Monastic Medicine in Kievan Rus' and early Muscovy

Medicine was largely in the hands of folk healers until the 11th century. These were known by a variety of names and according to some authorities they doubled as pagan cult leaders.

A distinct secular medical tradition seems to have developed in Kievan Rus' by the mid-11th century, but little is known about it.

When Christianity was introduced in 988, both folk and secular medicine began to give way to monastic medicine - at least in theory (because all of the written records were written by monks?).

Serious monastic medicine did not begin to develop in the west until the monastery of Montecassino was founded by St. Benedict of Nursia in 529. From here the Benedictines spread the medical texts and teachings to other monasteries, most notably Fulda in Germany. And Irish missionary monks founded centers in Switzerland (St. Gall and Reichenau) and in Italy (Bobbio).

In contrast, in the East, the monastic movement had already become less isolationist in the 4th century and, with the work of St. Basil the Great, it became more dedicated to Christian charity and thus more involved with the community. This outreach, of course, included the care of the sick and aging and so monastic medicine in the East developed more than that in the West. Already in 375, St. Basil the Great included a hospital and leprosarium in the institutions he founded in Caesarea, Syria.

St. John Chrysostom followed Basil's example in Constantinople in 400-403, building a number of hospitals. The most important from a medical standpoint were the ones attached to the Pantocrator monastery. The monastery was endowed and funded in 1136 by Emperor John II Komnenos (1118-1148) and his wife Irene. It had two hospitals: a 6-bed unit for sick monks, and a larger facility for the city. It's constitution gives valuable insight into how the facility operated. It had fifty beds divided into 10-bed wards: two for the sick, and one each for surgery, gynecology and ophthalmology. Each unit had a bed for emergency cases and 6 beds for severe cases or bedridden patients. There was also a psychiatric ward (mostly for epilepsy), an outpatient clinic, and a home for the disabled elderly. It was staffed by 35 men and women, including PA's and nurses, nearly all of whom were clergy. Support facilities included 2 churches for patients (separate for males and females), a pharmacy with a staff of 6, a separate staffed library complete with copyists, baths for hydrotherapy, a kitchen bakery, a mill, a laundry and a cemetary. Treatment methods basically followed Galen, but staff physicians also wrote their own treatments. (There was an unofficial medical school with a single instructor and a required curriculum including anatomy, physiology, disease theory and clinical experience.)

As Christianity took root in Kievan Rus' in the time from the 11th to the 13th centuries, some 70 monasteries were founded, generally after the model of Athos. Their early history is sketchy. The Primary Chronicle makes it clear that there were monasteries before 1051, but no further details are available about this earliest stage. The founding of the Pecherski Monastery near Kiev has a lengthy 1051 entry in the Primary Chronicle about its founding, and numerous other entries in the Primary Chronicle and also the very valuable Kievo-Pecherskij Paterik, a collection/synthesis of written and oral works attributed to 3 Pecherskij monks, Nestor, Simon and Polikarp. It is the single most important source on monastic medicine in Kievan Rus'.

Care for the sick was an important virtue in Kievan Rus' following the culture of its Byzantine exemplar. There were special legal protections under the Church for the sick and those caring for them. And Efrem, bishop of Pereyslavl establish a number of hospitals in 1091 to provide free care for his flock, patterned after those in Byzantium where Efrem had lived for 18 years. Thus care for the sick was an important mission for Pecherskij Monastery from its beginning.

Early in the history of Pecherskij Monastery, a separate facility had to be built to handle the need. It's description makes it seem comparable to the hospice-hospitals prevalent in the West. Like in the West, there was also a separate facility for the sick monks. In the 12th century, the facilities were expanded. Prince Svyatopolk Davidovich of Chernigov took vows there in 1106 (becoming Nikolai Svytosha) and then founded a hospital which became the nucleus of the Bol'nichnij Monastery, part of the Pecherskij complex but with its own abbot until the 18th cent. Further details are not known.

The Pecherskij Paterik indicates a tremendous rivalry between secular court physicians, the monk-physicians and folk healers (volxvy). Not surprisingly, the secular physicians and the folk healers tended to come in last in the contests narrated in the Paterik.

The Pecherskij Paterik mentions the treatment of leprosy, several unspecified illnesses, epilepsy fever, urinary obstruction and kidney dysfunction. The prevailing therapy was herbal, accompanied by a liberal dose of prayer. Hydrotherapy, the steam bath (banya), was also common, especially for gout and arthritic conditions. There are no references to phlebotomy or surgery.

Medical texts that would have been available to the Pecherskij monks would have included the Izbornik Svyatoslava (1073), a encyclopedic work covering hygiene, diet and medical botany. Another source was the "Theology of Saint John Damascene" which gained in popularity from the 10th century on and included astronomy, the four elements and the four humors. John, the Exarch of Bulgaria, who had translated the "Theology" also wrote the Shestodnev with sections on anatomy, physiology and materia medica, in addition to its primarily theological contents. It drew extensively from Aristotle, Dioscorides, Theophrasots, Hippocrates and Galen. A 4th Byzantine source was the Fiziolog, popular from the early 11th century, which contained fantastic animal stories with a generous amount of medicobiological information.

During the Mongol period, as power shifted to the north, medicine was largely in the hands of monks (and folk healers). No secular physicians are named in contemporary sources. The clergy was held in high esteem for its medical expertise, even by the royalty of the Mongol Golden Horde, if the chronicles are to be believed.

Since many Russian clergy spent significant periods of time in Constantinople, it is reasonable to assume that many of them also studied medicine there, at the Pantocrator monastery.

Many new monasteries were founded during the Mongol period, serving as spiritual and intellectual centers. The most illustrius were the Trinity-Sergius Monastery (45 miles NE of Moscow) and the Kirillo-Belozerskij (forests around Beloopzero, 300 miles N of Moscow), which actively practiced medicine and served as modest repositories of medical knowledge.

Information is lacking about the actual medical activities at Trinity-Sergius, but inferences may be made from the contents of its library. It was supposedly founded by St. Sergij himself (mid 14th cent). It grew the most significantly in the fifteenth century and many of the texts came from Mt. Athos where they were translated. The oldest of medical interest is the late 12th/early 13th century sbornik which contains part of an early herbal. There are five copies of the Paleja (oldest dated 1406) which is a biblical history, but also includes unusual explanation of nature, human embryology, anatomy and information from various herbals and lapidaries. The Shestodnev, mentioned earlier, was well represented. There was also a copy of the Pchela, in which 4 of the 70 chapters are devoted to hygiene and medicine including a chapter titled "On Physicians." There are other important sborniki with secular tracts. One, a 15th century anthology of selected writings by John Damascene, includes short essays on bloodletting, the zodiac, moon phases, illness and astrology, "Galen on Hippocrates", an brief overview of Galen's physiology, and the classic humoral theory of disease. Another 15th century sbornik contains medical and astrological information identical to the Damascene anothology, plus an exerpt from a 6th century Byzantine historian, and the Gromnik, an astrological tract. A 16th century sbornik discusses thunder and lightning, meteors, the oceans and animals. It is impossible to determine to what extent these texts were used in actual medical practice, but the fact that there were several copies of the texts on bloodletting, disease theory and critical days, indicates some demand for them.

There is no mention of special medical facilities at the Trinity-Sergius Monastery before 1552 when the Short Chronicle of Trinity-Sergius says a hospital was built. A stone replacement was built in 1635. The Chronicle does not make it clear whom these facilities were meant to serve and historians debate the question.

While in Western Europe, the most important monasteries for intellectual activity were in urban centers, in Russian, the most important ones were in the remote North. This is the tradition that the Kirillo-Belozerskij Monastery belongs to. Early on it gained fame as a center of scholarship and developed its own literary style and book illumination. Famous figures associated with the monastery include its founder, Kirill, Efrosin and Gurij Tushin. Efrosin wrote an early version of the Zadonshchina (a Russian epic tale) and many other literary, medical and scientific works. Gurij Tushin wrote many religious works and "Prorochestva ellinskix mudrecov" which draws on writers such as Plato, Aristotle, Homer, Euripides, and Pythagoras.

The earliest evidence concerning medical practice at the Kirillo-Belozerskij Monastery comes from its library as well. Kirill and his successors collected many books. From the 15th to the 17th centuries, its library had few rivals in Russia. It was the first Russian library to catalog its books - in the late 15th century. It also established branch libraries in the mid-17th cent. (or earlier) including one at the largest of its two hospitals - probably the first medical library in Russia.

One of Kirill's 4 sborniki contains the earliest known version of "Galinovo na Irokrata" dated 1424, presumably transcribed from a version traceable to Mt. Athos. The same sbornik also discusses the human embryo and some purely scientific issues.

By 1530, the monastery supported 4 hospitals. One was set aside for laymen and there was a separate almshouse with room for 11. Nothing else is known about the hospitals exept that they were all wooden and, thus, susceptible to fire. They burned down in 1557, whereupon the 4 hospitals were combined into a larger structure which was rebuilt in stone in 1643. Recently restored, it is 35 by 17.5 meters, relatively low with a sloping roof, divided into two large wards measuring 220 sq meters each. The wards are separated by a corridor 5.35 meters wide. Small, well-placed windows provide ample light and ventilation. The interior is spartan and functional. Both it and the smaller hsopital added in 1730 were placed in a secluded corners of the monastery complex, indicating that peace and quiet were important components of care. There are no surviving treatises of bloodletting in the library and surgical instruments are absent, but the fact remains that surgery had been a separate branch of medicine since Kievan times and barber-surgions, krovopuski, were common in the Novgorod region.

In summary, the Russian monastic hospitals followed closely the Byzantine model of charity, built their hospitals after the Byzantine models and read some Greek medical texts in translation, but also relied on native materia medica and the banja to create an amalgamated medical tradition which endured into the 17th century and beyond. The monastic medical tradition dating from Kievan Rus' is well-documented and although it was not as sophisticated or "scientific" as the Byzantine tradition, it compares favorably to that available in the West. In addition, it is quite certain that monastic intellectual life was not as sterile or one-dimensional as it has often been supposed.