MILITARY MEDICINE IN THE MEDIEVAL EASTERN EUROPE

The article considers some evidences about military medicine in the Eastern Europe, especially on the modern Ukrainian territory, in 11th–13th centuries. Analogies from the West­European history are represented. The information from contemporary chro­ nicles illuminates medieval medical thoughts in the practice of Rus’ physicians. Some facts are leaded out the logical way. Connections between contemporary conditions and the next development of medicine in late­medieval Ukraine are followed. Research Methodology. As the main method, a logical analysis is used that allows supplemen­ ting missing information by comparison with analogous situations in other regions, investigating the text in order to find additional data, in some cases, to suggest the most likely option. A chronological method for supplying the material was also used. Results. It is concluded that military medicine in Kievan Rus’ of the 11th–13th centuries was not inferior to Western European analogues. Some differences are associated with the earlier and strong influence of Byzantine and local traditions. Military medicine at that time was not so clearly separated from the civilian. Some lagging behind Western Europe is noticeable in the theoretical part ­ in Russia medical schools have not been formed, unlike the universities of Italy, France, England and Spain. Some monks and priests collected Byzantine medical treatises, sometimes supplementing them with descriptions of local traditions, but no more. Secular doctors had good practice, as evidenced by the description of the anamnesis of illnesses and wounds in the annals, but their knowledge was passed only to their own children. This is one of the reasons that in the subsequent there was a backlog from Western Europe. No velty. Separate articles of the Old Russian chronicles are presented as a source of not only political and cultural, but also medical information. For the first time, a fairly pro­ found knowledge of the ancient Russian chroniclers in this field has been demon­ strated. A similar theme is quite common in foreign historiography, but still remains little studied in the domestic. The practical significance. The material of the article can be used to prepare general works from the history of medicine or for further scientific work in this direction.

When we talk about Medieval Europe today the scene of savage wars without any modern humanistic principles is circumstanced. Every arrow, every sword-cut without sanitary work brought the death. Is it a truly picture? Of course, our answer can't be absolutely verified. We have too less sources about medicine in the Early Medieval Europe, some more from middle and late medieval period, but mostly these are theoretical works of intellectuals from universities, not practicing physicians. Military medicine is almost absent here, but it must be something in many armor conflicts between people in these times.
There are some tendencies in research literature of this question. There are some encyclopedic researches about military medicine as Jack Edward McCallum's [4] and medieval medicine generally [5]. Structured knowledge about military medicine in the Middle Ages is presented in the Internet work-in-progress by Lady Sofya la Rus, Mka Lisa Kies, MD based on classes taught starting in 2006. Levels of military medicine, predicted needs in medical support ratios for Medieval Armies, period military healthcare providers, texts with medical information, disease prevention, battle wounds and general wound protocol (treatment) are presented in light popular form. As a conclusion: "There was military medicine in the Middle Ages!" [6].
From special researches among most represented is history of medicine in the Crusades (11 th -13 th centuries). There are the article of Eran Dolev and Nashon Knoller in "The Israeli Medical Association Journal" (2001) [3] and the monograph of Piers D. Mitchell (2005) [7]. Such interesting in these events is connected with the point there Latin (West-European), Muslim and Byzantine traditions became closest in medicine (and military too).
The main development of European medicine during the Middle Ages began in the 11 th century at the Salerno Medical School in southern Italy. Later Arnold of Villanova (Arnaldus de Villa Nova, 1235-1311) gave new incitement to the medieval medicine thought in West Europe. Practical steps in military medicine were made by Magnus the Good (1024-1047) in Norway, Lois IX of France (1214-1270), James II of Aragon (1267-1327). In the English army new surgical teams appeared in French campaign of Henry V (1387-1422) and were connected with the names of Nicholas Colnet, Thomas Morstede, William Bradwardine [6].
As an examples of battle wounds Britain and American writers mostly present Visby or Wisby (1361) * and Towton (1461)  At first, we have based on known facts and make some analogy by the way of logic. From Viking's saga *** about Magnus the Good is known, that he assigned 12 men to care for the wounded in the battles. The number can be relative (12 is popular in many mythical traditions), but we have a serious evidence about the first-aid level care in Viking army. Successor and relative of Magnus was Harald Hardrade (1015-1066), which many years lived in Kyiv on the court of prince Yaroslav the Wise (978/983-1054) and was married with Rus' princess Elizabeth, daughter of Yaroslav. His biography was typical for many Viking's konungs **** , but also we must remember what the Rurik dynasty had the Scandinavian origin too and the guardians of their army were Vikings. It's possible to presume, that Military Medicine organization in this army was equal to Magnus the Good's form with some local Slav traditions. But to be sure it's necessary to look on local chronicles.
Among fundamental sources of this Ukrainian historical period is a chronicle (litopys) "The Tale of Past Years" (Primary Chronicle). In 1076 the death of Svyatoslav Yaroslavovych (1027-1076) is described here: "In this year Svyatoslav, son of Yaroslav, was dead in 27 th December because of a bump-slit (on neck)" [1, P. 121]. So, we have early description of an oncological operation, not successful yet. Such operation hadn't military character, but we must remember, that every ruler in this time was a commander, and his physicians were especially specialized in arms wounds (like ancient Claudius Galenus). And Svyatoslav is known like the best warrior from sons of Yaroslav the Wise and logically his court's physicians came from the army. Year 1097 is known because of the Council of Liubech, also known as Congress of Rus' Princes, and the tragedy of Terebovlian prince Vasyl'ko Rostyslavovych (1067-1124), which was blinded by the Great Prince of Kiev Sviatopolk and Volhynian prince David. It was happened in the night on 7 th November 1097: "… And then others came in and overturned him, and tied him, and put on his chest the board from the stove … . Then two more arrived and took of second board from the stove, and sat both dawn, and pressed him so hard, that his chest cracked. And torchyn * named as Berendij, Sviatopolk's shepherd, approached with the knife. He tried to turn the knife in the eye, but missed and cut his face -that was [later] the wound on his face known. Soon he turned the knife in his eye and draw out apple (of the eye), then in second eye and draw out another. And was (Vasyl'ko) like dead" [1, P. 148-149]. Making political and military enemies blind was a common thing in these times, but is interesting detailed description of process. Maybe, this is connected with the method. In Byzantine Empire very often individuals and ever thousands of people were made blind. But it was without drawing out apples of the eye, but by red-hot irons on the distance. So, execution on Vasyl'ko was too cruel even for these times. But he didn't became dead and lived more almost 27 years (died 1124) -it's mean, that some care and medicine of the time were able to safe life even for such wounded persons. The chronicle hasn't any evidence about the special medical care for the prince, only one woman that gave Vasyl'ko a clean shirt is recalled. This fact is similar to the thesis of Piers D. Mitchell about medieval hospitals that "the requirements of many of the patients… were simply rest and care, rather than the more specialized medical treatment" [7, P. 213].
As the repetition before war Rus' (and West-European too) princes usually used hunting. Here traumas were also often. So The hunting and battles were very dangerous for the life of Rus' rulers, but Volodymyr Monomakh had good physicians. Among them is best known Agapetus of Pechersk (?-1095), a monk in Kyiv Pechersk Lavra. He mostly healed by herbs and diet -it was a local pre-Christian tradition. As his opponent another anonym physician in Kyiv by Armenian origin is recalled. He only made diagnosis of an illness: mortal or not. Such profession based on well-known Byzantine treatises and had more theoretical, then practical character. Byzantine medicine thought was based on Nestorian medicine (4 th century AD) with some influence of Muslim medicine theory. But Rus' climatic persuasions and local traditions were different. So, mortality in Rus' with mostly Byzantine theoretic physicians was high.
The closest Rus' region to the West European medieval culture was the Galician-Volhynian principality (1199-1340). Mostly about its society, history and culture we have information from "The Galician-Volhynian Chronicle" (1201-1292, truly 1205-1289). From Chronicle's episodes is one interesting description of prince Volodymyr Vasyl'kovych (1247/9-1288) illness before the death: "Great Prince Volodymyr Vasyl'kovych lied in illness by four years. Let's talk about his ailment.
His lower lip became to putrefy. Few on the first year, on second and thirdmore became to putrefy. But he was not very sick yet, walked and rode on horseback when he wanted. When fourth year was ended and winter came he grow very weak -and all meat from the chin fall off, and all lower teeth and jaw putrefied. It was second Iob. … When he came from the Church, lied down, nowhere withdrawn, became more ill. And all meat from the chin fall off, and chin-bone putrefied, and ever his larynx one can see. He didn't eat by the week, only drunk less water.
And in Thursday night he became exhausted… And he ended the prayer, leaded his hands to the sky and gave the soul in God's hands" [1, P. 442-444].
Such detailed anamnesis of illness is rare in medieval non-medical sources. The illness is not named, but it's possible to suspect a kind of leprosy. This illness was very frequent in Ancient and Middle Ages even among aristocracy. We can suspect some leprosy, at first, because of the Old Testament prophet Iob's recalling -his illness is known as leprosy in medieval tradition, at second, from the description of the illness and even the exterior of Volodymyr Vasyl'kovych: "He had low voice and sturdy lower lip" [1, P. 445] (the same lip became to putrefy). All these evidences make it possible to have some conclusions. East-European military medicine on Ukrainian ground in 11 th -13 th centuries was equal to West-European analog in own development. Some differences are connected with Byzantine influence (more early in Kyiv than on the West) and local traditions. The military medicine was not so strong demarcated here with the civil one. Some lagging behind the theoretical base is noticeable. Kyiv as Rus' capital and the Galician-Volhynian principality didn't formed special medicine schools. It was no universities like in Italy, France, England and Spain. Some monks and priests collected Byzantine treatises, preserved knowledge about local medical traditions, but no more. Secular physicians had a great practical experience, as we saw in chronicle's detailed anamnesis of illness, but it's any evidence about an attempt to pass it next generations (maybe, only in close family sense such existed). This is why theoretically the regional medicine lagged from the West-European one in next centuries.