"Influenced by the social order": the historian of medicine - about the oldest surgical operations and the formation of the natural sciences

- Elena Ilyinichna, during recent excavations in Israel, scientists managed to find the remains of two brothers, one of whom was subjected to craniotomy during his lifetime.

The age of the remains is the 15th century BC.

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When were surgeries first started and how difficult were they?

When did medicine appear as a separate occupation?

- It is believed that medicine appeared at the moment when a person realized the value of the life of another person.

And this happened back in primitive society - even then people began to provide each other with medical care.

The Israeli find is not the first of its kind.

So, in 1926, during excavations on the territory of Armenia, a trepanned skull of a resident of the ancient state of Urartu (from the 8th to the 6th century BC) was found.

There is not only archaeological, but also ethnographic and historical evidence that people have resorted to such operations since ancient times.

The nature of the holes on the found turtles suggests that people lived for a long time after such an intervention.

Often they had a ritual meaning: according to ancient beliefs, trepanation allowed the release of an evil spirit that inhabited the human body.

• Skull of the Stone Age with traces of trepanation, found in the town of Chalagantepe (Aghdam region).

  5th millennium BC

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  Museum of the History of Azerbaijan, Baku

• © Wikimedia Commons / CC BY 3.0 / Stanislav Kozlovskiy

As for other surgical operations, primitive people could do limb amputations in case of injury.

Of course, complex operations were then still inaccessible, primarily due to the lack of normal anesthesia.

Although already then used herbal remedies that dulled the pain.

- Is it possible to single out those civilizations of the Ancient World that had the most developed medicine?

And how different are the medical methods from each other?

- Medicine of all ancient civilizations had common features and characteristic differences.

First of all, all the medicine of the ancient world came out of traditional medicine.

One of the hypotheses of the origin of diseases in the ancient world was supernatural (invasion of ancestral spirits, demons, etc. into a person), but traditional medicine has always looked for the cause of the disease in the outside world.

The ancient world was pagan, there were gods of medicine.

In the ancient world, the profession of a doctor arose, which required a certain education.

Medicine professional was temple and secular.

Secular doctors looked for the causes of diseases not in the realm of the supernatural, but in tangible reality, they professed a rational approach.

The development of medicine was greatly influenced by the social order.

For example, although secular doctors appeared in Mesopotamia, over time they were supplanted by spellcasters.

The fact is that the legislation made too high demands on “materialist” doctors.

They were supposed to treat everyone who turned to them.

The spellcasters refused to help the seriously ill if they were not sure of a positive result.

Mesopotamian doctors hypothesized that man is composed of juices.

Subsequently, this hypothesis was adopted in Egypt, and then in Ancient Greece.

Hippocrates developed it, and it became known as humoral and lasted until the 19th century.

According to this theory, four main fluids flow in the human body: blood, phlegm, yellow bile and black bile.

Normally, these fluids are in balance, but an excess of one or more of them causes disease.

• Hippocrates

• Gettyimages.ru

Another interesting feature of ancient Chinese medicine was that the emphasis was always on disease prevention.

This was dictated by the fact that the doctor was paid only if his patients were healthy and not sick.

All the efforts of Chinese doctors were aimed at preventing diseases.

The medicine of ancient India was distinguished by a high level of surgery for those eras, since it was allowed to study the structure of the human body.

The Hindus were able to empirically come to the decontamination of instruments, so they were able to carry out successful operations.

Moreover, they had herbal medicinal painkillers.

As for Ancient Egypt, there medicine was at such a level that there was even a differentiation of doctors.

For example, there were already dentists who were the first to start prosthetic teeth.

— And what role did trade and military-political contacts of ancient states play in the exchange of knowledge?

- A very important role.

The development of science in Ancient Greece was largely due to the fact that, for various reasons, the Greeks were forced to engage in the development of nearby islands and trade with neighboring states.

All this led to the enrichment of Greek culture, the acquisition of new knowledge.

In addition, in ancient Greece they managed to separate theurgic medicine from secular medicine, which contributed to its development.

As the new empire of antiquity, Ancient Rome, emerged, doctors from all the territories conquered by the new state, mostly Greeks, rushed to its capital.

From the 1st century A.D.

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In Rome there was a state medicine.

- Medicine in the Middle Ages in Europe is often associated with self-mutilation and poor sanitation.

Meanwhile, already in the 12th century, universities were operating in Europe, where doctors could study for ten years.

What was the level of medieval medicine?

- After the first centuries of complete decline, starting from the 10th century, a revival of education, including medical education, began on the territory of the former Roman Empire and modern Italy.

And already in the XII century, the first universities began to appear, which were created by the Catholic Church.

The medieval university had only three faculties: law, theology and medicine.

The entire educational process was under the control of theologians, who had a negative attitude towards the pagan knowledge of the Ancient World.

Theologians chose from the works of the outstanding doctors of antiquity only that which corresponded to the views of the church on man and disease.

Of course, this approach was a terrible brake on medicine: doctors literally used the same knowledge and works for centuries, science did not develop.

The system of education changed only in the XVIII-XIX centuries.

• Depiction of a surgical operation, 1345

• Gettyimages.ru

• © Christophel Fine Art

- How complex operations could be performed by doctors in the Middle Ages?

- Abdominal operations in the modern sense began to be carried out only in the second half of the 19th century.

Before that, there were no strong painkillers, no ideas about asepsis and antiseptics, they did not know how to effectively stop bleeding, and also did not have the necessary knowledge of topographic anatomy (a section of anatomy that studies the layered structure of anatomical regions, the relative position of organs. - RT

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In the Middle Ages, surgery was performed not by physicians, but by artisans who passed on knowledge and skills from generation to generation.

Subsequently, surgical schools appeared, but their graduates did not have the status of doctors.

The operations were mostly external in nature, surgeons of that era could perform amputations and remove stones from the bladder.

Due to the lack of anesthesia, surgeons simply had to tie up patients and perform operations very quickly, in a matter of minutes, so that the person would not die from pain shock.

Not to mention post-operative complications, such as sepsis, from which many patients died.

Mortality after surgery was very high, reaching 90%.

- It turns out that the appearance in the 19th century of effective anesthesia and antiseptics, their widespread use was a big breakthrough and 

- The first developed state system for providing medical care to the population was created in the USSR.

The Bolsheviks believed that medical care should be free and accessible to all segments of the population.

At the same time, they themselves relied on the experience of tsarist Russia, where there was a developed system of medical care.

It was divided into public, private, charitable and zemstvo medicine.

Zemstvo medicine appeared after the abolition of serfdom and was unique in that even peasants could receive free medical care.

Subsequently, the Russian zemstvo system of medical care was recognized at the level of the League of Nations as almost the best in the world.

• Nikolai Semashko

• © Wikimedia Commons

When the Bolsheviks came to power, they faced problems because the previously created system was destroyed, and the need for medical care grew due to the war and epidemics of those years.

Nikolai Semashko took over the organization of the national healthcare system.

He summed up all the experience that had been accumulated up to that point.

He managed to create a system that was very effective, despite the fact that Soviet power had not yet been strengthened.

— The history of medicine is closely connected with the history of social thought and philosophy.

Why is anti-medical theories now growing in popularity, such as the ideas of not vaccinating, etc.?

Will new dark ages threaten if such sentiments intensify?

- I can only express my personal opinion, not a scientific assessment.

I think that humanity is moving forward, but in a spiral, sometimes there is a rollback.

The carriers of obscurantist, anti-scientific ideas have always been and are, it’s just that in difficult historical periods they often come forward and their voices begin to sound louder.