LECTURE No. 7. The development of medicine in Russia in the first half of the XNUMXth century

1. General historical characteristics of the period under review

Let's start our consideration of the historical period with the estates that existed in Russia at the beginning of the XNUMXth century. An estate is a closed group of people with certain rights and obligations that are inherited.

Thus, there were privileged and tax-paying classes. Privileged: nobility and clergy. Taxpayers - merchants (I, II and III guilds), Cossacks (about 1,5 million people), townspeople, peasants.

In 1801, on the night of March 11-12, Emperor Paul I was killed as a result of a conspiracy. For the general public, the cause of the death of the emperor was apoplexy. Alexander Pavlovich, or Alexander I, ascended the throne. With the ascension to the throne of Alexander I, numerous changes were expected. His mentor in childhood was F. S. La Harpe, a prominent political figure from Switzerland, who was a liberal in his convictions, an opponent of slavery. These thoughts he instilled in his pupil. In addition, in his youth, Alexander was fond of the ideas of such enlighteners as F. Voltaire, C. Montesquieu, J. Rousseau. Thus, Alexander's thoughts about equality and freedom coexisted with autocratic rule, and this was reflected in his reforms, all of which were, so to speak, half-hearted.

So, 1801 - The secret committee. This committee included N. N. Novosiltsev, P. A. Stroganov, A. A. Czartorysky, V. P. Kochubey. The secret committee discussed the issues of the spread of education, various kinds of state reforms, as well as the problems of serfdom. In 1802, the boards that had been created under Peter I were replaced by ministries. At the head of the ministry was a minister who reported directly to the king. In 1803, a new regulation was issued, which spoke about the organization of educational institutions. There was now the following division between the schools:

1) parochial schools;

2) district schools;

3) gymnasiums;

4) university.

In addition, new universities were opened: St. Petersburg, Vilna, Derpt, Kharkov. And already in the charter of 1804, universities received the right to choose their own professors and rector, as well as to solve their university problems on their own.

In 1803, the "Decree on free cultivators" was also issued. Its essence was that the landowners could now release peasants with land for a certain ransom.

It is necessary to mention the new "Censorship Charter" published in 1804, which also had a liberal character.

June 1812 - the beginning of the Patriotic War. Russia's enemy was France, led by Napoleon. It is impossible not to mention the famous battle of Borodino - Borodino battle.

The Russians won a political and moral victory here. Here is what Napoleon said about this battle: "The French showed themselves in it (the Battle of Borodino) worthy of victory, and the Russians acquired the right to be invincible." The Russian army won this war, and Napoleon's army was defeated.

It is necessary to mention the foreign campaigns of the Russians in 1813-1815.

Tasks:

1) return pre-revolutionary monarchs to the thrones of Europe;

2) liberate Europe from Napoleon;

3) to restore feudal-absolutist regimes in Europe;

4) provide Russia with European hegemony. Origins of Decembristism:

1) the war of 1812;

2) foreign campaigns of 1813-1815;

3) advanced literature;

4) the contradictions of Russian reality, that is, the contradictions between the interests of national development and the feudal-serf system.

So, four noble associations are formed, which received the names "pre-Decembrist":

1) "Order of Russian knights";

2) "Holy artel";

3) "Union of Salvation";

4) "Union of prosperity".

The "Union of Salvation" arose in 1816. Its founders were Nikita Muravyov, Ivan Yakushkin, Sergei Trubetskoy. The main goal was to introduce a constitution and civil liberties.

Speech Tactic: Plot to assassinate a reigning monarch and replace him on the throne with a more accommodating ruler.

The "Union of Welfare" was founded in 1818. It included about 200 people. The fate of the serf and the ordinary soldier was in the center of attention. Great importance was given to the humanistic education of youth.

To achieve their goal, the members of the organization had to actively participate in public life, in the activities of legal scientific, literary and educational societies. One of the goals was to establish a republic. They used the tactics of military revolution.

Two societies were established in Russia: in February 1821 - a large secret "Southern Society". It is headed by P. I. Pestel, the creator of Russkaya Pravda. Autumn 1822 - "Northern Society", headed by N. M. Muravyov. The main document of the "Northern Society" was the "Constitution". Consider the main differences between "Russian Truth" and the "Constitution".

"Constitution":

1) the preservation of the monarchy;

2) the abolition of serfdom;

3) transfer to the liberated peasant of two acres of land per household;

4) the introduction of a federal structure and the creation of a bicameral representative body;

5) limiting the power of the monarch, expanding the powers of representative bodies.

"Russian Truth":

1) the proclamation of Russia as a single and indivisible republic with a unicameral parliament (people's council). unitary state;

2) suffrage from the age of 18 (for males);

3) the State Duma should have state power;

4) the president is the one who has been in the Duma for the last year;

5) liquidation of estates;

6) the abolition of serfdom;

7) transfer to the liberated peasants of half of the entire land fund (10-12 acres).

December 14, 1825 at 11:00 a.m. the Decembrist uprising ("Northern Society") began. December 25, 1825 (lasted until January 3, 1826) - uprising in the South - "Southern Society". However, both of these uprisings were suppressed by the tsarist troops.

On November 19, 1825, Alexander I died. Nicholas I, who at that time was 19 years old, ascended the throne. Under Nicholas I:

1) strengthening of political investigation;

2) tightening of censorship. 1826 - censorship charter (included 230 articles);

3) educational reforms. 1828 - school charter. 1835 new university charter;

4) 1839 - monetary reform (silver ruble);

5) peasant policy.

It must be said that the entire internal policy of tsarism under Nicholas I served the interests of the nobles and serfs.

Let us designate the main directions of the foreign policy of Nicholas I.

1) the fight against revolutionary movements in Europe;

2) attempts to resolve the Eastern question. The Eastern question is international relations related to the division of the territory of the former Ottoman Empire (Turkey).

In the 1820-1840s. in Russia there were two main directions in the social movement:

1) revolutionary;

2) liberal.

The most prominent representative of the liberal movement is P. Ya. Chaadaev ("Philosophical Letter").

Raznochintsy - people from different classes who received an education. Raznochintsy counted on a coup by the forces of the army with the obligatory involvement of the people. The most prominent representative of the revolutionary socialist trend was AI Herzen. Herzen was the creator of "Russian socialism" (or "populism"):

1) Russia can enter socialism without going through the capitalist stage;

2) the basis of the future socialist system in Russia is the peasant communities;

3) it is necessary to overthrow the autocracy, abolish serfdom, distribute land to the communities.

October 16, 1853 - Turkey declared war on Russia. Causes of the Crimean War:

1) Turkey's desire to wrest Crimea and the Caucasus from Russia;

2) clash of colonial interests of Russia, England, France, Austria in the Middle East and the Balkans.

The nature of war is predatory, predatory, predatory.

In 1856, the Treaty of Paris was concluded - the result of the Crimean War. Terms of the Peace of Paris:

1) Russia lost the mouth of the Danube and Southern Bessarabia;

2) the return of Turkey to Kare and the receipt of Sevastopol, Evpatoria;

3) Russia was forbidden to have a military fleet on the Black Sea.

The results of the Crimean War:

1) the war served as an impetus for the collapse of the autocracy and the abolition of serfdom;

2) the war dealt a crushing blow to the entire foreign policy system of tsarism.

2. Socio-political situation

In the first half of the XIX century. medicine in Russia developed against the backdrop of the disintegration of the feudal serf system and the formation of capitalist relations. At the same time, the political and economic privileges of the nobility were consolidated, as well as the strengthening of unlimited power and the arbitrariness of the landowners over the peasants.

The state, contributing to the development of industry and trade, allowed a number of concessions and indulgences to the emerging bourgeoisie. I must say that in factories and factories for the first half of the XIX century. the number of workers has increased several times.

Part of the population moved from villages to cities, abandoning agriculture. However, even though there was an increase in industry, Russia still remained an agrarian country.

As a result of the disintegration of the feudal serf system, the growth of peasant movements in Russia, an anti-serf ideology was formed - this was in the interests of the capitalist development of the country. In the struggle against the dominant feudal-religious worldview, materialistic views were born. The acquaintance of advanced Russian people with the materialistic and revolutionary currents of Western European and domestic thought, as well as the war of 1812, provided the ground for the development of progressive philosophical, sociological and natural-scientific views in Russia.

3. Decembrists and their requirements in the field of medicine

The progressive, progressive people of Russian society opposed the reactionary ideology of the autocratic-feudal system of Russia. The Decembrists waged the most decisive struggle against it. The Decembrists put forward both economic and general political demands, as well as demands in the field of medicine and health care.

If we turn to Pestel's Russkaya Pravda, then its final chapter contains plans and programs for organizing medical care in the country.

So, the Decembrists said that in each of the volosts it is necessary to arrange a shelter for children, as well as a maternity hospital. In addition, the plans of the Decembrists included making medical care available to the public after the coup.

All in the same "Russkaya Pravda" by Pestel, the question of providing for the disabled was raised. He said that this should become the responsibility of the state.

4. Development of anatomy and surgery in Russia in the first half of the XNUMXth century

Let us designate the main problems of surgery in the first half of the XNUMXth century:

1) non-use of antiseptics;

2) ignorance of anatomy by surgeons;

3) non-use of anesthesia.

At this time, the most advanced surgeons recognized that it was necessary to know human anatomy very accurately in order to teach surgical interventions. I must say that in Russia there was no so-called guild division of medical workers. At the same time, there was such a division in the countries of Western Europe.

I. F. Bush (1771-1843) - a surgeon from St. Petersburg was the author of the first original Russian textbook on surgery. I. F. Bush clearly characterized the attitude of Russian doctors to surgery: "Russian doctors have never entered into the futile and harmful debate of foreign doctors about the separation of surgery from medicine."

If we turn to Western Europe, then even in the first half of the XIX century. surgery bore the imprint of medieval traditions, as if the craft training of surgeons. Many who were considered surgeons did not know anatomy. Now consider the connection between anatomy and surgery in Russia. Already at the end of the XNUMXth and the first half of the XNUMXth centuries. Surgery in Russia developed in close connection with anatomy. The separation of surgery and anatomy occurred in the middle of the XNUMXth century.

Surgical interventions during this period of development of medical science in Russia were not very common. They were limited to the outer parts and limbs of the human body. Various departments were created in hospitals: along with departments "for internal diseases" - these are therapeutic departments, departments "for external diseases" were created - this is for patients with surgical diseases.

Let us designate some of the most famous and prominent anatomists and surgeons of the first half of the 1771th century: I. F. Bush (1843-1766), E. O. Mukhin (1850-1764), P. A. Zagorsky (1846-1789), I. V. Buyalsky (1866-1810), N. I. Pirogov (1881-XNUMX). All these talented anatomists and surgeons have repeatedly emphasized in their atlases, textbooks and various other writings that surgeons need to know anatomy well.

N. I. Pirogov

Nikolai Ivanovich Pirogov (1810-1881) - one of the largest representatives of Russian medicine in the XNUMXth century. In his monograph dedicated to Pirogov, A. N. Khozanov characterizes Nikolai Ivanovich Pirogov as "a brilliant anatomist, physiologist, clinician, founder of military medicine and a public figure who caused a radical change in scientific medicine in general and surgery in particular." It must be said that in a number of cities streets, some institutions, etc. are named after Pirogov. Moreover, Pirogov is depicted on the badges of members of the Academy of Medical Sciences, although he had nothing to do with the organization and work of the Academy.

As a young scientist, Pirogov had already gained some notoriety for his achievements in the field of anatomy. He graduated from the medical faculty of Moscow University. Among the teachers of Pirogov, it should be noted the professor of anatomy and surgery Yu. Kh. Lodar and the professor of Dorpat University I. F. Mayer (1786-1858). After that, he continued his studies at the Tartu Professorial University. In the same place, in 1832, he defended his doctoral dissertation. The topic of his work: "Is ligation of the abdominal aorta for inguinal aneurysm an easy and safe intervention."

It is worth noting that the drawings of vessels and preparations made by Nikolai Ivanovich were so professional, accurate and valuable that the University of Tartu acquired them for its museum. After graduating from the professorial university, at the beginning of 1833, Pirogov was sent to Germany for improvement. Pirogov worked for such then famous surgeons as F. Schlemm, B. Langenbeck. About his work in Germany, Pirogov said: “I found... practical medicine completely isolated from its main real foundations: anatomy and physiology.

It was so that anatomy and physiology - in themselves. And surgery itself has nothing to do with anatomy." Upon returning from abroad, at the suggestion of Mayer, who resigned, Pirogov was elected an extraordinary professor at the University of Tartu. The fact is that Nikolai Ivanovich was then only 26 years old, so he could not to elect an ordinary professor, but a year later he became one.During his work in Tartu, Pirogov wrote about 10 major scientific papers.

For more than 8 years, he studied the anatomy of fasciae, arteries in relation to the possibilities of surgical operations (in fact, he laid the foundations of operative surgery and topographic anatomy). So, the work of 1837, which is called "The Surgical Anatomy of the Arterial Trunks and Fascia", put Pirogov among the best anatomists in the world. He repeatedly emphasized the connection between anatomy and surgery, the role of anatomy in the practice of a surgeon. Nikolai Ivanovich wrote that only "in the hands of a practical doctor can anatomy be useful to listeners."

Pirogov urged doctors not to hide their mistakes, and in the "Annals of the Surgical Department of the Clinic of the Imperial Derpt University" (1839) he wrote: "I consider it a sacred duty of a conscientious teacher to immediately make public his mistakes and their consequences for warning and edification of others , even less experienced, from such delusions.

In 1840, I. F. Bush resigned, and Pirogov was invited to the department at the Medical-Surgical Academy of St. Petersburg. Then Pirogov proposed creating a department of hospital surgery so that the connection between practical activities and scientific achievements becomes stronger, so that students “... observe nature not with the eyes and ears of their teacher, but with their own.”

So, in addition to faculty clinics, hospitals began to be created. In St. Petersburg, Pirogov left in 1841 - a qualitatively new and most productive stage in the activity of Nikolai Ivanovich began. It was during this period that he created the well-known "ice anatomy".

In 1843-1844. Pirogov used the method of freezing corpses and the thinnest cuts of their parts and organs, which preserve the topography of the organs of a living person. Nikolai Ivanovich Pirogov wrote about this method in his work "A complete course in applied anatomy of the human body.

Anatomy is descriptive, topographical and surgical" in the atlas with detailed explanatory text. Regarding the "ice anatomy" surgeon V.I. Razumovsky wrote: "As a result of many years of tireless work - an immortal monument that has no equal... This work immortalized the name of N. I. Pirogov and proved that Russian scientific medicine has the right to be respected by the entire educated world." Pirogov improved the methods of teaching and researching anatomy, introduced the principles of layer-by-layer preparation in the study of arteries and fascia, various anatomical areas. With this, N. I. Pirogov radically changed the concept about surgical anatomy.

It must be said that Pirogov was an experimental surgeon: he performed many surgical operations, such as anesthesia, cutting the Achilles tendon, and others, with extensive use of the experiment.

In 1851, he developed methods for "osteoplastic removal of the bones of the lower leg during exfoliation of the foot and resection of the joint. N. I. Pirogov's proposal on the nature of purulent inflammation (pyemia) should be noted.

These purulent inflammations were a kind of scourge of obstetrics, surgical and other hospitals. Nikolai Ivanovich said that inflammatory diseases are caused by a "passive aggregate of chemically active parts," that is, an organic principle, "capable of developing and multiplying." So, we can say that Pirogov came close to explaining the causes of purulent lesions, even before the era of the development of bacteriology.

All this led to the fact that patients with purulent lesions were isolated, and wards or even departments were specially arranged for them. The staff had to strictly observe sanitary and hygienic standards.

During the Crimean War, N. I. Pirogov went to the front, where he collected a lot of unique material, which formed the basis of another classic work by Pirogov, "The Beginnings of General Military Field Surgery, Taken from Observations of Military Hospital Practice and Memoirs" (1865 -1866). Later, Pirogov continued his observations and "principles of organizing surgical care" during the wars.

For example, he worked as an inspector in 1877 during the Turkish-Bulgarian War. It is impossible not to recall the expression of Pirogov: "War is a traumatic epidemic. The properties of wounds, mortality and the success of treatment depend mainly on the various properties of weapons."

This is a statement from a brief work on the experience of the war in Bulgaria - "Military medical practice and private assistance in the theater of war in Bulgaria." Here are the main innovative ideas of N. I. Pirogov as a military surgeon.

1. Pirogov was against "hasty operations carried out, thus advocating saving tactics in relation to the wounded and sick." He called for abandoning early amputation in case of gunshot wounds of the limb, accompanied by bone damage. He was a supporter and recommended to all the so-called savings surgery.

2. Nikolai Ivanovich Pirogov attached great importance to the correct immobilization of patients with fractures. I must say that he was one of the first to introduce plaster bandages into widespread practice. Starch dressings were also used.

3. Particular attention was paid to “...well-organized triage at dressing stations and military temporary hospitals...”

4. Pirogov was also an innovator in the use of anesthesia. He was one of the first in Europe to use ether anesthesia (ether dressing) in the conditions of hostilities near the village of Salty while helping the wounded. Thus, chloroform, ether, and other types of anesthesia are firmly rooted in medical practice.

5. It is impossible not to say about Pirogov's views on hygiene, on the prevention of various diseases. Here is what he said: "I believe in hygiene. This is where the true progress of our science lies. The future belongs to preventive medicine. This science, going hand in hand with the state, will bring undoubted benefits to mankind."

Nikolai Ivanovich Pirogov, apart from being a first-class surgeon, was an excellent organizer and innovator in the field of medicine and healthcare.

1. Let us turn to the work of N. I. Pirogov "Basic Principles of Military Field Surgery". Here we meet the following words: "Not medicine, but the administration plays a major role in helping the wounded and sick in the theater of war."

2. It should be said that N. I. Pirogov appreciated the help of volunteers in hospitals and on the battlefield. For example, during the Crimean War, Nikolai Ivanovich Pirogov organized a dressing station right "under enemy fire." At this point, the sisters of mercy of the Exaltation of the Cross Community of the Red Cross worked selflessly. I must say that in general, under the leadership of Pirogov, 120 sisters worked in the Crimean War. All of them were competently divided by N.I. Pirogov into various groups: nurses on duty, housewives, dressing, transport, pharmacy, etc.

It should be noted that N. I. Pirogov was a good teacher. He made high demands on himself as a teacher. In the presentation of any course, Pirogov strove for great clarity: various kinds of demonstrations were used at lectures, new methods were introduced in the teaching of surgery and anatomy. It must also be said that N. I. Pirogov introduced clinical bypasses.

The defeat in the Crimean War, intrigues at the Medical and Surgical Academy and other factors influenced Pirogov, and at the age of 46 he decided to leave the academy and accepted an offer to become a trustee of educational districts in Odessa.

After that, he became a trustee of educational districts in Kyiv. The character of Nikolai Ivanovich Pirogov, his views on education, as well as a new outbreak of reaction after D. Karakozov shot at Alexander II - all this influenced the fact that the government removed Pirogov from all his posts, after which he moved to live in his estate Cherry, which was located near Vinnitsa. There, N.I. Pirogov provided medical assistance to the local population, and also wrote memoirs. It is worth mentioning the famous "Diary of an Old Doctor", as Pirogov said, this diary "written exclusively for himself, but not without a back thought that maybe someday someone else will read it."

I. P. Pavlov spoke fully and vividly about Pirogov: “With the clear eyes of a man of genius, at the very first time, at the first touch of his specialty - surgery - he discovered the natural scientific foundations of this science: normal and pathological anatomy and physiological experience and in for a short time he established himself on this basis so much that he became a creator in his field.Almost no sooner than he left his youthful age, when he found himself abroad, not only did he not portray himself as a timid student, but looked at foreign teachers as a strict critic and took from them only what was really valuable."

Nikolai Ivanovich Pirogov died in 1881. He played one of the main roles in the development of medical science in Russia. After his death, the All-Russian Scientific Society was established in his memory. The estate of N. I. Pirogov Cherry was renamed Pirogovo, and the house became the museum of N. I. Pirogov. Near the Pirogov Museum there is a crypt where the embalmed body of the great Russian medical scientist lies.

S.F. Khotovitsky

Stepan Fomich Khotovitsky - a doctor, one of those who laid the foundations of pediatrics in Russia. S. F. Khotovitsky graduated from the Medical and Surgical Academy in St. Petersburg in 1817. From 1822, he began teaching forensic medicine there, as well as obstetrics, etc. In 1830, S. F. Khotovitsky became a professor, and already in 1832 - Head of the Department of Obstetrics, Women's and Children's Diseases.

Khotovitsky was the first to give a full course of lectures on childhood illnesses (1836). In 1847, the fundamental work of S. F. Khotovitsky was published, which was the first manual on pediatrics in Russia and was called "Pediatrics". Here are a number of works by Khotovitsky: "On Anthrax" (1831), "On Cholera" (1832), as well as "Medical-folk instructions for religious schools" (1844).

M. Ya. Mudrov

Matvey Yakovlevich Mudrov (1776-1831) - Dean of the Medical Faculty of Moscow University. One of the most eminent therapists of that time. Mudrov's pedagogical and scientific views were based on the democratic tradition characteristic of Russian medicine, the doctrine of the integrity and individuality of the patient's body, the ideas of nervism and the highly humane principles of approach to the suffering. Matvey Yakovlevich

Mudrov repeatedly expressed his social and scientific views at solemn meetings of Moscow University. Probably, the most complete idea of ​​his views is given by the speech "A word about the way to teach and learn practical medicine or active medical art in the beds of the sick" (1820). In this speech (as well as in other works by Mudrov), a program of approach to the prevention of the healthy, to the treatment of the sick was outlined, a number of provisions were put forward that became aphorisms.

1. "We should not treat the disease itself, for which we do not find parts and names, we should not treat the cause of the disease, which is often unknown to us, the patient, or those around him, but the patient himself, his composition, his organ, his strength."

2. "The same disease, but in two different patients requires a very different approach."

3. "...Starting with love for my neighbor, I should instill in myself all the others that stem from one medical virtue, namely: helpfulness, readiness to help at all times, day and night; friendliness that attracts the timid and the brave; mercy towards strangers and the poor, unselfish indulgence towards the sins of the sick; meek severity towards their disobedience; polite importance towards superiors; talking only about what is necessary and useful; modesty and bashfulness in any case; moderation in food; inviolable calmness of face and spirit when dangers of the sick; cheerfulness without laughter and jokes during occasional family disturbances; curbing the tongue in competitions for any reason; cordially accepting good advice, no matter who it comes from, convincingly rejecting harmful proposals and advice, avoiding superstition; chastity .. "In a word, wisdom. Medicine must be combined with wisdom, for, according to Hippocrates, a doctor who loves wisdom is like a father."

4. The doctor must "... guide the sick well for the sake of health, take care of the healthy so that he does not get sick, take care of the healthy and for the sake of well-being of behavior."

5. “Taking healthy people into your own hands, protecting them from hereditary or threatening diseases, providing them with a proper way of life is fair and calm for a doctor. And it is easier to protect from diseases than to treat them...”

Mudrov repeatedly emphasized the importance of the influence of the psyche, which he associated with the activity of the brain, demanded "to investigate the actions of the soul, depending on the brain, states of mind, melancholy, sleep."

Author: Bachilo E.V.

<< Back: Medicine in the Russian Empire in the 18th century (General characteristics of the historical period. Main features of the economy and culture of Russia in the 18th century. Development of medicine at the beginning of the 18th century. Medical faculty of Moscow University. Hospital schools. Doctors of medicine in Russia. Management of medical institutions. Opening of the Academy of Sciences and all kinds of arts. Hydropathics. Production of medical equipment in the 18th century)

>> Forward: Development of medicine in Russia in the second half of the 19th - early 20th centuries (General historical characteristics of the period under review. Development of therapy. Advanced features of domestic therapy in the second half of the 19th century. Surgery. Asepsis. Development of hygiene in Russia. Pediatrics. Pathological anatomy in Russia. The importance of zemstvo medicine in Russia for the development of medical science)

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