LECTURE No. 8. The development of medicine in Russia in the second half of the XNUMXth - early XNUMXth centuries

1. General historical characteristics of the period under review

On March 30, 1856, Alexander II declared: "It is better to abolish serfdom from above than to wait until it begins to abolish itself from below." Thus, on January 3, 1857, the Secret Committee on the Peasant Question was established. On July 26, 1857, Lansky proposed a reform project to the tsar. Since 1858, an open discussion of the abolition of serfdom began in the noble committees of the province. On December 4, 1858, Rostovtsev developed a new draft reform. So, on February 19, 1861, Alexander II signed the regulation on the peasants and the manifesto announcing the abolition of serfdom.

Landowner peasants (about 23 million people) received personal freedom, an estate, and a field plot.

Results of the reform:

1) the personal emancipation of the peasants saturated the market with free wage labor;

2) the reform established a legal line between feudalism and capitalism;

3) the reform was of a half-hearted nature: the preservation of landownership and the preservation of feudal duties.

60-70s XNUMXth century - the time of liberal reforms. Reasons for the reforms:

1) the rise of a mass and revolutionary-democratic movement in the country;

2) the abolition of serfdom, which changed the economic basis of the country's development. This made it necessary to change the political, military, legal, cultural institutions;

3) pressure on the government from the bourgeoisie and part of the landowners who have become capitalist and interested in bourgeois reforms.

Zemsky Reform

Zemstvo reform - the reform of local self-government - 1864. There are two main features:

1) classlessness;

2) electivity.

The Zemstvo Assembly became the governing body of the Zemstvos. For the peasants, the elections took place in three stages. Zemstvo councils, which were elected by zemstvo assemblies for 3 years, became the executive body of the zemstvos.

The functions of the zemstvos are exclusively the economic needs of the county or province.

Significance of the reform: contributed to the national development of the country, established local statistics, disseminated agronomic innovations. They built roads, schools, hospitals, etc.

City Reform - City Government Reform - 1870

The city reform implied the presence of two bodies: an administrative and an executive body. The city council became the governing body. The executive body was the city government, which was elected by the city duma for 4 years. At the head of the city council was the head.

The function of the city duma and the city government is to ensure the economic needs of the city.

Significance of the reform: organization of local statistics, dissemination of agronomic innovations, construction of roads, schools, hospitals, etc.

Judicial reform of 1864

Russia received a civilized judiciary. The court became classless and the same for everyone. Judicial principles:

1) competitiveness of the parties in court;

2) the independence of the court from the administration;

3) irremovability of judges;

4) publicity of legal proceedings.

The institution of jurors was also created. There were several stages of legal proceedings:

1) world court (1 person) - dealt with civil claims, minor offenses;

2) district court (3 persons). He operated within the county. Handled all civil and almost all criminal cases;

3) Judicial chamber (7 people). The judicial chamber was one for several provinces. She dealt with especially important criminal cases and almost all political cases;

4) Supreme Criminal Court. It was convened at the request of the king;

5) The Supreme Court - the Senate. The meaning of the reform:

1) contributed to the development of civilized norms, law and order in the country;

2) was a major step in the XNUMXth century. to the rule of law in Russia.

Military reform

Military reform 1862-1874

The reformer was Dmitry Alekseevich Milyutin. Reasons for military reform:

1) a revolutionary upsurge in Russia, which made it necessary to strengthen the army;

2) defeat in the Crimean War;

3) streamlining spending on the army.

The entire territory of Russia was divided into 15 military districts.

The significance of the reform: the Russian army was rebuilt in a modern way, contributed to economic growth and the construction of railways.

Financial reform of 1860

An excise system was introduced for:

1) tobacco;

2) salt;

3) wine and vodka products.

A unified state bank of Russia was established, and the state budget was streamlined.

The reform of public education in 1863-1864.

A new university charter was issued which returned autonomy to the universities (1863). And in 1864 a new charter for gymnasiums was issued. Merchants, philistines, peasants received the right to study at the gymnasium.

result of the reforms carried out. Major historical moments

Significance of the reforms of the 1860s-1880s:

1) the transformation of the Russian state from a feudal to a bourgeois monarchy began;

2) not a single reform, however, became fully consistent, each retained the remnants of the feudal system;

3) Russia has firmly embarked on the path of capitalist development.

The main points in the development of capitalism in agriculture in the second half of the XNUMXth century:

1) the growth of the marketability of agriculture;

2) the restructuring of the landlord and peasant economy on a capitalist basis;

3) the preservation of feudal vestiges in agriculture and Russia's lagging behind the advanced countries of the West;

4) the stratification of the peasants (poor peasants, middle peasants, kulaks) and the formation of a class of rural proletariat and rural bourgeoisie.

1861-1866 - the years of the emergence of various social movements. So, there were three main directions of populism:

1) rebellious direction (leader - M. A. Bakunin);

2) propaganda direction (leader - P. L. Lavrov);

3) conspiratorial direction (leader - P. N. Tkachev).

In the autumn of 1876, the revolutionary populist organization "Land and Freedom" was created. Activity goals:

1) complete community self-government;

2) freedom of religion;

3) the transfer of all land into the hands of the peasants;

4) self-determination of nations. Means of achievement:

1) organizational activity;

2) disorganization activity.

The Narodniks wanted to rouse the peasantry to the revolution. 1877-1878 - Russian-Turkish war. The results of the war:

1) the war was won, but unsuccessful;

2) Russia's influence in the Balkans has not become stronger;

3) the concessions of Russian diplomacy in Berlin testified to the military-political weakness of tsarism and the weakening of its authority in the international arena;

4) after the Berlin Congress in Europe, a new alignment of forces was indicated: Germany and Austria-Hungary, Russia and France.

On August 15, 1879, the organization "Land and Freedom" broke up into two parts:

1) "Black Repartition" (represented by Akselerod, Vera Zasulich, G. V. Plekhanov, L. G. Deich, etc.). Included about 100 people;

2) "Narodnaya Volya". Adhered to terrorist tactics (representatives A. Mikhailov, A. Zhelyabov, N. Kibalchich, etc.). It included about 10 people.

Program of the People's Will:

1) overthrow the autocracy;

2) introduce democratic freedoms;

3) introduce universal suffrage;

4) create a parliamentary democratic republic in Russia;

5) give the land to the peasants, factories to the workers;

6) proclaim national equality and the right of nations to self-determination.

The means to achieve it is a peasant uprising supported by the workers, the military and under the leadership of the Party.

On February 12, 1880, an "Extraordinary Commission" was created, which was supposed to ensure the safety of the king. On March 1, 1881, the murder of Alexander P. took place. Before, 24 attempts were made on him, and 25 became fatal for him.

On the same day, Alexander III became king. The goals of the domestic policy of Alexander III are the restoration of serfdom and the revision of legislative acts of the 1860-1870s.

Counter-reforms of Alexander III 1889-1892:

1) July 12, 1889 - Law on zemstvo district chiefs.

The World Court was abolished, its rights were transferred to the zemstvo chief. Meaning: the nobility regained a significant share of their former pre-reform power over the peasants;

2) June 12, 1890 - Law on provincial and district institutions. This counter-reform undermined the democratic foundations of the zemstvo reform of 1864. It turned the zemstvos into a decorative body;

3) June 11, 1892 - urban counter-reform. The city government was now dominated primarily by large householders, i.e., nobles and officials.

In addition to all this, punitive censorship was introduced, the autonomy of universities was destroyed, a circular was issued about "cook's children."

1896 - coronation of Nicholas P. The peasant question was never resolved.

The main directions of foreign policy:

1) European;

2) Balkan-Middle Eastern;

3) Middle Eastern (or southern);

4) Far East (Korea, China, Manchuria) - the main direction.

The development of capitalism is followed by the development of the political system. The conservative trend in Russia has not become a powerful political force. The liberal movement went through several stages in its development:

1) the first half of the XNUMXth century. - liberal ideas originated in the "top";

2) the second half of the XNUMXth century. - liberal ideas penetrate society (zemstvos);

3) the beginning of the XNUMXth century. - liberal ideas leave the "top" and remain in society.

Classes are formed. Classes are fairly large groups of people who differ in their attitude to the means of production and places in the organization of production. There is also the formation of parties.

The party is the organization of the most active part of the class, which sets as its task the conduct of the political struggle for the interests of this class, expresses and defends them most fully and consistently. Party types: conservative, liberal, social democratic. Here are the names of the formed parties: Socialist-Revolutionaries, Bolsheviks, Mensheviks, Cadets, the Union of October 17th.

January 3, 1905 - the beginning of the strike in St. Petersburg. It was a kind of beginning of the revolution of 1905-1907.

Reasons for the revolution:

1) national oppression;

2) preservation of autocracy;

3) unresolved agrarian problem;

4) lack of democratic freedoms.

Reforms of 1905-1906:

1) October 21, 1905 - a decree on amnesty for political crimes was signed;

2) November 24, 1905 - censorship for non-periodicals was eliminated;

3) March 26, 1906 - censorship for the periodical press was eliminated;

4) December 11, 1905 - electoral law for the election of the State Duma;

5) February 20, 1906 - regulation on the establishment of the State Duma;

6) February 20, 1906 - Decree on the reorganization of the State Council;

7) April 23, 1906 - new "Basic Laws" of the Russian Empire.

April - July 1906 - work of the First State Duma.

February - June 1907 - the work of the II State Duma. June 3, 1907 - there was a coup d'état, the dissolution of the II State Duma, the establishment of the third June monarchy.

1908 - the beginning of the reorganization of the army.

2. The development of therapy. Advanced Features of Domestic Therapy in the Second Half of the XNUMXth Century

I must say that Russian clinicians of the second half of the XIX century. did not take the position of therapeutic nihilism. Let's name the largest therapists of this era: G. A. Zakharyin, S. P. Botkin, A. A. Ostroumov. All of them proceeded from the fact that the human body is a single whole, and also developed the materialistic traditions of Russian science, they were quite critical of the achievements of science in other countries and used only what was really of interest. The body in the understanding of domestic therapists is the unity of mental and physical principles, moreover, the physical, material was considered primary, and the mental - derived from the physical. This was the advantage of domestic clinicians over a large number of clinicians who healed in other countries. Fundamentals of the national clinical school: a thorough description of the disease, careful collection of anamnestic data, direct observation of the patient and others - all this contributed to the development of clinical medicine.

I must say that there were a number of disagreements between S. P. Botkin and G. A. Zakharyin, but the opinion that they opposed each other ^- erroneously. Each of these clinicians had their own characteristics in the method of examining the patient. But it is impossible not to say what was fundamentally common between them: both of them interpreted the disease as a process that affects the entire body, and each of them pointed out the role of the nervous system in pathology and physiology.

S. P. Botkin

Sergei Petrovich Botkin (1832-1889) is one of the outstanding Russian clinicians. He graduated from the medical faculty of Moscow University in 1854. From 1862 to 1889. he was the head of the academic therapeutic clinic of the St. Petersburg Medical and Surgical Academy.

I. M. Sechenov and S. P. Botkin put forward the following assumptions:

1) the leading role of the environment in the origin of the acquired and inherited properties of the organism;

2) about the primary role of the environment in the origin of diseases.

Let us turn to S. P. Botkin’s speech “General Fundamentals of Clinical Medicine” (1886), where he said: “The study of man and the nature around him in their interaction with the aim of preventing diseases, treating and alleviating diseases constitutes that branch of human knowledge that known as medicine." One drawback of this definition of medicine should be noted. The fact is that S.P. Botkin did not indicate that, in addition to the external physical environment, the human body is also affected by the social environment. S.P. Botkin explained the tasks of medicine as follows: “The most important and essential tasks of practical medicine are the prevention of disease, treatment of developed disease and, finally, alleviation of the suffering of a sick person.” S.P. Botkin tried to translate clinical medicine into an exact science; he believed that “the inevitable path for this is scientific... if practical medicine should be placed among the natural sciences, then it is clear that the techniques used in practice for research observation and treatment of the patient should be the techniques of a natural scientist."

S. P. Botkin was distinguished by the ability to find an individual approach to the patient, great observation, the ability to correctly assess the significance of various manifestations of a particular disease. All this made Botkin a subtle diagnostician. Here are a number of scientific generalizations and observations by S. P. Botkin:

1) infectious origin of catarrhal jaundice;

2) the doctrine of the peripheral heart, of collapse;

3) the doctrine of the causes of death in lobar pneumonia;

4) the relationship of the formation of gallstones with microorganisms;

5) the doctrine of the fall of the pulse due to the weakness of the vessels;

6) the doctrine of the "wandering kidney" and the phenomena of enteroptosis;

7) the presence of nerve centers;

8) in-depth analysis of the lesions of the nervous system, as well as the hematopoietic system, the circulatory system.

Sergei Petrovich Botkin showed the reflex mechanism of a number of pathological processes.

Let us now turn to S. P. Botkin's Clinical Lectures. Here he gave an analysis of many clinical phenomena, symptoms and symptom complexes from the point of view of the reflex theory. So, Botkin considered the neurogenic origin of certain forms of fever, sweating on one side of the body, contractility of the spleen. Botkin also introduced such a thing as a pathological reflex. With the creation of the neurogenic theory, Botkin marked the beginning of a new stage in the development of clinical medicine.

The organization of medical affairs was also included in the circle of interests of Sergei Petrovich Botkin. At his suggestion, the conditions and equipment of city hospitals in St. Petersburg began to improve.

Laboratories were set up in hospitals, medical conferences were held, post-mortem autopsies were performed, and the nutrition of patients was also improved. Thus, Botkin contributed to the improvement of medical care for the population. Another merit of Botkin in the organization of health care was the introduction of the so-called Duma doctors. They were supposed to provide assistance at home to the poorest population of the city.

In 1886, a commission was set up to improve sanitary conditions and reduce mortality in Russia. This commission was headed by Sergei Petrovich Botkin. The materials collected by this commission were analyzed and conclusions were drawn about high infant mortality, insufficient medical care, etc.

All this indicated that the conditions of the tsarist system entailed not only a deterioration in the health of the population, but even worse, led to the degeneration of the nation. Unfortunately, the materials collected by this commission were not discussed in any of the instances, and, in fact, the work of the commission turned out to be fruitless.

It is also impossible not to say about S. P. Botkin as an outstanding teacher of higher medical school. He created an extensive school of his followers.

G. A. Zakharyin

Grigory Antonovich Zakharyin (1829-1897) - one of the leading clinicians of the 1852th century. He graduated from the medical faculty of Moscow University in 1862. From 1895 to XNUMX. G. A. Zakharyin was the head of the faculty therapeutic clinic of Moscow University. He was an innovator in his clinical and teaching activities. Through his students, he had a significant impact on the development of medicine.

G. A. Zakharyin expressed the main task of the clinician as follows: "To determine what disease (research and recognition), how it will go and how it will end (prediction), prescribe a treatment plan and carry out in accordance with the course of the disease (observation)". G. A. Zakharyin attached great importance to clinical lectures: “A clinical lecture should be an example of the correct methodology and individualizing clinic.

And the more it differs from the chapter of the textbook, the more it has the right to be called a clinical lecture. "G. A. Zakharyin's research covered a number of issues of clinical medicine. He described the picture of syphilis of the lungs (syphilitic pneumonia, pulmonary tuberculosis clinic), syphilis of the heart, in addition , he gave a classification of tuberculosis. G. A. Zakharyin put forward a theory about the role of endocrine disorders in the etiology of chlorosis. One of the main merits of Zakharyin is the development of a method of direct clinical observation and the development of a method for interviewing a patient.

The initiative of the survey should remain in the hands of the attending physician. It must be said that Zakharyin's survey covered not only the past (anamnesis), but also the present state, as well as the environment in which the patient lives. In fact, in the survey, G. A. Zakharyin has two main principles: physiological (by systems and organs) and topographic. The method of such a survey covers all systems and organs: blood circulation, respiration, genitourinary system, gastrointestinal tract (which includes the stomach, liver, intestines, spleen), hematopoietic system, metabolism, nervous system, as well as neuro-emotional state (headaches , intelligence, sleep, mood, memory, paresthesia, dizziness, etc.).

G. A. Zakharyin attached great importance to treatment. In the medical advice of Zakharyin, instructions to the patient about the lifestyle and regimen occupied a large place. Here's what he said: "Change the environment, change the activity, change the way of life, if you want to be healthy."

It is worth noting that, along with peace, Zakharyin recommended movement. G. A. Zakharyin, along with the use of medicines, also used hygienic and preventive measures, as well as general medical techniques - bloodletting, climatotherapy for patients with pulmonary tuberculosis (by the way, climatotherapy was recommended not only in the south, but also in nature in any area), massage , mineral water.

Issues of hygiene occupied a significant place in Zakharyin’s clinical teaching. Let us turn to the famous speech of G. A. Zakharyin, which is called “Health and education in the city and outside the city.” In this speech, G. A. Zakharyin says: “The more mature a practical doctor, the more he understands the power of hygiene and the relative weakness of drug therapy... Only hygiene can triumphantly fight the ailments of the masses. The very success of therapy is possible only if hygiene is observed.”

It must also be said that only rich people could follow most of the advice of G. A. Zakharyin.

A. A. Ostroumov

Aleksey Alekseevich Ostroumov (1844-1908) graduated from the medical faculty of Moscow University in 1870. From 1879 to 1900 He was the head of the Department of Hospital Therapy at Moscow University. Aleksei Alekseevich Ostroumov was a follower of Zakharyin, especially in the application of clinical methods.

He also attached great importance to questioning the patient, believed that it was necessary to identify all the features of the case of the disease in this particular patient.

He continued to develop the traditions of S. P. Botkin in the development of experimental pathology and physiology. Like S. P. Botkin, A. A. Ostroumov was interested in the then new sciences - experimental pathology and pharmacology. A. A. Ostroumov attached great importance to the nervous system.

Ostroumov wrote: “The organism is a whole. The disorder of one part is reflected in the whole organism by a change in the vital activity of its other parts, therefore the weakening of the function of one organ upsets the entire organism... The organism as a whole changes in its functions when each of its parts is ill.” Ostroumov believed that through metabolism and the neuro-reflex system, the unity of the body, the interconnection of various organs with each other and the correlation of their activities are realized. A. A. Ostroumov analyzed various factors operating in the pathological process.

He became the developer of the doctrine of the significance of the course and etiology of the disease of the external environment in which this person lives, develops, etc. A. A. Ostroumov clearly defined the tasks of the doctor: “The subject of our study is a sick person, whose normal life is disrupted by the conditions of his existence in the environment... The purpose of clinical research is to study the conditions of existence of the human body in the environment, the conditions of adaptation to it and disorders.”

Ostroumov attached decisive importance in the treatment of the patient to general treatment, considered it necessary to place the patient in conditions with the most favorable diet, work, and housing for this patient.

A. A. Ostroumov believed that medical science is a part of natural science, and therefore, its development should take place in connection with other natural sciences. That is why he sought to combine clinical findings with biological data.

The shortcomings of the views of Aleksey Alekseevich Ostroumov include the fact that he exaggerated the role of a person's hereditary, innate predispositions to various diseases and belittled the adaptive properties of his environment. He underestimated the social side of human society.

3. Surgery. Asepsis

Mid XNUMXth century was marked for surgery by significant innovations - the use of ether and chloroform anesthesia. This made it possible for surgeons to operate more calmly and without unnecessary haste.

The fight against wound infection is one of the main tasks of surgery in the second half of the XNUMXth century. The development of surgery was greatly facilitated by the creation and introduction into practice of antisepsis and asepsis. Scourge of surgeons were purulent complications after operations and after wounds.

The fact is that suppuration slowed down the healing of wounds, in addition, caused septic complications in the wounded and sick after operations, exhausted the operated and wounded, and quite often led to death. During the Patriotic War of 1812 and subsequent campaigns in Western Europe, Russian doctors used evacuation, and also organized military delivery hospitals - it was they who revealed the advantages of Russian military field medicine. I must say that even before Pasteur made his discoveries, Russian surgeons (I.V. Buyalsky, N.I. Pirogov) were fighting wound infection. Buyalsky used an antiseptic solution of bleach to wash his hands, he believed that this was one of the best protective agents for surgeons, midwives, obstetricians, doctors and paramedics, both during operations, internal examinations, dressing gangrenous, cancerous, venereal and wounds inflicted by rabid animals. , and during the autopsy of dead bodies. N. I. Pirogov, in the treatment of wounds, used iodine tincture, silver nitrate, and bleach solution. It is also worth mentioning that in his clinic in St. Petersburg in 1841, N. I. Pirogov allocated a special department, which was intended for patients with erysipelas, pyemia, gangrene, etc. He did this in order to prevent the development of nosocomial infection.

During the 1880s the beginnings of asepsis appeared. Asepsis included some techniques that were developed by antiseptics (disinfectant treatment of the surgical field and the surgeon's hands, strict cleanliness of the operating room). Sterilization of instruments, clothing of operating room personnel, and dressings was introduced. In 1884, the Russian doctor L. O. Heidenreich proved that steam sterilization at elevated pressure is the most perfect. He suggested an autoclave. Gradually, chemical methods of disinfection (for example, dressings) were replaced by physical ones. It must be said that asepsis was the result of the work of surgeons from various countries. At the end of the 1880s. in Russia, aseptic methods began to be used in a number of clinics. For example, N. V. Sklifosovsky - in Moscow, A. A. Troyanov - in St. Petersburg, as well as M. S. Subbotin - in Kazan, etc.

It must be said that the introduction of antiseptics, asepsis and anesthesia contributed to the flourishing of surgery. Thanks to the knowledge of anatomy, surgeons were able to develop a technique for operating approaches, in particular to deep-lying organs and tissues. The introduction and development of asepsis allowed surgeons to operate not only on the limbs and the surface of the body, but also to penetrate into its cavities.

In the early 1890s "dry" method of operation was introduced. The essence of this method was that the surgeons avoided washing the wound with antiseptic agents and sterile saline. The tools of E. Kocher and J. Pean, as well as the proposal of F. Esmarch, made it possible for surgeons to operate with little blood loss and in a "dry wound".

At the end of the XIX century. abdominal surgery began to develop widely, a large number of operations on the abdominal cavity were performed. For example: gastroenterostomy (G. Matveev, T. Billroth), pylorotomy (J. Pean), excision of the caecum (T. Billroth), gastrostomy (N.V. Sklifosovsky, A. Nussbaum), excision of the pylorus (T. Billroth), partial excision of the large and small intestines. Operations on the liver and kidneys began. The first cholecystotomy operations were performed in 1882 and 1884. Nephrectomy operations were performed quite often.

One of the important achievements is that operations on peripheral nerves (nerve suture, nerve traction), on the brain (for example, removal of tumors) have begun. In addition, new dressings were introduced (cotton wool, gauze bandage, muslin, gauze, etc.).

Local anesthesia began its development with the use of cocaine. The first to study the effect of cocaine on sensory nerves was the St. Petersburg pharmacologist A. K. Anrep in 1880. He was also the first to give patients subcutaneous injections of cocaine. Well, since 1884, cocaine anesthesia has been used in surgery.

In 1886, L. I. Lushkevich was the first to use regional (regional) anesthesia; he described a violation of the conduction of nerves in a person after cocaine was injected subcutaneously. L. I. Lushkevich was also the first to use conductive anesthesia of the finger during surgery (long before Oberst). A. V. Orlov pointed out in 1887 the advantage of weak solutions of cocaine. So, local anesthesia was quite common in the practice of zemstvo doctors.

I must say that zemstvo medicine in the late XIX - early XX centuries. significantly improved medical care for the rural population. Zemstvo medicine also played a big role in the development of surgery in Russia. Thus, surgery is one of the first medical specialties required in zemstvo hospitals.

It should be noted that the surgical specialty developed not only in university clinics and hospitals in large cities, it also developed in districts, in zemstvo district hospitals. Major surgeons were formed there, who could perform fairly complex operations.

The use of spinal anesthesia and intravenous anesthesia marked the beginning of the XNUMXth century.

In the second half of the XIX - early XX centuries. in the field of surgery, such surgeons as A. A. Bobrov shone. I. I. Dyakonov, N. V. Sklifosovsky, V. I. Razumovsky, N. A. Velyaminov. In fact, they became in theoretical and practical terms the successors of the work of Nikolai Ivanovich Pirogov. They performed complex operations, studied the problems of general surgery, and created new surgical techniques.

N. V. Sklifosovsky (1836-1904) - one of the largest Russian surgeons, a public figure, a prominent, progressive scientist. He did a lot to introduce asepsis and antisepsis into surgical practice. He developed abdominal surgery.

For example, operations on the stomach, gallbladder, liver, bladder, ovariotomy. His merits in the field of military field surgery are great. The contribution of A. A. Bobrov: he invented an apparatus for infusing saline, developed a new special method for operating hernias. In addition, he organized a sanatorium in Alupka for the treatment of children with tuberculosis of the bones and joints. P. I. Dyakonov, in addition to developing issues of asepsis and antisepsis, anesthesia, dealt with issues of plastic surgery, as well as issues of treatment of cholelithiasis.

Surgery expanded the possibilities of influencing the disease process. It is no coincidence that at the end of the XIX century. in some clinical specialties, such as, for example, urology, ophthalmology, gynecology, surgical methods appeared in addition to therapeutic methods.

Reconstructive surgery had its own development - plastic surgery, prosthetics. In surgery of the late XIX - early XX centuries. the effectiveness of surgical intervention has increased due to the emergence of new, the complication of old surgical methods, as well as the use of new complex instruments and devices.

I. M. Sechenov

Ivan Mikhailovich Sechenov (1829-1905) graduated from the military engineering school, and after him from Moscow University. After that, he taught at Moscow, Odessa, St. Petersburg universities. Sechenov was fired from St. Petersburg University for his radical materialistic views, and continued to work at Moscow University in the Department of Physiology. Let us designate the main directions of Sechenov's research activity:

1) chemistry of breath;

2) physiology of the nervous system;

3) the physiological foundations of mental activity.

So, I. M. Sechenov became the founder of Russian physiology. He was the founder of the materialistic school of Russian physiologists. This school played an important role not only in the development of psychology, physiology and medicine in Russia, but throughout the world.

However, it must be said that Sechenov, a world-class figure, is not considered such abroad; if they talk about Sechenov, then it is necessary along with Pavlov, who was the successor of his research.

Sechenov for the first time began to consider the activity of the brain as a reflex. Before Sechenov, only those types of activity that were associated with the spinal cord were considered reflex. I. M. Sechenov established that in the brain of a person (and animals) there are special nervous mechanisms that have an inhibitory effect on involuntary movements. Sechenov called such mechanisms "delay centers".

In numerous experiments, a physiological center was discovered, which is located in the middle parts of the brain. This center was called the "Sechenov center", and the phenomenon itself, established in these experiments - "Sechenov braking".

It must be said that I.M. Sechenov studied the human body in unity with its surrounding conditions. He said: “Always and everywhere, life is made up of the cooperation of two factors - a certain but changing organization and influence from the outside... An organism without an external environment that supports its existence is impossible, therefore the scientific definition of an organism must also include the environment that influences it, since without the latter the existence of the organism is impossible." Mental activity must be studied scientifically, like any other bodily activity, without various kinds of references to supernatural causes.

I. M. Sechenov laid the foundation for the modern natural science substantiation of the materialistic theory of reflection, creating the doctrine of the reflexes of the brain, extending the concept of "reflex" to the activity of the higher department of the nervous system. Here are some of the works of I. M. Sechenov.

1. "To whom and how to develop psychology" (1873).

2. "Objective Thought and Reality" (1882).

3. "Elements of Thought" (1902).

In the above works, Sechenov developed the materialistic doctrine, thereby proving the formation and influence of the external environment.

I. M. Sechenov also dealt with the problems of occupational health, emphasized the paramount importance of upbringing and the external environment in the formation of personality, and emphasized the role of training and work skills.

Of all the works of Ivan Mikhailovich Sechenov, the work "Reflexes of the Brain" is especially distinguished by the strength of philosophical judgments and the depth of thought.

The physiology of Sechenov was strongly influenced by the materialistic philosophy of N. G. Chernyshevsky, A. N. Dobrolyubov, D. I. Pisarev, who shared dialectical, evolutionary views, they also supported the teachings of Charles Darwin, and opposed vulgar materialists and racists.

I. P. Pavlov

Ivan Petrovich Pavlov (1849-1936) - the great Russian physiologist. He became the developer of new principles of physiological research, which ensured the knowledge of the body as a single whole, which is in unity and constant interaction with the environment. Pavlov also acted as the creator of the materialistic doctrine of the higher nervous activity of animals and humans.

From 1874 to 1884 - this is the first period of Pavlov's scientific activity. During this period, he was mainly engaged in the physiology of the cardiovascular system. One of his works, The Centrifugal Nerves of the Heart, which was published in 1883, is an important contribution to physiology. Here he showed (for the first time!) that on the heart of warm-blooded animals there are nerve fibers that are capable of weakening and strengthening the activity of the heart.

IP Pavlov suggested that the reinforcing nerve, which he discovered, acts on the heart by changing the metabolism in the heart muscle. During the same period of his work, Pavlov investigated the neural mechanisms that regulate blood pressure. It should be noted that already in the early works of IP Pavlov, high skill and innovation in experiments can be traced.

With regard to the methods of studying the whole organism, Pavlov was a progressive scientist:

1) abandoned traditional acute experiments;

2) noted the shortcomings of acute vivisection physiological experience;

3) developed and put into practice the method of chronic experiment;

4) developed a method for studying particular physiological functions on a whole organism under natural conditions of interaction with the environment;

5) developed new techniques that made it possible to conduct an experiment on a healthy animal that had recovered quite well from surgery;

6) developed new methods of "physiological thinking";

7) developed special operations on the organs of the digestive tract.

Let us turn to the famous work "Lectures on the work of the main digestive glands." Here he sums up a kind of results of work on the physiology of the digestive system. It must also be said that it was for this work that Ivan Petrovich Pavlov was awarded the Nobel Prize in 1904.

Let us turn to the report of I.P. Pavlov in 1909, which was called “Natural Science and the Brain.” Here we can find the following lines: “Here and now I only defend and affirm the absolute, indisputable right of natural scientific thought to penetrate everywhere and as long as it can show its power. And who knows where this opportunity ends... "In this report, Pavlov shows that there are no limits to human knowledge.

I. I. Mechnikov

Ilya Ilyich Mechnikov (1845-1916) played one of the main roles in the development of both domestic and world microbiology, immunology and epidemiology. Mechnikov's research in these areas was a kind of continuation and development of his previous work in the field of pathology. I. I. Mechnikov was an outstanding scientist in various fields of knowledge: zoology, embryology, pathology, immunology, etc. He was one of the founders of modern microbiology, as well as the founder of comparative evolutionary pathology.

Ilya Ilyich Mechnikov graduated from the natural department of Kharkov University in 1864, after which he continued his studies and specialization in Germany and Italy in the field of embryology. In 1868 he defended his doctoral dissertation at St. Petersburg University.

After that, he received an associate professorship at Novorossiysk and then at St. Petersburg Universities. From 1870 to 1882 was a professor at the Department of Zoology and Comparative Anatomy at the Novorossiysk University. In 1886, I. I. Mechnikov and the then young doctor N. F. Gamaleya organized the Pasteur anti-rabies station - it was the first station in Russia, and also the second in the world after Pasteur's in Paris. This station was organized in Odessa, after that the same stations were organized in St. Petersburg, Moscow, Samara and other cities of Russia. However, as a result of a conflict with the authorities at the anti-rabies station and at the university, I. I. Mechnikov leaves his job and leaves for Paris at the invitation of L. Pasteur. There he heads one of the institute's laboratories, is Pasteur's deputy, and after his death, director of the institute. Subsequently, I. I. Mechnikov was elected an honorary member of the St. Petersburg Academy of Sciences.

The activities of I. I. Mechnikov can be divided into two periods. The first period includes the time from 1862 to 1882. At this time, Mechnikov was a zoologist and primarily an embryologist. II Mechnikov solved a number of the most difficult problems of embryology. It was he who showed the presence of germ layers - the laws of development of the animal organism common to animals. Mechnikov established a genetic link between the development of invertebrates and cavitary animals. The basis for the evolutionary doctrine was the data of embryology, which were discovered by Mechnikov.

Mechnikov was an active follower of Charles Darwin. However, this did not stop him from criticizing certain aspects of Darwin's work. For example, Darwin's uncritical transfer to biology of Malthus' doctrine of the role of "overpopulation".

Mechnikov's discoveries include the discovery of intracellular digestion. He discovered it when he was researching questions about the origin of multicellular animals. I. I. Mechnikov showed that in the body of an animal that has digestive organs, there are cells that are able to digest food, but do not take a direct part in digestion. It is with the work on intracellular digestion that the first period of the activity of Ilya Ilyich Mechnikov ends.

The second period is, as it were, a logical continuation of the first and is based on it. The fact is that the ideas about intracellular digestion were leading in the works of Mechnikov on the problems of pathology in the second period.

In 1883, Mechnikov's speech "On the Healing Powers of the Organism" put forward a number of provisions on the active role of the organism in the infectious process, as well as on the relationship between the macroorganism and the microorganism. Subsequently, I. I. Mechnikov widely developed the doctrine of phagocytosis, confirmed it by numerous studies on a variety of materials. In 1892, in Mechnikov's Lectures on the Comparative Pathology of Inflammation, one can read the following: "A real comparative pathology should embrace the entire animal world as a whole and study it from the most general biological point of view." Mechnikov "created a new theory of inflammation as an active defensive reaction of the body against the disease that penetrates into it, developed by representatives of the animal world in the process of their historical development." I. I. Mechnikov said: "Inflammation as a whole should be considered as a phagocytic reaction of the body against irritating agents; this reaction is carried out either by mobile phagocytes, or with the action of vascular phagocytes or the nervous system."

In 1900 Mechnikov's book "Immunity in Infectious Diseases" was published. Here he acted as the founder of a new science - immunology, as well as the developer of the doctrine of immunity. I. I. Mechnikov showed that "the mechanism of the emergence and development of an infectious disease depends not only on the microorganism, but along with the microorganism at all stages of the infectious process - during its occurrence, development, course and gathering - an important role is played by the microorganism, which does not remain indifferent ". Mechnikov considered the infectious process as a complex process of interaction between a pathogenic microorganism and a microorganism. Mechnikov also showed that the occurrence and course of the infectious process to a certain extent depends on the external environment, and the nervous system also plays a role in the protective functions of the body.

Mechnikov repeatedly met opponents on his scientific path. For example, his phagocytic theory was criticized by some microbiologists and pathologists (mainly A. Koch, K. Flügge, etc.). He persistently and passionately defended his innocence for about 25 years, repeatedly proving the inconsistency of the arguments of his opponents. After many years of opposition, the theory of I. I. Mechnikov became widespread and universally recognized, and I. I. Mechnikov was awarded the Nobel Prize in 1908. The development of his ideas continued in the works of N. N. Anichkov, J. Fischer, L. Ashof etc.

In addition to all this, I. I. Mechnikov conducted a large number of studies on particular issues of medicine. For example, he studied cholera, relapsing and typhoid fever, syphilis, childhood intestinal diseases, and tuberculosis.

Together with E. Roux, I. I. Mechnikov made an experimental infection of a monkey with syphilis. This was of great importance in the development of venereology.

As for the methods used by Mechnikov, this is a comparative biological method, the desire to study and consider the phenomena of organic nature in their connection, interdependence and contradictory development. Ilya Ilyich Mechnikov created a fundamental school of microbiologists and epidemiologists both in Russia itself and abroad. L. A. Tarasevich, G. N. Gabrichevsky, N. F. Gamalei, A. M. Bezredka, D. K. Zabolotny, as well as the first woman who became a professor of microbiology, P. V. Tsiklinskaya, can be attributed to the students of Mechnikov. and etc.

"A characteristic feature of advanced Russian doctors, which is especially pronounced in the field of microbiology and epidemiology, is heroism, dedication, readiness to sacrifice oneself in the name of science." So, I. I. Mechnikov adopted cholera culture in order to prove the specificity of vibrio in the etiology of Asian cholera.

I. I. Mechnikov outlined his views on medicine, biology, and human life in the books "Etudes on the Nature of Man" (1903), "Etudes of Optimism" (1907). As in earlier works, here Mechnikov substantiated the idea of ​​"orthobiosis" - "the development of a person in order to achieve a long and active old age, leading to the enjoyment of life and, so to speak, to natural death."

4. Development of hygiene in Russia

Hygiene was developed in Russia almost simultaneously with its development in Germany. Together with Germany, Russia was one of the first countries in which independent departments of hygiene were created. The creation of these departments was provided for by the university charter of 1863. In 1865, the St. Petersburg Medical and Surgical Academy, as well as the medical faculties of Kazan and Kyiv universities, decided to create departments of hygiene at these universities. In 1871, teaching began at these departments in Kyiv and St. Petersburg. The creation of hygiene departments at universities significantly influenced the further development of hygiene as a science in Russia. The following conditions also contributed to this: the rapid development of industry (especially in the 90s of the XIX - early XX centuries), the increase in population, mainly in cities, various achievements in the field of natural science. The latter made it possible to accurately determine any hygienic expressions, and also made it possible to study the natural sciences by various qualitative and quantitative methods. The question of improving public life in terms of hygiene and preventing various kinds of contagious diseases was constantly raised. Special features of the development of hygiene in Russia in the second half of the XIX century. social movements, the defeat in the Crimean War, the growth of the revolutionary upsurge (especially after the defeat in the Crimean War), and the difficult sanitary and living conditions of the Russian peasantry. Hygiene issues at that time were given great importance, even by the leading representatives of the Russian intelligentsia, who had no contact with medical science (for example, D. I. Pisarev).

Russian hygienists were closely associated in their work with chemists, physiologists, and other representatives of natural science. Some of the hygienists even worked closely with various attending physicians and clinicians, as well as with practical health workers locally, in cities, and zemstvos. In 1882, V.V. Svetlovsky wrote that “... hygiene as a science must stop preoccupying itself with depicting some kind of ideal, normal life, which does not exist for anyone anywhere, but must devote itself to the study of those sanitary conditions of life, which exist in reality. Sanitary issues, as is known, are closely related to economic issues or, generally speaking, to issues of social science."

A new understanding of hygiene as a science, which was different from the Western European understanding, was created by the largest hygienists of the second half of the XNUMXth century: F. F. Erisman and A. P. Dobroslavin. At the same time, domestic hygiene had a public character.

F. F. Erisman

Fedor Fedorovich Erisman (1842-1915) - one of the greatest hygienists of the second half of the 1869th century. He is of Swiss origin. He graduated from the medical faculty of the University of Zurich. After graduating from the university, F. F. Erisman specialized in the ophthalmologist F. Horner, after which he defended his thesis, which was called "On embolisms" mainly of tobacco and alcohol origin. F. F. Erisman was carried away by the revolutionary democratic ideas of Russian students who were studying in Switzerland (the fact is that in Russia women were not yet allowed to study at medical faculties) and in 1871 he came to Russia. Here, for the first time, he worked in St. Petersburg as an ophthalmologist. He conducted numerous studies of vision in schoolchildren, revealed patterns of the influence of school conditions on the development of children's vision. The results of these studies were published in the work "The influence of schools on the origin of myopia". He proposed a special school desk, which to this day is widely known as the Erisman desk. In addition, F. F. Erisman conducted surveys of the living conditions of doss houses and basement apartments. In 1879, the articles "Vyazemsky's overnight houses", "On basement dwellings in St. Petersburg" were published. In these articles, F. F. Erisman wrote about unsanitary living conditions, and also cited facts of extortion by homeowners. The reaction to these articles turned out to be rather surprising - Prince Vyazemsky was convicted. However, Erisman realized that he lacked training in hygiene. And then, he learned the methods of hygienic examinations from K. Voit and M. Pettenkofer. During these years, the prince published many articles on hygiene, as well as various kinds of manuals. In these works, F. F. Erisman clearly defined the immediate goal of hygiene. It consisted in investigating the influence on a person of various natural phenomena that act on him continuously, and then to study the influence of the artificial environment in which a person lives, and also to find such means that would mitigate the effect of all adverse factors on the human body, that act on the part of society and nature. In 1882, F. F. Erisman moved to Moscow. At first he worked in the sanitary organization of the Moscow provincial zemstvo, then in the Moscow city sanitary organization. From 1896 to 1080 F. F. Erisman was a professor of hygiene at Moscow University at the Faculty of Medicine. F. F. Erisman, E. M. Dementiev, A. V. Pogozhev carried out extensive sanitary inspections of factories. So, they conducted a sanitary inspection of 114 factories in the Moscow province with a population of more than XNUMX thousand. In these studies, the following indicators were studied:

1) duration of the working day;

2) salary;

3) living conditions;

4) nutrition;

5) living conditions of workers and their families;

6) composition of workers.

As a result of inspections, F. F. Erisman wrote: “The poor sanitary condition in which the factory population finds itself at the present time is not unconditionally associated with industrial labor, but depends only on the unfavorable conditions in which modern civilization has placed this labor, fully providing it unlimited exploitation by greedy and selfish entrepreneurs... It is not industry itself, as if by force of a law of nature, that undermines public health and causes high mortality rates, but the unfavorable economic conditions in which workers are placed by the modern method of production are to blame ". The inspection of factories yielded a lot of material, which took up 19 printed volumes and outlined the situation of workers in Russia. Based on these materials, the doctor E. M. Dementiev wrote the book “The Factory, What It Gives to the Population and What It Takes from It.” All this had enormous socio-political significance. For example, information obtained during the inspection of factories by F. F. Erisman was used in the first Russian workers' Marxist circles for propaganda purposes.

F. F. Erisman wrote about the goals, objectives and essence of hygiene: “Only measures that improve the sanitary conditions of entire groups of the population or the entire population can bring benefit... The health of an individual is only a part of public health... It is not in human nature there are no grounds for recognizing human illness as an inevitable fatal necessity... Human mortality is in close connection with the imperfection of our life system.”

In addition, Erisman pointed out that the proposals of the commission on the issue of mortality in Russia, which was headed by S.P. Botkin, were not entirely complete. He said: "Poverty is the most general disaster of the Russian people, and no matter how important these or those sanitary influences on the health of our population, they are very often suppressed by the influence of an even more powerful economic factor."

F. F. Erisman stood on the position of a close connection between scientific hygiene and practical sanitary activities. He believed that it was impossible to oppose scientific (experimental) hygiene and public hygiene. He said: "Deprive hygiene of its social character and you will inflict a mortal blow on it, turn it into a corpse, which you will not be able to revive in any way.

Declare that hygiene is not a science of public health and that it should only deal with the development of private issues within the walls of the laboratory - and you will be left with the ghost of science, for which it is not worth working. "Thus, the practice of sanitary work subsequently confirmed the point of view of F. F. Erisman.

Knowledge of the methods of hygienic research for a doctor is certainly useful and necessary, however, these methods should be based on the very object of studying hygiene as a medical science - a living person.

In 1896, due to student unrest, F. F. Erisman was fired from Moscow University, and he was forced to leave for his homeland in Switzerland. He nevertheless continued to publish his works in Russia. Subsequently, at various congresses and in the press, F. F. Erisman repeatedly emphasized the advantage of Russian public sanitation and the social traditions of Russian doctors in comparison with doctors of other countries. N.A. Semashko correctly noted that “... many of the provisions that he (F.F. Erisman) defended during his lifetime have not lost their significance at the present time.”

A. P. Dobroslavin

Alexei Petrovich Dobroslavin (1842-1889) is another major scientist in the field of hygiene. In 1865 he graduated from the St. Petersburg Medical and Surgical Academy. In 1869, Alexei Petrovich Dobroslavin defended his doctoral dissertation. After that, he studied how things are with hygiene abroad in Paris and Munich with M. Petenkofer from well-known hygienists, such as, for example, M. Pettenkofer. And from 1870 until the end of his life he was a professor of hygiene at the Medico-Surgical (later it became the Military Medical) Academy. He was the first in Russia to compile original textbooks on hygiene. These textbooks were based on experimental research. It should be noted such a fundamental work as "Hygiene, a course of public health" (1889), as well as "A course of military hygiene with practical exercises in it" (1884), "Essay on sanitary activity" (1874), a textbook "Military Hygiene" (1885). He was the founder and editor of the journal "Health", as well as one of the initiators of the organization "Russian Society for the Protection of Public Health". A.P. Dobroslavin mastered new methods of hygienic research and applied them widely.

He correctly assessed the positive aspects of experimental hygiene. Proceeding from natural-scientific premises (by the way, modern hygienists of Western Europe proceeded from the same premises), from the successes of physiology, physics, chemistry, A.P. Dobroslavin betrayed hygiene, first of all, a social character.

He said that "hygiene gives its advice and instructions to the community, to entire groups of the population. Thus, the assistance provided by hygiene is of a public nature. There is no way to eliminate the pathogenic influences of the external environment without immediately acting on the entire population."

It must be said that A.P. Dobroslavin conducted pedagogical activities. However, in addition to teaching, he himself organized research in the field of food hygiene, school hygiene, communal hygiene, and military. A.P. Dobroslavin devoted a lot of time to the issues of protecting the health of large groups of the population - low-income strata of the population, the peasantry.

He studied the foods that were the main food for these population groups (sauerkraut, kvass, mushrooms, porridge from cereals, etc.). Dobroslavin conducted research on the improvement of places inhabited by people. These studies consisted in examining water supply, sewerage, etc. A.P. Dobroslavin repeatedly participated in anti-epidemic measures, improved disinfection equipment.

It should be noted that A.P. Dobroslavin believed that medical medicine should be divided into hygiene. However, this opinion was wrong. There was even some opposition between the views of A.P. Dobroslavin and F.F. Erisman.

5. ​​Pediatrics

In the second half of the XIX century. in Russia, Nil Fedorovich Filatov (1847-1903) was a prominent pediatrician. He was a follower of Zakharyin. Filatov graduated from the medical faculty of Moscow University, and in 1876 he defended his doctoral thesis, the theme of which was "On the relationship of bronchitis to acute catarrhal pneumonia." It is necessary to note the subtle observation of this doctor.

He was a good clinician who described a number of previously unknown diseases. For 25 years, he described glandular fever, scarlet fever, a latent form of malaria, and he studied acute childhood infections such as chicken pox, measles, scarlet fever, diphtheria. In addition to all this, N. F. Filatov was a talented teacher.

He has written a number of major textbooks on diseases in childhood. The following works by Filatov were widely disseminated: "Clinical lectures" (1881-1902), "Lectures on acute infectious diseases" (1885), "Textbook of childhood diseases" (1893-1902), "Semiotics and diagnosis of children's diseases" (1890). More than one generation of doctors was brought up on these textbooks.

In the book dedicated to the bicentenary of the Faculty of Medicine of Moscow State University, it is noted that "N. F. Filatov is the largest representative of the doctrine of childhood diseases in Russia, the founder of the Russian pediatric school, who enriched pediatrics with original guidelines and numerous scientific works." Among the students of N. F. Filatov, G. N. Speransky and V. M. Molchanov received special fame.

It should also be noted Nikolai Petrovich Gundobin (1860-1908). He developed the ideas of S. F. Khotovitsky. N. P. Gundobin studied the age characteristics of the child in sufficient depth in relation to the goals of the pediatric clinic. In 1906, under the leadership of Gundobin, the book "Features of Childhood. Basic Facts for the Study of Childhood Diseases" was published.

6. Pathological anatomy in Russia

The development of pathological anatomy in Russia took place directly in connection with clinics. Autopsies were regularly performed on the bodies of those who died in hospitals. Autopsies in Russia began to be carried out officially and regularly in the first half of the XNUMXth century. This is earlier than in other countries. At the Moscow Medical and Surgical Academy, Moscow University, St. Petersburg Medical and Surgical Academy, pathological anatomy was taught by anatomists in the course of normal anatomy, as well as by clinicians in courses of pathology and therapy. It should be noted that Russian doctors understood the great importance of pathological anatomy for the clinic. I. V. Buyalsky, I. E. Dyadkovsky, G. I. Sokolsky, N. I. Pirogov began reading a special course of lectures that were devoted to the problems of pathological anatomy. The reading of these lectures took place even before the creation of special departments of pathological anatomy.

A. I. Polunin (1820-1888) became the first professor of pathological anatomy at Moscow University. In his works, AI Polunin noted the importance of the nervous system in various pathological processes that occur in the body. Polunin criticized the cellular theory of Virchow, the humoral doctrine of Rokitansky. He believed that both solid parts and juices are equally important for the human body, and he was also sure that changes that occur in one thing (solid part or juice) entail changes in another. After Polunin returned from a trip to Western Europe in 1845, he noted that in some countries (for example, in Germany), clinicians paid insufficient attention to pathological anatomy. A. I. Polunin wrote: “Students do not have the right to be present at the autopsies of all the dead in the Charite. The autopsies themselves are carried out for the most part carelessly, superficially.

In the St. Petersburg Medical and Surgical Academy in 1859, an independent department of pathological anatomy was organized.

In St. Petersburg, M. M. Rudnev (1837-1878) was a prominent pathologist. The microscope has become almost an everyday research instrument for students of the academy - this is the merit of M. M. Rudnev. He repeatedly noted the great importance of pathological anatomy for clinical disciplines, and also spoke about the need for students to instill practical skills. MM Rudnev attached great importance to the nervous system in pathological processes. Rudnev used experimental methods in his research, which he conducted in various areas of pathological anatomy. He, like Polunin, criticized Virchow's teaching: "It is not true that the whole essence of morbid disorders was attributed to a change in cellular elements, for diseases can consist in a change in both solid and liquid parts of the body."

7. The importance of zemstvo medicine in Russia for the development of medical science

in Russia in the middle of the XNUMXth century. deep social and economic processes caused the emergence and development in the second half of the XNUMXth century. land medicine. The social and economic development of the country led to the abolition of serfdom, which stimulated the development of the capitalist mode of production.

As a result of the fact that capitalist relations began to intensify, the needs of the urban and rural population have increased in almost all spheres of human life, including in the field of medical care. The fact is that even a small increase in the needs for medical care of the rural population could not be provided by the forms that existed in the period before the formation of zemstvo medicine. The situation required the organization of new forms of medical care for the rural population.

Zemstvos accepted a small number of medical institutions (mostly hospitals in provincial and district cities) from the Order of Public Charity. When zemstvos were introduced, medical activity was not included in their mandatory activities. Epidemics influenced the development of the Zemstvo medicine reform. This forced the zemstvos to invite doctors. The main links of zemstvo medicine at the end of the XNUMXth century:

1) rural district hospital;

2) county and provincial sanitary doctor (bureau);

3) district and provincial congress of zemstvo doctors.

Zemstvo medicine has developed an original form of health care for the rural population: a rural medical district with free (in the richest provinces) medical care and a network of medical and sanitary institutions close to the population (zemstvo hospitals, feldsher and obstetric stations, outpatient clinics, a sanitary organization, etc.). ).

I must say that from the very beginning, mostly young doctors went to work in the zemstvos. This happened under the influence of populist ideas - the desire to serve the people. It was during this period that the type of zemstvo doctor took shape in moral and social terms. The images of zemstvo doctors were reflected in various literary works (for example, in the writings of Anton Pavlovich Chekhov, who knew firsthand the specifics and working conditions of zemstvo doctors), in the memoirs of contemporaries. Progressive zemstvo doctors not only treated sick peasants, but also worked to improve the living conditions of the population.

If we compare zemstvo medicine and the medicine of the Order of Public Charity that preceded it, then we can definitely say that zemstvo medicine played a progressive role in the development of medical care for rural residents. Medical assistance through zemstvo medicine was carried out in 34 provinces. Zemstvo medicine is a major step forward, a new and original phenomenon not only in Russia, but throughout the world. This way of organizing the health care of the rural population was the only example in history of organized medical care for rural residents under capitalism.

In 1939, the Hygienic Commission of the League of Nations, after conducting research, recommended establishing a system for organizing medical care for rural residents in various countries. According to the description, this system almost literally repeated the main features of Russian zemstvo medicine. By 1938, advanced hygienists in all capitalist countries could not offer anything better under capitalist conditions than to recommend the basic principles of zemstvo medicine. Thus, in 1947 N.A. Semashko wrote: “Thus, the local principle, first applied in Russia by zemstvo medicine back in pre-revolutionary times, should have received international recognition.”

Moreover, Soviet health care continued the initiatives of zemstvo medicine, improving the use of this form of health care organization. A number of traditions of progressive zemstvo doctors were adopted by Soviet doctors.

In addition to providing medical treatment and sanitary care to the population, progressive doctors of zemstvo medicine conducted a number of studies, gave sanitary descriptions of localities, and also studied the incidence of the population.

Zemstvo doctors examined the life of the peasants, their way of life, work. In addition to peasants, zemstvo doctors studied and described the life, way of life, working conditions of handicraftsmen, workers in factories that were located in the countryside, agricultural laborers in the southern provinces.

Zemstvo medicine also influenced the development of some clinical disciplines, such as obstetrics and surgery. Progressive scientific doctors repeatedly helped zemstvo doctors in improving their knowledge and specialization, etc. Among the leading doctors who helped zemstvo doctors, one can name surgeons N. V. Sklifosovsky, P. I. Dyakonov, obstetrician-gynecologist V. F. Snegirev and others They listened to the requests of zemstvo doctors, responding to them.

Zemstvo sanitary statistics played an important role in the development of medical science. Numerous works by zemstvo sanitary statisticians dealt with demography, morbidity and physical development of the population, issues of the sanitary condition of individual localities, working conditions for factory and agricultural workers, handicraftsmen, etc. Studies of morbidity and infant mortality were of great importance. By the way, it was Zemstvo sanitary statistics that first began to study the incidence.

V. I. Lenin gave a high assessment to the work of zemstvo doctors (in particular, devoted to the study of agricultural labor and statistical research).

Zemstvo medicine was characterized by the features of domestic medicine - preventive, sanitary and hygienic orientation. The activities of prominent zemstvo doctors characterized public health activities. In the works of many representatives of zemstvo medicine, advanced ideas of prevention were widely disseminated.

But it must be said that prevention in the understanding of zemstvo medicine differed from the concept of prevention in the Soviet sense. Zemstvo medicine had a half-hearted character. Many zemstvo doctors remained petty-bourgeois "culturalists" under the influence of populist ideology.

It is necessary to refer to article 3. P. Solovyov (he described zemstvo medicine in detail) “Fiftieth Anniversary of Zemstvo Medicine” (1914). Here Solovyov pointed out that the path of development of zemstvo medicine was not easy, was accompanied by numerous obstacles, represented “an eternal war in a completely peaceful matter,” where “everywhere every step forward is paid for at the cost of long efforts, similar to some kind of siege,” and also that “Zemstvo medicine made its way in zigzags.” He finished his article 3. P. Solovyov with the following words: “The building of zemstvo medicine, in every stone of which one can feel the expended energy of its builders - zemstvo medical workers, stands unfinished and is waiting for a real owner who will complete it in a worthy manner, using the experience of the builder, attracting all living creative forces."

Author: Bachilo E.V.

<< Back: Development of medicine in Russia in the first half of the 19th century (General historical characteristics of the period under review. Socio-political situation. Decembrists and their demands in the field of medicine. Development of anatomy and surgery in Russia in the first half of the 19th century)

>> Forward: Healthcare and the development of medical science in the Soviet period (1917-1991) (General historical characteristics of the period under review. The formation of Soviet medicine. The principles of medicine in the USSR. Higher medical education. Medicine during the Great Patriotic War. The development of medicine in the post-war period)

We recommend interesting articles Section Lecture notes, cheat sheets:

▪ Constitutional (state) law of the Russian Federation. Crib

▪ Business fundamentals. Crib

▪ Infectious diseases. Crib

See other articles Section Lecture notes, cheat sheets.

Read and write useful comments on this article.

<< Back

Latest news of science and technology, new electronics:

The existence of an entropy rule for quantum entanglement has been proven 09.05.2024

Quantum mechanics continues to amaze us with its mysterious phenomena and unexpected discoveries. Recently, Bartosz Regula from the RIKEN Center for Quantum Computing and Ludovico Lamy from the University of Amsterdam presented a new discovery that concerns quantum entanglement and its relation to entropy. Quantum entanglement plays an important role in modern quantum information science and technology. However, the complexity of its structure makes understanding and managing it challenging. Regulus and Lamy's discovery shows that quantum entanglement follows an entropy rule similar to that for classical systems. This discovery opens new perspectives in the field of quantum information science and technology, deepening our understanding of quantum entanglement and its connection to thermodynamics. The results of the study indicate the possibility of reversibility of entanglement transformations, which could greatly simplify their use in various quantum technologies. Opening a new rule ... >>

Mini air conditioner Sony Reon Pocket 5 09.05.2024

Summer is a time for relaxation and travel, but often the heat can turn this time into an unbearable torment. Meet a new product from Sony - the Reon Pocket 5 mini-air conditioner, which promises to make summer more comfortable for its users. Sony has introduced a unique device - the Reon Pocket 5 mini-conditioner, which provides body cooling on hot days. With it, users can enjoy coolness anytime, anywhere by simply wearing it around their neck. This mini air conditioner is equipped with automatic adjustment of operating modes, as well as temperature and humidity sensors. Thanks to innovative technologies, Reon Pocket 5 adjusts its operation depending on the user's activity and environmental conditions. Users can easily adjust the temperature using a dedicated mobile app connected via Bluetooth. Additionally, specially designed T-shirts and shorts are available for convenience, to which a mini air conditioner can be attached. The device can oh ... >>

Energy from space for Starship 08.05.2024

Producing solar energy in space is becoming more feasible with the advent of new technologies and the development of space programs. The head of the startup Virtus Solis shared his vision of using SpaceX's Starship to create orbital power plants capable of powering the Earth. Startup Virtus Solis has unveiled an ambitious project to create orbital power plants using SpaceX's Starship. This idea could significantly change the field of solar energy production, making it more accessible and cheaper. The core of the startup's plan is to reduce the cost of launching satellites into space using Starship. This technological breakthrough is expected to make solar energy production in space more competitive with traditional energy sources. Virtual Solis plans to build large photovoltaic panels in orbit, using Starship to deliver the necessary equipment. However, one of the key challenges ... >>

Random news from the Archive Pills instead of sports 08.10.2022 Experts say that there are diseases in which any serious physical activity is simply contraindicated. Physical activity is an important part of everyone's life because it promotes health and relieves stress. But not everyone has the opportunity to play sports, for example, it is problematic for the elderly or those who have medical contraindications. Scientists have come up with a way that will allow them to solve such a problem. Experts have created a pill that can replace sports. In one 2017 study, they proved in mice that fitness can be improved with GW501516 and GW1516. It is sold illegally on the black market to improve performance. After taking the drug for 8 weeks, mice could run on a treadmill for 70% longer than the control group - more than 100 minutes. Later, a similar study was conducted at the Tokyo Medical and Dental University. Scientists have developed a new drug that mimics the changes in muscles and bones that occur as a result of exercise. The mice were given locamidazole, a drug derived from aminoindazole. Experts noticed that the drug stimulates the growth of muscle cells and young bone cells. So far, most of the work has been done in animal studies, and so far very few scientists are testing this kind of drug in humans. Experts emphasize that taking one drug can help in sports, and the other can strengthen bones. But scientists have a lot of work ahead, because there is still a whole series of studies and tests to be carried out.

Other interesting news:

▪ Contacts between shipbuilders of ancient Rome and Vietnam

▪ Memory programmer BK PRECISION 848

▪ New LED lamps from Samsung

▪ Mushrooms in a gas tank

▪ JUICE space probe

News feed of science and technology, new electronics

Interesting materials of the Free Technical Library:

▪ section of the site Electrician's Handbook. Article selection

▪ article Pediatric surgery. Lecture notes

▪ How does grass spread seeds? Detailed answer

▪ article Electrician for the maintenance of electrical equipment of power plants. Standard instruction on labor protection

▪ article Welding machine with voltage boost and smooth current control. Encyclopedia of radio electronics and electrical engineering

▪ article Universal clamp. Encyclopedia of radio electronics and electrical engineering

Leave your comment on this article:

All languages ​​of this page

Arabic	Hebrew	Polish
Bengali	Hindi	Portuguese
Chinese	Italian	Spanish
English	Japanese	Turkish
French	Korean	Ukrainian
German	Malay	Vietnamese

Home page | Library | Articles | Website map | Site Reviews

www.diagram.com.ua
2000-2024