An open-closed-open society
During its early history, most Russians had little or no access to qualified medical care but relied on traditional folk and herbal remedies. Ancient Russia got more shape and became Kievan Rus' in the second half of the 9th century. It was a feudal state with Kiev as the capital. The gateway was a river connecting the north of Rus' with Scandinavia and in the South with Byzantium. With the conversion of the Kievan Rus' state to Byzantine Christianity in 988, many monasteries were established, some of which also functioned as centres of education and offered basic medical care. In the eleventh century, many Kievan monks spent time in the monastery on Mount Athos in Greece. Back home, they put into practice the rudimentary learned medical skills they had acquired. Monks and chroniclers knew Latin and Greek and collected early and medieval manuscripts. Greek and Byzantine manuscripts came to Kiev through Bulgaria and Byzantium. These manuscripts were translated to Russian, and the monks added their own knowledge based on local folk experience.

Map of Kievan Rus'

An early medieval forerunner of present-day Russia.

From the late 8th century onwards, the trade route from the Varjans to the Greeks developed, a trade route that was almost entirely over water and that connected Scandinavia with the Byzantine Empire.

Principalities of the later Kievan Rus’ (after the death of Yaroslav I in 1054. The background map is a modern map of Europe showing current national boundaries, and modern artificial waterways and reservoirs in Russia.

Principalities of Kievan Rus' (1054-1132).

CC BY-SA 3.0. Wikimedia Commons, the free media repository.

A metal engraving depicting old trade route at the Staraya Ladoga fortress in the village of Staraya Ladoga, Russia

© Photographer Inge F. Hendriks, Private collection.

The oldest and most famous monastery, founded in 1051, was the Pecherskaya Lavra or "Monastery of the Caves" in Kiev. It received wounded and needy with all kinds of diseases from all over Kievan Rus'. For the most severe cases, the monastery hospital had a special ward, where monks provided primary care for the sick. Some monks were specialised in the treatment of skin or childhood diseases. The people could also turn to folk healers for rudimentary medical care.

Pecherskaya Lavra or "Monastery of the Caves" in Kiev founded in 1051
Kiev-Pechersk Lavra Complex (National Reserve of Kyiv-Pechersk Lavra) in Kiev, Artist Falin, 2013.
CC BY-SA 3.0, Wikimedia Commons, the free media repository.

Cauterisation instruments
Cauterisation refers to an iron instrument, which is generally heated to a dull red glow. Cauterisation is a medical technique in which a part of a body is burned to close off skin or a blood vessel.
Inv.Nrs. ERTh-942, 944, 1061, 1063, 1064, 1065. Photographer Olga Lapenkova.
© The State Hermitage Museum, Saint Petersburg, 2021
As heads in the settlements, the family fathers exercised "home medicine" in a practical, rough and arbitrary way. Their medical knowledge and secrets were passed on from father to son. They knew how to treat sores and burns proficiently with ointments. An overlap existed between instruments used for domestic, cosmetic, and surgical purposes.
Widespread use was made of herbal remedies derived from plants such as sage, nettle, plantain or wild rosemary, and from animals sources such as honey and cod liver oil. Folk healers were well aware of the healing power of the banya (sauna), which was the cleanest room in the house and was used for caring and cleaning the body, bloodletting, massage, delivering a child and caring for the new-born. Banya's are even nowadays in use in Russia. The oldest Russian law, the "Russian Truth", framed between 1113-1125, recognised the work of the folk healers.

Herbarius is a herbal book

A herbarius, not to be confused with a Herbarium, is a herb book or herbal book containing drawn/illustrated plants and/or flowers with captions about their properties and use. Herb books date from the period from 1300 to about 1800. They arose from the interest in the medicinal use of herbs. It was important to be able to find the right species to have. That is why the plants, the properties of the growing place and their medicinal use were often described in detail.

Herbarius, Venice, 1499.

© Fundamental Library of Military Medical Academy named SM Kirov.

In 1223 from the Far East, the Mongolians under the leadership of Genghis Khan invaded Kievan Rus', cut off the principality from the rest of Europe. The Mongolian yoke lasted for almost 250 years but showed cracks over time.In 1481 the principality of Moscovy with the capital Moscow was able to take over the lead. The new state of Muscovy sought reconnection with Europe through the free port of Archangelsk and became an open society again. Loyalty to a leader led to hostility and war, and all kind of injuries. The people founded settlements and villages, urbanisation developed, and welfare became more common. As a result, infectious diseases developed. The demand arose for a different and more extensive form of Medicine, not only for external but also internal conditions. Only rich people received qualified medical care, which foreign physicians provided. The first Muscovite emperor appointed as his court-physicians a few foreign doctors. But for their children's illness, the court still had more trust in the empirical experience of the traditional folk remedies.

Map of Moscovian Rus’

The newest general map of the entire Russian Empire.

Inv.Nr. ERG-26697. Photographer Darya Bobrova.

© The State Hermitage Museum, Saint Petersburg, 2021

In the second half of the 16th century, trade developed with England and other countries, which ushered in a new era with the transition from rural to pharmaceutical medication. Widespread connections with other countries ensued, and evolved drugs became more readily available. The first Doctors Medicinae (comparable to a PhD-physician) were invited to Russia, including the brothers Lindsay and the pharmacist James Frencham from England. In 1557 the Dutchman Arend Claessen van Stellingwerff, a pharmacist, was invited and became the court pharmacist for 40 years. In 1581 in the Kremlin in Moscow, the first Imperial Pharmacy was opened, which supplied the Imperial family and almost nothing to private individuals. Frencham became its head and introduced less common drugs such as opium, camphor and Senna leaves.

A compilation of images from the Incunabula Nr 2

Incunabula is also known as crib prints. These are books or writings set in movable type and printed before 1 January 1501 in Europe. A complitation of the Incunatable Nr 2 contains Celsus Aulus Corneli and Johannes de Ketham from Germany with 7 treatises "On Medicine" about urine, bloodletting, women's secrets, surgery, avoiding of the plague, anatomy and children's disease. Venice, 1493 Ancient Roman scientist.

© Fundamental Library of Military Medical Academy named SM Kirov.

Also, the development of book printing was not unnoticed by the tsars. Together with other Russian noblemen printing presses were acquired and installed. Scientific sources of European knowledge, such as the manuscripts of Aristotle, Hippocrates, Celsus and Galen, became available. The first handwritten book on Medicine of Roman origin was translated in 1423 to Polish and then appeared in a Russian translation. This textbook of 1561 pages contained copied drawings of herbs, trees, animals, a distillation of brandy wine, philosophical education, bloodletting and pharmacy. By 1616 German herb catalogues with colour pictures, which had existed since 1534, had been translated into Russian.
Portrait of Tsar Mikhail Fyodorovich Romanov (1613-1645)
Inv.Nr. ERZh-520. Photographer Vladimir Terebenin, Leonard Kheifets.
© The State Hermitage Museum, Saint Petersburg, 2021
In 1613 the first Romanov Tsar, Mikhail Fyodorovich (1613-1645) ascended the throne, and a time of new medical developments dawned.(Fig. 07: Image of Mikhail Fyodrovich) The first reigning Romanov instituted improvements in social welfare and healthcare. He ushered in the birth of scientific Medicine in Russia. Around 1620 Mikhail Fyodorovich established the Aptekarskiy Prikaz (Ministry of Pharmacy) in Moscow. The Prikaz was led by pharmacists to supervise and organise the work of pharmacists, medics and barber-surgeons. The "Minister" of Healthcare was an pharmacist and not a doctor medicinae.A new second pharmacy, located in the centre of Moscow, was opened. It had a significant turnover and employed several qualified pharmacists responsible to the Aptekarskiy Prikaz (Ministry of Pharmacy).

After the death of the tsar, his son inherited the two imperial pharmacies in Moscow. The sovereign laid out three herb gardens in Moscow. Together with the surrounding villages, they provided the Imperial pharmacies with native herbs such as Symphytum majus, Helleborus Niger, Hypericum, Anisum stellatum and Rhubarb. However, additional herbs still had to be imported from abroad.

Aptekarskiy Prikaz in the Kremlin

The building of the Aptekarskiy Prikaz in the Moscow Kremlin,

pen-and-ink drawing, artist Margarita V. Apraksina, Saint Petersburg, 2016.

© Photographer Inge F. Hendriks, Private collection.

In 1654, de Prikaz opened the first medical school, where court physicians and foreign doctor medicinae trained barber-surgeons. Instructions included surgery, anatomy, pharmacology, practical diagnosis of internal diseases and ambulatory medicine.

From the Stroganov Herbarium in 8 volumes end 17th begin 18th century

Fruris maritian nodofres?
Volume VII page with Inv.Nr. ERTh-2279. Photographer Olga Lapenkova.
© The State Hermitage Museum, Saint Petersburg, 2021
Capsélla búrsa-pastóris «Shepherd's Purse»
Volume III page with Inv.Nr. ERTh-2283. Photographer Olga Lapenkova.
© The State Hermitage Museum, Saint Petersburg, 2021
Amaranthoides Lychnidis fol capitulis purp: B
Volume VIII page with Inv.Nr. ERTh-2278. Photographer Olga Lapenkova.
© The State Hermitage Museum, Saint Petersburg, 2021
In the 1660s, two wars broke out between England and Holland, among others, about Russian trade. In the latter half of the seventeenth century, the Dutch took over the leading market position for exporting and selling pharmaceutical products and herbs from the English. Special staff members of the Imperial Pharmacies were appointed to deal with deliveries, supplies, bookkeeping and the end-of-year financial statement to the Aptekarskiy Prikaz. Another responsibility was to supply the correct items as provided in the signed prescription to the doctor medicinae. Even the books acquired by the tsars and noblemen in the 15th and 16th centuries were officially handed over to the Prikaz in 1661. They hence became available to medical doctors, surgeons and pharmacists
Correspondently, in the Netherlands, more or less the same development took place. The country was a remote corner in the northwest of Europe. It was sparsely populated with mainly farmers and fishermen. The Dutch lived among the nobility and clergy. Years of contention between the nobility did not promote any scientific practice of Medicine. Practically no medical knowledge penetrated from outside either. It is known that libraries of some monasteries contained medical books, which shows that medical influence from Arabia existed in the Netherlands. Monasteries provided out of mercy simple medical aid, called monastic Medicine. Along with the monks, a second group, the barber-surgeons, provided medical care.

Map of the Northern Netherlands
The XVII Dutch Provinces, author L. Schenk, 1748. In public domain.

Title page with a compass and a globe, Exoticorum libri decem, Quibus Animalum, Plantarum ..., Carolus Clusius, Petrus Bellonius, Nicolas Monardus, Book 1, Leiden 1605. A kind of encyclopedia of knowledge about the plant and animal world around 1600. B00286

© Rijksmuseum Boerhaave, Leiden

Quince, fruit, seeds (plant), Arbor peregrina ex Guinea. Fructus peregrinae arboris historia. In: Exoticorum libri decem, Quibus Animalum, Plantarum..., Carolus Clusius, Petrus Bellonius, Nicolas Monardus, Leiden 1605. B05087

© Rijksmuseum Boerhaave, Leiden

Woodcut page with butterbur

In: Den nieuwen herbarius, dat is, dboeck vanden cruyden, Leonhart Fuchs, Basel. 1543. B05514

© Rijksmuseum Boerhaave, Leiden

Woodcut pumpkin page

In: Den nieuwen herbarius, dat is, dboeck vanden cruyden

© Rijksmuseum Boerhaave, Leiden

Coloured engraving of pineapple with insects. In: Metamorphosis insectorum Surinamensium, or the change of Surinamese insects, Maria Sibylla Merian, Fig. ii, Amsterdam, 1705. B05593

© Rijksmuseum Boerhaave, Leiden

Coloured engraving with watermelon, caterpillar and butterfly. In: Metamorphosis insectorum Surinamensium, or the change of Surinamese insects, Maria Sibylla Merian, Fig. ii, Amsterdam, 1705. B05593

© Rijksmuseum Boerhaave, Leiden

Cauterisation procedure with red-hot hot iron instruments
Folk healers and barber-surgeons used the cauterisation procedure. The practitioners scorched the skin with hot metal instruments to destroy some tissue in an effort to stop bleeding, remove an unwanted growth or reduce other potential medical damage. The practice was once widespread for the treatment of wounds. General system of Surgery in three parts containing the doctrine and management. Translated into English from Latin of dr. Laurence Heister, London, 1750. In public domain.
The lion's share of the medical aid was in the hands of the barber-surgeons. They were not academically educated but simple illiterate people. They bled both sick and wounded, treated their wounds and ulcers with bandages and ointments. They had acquired a little empirical knowledge of internal diseases. They often practised the profession of a barber at the same time. Minor interventions such as bloodletting and wound care took place in the barber's shop. These barbers were called not only rural surgeons but also field shearers, because they went into the field with the army.

Pharmacy jar, Wide Italian albarello, decorated with blue and yellow edges (a green edge at the top and bottom) and especially geometric patterns. Presumably Northern Netherlands, c. 1625. V10171

© Rijksmuseum Boerhaave, Leiden

Pharmacy jar, Albarello with blue floral decor with heron, Albarello 'Rio Barbaro', 1575-1625, Presumably Tuscan. V10175

© Rijksmuseum Boerhaave, Leiden

The barber-surgeons should not be underestimated because they had a lot of experience. They even treated skull injuries through trepanation. Treatment of internal diseases was left by the surgeons to the quack-fresh or the so-called 'medicinal damsels'. Barber-surgeons wrote the two oldest known original Dutch medical works. The books do not describe scientific Medicine but practical surgery. In the Netherlands, similar to Europe, for hundreds of years, the views and theories of Galen of Pergamum (AD 130-200) dominated all Medicine. No essential medical science was practiced until 1500 – 1600. After the rise of universities in Europe, a broader interest in medical science developed.

The terebra (trephine) of wood and rope
During the time of Hippocrates (c. 400 BC), and later during the periods of Celsus, Galen and others, skull drilling was freely practiced in Western civilisation. The instruments used by the early Greek surgeons varied somewhat. The drills were mainly used for making a round hole in the skull using a wooden cross with a strap around the centre or on a crossbar.
General system of Surgery in three parts containing the doctrine and management. Translated into English from Latin of dr. Laurence Heister, London, 1750. In public domain.
Cyrurgie, author Jan Yperman, early 14th century. In public domain.
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