the volcano). Of the many works of Pliny, only “Natural History” (“Historia naturalis”) has been preserved in 37 books; it summarizes the knowledge of that time on astronomy, geography, history, zoology, botany, agriculture, medicine, mineralogy (Pliny analyzed over two thousand works of more than a hundred authors). Books of XXIII — XXVIII of his work are devoted to the review of medical knowledge. . Drugs of animal origin are described in books XXVIII — XXXII. For many centuries, the Natural History of Pliny was one of the main sources in the field of the natural sciences.

Along with strictly scientific knowledge, Pliny presented paradox-graphographers and even folk beliefs. This is consistent with the tradition of book encyclopedic knowledge characteristic of late antiquity. Thus, book VII contains information on anomalies of human nature (paradoxography): on the birth of twins and triplets, on freaks babies, and even on the transmission of signs by inheritance in the “fourth generation”. Pliny also narrated the superstitions and prejudices of that time: he described the phoenix bird and the hippo-pentaurus, which, he claims, he saw himself in embalmed form.

Pliny's contemporary was the eminent Roman military doctor Dios - the corridor of Pedania from Cilicia (ancient Greek).

Dioskurides, lat . Dioscorides Pedanius, I c . n e .), a native of the Greek . His essay “On Medical Matter”, i.e., on medicinal plants (“De materia me-dica”, Fig. 58), written in Greek, contains a systematic description of 600 medicinal plants used in medical practice during the time of the emperor Claudia (41-45) and Nero (54-68). Work Dioskorida enjoyed unquestioned authority until the XVI century. and played a significant role in the development of plant taxonomy. In the Byzantine Empire, and then in the Arabic-speaking East, it was the main source of knowledge about the plant world. In the Arabic translation, he became known in medieval Western Europe.

The most valuable copy of Dioskorid’s work that has come down to us is an illustrated manuscript, rewritten no later than 512 by order of the citizens of Perra (suburb of Constantinople) for Juliana Anikia, daughter of Caesar Flavius ​​Onius, as a token of gratitude for the foundation of the church. Currently, it is stored in the Austrian National Library in Vienna, from which it got its name - "Dioscorides Vienna".

The development of surgery during the empire is evidenced by sets of surgical instruments found during excavations of ancient cities: in the “surgeon's house” in Pompeii (Fig. 59), in Baden, Bingen, Chersonesus and Blvia (in our country), etc. forceps, forceps, grabs, spoons, retractors, bone saws, surgical knives and needles, catheters, obstetric mirrors and other instruments used in surgery and obstetric and gynecological practice.

The most extensive in all ancient literature essay on obstetric aid, gynecology and childhood diseases was composed by Soran of Ephesus (Soranus, 98-138), a Greek physician who practiced in Rome at the beginning of the 2nd century. Of the twenty works written by him, the works “Gynecology”, “On dressings”, “On fractures” have come down to us.

Soran belonged to the methodical medical school. In the process of obstetric aid, he tried to move away from coarse and violent methods as much as possible, described methods of preventing rupture of the perineum, turning the fetus on the pedicle and head (Fig. 60), embryotomy surgery, developing various methods of examination (probing, tapping, hearing sounds in the area fetal, the study of pulse, sputum, urine). He paid great attention to the care of children at an early age: infant dietetics, the rules of breastfeeding, etc. In subsequent epochs, the works of Soran became widespread in the Middle East and Western Europe and up to the XVIII century. were considered the main source of knowledge on obstetrics, gynecology and treatment of young children.

In the peribd of the late empire, the fate of Roman culture, including philosophy, natural science and medicine, was largely determined by the general political and economic crisis. As a result, dualistic trends have intensified in many branches of the natural sciences.

Contradictions inherent in the late ancient science, clearly manifested in the writings of an outstanding astronomer, astrologer and mathematician of antiquity Ptolemy from Ptolemiad (lat. Ptolemaeus, ca. 83 - ca. 116). On the one hand, he created an outstanding work “The great mathematical construction of astronomy in 13 books” (in Arabic translation. It is known as “Almagest”), in which he substantiated the theory of the geocentric motion of planets accepted at that time (it existed in science before 1543 when it was refuted by N. Copernicus, who justified the heliocentric system). On the other hand, it is Ptolemy who owns one of the largest works of ancient astrology, the Four Chelsea (Tetrabiblos), which sets out ideas about the influence of celestial bodies on humanity, continents and natural phenomena in Yayla. Astrology * in the Roman Empire was in high esteem. Astrologers were invited to the service of the court. Their main task was to compile horoscopes.

This duality characterized the activities of many scientists of the period of late antiquity. In the field of medicine, this dualism is clearly manifested in the activities of the greatest doctor of the ancient world - Galen.

Galen: his teaching and galenism

The outstanding physician of the ancient world, Galen of Pergamum (Galenos, 129–1999), a Greek by birth, was born in the city of Pergamum (now Bergamo, Turkey) in a family of mathematician and architect Nikon. At the age of 14, Galen began his studies at the school of philosophy, where he became acquainted with the teachings of the Stoics, Platonists, Peripatetics, and Epicureans. From the age of 17, he devoted himself to medicine, which he studied in Pergamum, Smyrna, Corinth, Athens, but especially in Alexandria, where his teachers were the followers of Herophilus and Erazistrata.

With great care, Galen studied the works of his predecessors and contemporaries (he knew many languages, but wrote his works in Greek). Subsequently, quoting them or referring to them, Galen retained for subsequent generations the names and achievements of those whose writings were killed or burned during numerous fires of manuscript repositories.

Galen traveled a lot: visited Cyprus, Palestine, Lemnos, Cappadocia, Aquilea. Returning to Pergamum, he worked for a number of years (157-161) as an archiatrist at a school of gladiators. After the uprising of gladiators, Galen moved to Rome, where he became famous for his lectures and successful medical practice. Since 169, Galen has been the court archiath of the Roman emperors.

Galen is recognized as the author of more than 125 works on medicine, of which about 80 have survived to the present (fig. 61). The most important among them are: "On the designation of parts of the human body" ("De usu partium cor-poris humani"), "On anatomy ..." ("De anatomicis administrationibus. Libri I — IX"), "Therapeutic methods" (" De methodo medendi ”),“ On diseased parts of the body ”(“ De locis affectis ”),“ On the composition of medicines ... ”(“ Decomposition of medicamentorum ... ”, etc.). Several of Galen’s works are devoted to the comments of Hippocratic collection, thanks to which many of them have reached our time;

The natural scientific position of Galen manifested itself in his extensive medical practice and research in the field of anatomy and physiology (Greek. Physiologia - the study of life processes, from the Greek. Physis - nature and logos - the teaching). By the time Galen arrived in Alexandria, sections of human corpses had stopped there (influenced by Christianity), and Galen dissected monkeys, pigs, dogs, ungulates, and sometimes even lions and elephants; often produced vivisection. The data obtained from the numerous autopsies of animals, he endured to human anatomy. So, in the treatise "On the anatomy of the muscles," he described about 300 muscles. Among them are those that are absent in man and exist only in some animals. At the same time, Galen did not describe the muscle, which is characteristic of the human hand, opposing the thumb. Subsequently, this and many other mistakes of Galen were corrected by the outstanding anatomist of the Renaissance Andreas Vesalius (1514-1564).

Galen studied in detail the anatomy of all body systems. He described the bones, muscles, ligaments, internal organs, but his achievements in the study of the nervous system are especially great. Galen described all parts of the brain and spinal cord, seven (out of twelve) pairs of cranial nerves, 58 spinal nerves and nerves of the internal organs. He widely used the transverse and longitudinal sections of the spinal cord in order to study the sensory and motor disorders below the section.

He described in detail the anatomical structure of the heart, coronary vessels to the arterial (botall) duct. Moreover, Galen had mistakenly thought that the septum of the heart was blood-permeable (as is the case with the fetus). In his opinion, the blood could easily pass from the right heart to the left heart, bypassing the peripheral vessels and the known circulation circles (Galen did not know the circular movement of blood). For many centuries, this erroneous point of view was considered absolutely correct in Europe and was not subject to criticism until the 16th century, when the Spanish scholar M. Theros in his work “The Revival of Christianity” for the first time (in Europe) described the small circle of blood circulation (see . p. 185). The mathematical and experimental substantiation of the circular movement of blood was given only in 1628 by the English scientist William Harvey.

Galen was widely practiced. His teaching about the disease was humoral in nature and was based on the ideas of the four main juices of the body: blood, mucus, yellow and black bile. He was an experienced surgeon and considered anatomy the foundation of surgery. “I often had,” he wrote, “led by the hand of surgeons who were little sophisticated in anatomy, and thereby saved them from public shame.”

Galen made a great contribution to the development of pharmacology. A number of drugs obtained by mechanical and physico-chemical processing of natural raw materials (as suggested by Galen), so far called "herbal preparations" (the term introduced by Paracelsus, 1493-1541).

Galen lived in the period of decomposition of the slave system, when idealistic tendencies revived in philosophy. A great influence on the formation of Galen's worldview was exerted both by Plato’s philosophy, which, along with cosmological dualism (ideas and matter), recognized anthropological dualism (of body and soul), and Aristotle’s teaching on the expediency of everything created in nature (teleology).

Proceeding from Plato's teachings about pneuma, Galen believed that in the body “pneuma” dwells in various forms: in the brain, “spiritual pneuma” (spiritus animalis), in the heart — “vital pneuma” (spiritus vitalis), in the liver -S- "natural pneuma" (spiritus natu-ralis). He explained all life processes by the action of non-material “forces” that are formed during the decomposition of pneuma: the nerves carry “spiritual strength” (vis animalis), the liver gives blood “natural strength” (vis natu-ralis), the pulse arises under the action of “pulsating force” . (vis pulsitiva) and m, p. Similar interpretations gave idealistic content to the painstakingly collected experimental material of Galen. He correctly described what he saw, but interpreted the results in an idealistic way. This is the dualism of the teachings of Galen.

In the Middle Ages, the Catholic Church and the scholastics (see p. 171) used the idealistic aspects of the teachings of Galen and associated them with theology. Thus, Galenism arose - a distorted, one-sided understanding of the teachings of Galen. The denial of Galenism, the restoration of the true content of the teachings of Galen, and then the correction of a number of erroneous provisions of this doctrine required many centuries.

The teachings of Galen and its importance for the development of science can not be overestimated. For 14 centuries, Galen's works were the main source of medical knowledge in the Near and Middle East and in Europe. In the history of science, Galen was and remains the ancestor of experimental anatomy and physiology, a brilliant therapist, a pharmacist and a surgeon — a doctor-philosopher and researcher who knows nature. He belongs to the pleiad of prominent scientists of the world.

From the 2nd the territory of the Roman Empire began to shrink under the onslaught of neighboring states and tribes.

In 395, after the death of Emperor Theodosius, the once mighty empire was divided into two parts: the Western Roman Empire, which fell in 476, and the Eastern Roman Empire, which existed until 1453. The fall of the slave-owning system of the Western Mediterranean meant the beginning of a new period of human history - Middle Ages and their characteristic new social, device - feudalism. The culture of feudal society (including medicine) was born in difficult economic, social and political conditions. However, despite all the difficulties of development, its most important source was the achievements of the great civilizations of the ancient world, which formed the basis of the entire subsequent development of humanity.