|
Arabic
Bengali
Chinese
English
French
German
Hebrew
Hindi
Italian
Japanese
Korean
Malay
Polish
Portuguese
Spanish
Turkish
Ukrainian
Vietnamese|
Lecture notes, cheat sheets
History of medicine. Lecture notes: briefly, the most important
Directory / Lecture notes, cheat sheets Table of contents
LECTURE No. 1. Introductory lecture. Medical symbols of various times and peoples The history of medicine is a science about the development, improvement of medical knowledge, medical activities of different peoples of the world throughout the history of mankind, which is inextricably linked with philosophy, history, natural science, and the development of culture. In fact, the history of medicine studies the patterns of development of medicine and healing, their history from ancient times to the present. Throughout the development of medicine, there have been a large number of symbolic images, since medicine was constantly associated with people's grief, joy, etc. Some symbols are a thing of the past, they were forgotten, some still remain. In the old days, an emblem was called an "intricate picture", which conditionally depicted an idea. The emblem (emblema - "insert", "convex image") is a metal sheet of relief work, a convex decoration, an insert. It is also necessary to introduce such a thing as a "symbol". A symbol (simbol - "sign") is a kind of conventional sign, sign. In the old days, a signature or a witty saying to a drawing was called a symbol. If we turn to Ancient Greece, then among the Greeks the word "symbol" meant a certain conventional sign, the meaning and meaning of which was known only to a certain circle of people. Now let's turn to the medical emblem. A medical emblem is a symbolic image that symbolizes the medical field, belonging to the medical profession, various branches of medicine, and some separate medical specialties. For example, in the Middle Ages, lily of the valley was a symbol of medieval therapy. There are a number of common medical emblems: 1) an image of a snake, including in combination with a bowl, with Apollo's tripod, a candle, a mirror, a staff; 2) an image of a heart in the palm of your hand; 3) an image of a burning candle, symbolizing a certain direction in the field of medicine: a) symbols of therapy - lily of the valley, Florentine baby, pelican, urinary (vessel for collecting urine), a hand that feels the pulse; b) symbols of surgery - a drop of blood, various surgical instruments, a pentagram; c) various military medical emblems, emblems of various medical societies. The first inscriptions and images that personified medicine appeared on coins in ancient Greece. Along with the gods and rulers, a snake was minted. In some cases she was alone, in some with the tripod of Apollo, in others with the staff of Asclepius. Consider the snake as a medical emblem. In primitive society, she was one of the main totem animals. In the mythology of ancient civilizations (Babylon, Egypt, Mesopotamia, China, India), the connection between the snake and fertility was often reflected. The snake is a dual, wise and insidious creature that can both betray and help. The snake personified knowledge, wisdom, immortality, power. If we turn to Babylon, then the snake was the emblem of the god of doctors. Rejuvenation, recovery, wisdom were associated with the snake. In Egypt, the snake was the symbol of the god Thoth. This god was the patron saint of doctors. But the Goddess of health and life (Isis) was depicted with snakes that personified eternal life. Another emblem is a staff that is entwined with a snake. It is a stylized image that has a red color and is located on a white background. Today, this emblem is the official emblem of medicine in some European countries. Another emblem is the rod of Hermes (among the Romans - the rod of Mercury). I must say that in the Renaissance, doctors considered themselves merchants, and Hermes, respectively, their patron. Consider another emblem - the emblem of the World Health Organization: the emblem is a staff, which is located vertically and wrapped around a snake. Depicted against the background of a globe bordered by laurel branches (this is the emblem of the UN). Now let's talk about the essence of the subject "History of Medicine", why it is needed, what are its tasks. In order to know the past, various sources are used: 1) archeological data; 2) tools of labor; 3) written monuments; 4) manuscripts; 5) printed books; 6) works of art. The history of medicine considers the development of both practical and theoretical components of medicine. The study of the history of medicine is necessary for a doctor, a student of a medical university, because it allows you to deepen special medical knowledge, and also to some extent warns the doctor against hasty, unreasonable conclusions. The path of development of medical science, all its difficulties, successes, failures, and so on, show the humanism of medicine as a science, instill a sense of pride and respect for the medical profession. LECTURE No. 2. The origin of medicine. Medicine in primitive communities. The emergence of healing When medicine arose, or rather, the beginnings of medical care, it is not known exactly. There are many opinions and theories about this. The most common version: medicine arose simultaneously with the emergence of man, it turns out that medicine arose several hundred thousand years before our era. If we turn to the words of the famous, prominent scientist I.P. Pavlov, he wrote: "Medical activity is the same age as the first person." Traces of first aid were discovered during the period of the primitive communal system. It must be said that the primitive tribal community experienced two periods in its development: 1) matriarchy; 2) patriarchy. Let us briefly trace the main points in the development of the primitive tribal community: 1) people began to live in small communities, which were then subdivided into clans, as well as tribal unions; 2) the use of stone tools in order to get food, hunt; 3) the appearance of bronze (hence the name "bronze age"), and after the appearance of iron. In fact, it changed the way of life. The fact is that hunting began to develop, and since hunting is the lot of men, there was a transition to patriarchy. With the advent of various tools, the number of injuries that people could receive has increased. If you pay attention to the rock paintings, you can clearly see that hunting, various military battles brought people a lot of trouble and, of course, injuries, wounds, etc. Here you can see primitive first aid techniques - removing an arrow, etc. It should be noted that initially there was no division of labor as such. Long before the beginning of civilization and the formation of the state, and especially during the period of matriarchy, women were a kind of keepers of the hearth - this included caring for the community, the tribe, as well as providing medical care. Proof of this can be considered the fact that today in the coastal steppes and other places the first settlements are found by stone sculptures - rough figures of women - guardians of the tribe, clan, etc. The next period of development was when people received fire. Let us turn to the words of F. Engels: “...The production of fire by friction for the first time gave man dominance over a certain force of nature and thereby finally separated man from the animal kingdom.” Due to the fact that people received fire, their food became more varied. In fact, the production of fire accelerated anthropogenesis, accelerated human development. At the same time, the cult and importance of women as guardians of the hearth and healers weakened. Despite this, women continued to collect plants, which they then ate. The discovery of the poisonous and medicinal properties of plants occurred purely empirically. So, from generation to generation, knowledge about plants was transmitted and accumulated, about which of them can be eaten, which ones cannot, which ones can be used for treatment, and which ones should not. Empirically, medicinal products of animal origin (for example, such as bile, liver, brain, bone meal, etc.) were added to herbal remedies. Primitive man also noticed mineral remedies for treatment and prevention. Among the mineral remedies for treatment and prevention, one can name a very valuable product of nature - rock salt, as well as other minerals, up to precious ones. I must say that by the period of Antiquity, a whole doctrine appeared about the treatment and poisoning with minerals, especially precious ones. In connection with the transition to a settled way of life, the role of women, in particular the economic one, decreased, but the medical role was preserved and even strengthened. Over time, the man became the master of the tribe, clan, and the woman remained the keeper of the hearth. The history of medicine has only a few millennia. Despite everything, the medicine of primitive communities still deserves serious attention and study. After all, it was then that traditional medicine appeared and began to develop. The knowledge of people, obtained by the empirical method, accumulated, the skills of healing improved, at the same time the question of the causes of diseases began to arise. Naturally, people of that time did not have such an arsenal of knowledge as today, and could not explain the occurrence of diseases from a scientific point of view, therefore, people considered the causes of diseases to be any magical forces that are unknown to man. From another point of view, people found a magical explanation for the causes of the disease later, and the initial explanations were purely materialistic in nature, which was associated with the experience of obtaining means of life. During the period of late matriarchy, when well-being and life became more and more dependent on the results of hunting, a cult of an animal arose - a totem. Totemism from the Indian, means "my kind." It should also be noted that until recently, and among the Indians in America and still the names of the tribes were associated with the name of any animal or bird, the hunt for which gave food to the tribe - the monkey tribe, the bull tribe, etc. More than that , some even associated their origin with any animal. Such representations are called animalistic. Hence the wearing of amulets. In addition to all this, people could not help but notice the effect of weather conditions on life and health. There is an opinion that primitive people were very strong in health. The fact is that, of course, there was no impact on people at that time of adverse man-made factors - air pollution, etc. However, they constantly fought for their existence with natural conditions, they also suffered from infectious diseases, died in wars with each other, were poisoned low-quality food, etc. There is an opinion that the average life expectancy of people of that time was 20-30 years. Now let's turn to such a concept as paleopathology. 1. Paleopathology is a science that studies the nature of diseases and lesions of ancient people. Among these diseases are such as necrosis, alkalosis, poliomyelitis, periostitis, rickets, bone fractures, etc. As society developed, it came to such phenomena as fetishism, that is, the direct personification and exaltation of natural phenomena, and later animism. 2. Animism - the spiritualization of all nature, the settlement of its diverse spirits and supernatural beings, as if acting in it. Already in the days of patriarchy, the so-called ancestor cult appeared. An ancestor, that is, already some kind of separate personality, maybe even born of a person’s fantasy, could become the cause of a disease, could move into the body of a person and torment him, causing illness. Accordingly, in order for the ailments to stop, the ancestor must be appeased by sacrifice or expulsion from the body. So, we can say that such ideas largely formed the basis of religion. Shamans appeared, who were "specialists" in exorcising or appeasing spirits. Thus, along with materialistic ideas and the rudiments of knowledge acquired by people, animistic, religious views develop. All this forms folk medicine. There are two principles in the activities of traditional healers - empirical and spiritual, religious. Although, of course, there are still healers who confine themselves to ordinary gathering of herbs, preparation of potions and so on without "theoretical and religious" beliefs. The concept of folk hygiene is very closely related to the concept of "folk medicine", the separation of which from medicine is very conditional, since traditions and rules, observations about the dangers of unclean air, water, poor nutrition and other, entered the arsenal of traditional medicine and were used in the treatment and prevention of various diseases. diseases. It is necessary to define the concept of "traditional medicine", which is given in the orders of the Ministry of Health and Social Development of the Russian Federation. Traditional medicine is methods of healing, prevention, diagnosis and treatment based on the experience of many generations of people, established in folk traditions and not registered in the manner prescribed by the legislation of the Russian Federation. Now it is necessary to decide whether traditional medicine can be called traditional. The fact is that traditional medicine developed, as if coming out of the bowels of traditional medicine. So, from this point of view, it would be correct to talk about traditional folk medicine. Thus, the beginnings of medical science appeared with the advent of man, and from the very beginning medicine was folk medicine, as it was carried out by healers, healers, and so on with the help of various potions of plant, animal, mineral origin, as well as using elementary "medical tools" for dressing in the treatment of fractures and wounds, bloodletting, craniotomy, etc. LECTURE No. 3. Hippocrates and his contribution to the development of medicine In the history of the development of medicine, one can hardly find another name with which almost the birth of medicine would be associated. We will talk here about Hippocrates II the Great, who went down in history as Hippocrates. This great healer lived about 2500 thousand years ago at a time when Hellenic culture reached the apogee of its development. Temporal periodization dates this period to the V-IV centuries. BC e. Then not only medicine flourished, almost every branch of human activity moved forward by leaps and bounds and had its representatives who went down in history: the outstanding politician of that time was Pericles (444-429 BC), universally recognized then and subsequently as philosophers Democritus, Anaxagoras, Gorgias, Socrates, Empedocles, in poetry Aeschylus, Sophocles, Aristophanes stood out, in the field of architecture Praxiteles, Phidias, Polykpetes became famous, in history it was the era of Herodotus and Thucydides. Euryphon and Praxagoras became the great colleagues of Hippocrates, and Herophilus and Erasistratus became his followers. However, no matter how they praised the contribution of Hippocrates to medicine, very limited information has reached our days about Hippocrates himself, which does not even allow us to accurately determine the date of his birth and death: some data indicate that he died at the age of 104 years, others - about that he died at the age of 83. It is assumed that he was born in the first year of the XX Olympiad. The place of his birth was the island of Kos (later on, the flourishing of the Kos medical school is associated precisely with the name of Hippocrates). Translated from Greek, the name of the great healer is translated as "horse tamer". For a long time after his death there was not a single source containing information about the biography of Hippocrates. Only more than 600 years after the death of Hippocrates, the doctor Sorans Fr. Kos (around the XNUMXnd century AD) first recorded the biography of the healer, and his work was continued by the lexicographer Svida (XNUMXth century) and the prose writer, philologist I. Tsetse (XNUMXth century). Since they could not conduct a complete analysis of his activities and works, their stories bear the imprint of legend and mystery that surrounded the personality of Hippocrates. From the most reliable sources it is known that he was a descendant of the great Asclepius in the seventeenth generation on his father, and on his mother belonged to the genus of Heraclides (i.e., descendants of Hercules). In addition, he is credited with family ties with the rulers of Thessaly and the Macedonian court. Hippocrates' teachers in the medical art were his grandfather Hippocrates I and father Heraclid. When he left his native home and finished home schooling, he continued his further knowledge of the medical art in Cnidus, and later with Herodicus and the philosopher-sophist Gorgias. Hippocrates received a wide field for applying and improving his knowledge by becoming a wandering doctor. The fame of him quickly spread along the coast of the Eastern Mediterranean. After long wanderings, already in his old age, he stopped in Larissa (Thessaly), where he spent the rest of his life, dying in the same year as Democritus (about 370 BC). The inhabitants of Thessaly honored the tomb of Hippocrates, on which were written poems by an unknown poet dedicated to the great doctor: Here is buried Hippocrates, a Thessalian born on Kos, Phoebe, he was the very root of the immortal branch. He healed many diseases, erected trophies to Hygiea, He deserved many praises - knowledge is not an accident. The name of Hippocrates was repeatedly mentioned in the writings of his contemporaries: he was mentioned by Plato, Diocles from Carista, Aristotle. In their works, comparisons of Hippocrates with the great sculptures and politicians of Ancient Hellas were found. Not just like that, Aristotle even wrote about it as a state that can be considered strong, unlike others, not in terms of its size, but in terms of the state tasks it performs, just like Hippocrates himself, not as a person, but as a doctor, is greater than any other, even many times its body size. Hippocrates chose the path of medicine for himself not by chance, for all his predecessors, starting from Asclepius himself, were doctors. In total, seven Hippocrates are known in history, one of which - the grandson of Hippocrates II, the son of his heir Dragon - treated the wife of Alexander the Great, Roxana. All seven Hippocrates left behind works on the art of medicine, just like many other healers of that time, but history does not know of a single work that would definitely belong to the pen of Hippocrates II the Great. This uncertainty is explained by the fact that all doctors of that time wrote anonymously, because knowledge was initially transferred only within family medical schools, that is, from father to son and to a few who wished to study the medical art. Thus, these works were intended "for home use", their author was known by sight. Only in the III century. BC e. in the Alexandria Manuscript Depository, which was founded by the first ruler of Ancient Egypt, Ptolemy I Soter (323-282 BC) - the diadocho of Alexander the Great, writers, philologists, historians and doctors of that time compiled the first collection of ancient Greek medical writings. The work was then carried out colossal, since manuscripts from all over the world were brought to Alexandria. The total number of papyrus scrolls subject to further processing and translation soon exceeded 700 thousand. Among this huge number of works, 72 compositions on a medical theme were found. All of them were written in Greek, or rather, in the Ionian dialect around the 1525th-XNUMXth centuries. BC e. None of these writings had the signature of the author. It was practically impossible to distinguish from them those that could have belonged to the pen of Hippocrates: not a single work matched the rest in terms of writing style, depth and style of presentation, philosophical and medical position. Moreover, open disagreements were found in the discussion of many issues up to directly opposite opinions. This once again confirmed that they all belonged to different authors. Having lost hope of establishing the authorship of the works, historians combined all these medical texts into one collection and called it "Hyppokratiki sil-logi" or "Hippocratic collection" in honor of the great Greek physician. Later, the title and text of the collection were translated into Latin, and it became better known as "Corpus Hippocraticum". So that this great work would not be lost in the abundance of other literary treasures of that time, it was repeatedly copied, not only in Greek, but also in Arabic, Latin and Italian and many other languages of the world. And only eighteen centuries later, in XNUMX, when printing was invented, it was first published in Rome in Latin. The publication immediately gained immense popularity a year after its release in Greek in Venice, after which it became almost the most famous and widely read work in all of Europe. The work existed for a long time unchanged, and in the XIX century. the French encyclopedist and philologist Emile Litre engaged in a deep analysis, but did not find out which works included in the collection may belong to Hippocrates. Scientists involved in the study of the collection came to the conclusion that no more than 3-4 works can be attributed to the authorship of the great doctor. First of all, they decided that these were "Aphorisms", "Epidemics", "Prognostics", "About air, waters, localities". First of all, it is worth mentioning the "Aphorisms". Perhaps, only in relation to this work there is practically no doubt that it belongs to Hippocrates. "Aphorisms" (from the Greek. aphorismos - "complete thought") were not only on medical, but also on universal, philosophical topics. The beginning of the composition already foreshadows the significance of this work in the scientific world: "Life is short, the path of art is long, opportunity is fleeting, experience is deceptive, judgment is difficult." Undoubtedly, a person who so accurately and briefly was able to state the essence of human life in general and the meaning of medical practice in particular, must have had a remarkable mind, wisdom, subtle attention and had many years of experience behind him. And even if this saying was the only one in his life and he did nothing else either in the practical or in the scientific fields of medicine, people would already have to admit that he was a great doctor and thinker. Another work of the Hippocratic Collection, which became the basis for diagnosing diseases, is Prognostics (from the Greek prognosis - "initial knowledge"). This is the first work on ancient Greek therapy. The book provides detailed descriptions of the prognosis of various diseases, diagnosis, methods of examination, questioning the patient, monitoring him, as well as methods of "treatment at the patient's bedside." It was from this work that some diagnostic signs that have survived to this day have entered the centuries. For example, the "face of Hippocrates" (named not for external resemblance, but in honor of Hippocrates). This is a classic description of the face of a dying person, and now it is also applied to people with certain certain diseases (metastatic cancer of the gastrointestinal tract, etc.). This description in the “Hippocratic Collection” reads as follows: “...the nose is sharp, the eyes are sunken, the temples are sunken, the skin on the forehead is hard, tense and dry, and the color of the whole face is green, black, or pale, or leaden...” This and many other descriptions are still widely used in medical practice. "About the air, waters, localities" - an essay that has, rather, an ecological and geographical name, in fact, the first work on the harmful effects of environmental factors on the human body. The work details various "types of people" depending on the locality in which they live. As a person who traveled to a large number of countries, he could draw some generalizing conclusions about the occurrence of certain diseases in people inhabiting, for example, sea coasts, high mountain regions, and desert territories. He was also able to link the frequency of occurrence of certain diseases with the time of year and even with biological and circadian rhythms. Thus, Hippocrates determined that "different types" of people had different susceptibility to diseases, and therefore looked for both treatments that could be applied to all people, and different types of approach to treating the same disease that arose in people of different types. He also for the first time made an assumption about four bodily juices and, according to the predominance of one of them in the body, about dividing people into different types. This theory formed the basis of the much later formed doctrine of the four temperaments. This was already in the Middle Ages. The teaching said that if mucus predominates in the body (from the Greek phlegma - mucus), then a person has a phlegmatic temperament, if blood predominates (from the Greek sanguis - blood), then a person is sanguine, if bile predominates (from the Greek chole - bile), then the character of a person is choleric, and if there is a lot of black bile in the body (from the Greek melaine chole - bile), then the type of temperament will be melancholic. The basis of this system is erroneously attributed to the merits of Hippocrates, since even if he tried to divide people into types, it was not by temperament, but by predisposition to diseases. In addition, the names of temperaments are not contained in the work "On Airs, Waters, Localities", because some words (such as sanguis) are of Latin origin, and therefore they could not be used by Hippocrates. In the future, only the names of various "types of people" were preserved from the theory of temperaments. I. P. Pavlov connected them with the predominance of the processes of excitation and inhibition, as well as with possible body types. In such a work as "Epidemics in Seven Parts" one can find a description of 42 different diseases, which were the most studied, since the observations of patients with these diseases were carried out separately and all data were recorded as a kind of case history. Unlike modern concepts, then epidemics were understood not as infectious diseases, but as diseases that were most widespread among the population. Such diseases included consumption, paralysis, marsh fevers, eye, catarrhal, skin, venereal and other diseases. Here the origins of the clinical approach to the treatment of diseases have been described. The ancient Greeks thought not only about treatment, but also about the causes of diseases, that is, about their possible prevention. The reasons were divided into general, depending on the quality and conditions of the environment in which the inhabitants of a particular area lived (something most common that everyone uses, that is, something that enters the body with breathing), and individual, which depended on the lifestyle, working conditions, nutrition and living of each individual person. Particular attention in ancient Greece was paid to physical education, hygiene, hardening. This was especially applicable to men, in whom love for the Motherland and readiness to defend it at any moment were brought up from the cradle. The most severe methods of education were in Sparta, where children from the age of 7 were in the care of the state and were educated in military units. Among the medical texts of that time, works on surgery were found (from the Greek cheir - hand, ergon - business). The main focus was on studying methods for treating fractures, wounds, dislocations, and skull injuries. It was then that devices for straightening dislocated joints, for example, the “Hippocratic bench,” were described for the first time. Much has been written about bandages (from the Greek desmurgia - the study of bandages). The types of dressings described in the “Hippocratic Collection” are still used today, for example, the “Hippocrates cap”. The ancient Greeks also studied diseases of the teeth, gums, and oral cavity. Even then, they tried to eliminate bad breath, and local remedies were also used to treat diseases of the oral cavity: narcotic analgesics, herbal infusions and decoctions, astringents, etc. The ideas of ancient Greek doctors about the internal structure of the human body were rather scarce, because they did not open corpses . In this field they lagged far behind the Indian physicians, who, already several centuries before Hippocrates, introduced the autopsy of corpses into practice in order to study internal diseases. However, the advantage of the Greeks was that they achieved great success in the diagnosis and treatment of internal diseases, based on the data of examination, questioning, and physical methods of research. "Hippocratic Collection" contains information on pharmacology, it contains a description of more than 250 herbal medicines, as well as preparations of animal and mineral origin. In general, the "Hippocratic Collection" is a collection of all information from the field of medicine of Ancient Greece, created by doctors of the XNUMXth-XNUMXrd centuries. BC e. The foundations of modern medical ethics and deontology are also rooted in the ancient period. Then there were five main treatises, which contained information about what moral, physical, spiritual qualities a real doctor should have. These were such works as "The Oath", "On the Doctor", "Law", "Instructions", "On Causal Behavior". These works mainly spoke about the need for a doctor to educate himself in such qualities as determination, neatness, aversion to vice, contempt for money, an abundance of thoughts, a denial of fear of the gods, for a good doctor himself is equated with God. A true healer had to comprehend knowledge not only from the field of medicine, but also all those that are useful and can be useful, and also be able to keep in mind all the information known to him and apply them as needed. However, the excessive application of this knowledge in practice, when they could cause harm, was condemned, because the first law of healing was the law "first of all, do no harm." In addition, the doctor should not have paid special attention to monetary rewards, especially if the patient is in serious condition or poor (helping the poor was a holy deed). Along with knowledge of his business, a person involved in medicine had to look neat and dignified so that people would have no doubts about his professional qualities. A special place in the medical practice of Ancient Greece was occupied by the "Hippocratic Oath" or "The Oath of the Future Doctor", which was given by everyone who completed their training in the medical profession. The "oath" was not invented by Hippocrates, he only summarized in a single text all its main features that existed long before his medical practice. She first received the same literary design in the same Alexandrian library in the XNUMXrd century BC. BC e. Any oath of that time assumed the support of the gods, who were supposed to be the first punishers in the event of perjury. The medical oath contained references to the gods who were directly related to the medical art and those who practiced it. These were Apollo, Asclepius, Hygieia, Panacea. There are suggestions that the Hippocratic Oath got its name also because it mentions Asclepius, the ancestor of Hippocrates II the Great in the seventeenth generation. By giving the "Oath" at the end of his training, the doctor secured the trust of society and provided a guarantee of a high level of professionalism. The “oath” translated from ancient Greek is as follows: “I swear by Apollo the doctor, Asclepius, Hygiea and Panakea and all the gods and goddesses, taking them as witnesses, to fulfill honestly, according to my strength and my understanding, the following oath and written obligation: to consider the one who taught me medical art on an equal footing with my parents, to share with him my wealth and, if necessary, to help in his needs; to consider his offspring as his brothers, and this art, if they want to study it, teach them free of charge and without any contract; instructions, learned lessons and everything else in the teaching to communicate to his sons, his teacher and students, bound by obligation and oath according to medical law, but to no one else. I direct the regimen of the sick for their benefit, according to my ability and my understanding, refraining from causing any harm and injustice. I will not give to anyone the deadly plan asked of me, and I will not show the way for such a plan; likewise, I will not hand any woman an abortion pessary. Purely and undefiled shall I conduct my life and my art. In no case will I make sections in those suffering from stone disease, leaving it to people involved in this matter. Whatever house I enter, I will enter there for the benefit of the sick, being far from everything intentional, unjust and harmful, especially from love affairs with women and men, free and slaves. Whatever, during treatment - and also without treatment - I see or hear about human life from what should never be divulged, I will keep silent about it, considering such things a secret. To me, who inviolably fulfills the oath, may happiness be given in life and in art and glory among all people for all eternity, but to the one who transgresses and gives a false oath, let it be the opposite of this. All the norms set forth in the "Oath" and other works on medical ethics were strictly observed, because people feared not only the wrath of their compatriots and reprisals from the government, but also the punishment of the gods. In the modern world, each state has its own doctor's oath, which reflects the level of development of medicine, national and religious traditions, but they all retain common features with the ancient Greek oath. Thus, the "Hippocratic Collection" contains quite a few works whose authorship can be attributed to Hippocrates, and the names mentioned there - "Hippocratic Oath", "Hippocratic Bench", "Hippocratic Medicine" - did not appear because were what Hippocrates invented directly, but because many discoveries of that time were associated with the name of Hippocrates as the name of the then most famous doctor. These names simultaneously glorified the era in which certain innovations appeared. Therefore, Hippocrates is more of a legend of Ancient Hellas, but a beautiful and noble legend. In no case should we belittle his merits in the formation and development of world medicine. LECTURE No. 4. Medicine in the ancient Russian state. Kievan Rus IX-XIV centuries 1. Historical characteristics of the period under review The Eastern Slavs founded their state at the beginning of the XNUMXth century. Thanks to the chronicles, information about this event reached us, and the state became known as Kievan Rus. In Russia, there were significant advances in socio-economic terms: agriculture and craft began to be separated, communities gradually became smaller, strata of the population were formed, differing in income, and therefore early feudal relations developed. The largest centers of merchants and artisans were Kyiv, Novgorod, Polotsk, Chernigov, Pskov, in which the population grew, and consequently, the demand for goods of general use. The most important historical milestone was the great journey from the Varangians to the Greeks, which connected Russia with Byzantium and Scandinavia. The unification of these lands was carried out by the first Kyiv prince Oleg (882-912). This association then completed the formation of Kievan Rus. All the lands of the Eastern Slavs were united and finally accepted into Kievan Rus under Vladimir the Red Sun (978-1015). For the formation of a single nationality, he also decided on the transition of Kievan Rus to a single religion - Christianity in its Byzantine version. Some reasons for adopting Christianity: 1) the social inequality of people required justification and explanation; 2) a single state demanded a single religion; 3) isolation of Russia from Christian European countries. The adoption of a single religion was a good political move to establish contacts with Byzantine culture, and with Byzantium itself. The choice of religion was not accidental, since since the reign of Prince Igor (912-945), many of his associates, as well as his wife, Princess Olga, who ruled Russia after Igor's death and was Vladimir's grandmother, were Christians. In Kyiv there was already a church of St. Elijah, however, the spread, adoption and establishment of a single religion for all Slavic peoples was a protracted and painful process and lasted more than a century. In the middle of the ninth century in Russia, the Slavic alphabet was created - Cyrillic. Despite the fact that before the baptism in Russia there were prerequisites for a written explanation, the beginning of Slavic writing is attributed to this period. This merit should be attributed to Constantine (monastic Cyril (827-869)) and his brother Methodius, who invented the Cyrillic alphabet, which originally consisted of 38 letters, so that it was possible to preach the Christian religion to people who did not speak other languages, except Slavic. Since Moravia most of all needed the preaching of Christianity at that time (an ambassador to Cyril and Methodius was sent from there with a request to create an alphabet), she was the first to adopt the Cyrillic alphabet, and the Day of Slavic Writing was established in the Bulgarian state, which over time acquired nationwide scale and is celebrated in countries with Slavic culture and writing on May 24th. The development of Russia in political terms was influenced not only by the adoption of Christianity, but also by the dynastic marriages of the descendants of Prince Vladimir. His son - Yaroslav the Wise - married the Swedish princess Ingigerd. They had three daughters: Anastasia, who married the Hungarian king Andrei, Anna, the king of France, Henry I, and Elizabeth, married twice - first to Harald, the king of Norway, and then after his death, to the king of Denmark, Svein. In turn, the son of Yaroslav, Vsevolod, married the daughter of Constantine Monomakh, the Byzantine emperor. The goals pursued by concluding these marriages were political in nature, as they strengthened relations with England and France, and this, in turn, weakened the conquest movements of the Vikings and Germans at the western and northern borders of Russia. Since then, three monarchs of the highest rank have been officially approved in Europe - the emperor of the Holy Roman Empire, the Caesar of Byzantium and the Grand Duke of Kyiv. This facilitated the exchange of political and cultural information between countries, and also gave rise to such a phenomenon as Russian medieval culture. Ancient manuscripts passed through Russia, which were translated by monks. Their works, written on parchment, have survived to this day. The most important event of that time was the organization in the St. Sophia Cathedral, built in honor of the victory over the Pechenegs, the first library (1037). It was organized by Yaroslav the Wise, who was generally very interested in the spread of writing and culture in the Russian land. Later, his granddaughter Yanka Vsevolodovna organized the first women's school at the Andreevsky Monastery (1086). Judging by the archaeological excavations, literacy in Russia was very widespread, since the birch bark letters found during the excavations were written not only by princes, but also by simple artisans. Having received a high development, the Old Russian state existed until 1132, when, after the death of Mstislav Vladimirovich, it began to disintegrate into feudal possessions, which marked the beginning of a period of feudal fragmentation. It did not have any positive significance at that time, since Russia lost its political independence and was subjected to the invasion of the Mongol-Tatar Khan Batu (1208-1255). However, in Russia, over time, the following prerequisites for unification took shape. 1. Political: 1) the general desire for liberation from the Horde yoke; 2) the unity of Russia in culture, religion, language. 2. Economic: 1) urban development; 2) settlement and land development in the northeast; 3) the expansion of feudal estates and the growth of the feudally dependent population; 4) transition to three-field and increase in productivity; 5) rise in trade. The most important dates of the period under review 882 - Prince Oleg's campaign against Kyiv. After he killed Askold, he began to reign in Kyiv until 912. 988 - adoption of Christianity in Russia. 1072 - the creation of a code of laws - "Russian Truth". It was created by the sons of Yaroslav the Wise. Early XNUMXth century - Creation of "The Tale of Bygone Years". 1223 - Battle of the Kalka. The Mongol-Tatars defeated the Russian army. 1237-1240 - Batu Khan's invasion of Russia. The beginning of the Mongol-Tatar yoke. 1240 - Battle of the Neva. April 5, 1242 - Battle on the Ice, where Alexander Nevsky defeated the German knights. September 8, 1380 - Battle of Kulikovo. Dmitry Ivanovich Donskoy defeated the Mongol-Tatar army. 1382 - the attack of the Golden Horde Khan Tokhtamysh on Moscow, the ruin of Moscow. 2. Trends in medicine in the XNUMXth-XNUMXth centuries In ancient Russia, there were three main forms of healing: 1) folk medicine. The people who practiced it were called sorcerers and healers; 2) monastic medicine (mainly became widespread after the adoption of Christianity in Russia); 3) secular (or it is also called secular) medicine, which appeared during the reign of Yaroslav the Wise. She also bore the name of a foreigner. Doctors-artisans specialized in healing various diseases - skin, internal, there were also chiropractors, "kidney" masters (treatment of hemorrhoids). Ethnoscience. Transfer of medical knowledge Folk medicine is the oldest branch of medicine in the history of Russia. In fact, its roots were paganism, which was practiced by the Slavic tribes before the unification and creation of the state and before the adoption of Christianity. Thus, the moment of the birth of traditional medicine can be attributed to the time from which the historical description of the life of the Russian people begins, that is, to prehistoric times. With the adoption of Christianity, it has not been eradicated, it has survived more than a millennium of the already historical life of the people, and even in our time it continues to develop, is widely used in practice by those people who master this art, and sometimes come into dispute with scientific medicine. In our time, a fair number of cases are known when scientific medicine turned out to be powerless in the face of some case of a disease, even though it has reached the highest theoretical and practical development and technical equipment. And there were cases when a person was literally "pulled out of the coffin" and restored to his health by people who knew the skills of traditional medicine. With the development and growth of the Russian state, traditional medicine until the second half of the XNUMXth century. remained the only way to treat diseases and maintain the health of ordinary people, since there was no more accessible medical care. The situation changed in the second half of the XNUMXth century, when the first zemstvo institutions and proper zemstvo medicine appeared. No one can explain why, but the concern for the health of the entire Russian people was of little interest to the rulers of the Russian land for a very long time. existed until the end of the XNUMXth century. Only "sovereign doctors" who treated the sovereign, his family and those close to him. Peter I tried to change the situation, but did not achieve radical changes, making medicine accessible to the privileged segments of the population. I must say that at that time he did not even think that the help of a doctor is needed by all sectors of society. Only Alexander II, who abolished serfdom in 1861 and carried out a large number of transformations in all spheres of Russian life, became the author of the first steps towards the availability of medical care, carried out the zemstvo reform and introduced zemstvo medicine. Since its inception, healing has differed from other types of medicine in that it combines both knowledge of the healing properties of natural remedies and faith in miraculous powers. Healers and soothsayers, witches, sorcerers, witches, enchantresses, magicians were engaged in healing in Russia, they were afraid of them, since they were elevated to the rank of intermediaries between the healing forces of nature and man. They were afraid of them because they believed that they could turn the mysteries of nature both for the good and for the harm of man. They were engaged in performing various magical love spells, lapels, medicine, divination, casting and removing damage, etc. They were so trusted that not only common people, but also princes and members of princely families turned to them for help. Folk healers knew how to do bloodletting, trepanation of the skull, as well as treat injuries (apply splints), wounds with the help of various ointments, cauterization. As time passed, healers acquired a new name - healers. They became the organizers of family schools, in which the knowledge of medicine passed from father to son. Lechs widely used in their work not only herbal remedies (such as birch leaves, garlic, wormwood, horseradish, plantain, onion, hellebore, blueberries, etc.) and various magical conspiracies, but also products of animal and mineral origin, for example, chrysolite, ground into powder, was used for severe pain in the abdomen, and women were recommended to wear a ruby to facilitate childbirth. The most famous healing remedy from the time of the healers, which has come down to our days, has become the so-called sour water or narzan. The name is originally Russian and in translation means "bogatyr-water". The first mention of lechtsy was found in "Russian Truth" - the oldest code of laws. This code was compiled under Yaroslav the Wise in the 1113th century, and Vladimir Monomakh supplemented it with his "Charter" (1125-XNUMX). It was there that for the first time they found a law on the right to demand compensation for moral damage from a person who caused injury not only to the one who was injured, but also to the state treasury, as well as the right of a doctor (healer) to take remuneration for the assistance provided, the so-called bribe. Folk healers compiled treatises on the use of the healing powers of nature - herbalists and healers. This became especially widespread after the adoption of Christianity and the appearance of writing. Unfortunately, we inherited only a small fraction of those sources, since most of them died or were stolen during the wars. It is interesting that in the books that have come down to us there are means that were used not only after the adoption of Christianity, but also long before it. Monastery medicine The emergence of monastic hospitals can be attributed to the time of the adoption of Christianity in Russia. The monks, who believed that God knows everything on earth, perceived illness as a punishment for human sins, and sometimes as the infusion of demons into the human soul and body. Therefore, healing from illness was seen as God's forgiveness and remission of sins. Monastic hospitals were called "hospitals" and "hospice". The first mention of them dates back to the 1091th century. The most famous of them were the hospital in Pereslavl, founded in 1051 by Metropolitan Ephraim of Kyiv, and the Kiev-Pechersk Lavra, founded in XNUMX by monks Anthony and Theodosius on the outskirts of Kyiv. She got her name from the word "pechery", that is, the caves in which the monks lived and did their noble work. Kiev-Pechersk Lavra left its traces in the development of medicine and culture in Russia. Many chronicles were written there: from Nestor, Nikon, Sylvester. From there came the hagiographic literature. In the XIII century. there was created the "Kyiv-Pechersky Paterikon" - a collection of stories and stories about this famous monastery. Many famous architects and painters took part in creating the interior of the Lavra. About them, the life and activities of the monks, the ways and customs of Kyiv were told in the patericon. In 1661, it was first printed and published in the printing house of the same Kiev-Pechersk Lavra. People who entered the history of Russia are buried in the caves of the monastery: the founder of the Lavra, Anthony, the chronicler Nestor, the healers Damian and Agapius, and even the founder of Moscow, Yuri Dolgoruky. Oddly enough, in the Lavra they found ways to treat a wide variety of diseases - from infectious to mental. Within the walls of the monastery there was even something like isolation wards, where the seriously ill were placed, they were provided with individual care. People who no longer had hope of recovery were often healed by monks, after which they believed in God and prayers and were tonsured monks. Among the most famous healers who practiced in the Lavra were such people as the Monk Alimpiy, who became famous for treating people with the most severe cases of leprosy. For the treatment of skin diseases, he used icon paints, which apparently contained various medicinal substances. Similarly, the holy and blessed Agapios was a monk of the Lavra. He is known for curing the grandson of Yaroslav the Wise, who later became the prince of Russia, and went down in history as Vladimir Monomakh. The healers of the monastery treated for free, the patients were treated with tolerance, with love up to self-sacrifice. This attitude is the basics of medical ethics, which in our time, when studying at universities, is given great importance. The monastic hospitals were also centers of learning and enlightenment: the monks collected Byzantine and Greek manuscripts, translated from Latin and Greek, combined information into collections, supplemented their knowledge and knowledge of their ancestors, and taught medicine from these sources. Such writings as "Christian topography" by Kosma Indikoplova (circa 1549), "Shestodnev" by John the Exarch of Bulgaria, as well as the "Izbornik" translated from the Bulgarian original in 1073, which consisted of excerpts from the works of the greatest Byzantine theologians and preachers, were very famous. . In 1076 another Izbornik was compiled. It has become a kind of source of knowledge in all areas - from home life and the basics and norms of Christian morality to guidelines and advice on the treatment of various diseases, maintaining a healthy lifestyle, proper nutrition, etc. secular medicine Secular medicine appeared in Russia since the reign of Yaroslav the Wise. The representatives of this branch of medicine were doctors of free practice, who did not consider themselves either folk healers or monastic doctors. These were people, often of foreign origin (an Armenian doctor, whose name is unknown, who was very popular even at the princely court; the healer Peter, a Syrian who lived at the court of Nikolai Davydovich (prince of the XNUMXth century) in Chernigov) and they took money for helping the sick , without being embarrassed, which caused indignation among representatives of other branches of medicine. The monastic medicine, which was gaining momentum, especially struggled with secular and folk medicine. She erected the actions of magicians and sorcerers, as well as foreigners, into the framework of demonic deeds. There was an active persecution of sages, sorcerers, etc., caught even burned at the stake. These actions were akin to the European Inquisition. However, despite the stubborn struggle, healing in Russia did not become a purely ecclesiastical privilege. This can be seen from sources dating back to the period of the classical Middle Ages, which continue to mention both folk healing and secular medicine. With the passage of time, these two branches of medicine have acquired more and more differences and become isolated from each other. Sanitary business. Baths. Epidemics Unlike Western Europe, sanitary business in Russia in the X-XIV centuries. was quite well developed. This is evidenced by the excavations of ancient Novgorod, on the territory of which about 50 estates were found, equipped with baths, water pipes and drains. Entire areas were covered with wooden pavements dating back to the XNUMXth-XNUMXth centuries, in contrast to Western Europe, in which the first pavements were built only in the XNUMXth century, and the water supply system - in the XNUMXth century. These "innovations" were found in Germany. A special place in ancient Russia was occupied by a bath. Folk healers already then understood what benefits are brought to the body when harmful substances are removed from it along with sweat. A bathhouse in a house or estate was the cleanest place: they not only washed there, but also took birth, looked after newborns, and doctors and chiropractors were invited there. The first mention of the Russian bath refers to 1113 (chronicle from Nestor). A special misfortune of the Old Russian state was the epidemic of infectious diseases or "pestilence". Generalized diseases were written in chronicles, and only for the period from the 47th to the XNUMXth centuries. you can find information about XNUMX epidemics. They fell ill with plague, cholera, leprosy and other diseases. The centers of the emergence of epidemics were the border cities through which foreign caravans passed - Novgorod, Smolensk. So, for example, in 1230 in Smolensk, an epidemic claimed tens of thousands of lives, which indicates the extreme contagiousness of the disease. People understood that the disease passes from person to person, so they delimited the infected places where the sick were. If the epidemic spread to the whole city, the inhabitants went into the forests, leaving their houses, belongings and sick relatives, and sat out until the pestilence passed. However, the moment when the last patient died and there seemed to be no one to get infected was taken as getting rid of the disease. Knowing nothing about pathogens, people returned to the cities, and the epidemic sometimes returned with them. Considering the place cursed, people went so far as to burn entire settlements. Their mistake was also the fact that before the XV century. people who died from epidemics were buried according to religious laws in church cemeteries. This contributed to the renewal and spread of pestilence. Only in the XVI century. those who died from infectious diseases began to be buried outside the cemetery, outside the cities and villages. People did not understand that the cause of epidemics was not supernatural forces, but poverty and non-observance of hygiene rules, therefore, in some cases, it came to desperate acts: for example, in the XIV century. in Novgorod, during the plague epidemics, residents erected the church of St. Andrew Stratilates in 24 hours. She has survived to this day. During the period of the Mongol-Tatar invasion in Russia, there was the largest number of epidemics, most people died. The Old Russian state existed for three centuries. In 1132, the son of Vladimir Monomakh, the last prince of Kyiv, Mstislav Vladimirovich, died. The state broke up into several principalities - this was a period of feudal fragmentation, which weakened the political and economic independence of Ancient Russia. The invasions of the Mongol-Tatar hordes of Batu Khan finally destroyed all the principles of government and life on Russian land. LECTURE No. 5. Medicine in Russia XV-XVII centuries 1. General characteristics of the historical period. Required Concepts From the middle of the XII to the end of the XV centuries. there was a period of feudal fragmentation in the country. Causes of feudal fragmentation: 1) the development of feudal agriculture, as well as the formation of a new boyars - estates; 2) weak economic ties between different regions of the country; 3) urban growth; 4) the boyars, interested in a closer and more effective power of the local prince; 5) the fall of the economic and political influence of Kyiv. February 27, 1425 - the death of Vasily I Dmitrievich, who ruled from 1838-1425. At this time, the feudal war begins. The results of the feudal war include the following: 1) political instability; 2) recognition of Moscow as the capital; 3) the ruin and weakening of the country, which allowed the Horde and Lithuania to make new seizures of Russian lands; 4) the formation of a cruel, strong princely power in Russia; 5) the victory of the backward center over the economically powerful Galich, which predetermined the development of despotism in Russia. 1480 - the overthrow of the Mongol-Tatar yoke. 1549 - the First Zemsky Sobor was convened - a new body of power dealing with the most important state affairs until the election of a new king. 1530-1584 - years of life of Ivan the Terrible. 1565 - a decree was issued on the oprichnina. The oprichnina was beneficial in that the tsar could replenish the treasury, the army, and also expand his possessions. Oprichnina results: 1) the unlimited power of the king; 2) the introduction of a "reserved summer" - a temporary prohibition for peasants to leave the feudal lord, even on St. George's Day; 3) ruin of lands. The peasants are moving to the Urals, in the Volga region; 4) the establishment of a historical tradition of unity between the monarch and the boyars; 5) general mistrust that hinders the successful development of the economy; 6) the transformation of many nobles, whose estates and estates were ruined during the oprichnina, into beggars; 7) the oprichnina played a major role (if not decisive) in establishing serfdom in Russia. 1589 - introduction of the patriarchate. 1598-1605 - Board of Boris Godunov. June 20, 1605 - False Dmitry I entered Moscow. This time in the history of Russia was called the Troubles. The Time of Troubles is a civil war that clashed various classes: nobles, townspeople, boyars, serfs, peasants. The causes of the Troubles are as follows. 1. Economic: 1) strengthening the feudal exploitation of the peasantry; 2) the economic crisis that was caused by the oprichnina. 2. Political: 1) the growing dissatisfaction of the nobility with their position outside power; 2) dynastic crisis (appearance of False Dmitry). 3. The looseness of the moral foundations of society. 1613 - the beginning of the reign of the first of the Romanov family - Mikhail Fedorovich Romanov. At this time, new features appear in the Russian economy: 1) the emergence of manufactories, which led to the onset of the era of capitalism; 2) the increasing importance of fairs in domestic trade; 3) formation of the internal market, specialization of regions; 4) there is an elimination of the natural isolation of agriculture and its gradual involvement in market relations; 5) improvement of foreign trade; 6) manufactories serviced by the labor of serfs. 1649 - adoption of the Cathedral Code. Cathedral laying 1. Church and state. The rights of the church were sufficiently curtailed: the lands belonging to the church were transferred to the management of the state. Churches were forbidden to transfer the patrimony. 2. Registration of serfdom. Class years were abolished, the peasants were assigned to the landowner for life. The urban population was assigned to the city and had to engage in crafts and trade. 3. Nobles - a privileged class. Duty - military service, for which they receive land and peasants. Previously, the estate could be inherited, and the estate was given for service. Now the estate could be inherited. Meaning: 1) registration of serfdom; 2) the formation in Russia of a class system, including the clergy, the urban population, the nobility, and peasants. In the XNUMXth century There is a split in the Russian Orthodox Church. This split was long overdue, since there were quite a lot of disagreements in church rituals and books. That is why the idea to put everything in order arises. The schism ended with the fact that the churchmen were divided into supporters of Nikon and supporters of Habakkuk. Nikon will lose in this confrontation. A schism is a religious social movement that resulted in a separation from the Russian Orthodox Church of a part of believers who did not accept Nikon's reforms. Reasons for the split: 1) Nikon's reforms practically coincided with the formalization of serfdom; 2) according to the Old Believers, Nikon violated the main principle of the church - catholicity! All reforms were carried out on behalf of the patriarch alone, which violated the autonomy of the church and indirectly subordinated it to the state. In the period of historical development we are considering, it should be noted that the development of the Moscow principality took place, which became a fairly powerful medieval state. Required Concepts An epidemic is a widespread outbreak of an infectious disease. A pandemic is an epidemic that covers an area, a country, or a number of countries. Endemic is the constant presence of a certain disease in a given area, due to its natural features and the peculiarity of the living conditions of the population. 2. The development of medicine at the beginning of the XNUMXth century. Medical directions The fact is that the Mongol-Tatar yoke, under which Russia was for a long time, slowed down the development of Great Russia, the Kievan state, which, by the way, was considered one of the most civilized and largest. Therefore, after the victory over the Mongol-Tatar yoke, in 1480, medicine did not undergo significant changes. In Europe, during this period, universities opened, the number of doctors increased, even despite the fact that scholasticism dominated, there were persecutions of genuine science by the church. In Moscow, which united the principalities around itself in order to create a centralized powerful state, medicine still remained popular. Education took place according to the type of family apprenticeship. It should be noted that the national culture and, along with it, medicine were primarily of a civil nature, they were not subjected to oppression, the power of the church. For example, Copernicus, Jan Hus, J. Bruno, Servest and others were burned in Europe. Although in Russia they also persecuted sorcerers, witches, and so on and burned them, however, this is in no way comparable with the so-called witch hunt in Europe (I must say that thousands of people died at church fires). During the period under review, two main areas of medicine developed: 1) folk; 2) monastery. And also, besides this, the first healers appeared in the troops. 3. Sudebnik of 1550 and traditional medicine. Sovereign Pharmacy In 1550, Ivan the Terrible assembled the Zemsky Sobor in the Kremlin Palace, which received the name "Stoglavy" (according to the number of articles of laws or chapters approved by him). So, the "Stoglavy" cathedral approved the Sudebnik. It was decided that in Moscow, as well as in other cities, it was necessary to create schools that would teach children to read and write, as well as equip almshouses in the cities for the care of the sick, the elderly and the crippled, “so that they live in purity and in repentance and in every thanksgiving.” However, in the XVI-XVII centuries. For almost the entire population of Russia, traditional medicine remained the only way to maintain their health. The experience of Russian folk medicine was transmitted orally, and also preserved in numerous clinics and herbalists, reflected in legislative acts, historical and everyday stories (among which is "The Tale of Peter and Fevronia of Murom" - the story was written down in the XNUMXth century, it tells about miraculous healing of Prince Peter of Murom), chronicles. It must be said that in the clinics a fairly large place was given to "cutting" (ie, surgery). Among the "cutters" were bloodletters, chiropractors, and teethers. In addition, in Russia, operations such as abdominal surgery, skull drilling, and amputations were performed. Mandrake, wine, poppy were used as a means to put the patient to sleep. The tools were: probes, axes, saws, scissors, chisels, etc. These tools were carried through the fire. Wounds were treated with wine, ash, birch water. The wounds were sutured with hemp and flax fibers, as well as with thin threads from the intestines of animals. In order to extract a metal fragment, they began to use magnetic iron ore. An interesting fact is that original designs of prostheses for the lower extremities were created in Russia. It was clear that medicine required the creation of a central organ, that is, it required, in fact, the organization of the process. Under Ivan IV, in 1581, the Apothecary's Chamber was formed (the sovereign's court pharmacy). It was necessary to serve the royal family, as well as the nearest boyars. The premises of the sovereign's pharmacy were furnished very luxuriously. The walls and ceilings were painted, the shelves and doors were upholstered with "good English" cloth, the windows were with colored glass. They worked in the pharmacy every day - from early morning until late at night, and when one of the members of the royal family fell ill, pharmacists worked around the clock. The presentation of medicines to the king was very strict. First, the medicine that was intended for the king was tried by the doctors who prescribed it, as well as the pharmacists who prepared this medicine. Then the boyar tried the medicine, who subsequently gave it to the tsar. Having accepted a glass with the rest of the medicine from the tsar, the boyar was obliged "to pour it into the palm of his hand and drink it." The resettlement of foreign doctors, surgeons, and pharmacists to Moscow began in the first half of the 200th century. They appeared in the royal lists of "necessary people." It should be noted that foreign doctors did not need practically anything. For example, under Boris Godunov, every foreign doctor who came to serve in Russia received an estate with serfs, a fairly large annual salary (about XNUMX rubles), various goods and food, horses, for the maintenance of which hay and straw were allocated in sufficient quantities. , and also, when the medicine prescribed by the doctor had a positive effect, the king rewarded the doctor with expensive gifts. In addition, it should be noted that the service at the Russian royal court was quite prestigious. Epidemics and state anti-epidemic measures Particular attention should be paid to epidemics that claimed hundreds of thousands of lives. The development of trade with other countries had not only positive, but also negative sides. Trade gates quite often opened the way for terrible epidemics that raged in Europe in the Middle Ages. Pskov and Novgorod, large trading cities, were very often subjected to epidemics. In 1401 (and if we consider the chronicle of Nikon, then in 1402) a pestilence was described in the city of Smolensk, but no symptoms were indicated. If we turn our attention to Pskov, then in 1403 an epidemic occurred there, which was characterized as "a pestilence with iron." Scientists have concluded that this epidemic can be attributed to plague epidemics. An interesting fact is that during this epidemic, cases of recovery were recorded, but, unfortunately, this happened extremely rarely. Usually people who have been exposed to this disease died on the 2-3rd day of illness. Such epidemics in Pskov were repeated in 1406, and also in 1407. It should be noted that people considered the invasion of these epidemics to be the fault of their princes. That is why in 1407 the inhabitants of Pskov renounced their prince Danila Alexandrovich and called for another prince. It should be noted that starting around 1417, plague epidemics almost continuously "walked" across Russia. In some sources there are notes that "death mowed down people, like a sickle mows ears." These epidemics continued until 1427. From 1427 to 1442. there is no mention of any epidemic. However, in 1442, an epidemic again appeared in Pskov, which, according to the descriptions, can be attributed to the plague. In the future, various kinds of epidemics arose that claimed hundreds of thousands of lives. For example, in the epidemics of 1552-1554. in Novgorod, Staraya Russa, as well as in the entire Novgorod region, 279 people died, and in Pskov - more than 594 thousand people. I must say that especially many people of the clergy (priests, monks, etc.) died. During epidemics, the people used the usual means of treatment - fasting, building churches, prayers, etc. Along with the plague, other deadly diseases raged in Russia. For example, in 25 the prince's army, which was supposed to fight with Kazan, was struck by scurvy in the city of Svyazhsk. By the end of the XVI century. people began to realize that it is necessary to fight epidemics with real actions, and not with the construction of churches, prayers, etc. Now we need to talk about methods of combating epidemics (in particular the plague) in medieval Rus'. As already mentioned in the previous lecture, in the 1551th century. The first notes on the fight against epidemics began to appear. In the 1552th century, in 1572, the chronicles contain the first example of how outposts were constructed. The street where the sick were was closed on both sides: in Pskov, during the plague epidemic, “Prince Mikhailo Kislitsa ordered... Petrovskaya Street to be locked at both ends, and the prince himself ran on a ruin into the pasture.” In 1571, during an epidemic in Novgorod, “there was a checkpoint on the Pskov road so that guests with goods would not travel to Pskov, or from Pskov to Novgorod.” Let us pay attention to the Novgorod Chronicle. It says that in Novgorod in 1592 they began to prohibit burying people who died from an “infectious” disease near churches. They had to be buried far outside the city. Outposts were set up on the streets where sick people were found; courtyards where a person died from an “infectious” disease were locked, not allowing other survivors to leave. There was a watchman nearby who served people food and water directly from the street, i.e. he did not enter the yard. Priests were also not allowed to visit the sick. For failure to comply with the last rule, they were burned along with the person who was sick. Now let us turn our attention to Milton's History of Muscovy. The fact is that here was the first case of the introduction of quarantine in Russia, and this was done in relation to a foreigner. Jenkinson, the British ambassador, came to Russia for the third time. This was in XNUMX. He sailed across the White Sea on a ship. He was kept in Kholmogory for a long time, since there was a plague in Russia during this period. In Russian cities, quarantine was first registered during the plague in Pskov - in Rzhev in XNUMX. Hospitals and almshouses were set up in Moscow, Kyiv, Pskov and other cities. It must also be said that the first "civilian" clinics appeared. For example, Rtishchev organized a hospital in one of the Moscow courtyards, consisting of two chambers, which accommodated 15 beds. From among the employees of this hospital, a team of messengers was organized, which went around the streets and collected the "sick and crippled" and delivered them to this hospital. The people called it "The Hospital of Fyodor Rtishchev". According to contemporaries, this hospital provided "outpatient shelter for those in need of temporary assistance." It should be noted that for the period from 1654-1665. more than 10 special royal decrees were signed "on precaution against pestilence", and during the plague epidemics of 1654-1655. it was ordered to establish outposts on the roads and not to let anyone through under pain of death, this applied to everyone, despite ranks and ranks. Infected objects were also burned at these outposts, and the money was washed in vinegar. As for the letters, they were repeatedly rewritten along the way, and the originals were burned. During epidemics, the export and import of various goods were suspended, and work in the fields was stopped. As a result, crop failures and famine arose, which always dragged along after epidemics. Apothecary order and pharmacies The Apothecary Order was created in 1620. It included a permanent staff, which was provided entirely at the expense of the royal treasury. From the very beginning, the Pharmaceutical order included a small number of people: 1) 2 doctors; 2) 5 healers; 3) 1 pharmacist; 4) 1 optometrist; 5) 2 translators (interpreters); 6) 1 leader - clerk. However, later (60 years later) 80 people served in the Aptekarsky Prikaz: 1) 6 doctors; 2) 4 pharmacist; 3) 3 alchemists; 4) 10 foreign doctors; 5) 21 Russian doctors; 6) 38 students of medicine and bone-setting; 7) 12 clerks, translators, gardeners, business executives. The management of the pharmacy and the Sovereign Pharmacy Order was entrusted only to the boyars who were especially close to the tsar. Medicinal gardens began to be planted around the Kremlin, similar gardens were grown at the Nikitsky Gate, as well as in other places. That is why gardeners were needed in the Pharmaceutical Order. They were in charge of these medicinal gardens. The first of the sovereign's apothecary gardens was created near the western wall of the Moscow Kremlin (by the way, now the Alexander Garden is located on this site). It can be concluded that the Pharmaceutical order is the first state healthcare institution. Now it is necessary to identify the main functions of the Pharmaceutical order: 1) organization of medical care for members of the royal family; 2) organization of medical care for archers, boyars and other people who applied for it; 3) organizing the provision of domestic and imported potions; 4) strict control of land; 5) taking certain preventive and protective measures during epidemics; 6) invitation of foreign doctors and doctors; 7) training of doctors in the medical school under the Pharmaceutical Order; 8) supervision of apprenticeship in the pharmacy order; 9) providing internships for future domestic doctors with well-known doctors; 10) organizing the procurement of medicines. In 1634, not far from Moscow, near the village of Duholino, a special "glass" factory was created. It was a kind of small manufactory, where 15 people worked. This plant produced the so-called alchemical vessels. In 1654, under the Pharmaceutical Order, a school was opened that trained Russian doctors. From the very beginning, about 30 people have been trained in it. The training lasted from 4 to 6 years. After the doctor graduated from such a school, he, as a rule, was sent to the troops, and not only in wartime. The fact is that a little later each regiment will have a personal military doctor. Thus, along with the civil and monastic directions in medicine, there was another one - military medicine, which was not under the jurisdiction of the Pharmaceutical Order. Let's pay attention to the textbooks of schools under the Pharmaceutical order. Various medical books, zelniks, herbalists, cool gardens, as well as works translated from Latin and Greek by such authors as Vesalius, Galen, Aristotle "On the structure of the human body", "The Secret of Secrets", "Aristotle's Gates" were used as textbooks. and various others, which were supplemented by comments by domestic translators). The Apothecary Order, according to the instructions of the king, was to organize the procurement of medicines. Mostly herbal medicines. The population received medicinal potions in the markets, green rows. Later, by royal decree, 2 pharmacies were organized in Moscow. In 1581 - only for the king and his inner circle, and the second pharmacy, organized on March 20, 1672 - "for people and all kinds of ranks." The third pharmacy was opened in 1682 - at the first civilian hospital at the Nikitsky Gate. Foreign pharmacists were invited to Moscow pharmacies (French Jacobi, etc.). The supply of pharmacies with drugs was carried out in various ways. From the very beginning, medicinal raw materials were imported from England. At the same time, some materials were bought in the malls. For example, pork fat on a plaster - in meat, various medicinal herbs and berries - in the green row, combustible sulfur and black tar - in the mosquito row. There was also the so-called berry duty: royal decrees were sent to governors in different parts of Russia, which ordered the collection of various herbs that these lands are famous for, for the sovereign's pharmacy. So, for example, black hellebore root was brought from Kolomna, juniper berries from Kostroma, malt root from Astrakhan and Voronezh, etc. For failure to fulfill the berry duty, imprisonment was supposed. Another way to supply pharmacies with medicinal raw materials was their importation by foreigners. So, back in 1602, the pharmacist James French brought with him from England a very valuable supply of medicines at that time. These medicines were the best at that time. When the imported stocks were depleted, raw materials were purchased or ordered from other countries - from England, Holland, Germany, etc. I must say that usually medicines were prescribed from abroad, but then folk remedies were used more and more. Along with herbal remedies, exotic ones were also used, such as, for example, unicorn horn in powder, deer heart, powder from young rabbits in wine, "bezuy stone" (it was found on the seashore), etc. There was also a healthy lifestyle : the use of fir, pine from scurvy, cleanliness, a bath, which was a panacea for many diseases. Although there was a school in the Aptekarsky Prikaz, the inhabitants still preferred traditional healers. Firstly, the population trusted them more, and secondly, it was much cheaper than being treated by doctors. There was even a kind of hierarchy: "dokhtur, beaker and doctor, because the doctor gives his advice and orders, but he himself is not skilled in it, but the doctor applies and heals with medicine, and the beaker is a cook for these both." 4. Monastic and civil hospitals Monastery hospitals were built at the monasteries. So, in 1635, two-story hospital wards were built at the Trinity-Sergius Lavra (it must be said that these wards have survived to this day). The hospital wards that were built at Kirillo-Belozersky, Novodevichy and other monasteries have survived to this day. It should be noted that the monasteries in the Muscovite state had a very important defensive value. The fact is that during enemy invasions, temporary military hospitals were set up on the basis of hospital wards at monasteries, in which they treated the wounded. It must be said that the treatment and maintenance of patients in temporary hospitals was carried out at the expense of the state, although it was not under the jurisdiction of the Pharmaceutical Order. This is one of the distinguishing features of Russian medicine in the XNUMXth century. Let's turn our attention to civilian hospitals. As mentioned above, the boyar Fyodor Mikhailovich Rtishchev organized almshouses in his homes in Moscow, which can be considered the first properly arranged civilian hospitals in Russia. Note that medicines were issued for these hospitals from the Sovereign Pharmacy. In 1682, a decree was issued on the opening in Moscow of two "spitals" (i.e., hospitals) that served the civilian population. In addition to treating the sick, these institutions also taught medicine. In the same 1682, the Slavic-Greek-Latin Academy was established in Moscow. As for military hospitals, the first of them was opened in 1656 in the city of Smolensk. 5. The first Russian doctors of medicine in Russia in the 1621th century. the first doctors from Europe began to appear and began to dominate. Among the foreign doctors who were invited to the Russian service, one can meet quite well-known physicians. For example, in XNUMX Artemy Diya arrived in Moscow. He wrote a large number of works on medicine. Many of these works were printed in Paris. Also, such foreign doctors as Lavrenty Blumentrost, Robert Yakob worked in Russia. Domestic doctors also traveled abroad for training. Among those who have successfully completed training and also defended their thesis abroad, one can note P. V. Postnikov. He received his MD from the University of Padua, Italy. I must say that Peter Postnikov was even the rector of the University of Padua. In 1701, Postnikov returned to Russia and was enrolled in the Pharmaceutical Order. Unfortunately, Pyotr Postnikov, having returned to Russia, could not study medicine and physiology (this is his favorite branch of medicine), since he served as a Russian diplomat in France, England and Holland. He bought books, surgical instruments, supervised the education of Russian students abroad. You can also note George from Drohobych. He received the title of Doctor of Medicine and Philosophy at the University of Bologna, and also wrote the essay "Prognostic judgment of 1483 by George Drogobych from Russia, Doctor of Medicine of the University of Bologna", which was published in Rome. At one time (1481-1482) he was rector of the University of Bologna. He lectured at the University of Krakow (since 1485), worked in Hungary (1482-1485). In 1512, Francysk Skaryna from Polotsk received the title of doctor of medicine at the University of Padua. Then he worked in Koenigsberg, Prague, Vilna. LECTURE No. 6. Medicine in the Russian Empire in the XNUMXth century 1. General characteristics of the historical period 1700th century begins the war, which was called the Northern War. It lasted from 1721 to 1682. At that time, Peter I ruled in Russia. It must be recalled that Peter ascended the throne at the age of ten, in 1689. In fact, the state was ruled by Peter's elder sister, Sophia. However, in an attempt to stage a coup in 16 to seize the Russian throne, Sophia failed. She was removed from power and imprisoned in the Novodevichy Convent. Peter I began to fully manage the state. On May 1703, XNUMX, by order of Peter the Great, at the mouth of the Neva, on one of the islands, construction began on a wooden fortress (later it was replaced with a stone one), which was called Peter and Paul. In fact, this was the beginning of the construction of a new city - St. Petersburg. The Northern War ended with the conclusion of the Nystadt peace, after which Peter I was proclaimed emperor. Russia has become an empire. Peter carried out a large number of reforms - ranging from reforms of public administration and ending with relations between church and state. In 1722 the "Table of Ranks" was published. It was one of the most important documents, since it determined the system of ranks, as well as the procedure for promotion in the public service, both military and civilian. The era of Peter I was full of various transformations and innovations. During this period, Russia has significantly strengthened, strengthened, Russia's place in international affairs has increased significantly. Thanks to the creation of a regular army and navy, as well as an active foreign policy, one of the most important historical tasks of Russia was resolved - it established itself on the shores of the Baltic Sea. Practically not a single foreign policy problem in Europe was solved without the participation of Russia. After the death of Peter I in 1725 and until 1762, palace coups took place in the Russian Empire, and emperors changed very quickly. Following Peter, Ekaterina Alekseevna ascended the throne (years of reign: 1725-1727), with the help of Peter's closest associate, A. D. Menshikov. After Catherine Alekseevna, Peter II became emperor, who ruled the Russian Empire from 1727 to 1730. It should be noted that the dissolute and self-willed Peter II was practically not interested in state affairs. After Peter II, Anna Ioannovna ascended the throne, who ruled for 10 years (from 1730 to 1740). Anna Ivanovna was the wife of the Duke of Courland, but he died some time later, and the duchess was left a widow. During the reign of Anna Ioannovna, Courland Germans flooded Russia, they were given preference in all levels of the state apparatus. After Anna Ioannovna, the throne passed to Elizabeth Petrovna (end of 1741). She reigned for 20 years, until 1761. It must be said that the supreme power in this period gained some stability. During the reign of Elizabeth Petrovna in 1756, the war with Prussia began, which was called the "Seven Years' War". Consider the causes of this war: 1) rivalry between Austria and Prussia for hegemony in Germany; 2) the struggle of France and England for dominance over the colonies. Russia had its own goals for which it participated in this war: 1) seizure of the Baltic lands; 2) countering the growing aggression of Prussia. In 1763 the Seven Years' War ended. In 1761, Peter III, the grandson of Peter I, ascended the throne. However, he reigned for only half a year, after which he was replaced by his wife Ekaterina Alekseevna. So, from 1762 to 1796. The Russian Empire was ruled by Catherine II. During the reign of Catherine II, a peasant war took place - from 1771 to 1775. Reasons for the uprising: 1) difficult working and living conditions for working people; 2) strengthening the personal dependence of the peasants; 3) dissatisfaction of the Yaik Cossacks; 4) the overdue socio-psychological atmosphere. The territories of the uprising were the Volga region, the Urals, the Orenburg Territory. The composition of the peasant uprising: Cossacks, peasants, merchants, Bashkirs. Now it is necessary to note the reasons for the defeat: 1) the strength of the state mechanism (organization of the state mechanism); 2) weak organization of the rebels; 3) poor armament of the rebels; 4) the robber character and cruelty of the rebels; 5) the lack of a clear idea of their goals and a constructive program of the uprising. The historical significance of the peasant war: 1) Yaik renamed to Ural; 2) reforming the state administration system; 3) the destruction of the Cossack autonomy. During the reign of Ekaterina Alekseevna, two more Russian-Turkish wars took place. The first - from 1768-1777, the second - 1787-1791. After the death of Catherine II, in November 1796, her son Pavel Petrovich came to the throne. Education, Science and Social Thought in Russia in the XNUMXth-XNUMXth Centuries. In the XVIII century. Russia experienced a spiritual upsurge, the essence of which was as follows: the transition from a predominantly traditional, relatively closed and ecclesiastical culture to a secular and European culture with an increasingly distinct personal beginning. Enlighteners of that time: N. I. Novikov, D. I. Fonvizin, S. E. Desnitsky, D. S. Anichkov, A. N. Radishchev, etc. Let us pay attention to the education system in Russia in the XNUMXth century. The state system of general education secondary school was created, higher education was born anew, vocational training and estate educational institutions were developed. However, a fairly large part of the population, especially serfs, did not receive access to education. In 1725, the Academy of Sciences and All Arts was organized. 1755 - the opening of the Moscow University, 1783 - the Russian Academy was founded, studying the Russian language and literature. Members of the Academy: G. D. Derzhavin, D. I. Fonvizin, M. M. Shcherbatov, E. R. Dashkova, M. V. Lomonosov, etc. 2. The main features of the economy and culture of Russia in the XVIII century It must be said that in the XVIII century. the development of feudal society in Russia entered a new stage. This stage implied the strengthening of the Russian centralized state, the growth of commodity production, and at the same time the dominance of serfdom. The reforms of Peter I, which were carried out directly in the interests of merchants and landowners, had a significant impact on the development of national culture and production forces. As the Russian state developed, some quantitative changes constantly accumulated, which were supposed to turn into qualitative ones. This happened precisely during the reign of Peter. The transformation of quantitative changes into qualitative changes takes place through jumps. In fact, under Peter I, the process of the formation of a new culture, which began in the previous era, had its continuation. Economic development of Russia in the XVIII century. was accompanied by the rise of Russian science, art, culture. There was a formation of socio-political and philosophical thought, and this formation was closely connected with the development of trade and industry in the country, as well as with the growth of Russian national culture (and this is very important!), the emergence and further development of art, literature, and natural science. The goal of the leading thinkers of Russia in the XVIII century. It was: 1) drawing attention to the study of natural science in order to competently use the natural resources of Russia for its progressive economic development; 2) separation of science from the church. So progressive Russian thinkers of the XVIII century. made a big step from "religious ideology to secular knowledge." Let us turn to the St. Petersburg Academy of Sciences, which was opened in 1725. Foreign scientists were invited here. Thus, the first academicians published works on various medical issues. For example: 1) G. Duvernoy and I. Veitbrecht published a number of works on anatomy; 2) Daniel Bernoulli - "Works on the movement of muscles", on the optic nerve; 3) Leonhard Euler published several papers on hemodynamics. 3. The development of medicine at the beginning of the XVIII century. Faculty of Medicine, Moscow University To begin with, it should be noted that by the XVIII century. Russia stepped over the so-called period of backwardness, which was caused by the Mongol-Tatar yoke. Serfdom, which fettered a significant part of the country's population, was an obstacle to the development of the country, the Russian economy, science, and industry. However, if we consider certain areas, Russia was on the same level with civilized countries and even began to overtake them. Only in the 1755th century, namely in XNUMX, the first university was opened in Russia. This was done largely thanks to the Russian scientist M.V. Lomonosov, as well as the person supporting him, I.I. Shuvalov (by the way, Shuvalov was a favorite of Queen Elizabeth). M.V. Lomonosov in 1748 wrote in the draft regulations of the university at the St. Petersburg Academy: “I think that the university should definitely have three faculties: law, medicine and philosophy (the theological one is left to the synodal schools).” In the 1764th century and in the first third of the 13th century. Researchers such as S. N. Zatravkin and A. M. Stochik published two monographs concerning the medical faculty of Moscow University. It was generally accepted that the medical faculty was opened in 1758. But Stochik and Zatravkin presented documents that stated that the faculty began to function on August XNUMX, XNUMX. Then Professor I. X. Kerstens from the University of Leipzig was invited to the university. Kerstens began teaching classes, giving lectures, and was even appointed “doyen” (i.e., dean) of the medical faculty. Here is an excerpt from the documents of the Russian State Archive: “The Imperial Moscow University informed: ... the Faculty of Medicine is equipped with Dr. Johann Christian Kerstens, who was called from the glorious University of Leipzig with great medicine and great philosophy as professor of chemistry, pharmacology and mineralogy, who, as a result, in the strength of university institutions in medical science has been entrusted and he will assume that entrusted position, at the end of the present vacation days of this August thirteenth day at ten o'clock after midnight, and will give a speech in Latin, in which he will prove that chemistry is the first and best a means to improve medical science." From the very beginning, the faculty provided general education not only for future doctors, but later among its students began to appear those who devoted their whole lives to medicine. Over time, in addition to Kerstens, Professor Erasmus, prosector (vice-rector) Keresturi, as well as domestic professors who returned from abroad - P. D. Veniaminov, S. Ya. Zybelin began to work at the Faculty of Medicine. From 1768, lectures began to be given in Russian. Thus, a base for the training of medical specialists began to form in Russia. The medical university provided quality general education to future doctors, however, did not provide them with practical training (this will happen much later). Future doctors received practical skills in hospital schools. Here, training took place directly at the bedside of the sick, in hospitals. 4. Hospital schools Hospitals and hospital schools appeared in Russia in the late XNUMXth and early XNUMXth centuries. in the era of Peter I. He was a great reformer of the Russian state, he also did not disregard medicine. So, in his foreign trips, in addition to shipbuilding, he was interested in medicine. For example, Peter bought a collection of "freaks" from the famous anatomist Ruish for a lot of money, which later became the basis of the famous Kunstkamera (it must be said that the exhibits of that collection have survived to this day). Peter understood that healthcare in Russia was at a very low stage of development (high infant mortality, epidemics, shortage of doctors). Therefore, he began the construction of sea and land hospitals, and with them - hospital schools where doctors were trained. The organization of the construction was entrusted to Nikolai Bidloo. So, the first hospital was opened in Moscow on November 21, 1707. It was a land hospital, and a hospital school was also opened with it, which was designed for 50 students. Further, hospitals and hospital schools were opened under them in St. Petersburg, Revel, Kronstadt, Kyiv, Yekaterinburg, etc. It must be said that hospital schools were opened even in such little-known cities as Koluvanovo, Elizavetgrad. There they were calculated 150-160 people. The hospital schools had a fairly high level of teaching, high quality curricula. There was no such system in medical education in any country in Europe. In hospitals, rooms were specially equipped for clinical classes, teaching anatomy, and the basics of obstetrics. The teaching of anatomy necessarily included dissections. The activities of hospital schools were subject to general rules and guidelines. In 1735, a special "General regulation on hospitals" was issued. It included terms of training programs in medical disciplines (5-7 years), as well as in Latin language and philosophy, teaching rules, etc. The advanced character of hospitals is clearly visible in this regulation. Autopsies were allowed. At the end of their studies at the hospital school, students took an exam that included theoretical knowledge, clinical knowledge, as well as what is today called practical skills. I must say that the number of practical skills included the performance of 3-4 operations on the corpse. After N. Bidloo, who supervised education in hospital schools, his work was continued by M. I. Shein, P. Z. Kondoidi (3-1710). By order of Pavel Zakharovich Kondoidi, prototypes of the history of the disease began to be kept - "mournful sheets" that were wound up for each patient. Medical libraries were organized in hospitals. It should be noted that the head of the hospital (in accordance with the instructions of the medical office - the country's health management body) was a doctor. In hospitals, a pathological and anatomical examination was mandatory - an autopsy of corpses. In 1786 hospital schools were reorganized into medical and surgical schools. These schools opened the way to the formation of the corresponding medical and surgical academies. 5. Doctors of Medicine in Russia. Management of medical institutions. Opening of the Academy of Sciences and All Arts I must say that Peter I invited many foreign doctors to Russia, including those to work in hospitals and hospital schools. Foreigners were in the majority among doctors and teachers, and they fought against Russian doctors. But it should be noted that the requirements for doctors in the era of Peter were high. For example, to become a professor at a hospital school, you need to get a "degree" of a doctor of medicine, defend a dissertation. Throughout the 89th century 309 Russian and 1764 foreign doctors received the doctorate degree. Despite this, the number of Russian doctors of medicine grew. The first doctor of medicine who defended his dissertation in Russia was a graduate of Moscow University - F. I. Barsuk-Maiseev (the topic of his dissertation was "On breathing"). In 878, the College of Medicine received the right to award doctors the degree of doctor of medicine. By the end of the XVIII century. XNUMX doctors worked in Russia. Now let's turn our attention to administrative innovations. In 1710, the Apothecary Order was replaced by the Medical Office. The medical office became the central health authority. At the head of the Medical Office was a doctor-archiater. Subsequently, in 1763, the Medical Office was replaced by the Medical College. And in 1803, the Medical College was closed, and its functions were transferred to the corresponding department of the Ministry of the Interior. In 1775, orders of public charity were formed to manage medical institutions, and the positions of county doctors were also introduced. In 1797, civil medical councils were created in the provinces, except for St. Petersburg and Moscow, in which all medical affairs were managed by the chief doctors of the city. In 1723, by decree of Peter I, the Academy of Sciences and All Arts was established. The opening of this academy took place in 1725. The pillar of the academy was M.V. Lomonosov (despite the large number of foreign doctors) and his students, famous doctors of that period (A.P. Protasov, S. Zybelin, N.M. , D. S. Samoilovich, etc.). MV Lomonosov M. V. Lomonosov is a brilliant scientist, philosopher, poet, geographer, and natural scientist. He had truly enormous talent. He was very close and interested in medical problems. He believed that medicine is one of the most useful sciences for humans; it “through knowledge of the properties of the body... reaches the cause.” It must be said that Lomonosov attributed medicine to the field of physics: “The often great science of physics and the most useful to the human race is medicine...” The fact is that physics in those days had a broad meaning - natural science in general. Thus, M.V. Lomonosov, in fact, introduced medicine into the circle of natural sciences. In 1751, in his famous speech "On the Benefits of Chemistry," he made many striking statements about medicine. Lomonosov carefully studied anatomy, physics, physiology, as well as other sciences that could be useful for medicine. Lomonosov was sure that it was simply impossible "to talk about the human body without knowing either the addition of bones and joints to strengthen it, or the union, or the position of the muscles for movement, or the distribution of nerves for feeling, or the location of the viscera for the preparation of nourishing juices, or the length of the veins for the circulation of blood, or other organs of his wonderful structure. Lomonosov considered it necessary to study chemistry for the knowledge of medical science, he writes that “a physician cannot be perfect without a satisfied knowledge of chemistry. She knows the natural mixture of blood and nutritious juices, she discovers the addition of healthy and harmful food. She is not only from different herbs , but useful medicines are prepared from the core of the earthly taken materials. In 1761, M. V. Lomonosov wrote a letter to Count I. I. Shuvalov "On the reproduction and preservation of the Russian people." This letter is of great importance, in which he convincingly and vividly described the difficult situation of medicine in the country, the incidence, high mortality, especially high infant mortality. Lomonosov called for combating bad habits, improving the quality of training for doctors, and improving the level of medical care. It must be said that the letter to I. I. Shuvalov can be assessed as a kind of program for the revival of the health of Russians, but it was not published. It should be noted, however, that the progressive doctors of that period followed the precepts of Lomonosov. S. G. Zybelin Semyon Gerasimovich Zybelin (1735-1802) - the first Russian professor at Moscow University. It occupies an important place in Russian medicine in the XNUMXth century. After he graduated from the Slavic-Greek-Latin Academy in Moscow, he was sent for an internship and continued education at the University of Leiden. At the University of Leiden, he received the title of Doctor of Medicine. After which he returned to Moscow. From 1765 to 1802 Zybelin was a university professor. He lectured on chemistry and medicine. Incidentally, he was one of the first to start lecturing in Russian. Lectures by S. G. Zybelin included a wide range of theoretical and practical medicine, as well as many other aspects of a doctor's activity: 1) obstetrics ("woman's business"); 2) raising children; 3) diagnosis and treatment of various internal diseases; 4) hygiene; 5) study of the laws of nature; 6) laws of physiology and pathology; 7) prevention of the development of diseases. The teaching of pharmacy was also part of the duties of Semyon Gerasimovich Zybelin. The teaching of pharmacy by Zybelin included a fairly large course in formulation, courses in the art of pharmacy, a course in pharmaceutical chemistry, etc. Here are the titles of some of Zybelin's lectures: 1) "On the causes of the internal union of parts among themselves"; 2) "A word about the cause of the internal union of the parts of the body and among themselves, and about the strength that comes from that in the human body"; 3) "About the action of air on a person and the ways in which he enters it"; 4) "On the correct education from infancy in the reasoning of the body, serving for reproduction in the society of peoples"; 5) "On the benefits of inoculating smallpox"; 6) "On the composition of the human body and how to protect them from diseases"; 7) "On the harm resulting from keeping oneself too warm"; 8) "About ways how to warn can be an important reason, by the way, of the slow multiplication of the people, the reason consisting in the indecent food of babies given in the first months of their life." According to these lectures, one can judge that the approach to medicine was broad and deep, and the problems of protecting the health of the population were touched upon. In his lectures and teaching method, Zybelin followed the path of Lomonosov, followed the clinical principles of Hippocrates, Harvey's physiology, etc. Since the university did not have specialized clinics where students could gain clinical knowledge and experience, Semyon Gerasimovich Zybelin organized the so-called courses medical consultations, where he demonstrated patients. A. M. Shumlyansky Alexander Mikhailovich Shumlyansky (1748-1795) made a great discovery in the morphology and physiology of the kidneys. This discovery formed the basis of his doctoral dissertation "On the structure of the kidneys" in 1783. After numerous experiments, experiments, physiological and morphological studies, Alexander Mikhailovich Shumlyansky discovered (one might say anew) the structure (including microscopic) of the kidneys, their activity. In his writings, Shumlyansky refuted the theories of Malpighi (Malpighi bodies are not glands at all, but a vascular glomerulus), Ruish's opinion that there is a direct connection between the arterial capillaries of the kidney and the renal tubules. K. N. Shchepin Konstantin Ivanovich Shchepin (1728-1770) - a major Russian scientist XVIII in. He graduated from the Kiev-Mohyla Academy. After that he worked at the Academy of Sciences. In 1758 Shchepin defended his doctoral dissertation at Leiden University. His dissertation was on vegetable acid. Since 1762, Konstantin Ivanovich Shchepin taught physiology, botany, anatomy, surgery, and pharmacology at the Moscow Hospital School, being the first Russian professor there. He taught classes in Russian. Various strong-willed qualities, atheistic worldviews in the spirit of M.V. Lomonosov - all this became one of the reasons for Shchepin's dismissal from school. In 1770, Shchepin died in Kyiv, participating in the eradication of the plague. N. M. Ambodik-Maksimovich Nestor Maksimovich Ambodik-Maksimovich was born in 1744. After graduating from the hospital school in St. Petersburg, he was sent to Strasbourg, where he received a doctorate in medicine. Then he returned to his homeland and worked as a teacher in hospital schools. Since 1781, Nestor Maksimovich Ambodik-Maximovich taught as a professor a course in surgery, physiology, and pharmacology. Nestor Maksimovich is especially known for teaching obstetrics in Russian at the St. Petersburg Orphanage. This course also included information about gynecology, children's health, etc. In 1784-1786. Ambodik-Maksimovich published the fundamental manual "The Art of Weaving or the Science of Womanhood", which for many years was considered one of the best manuals on obstetrics, gynecology and child health. Nestor Maksimovich introduced obstetric forceps into the practice of obstetrics, and phantoms for teaching the practice of obstetrics. In the lectures of Ambodik-Maksimovich, practical advice was given on the nutrition of children, their upbringing, and the prevention of diseases. It should be noted that Ambodik-Maksimovich was one of those who laid the foundation for the creation of domestic medical terminology. He created in 1783 "Anatomical and physiological dictionary". It must also be said that Nestor Maksimovich paid great attention to herbal medicine (this can be seen in his manual of 1784-1788 "Medicinal Substance Or Description of Healing Plants for Food or Medicine Used"). Nestor Maksimovich Ambodik-Maximovich died in 1812. D. S. Samoilovich Danila Samoilovich Samoilovich was born in 1744. After he graduated from the hospital school in St. Petersburg, he served for about 8 years as a military doctor. From the beginning of the 1770s. Samoilovich was engaged in the study and eradication of the plague in Moscow, Moldova. Was sent to Strasbourg, Leiden. After he received his doctorate there, Samoilovich returned to his homeland and studied the plague using microscopes. He tried to find out the true cause of the disease. Incidentally, Samoilovich was elected to a number of foreign academies for his selfless work and fight against plague epidemics and received universal recognition. Samoylovich argued that there were possibilities for curing and preventing the plague. He objected to the general burning of houses, belongings of people who were sick with the plague, believing that this causes great economic damage. Samoylovich suggested methods for disinfecting the clothes of patients, methods for disinfecting household utensils, etc. Samoylovich also suggested that doctors who are involved in the elimination of plague epidemics, preventive vaccinations from plague buboes, where he believed the presence of a weakened virus. In 1792, Samoilovich published a book entitled "A brief description of microscopic studies on the essence of ulcerative poison." Samoylovich for a very long time sought the opportunity to teach in hospital schools. It should be noted his lecture "Speech to the students of hospital schools of the Russian Empire", written in 1783. This lecture raised a number of scientific, ethical, and organizational issues. He believed that in order "to become a doctor, one must be an impeccable person." Danila Samoilovich Samoilovich died in 1805. V. M. Richter Wilhelm Mikhailovich Richter graduated from Moscow University, after which he was sent to Germany (Berlin, Göttingen) to continue his education in obstetric art. After returning from Germany and receiving a doctorate in medicine, Richter was appointed professor of midwifery at Moscow University. In 1806, under the leadership of Wilhelm Mikhailovich, a midwifery institute and a maternity hospital (at Moscow University) were opened. A midwifery institute was also organized at the Imperial Orphanage. Richter wrote several midwifery textbooks. These allowances were used by students of hospital schools and the university. 6. Hydropathic. Production of medical equipment in the XNUMXth century Peter I also became the ancestor of mineral water treatment. By his order, hydropathic clinics were opened in Lipetsk, Staraya Russa, and the Olonets Territory, which are still operating. In these hospitals, both military personnel and civilians could receive procedures. Medical instruments were produced in special workshops, they were also called instrumental huts. 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." 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." LECTURE No. 9. Health care and the development of medical science in the Soviet period (1917-1991) 1. General historical characteristics of the period under review It is very difficult to give a clear framework and brief characteristics of such a long and difficult period in the development of Russia, because the Soviet period, which covered the time from 1917 to 1991. rich in various fateful events: the Great October Revolution of 1917, the period of the formation of the new Russia (1917-1920), accompanied by the Civil War and intervention, the split into "reds" and "whites", the NEP period, the formation of the USSR and the leading communist parties, the collectivization of the peasantry, the long rule of Stalin, which led to many irreparable consequences, the pre-war period and the years of the Great Patriotic War, constant changes in government, especially the last two decades of the existence of the USSR, and, finally, its collapse. All these events were experienced by the Russian people, people lived in constantly changing conditions. The beginning of the Soviet period - October 1917 - was marked by a revolution and the establishment of Soviet power in the center and in the regions. In the capitals, the approval of the new government was difficult, with obstacles and a constant change in the composition of the people at the head of this process. The coup took place in 2 stages: 1) February Revolution (February 23 - March 3, 1917); 2) October Revolution. In October, the Bolsheviks finally seized power, so the concept of the "Great October Revolution" combines both of these events, which are a continuation of each other. In February, it became clear that Russia was faced with a choice of ways to overcome the crisis, which became the logical consequence of the revolution: either it was necessary to pursue a democratic policy and its acceleration and thereby stabilize society, or to stabilize it against the backdrop of a brutal dictatorship, turn, could only lead to an aggravation of the social split, and consequently, both political and social forces. Two types of dictatorship were foreseen, one of which was to take root as a result - right-wing conservative and left-wing radical. The alternative to hard dictatorship has won. In October, events began that had a certain impact on the whole world, and in Russia radically changed the socio-economic, political and cultural traditions. The Bolsheviks, who seized power, announced the accomplishment of the Great Socialist Revolution. The formation of a new government was accompanied by a brutal Civil War. Its origins were the street battles of 1917, which were the result of a split in society into supporters and opponents of the revolution. Formally, its beginning was marked by the removal of the Provisional Government. The height of the war fell on 1918, when the forces of the opposing sides became practically equal, and the confrontation of the people turned into the category of fratricide. This period ended when the White Front was liquidated in the Crimea in 1920. Finally, the Civil War was completed in 1922, in the autumn, with the expulsion of Japanese military units from the Russian Far East. A special feature of the "Citizen", as it was called, was its interweaving with the anti-Soviet intervention of the Entente countries. This period was a terrible time in the history of Russia: the total damage to the national economy was more than 50 million gold rubles; compared to 1913, in 1920 industrial production decreased by 7 times, and agricultural production by almost 2 times. The number of the working class was almost halved: some returned to the villages, some settled in the bureaucratic strata, some died at the fronts. Those who remained did odd jobs. Partly in connection with this, partly for other reasons, the revolutionary class consciousness of the people became dulled. This was dangerous for the authorities because among the village residents, the majority of small owners, the number of which increased in connection with the earlier agrarian reform, were always wary of the Bolshevik power. Among the peasants, middle peasants began to predominate, as well as rural farm laborers and the poor. More than 8 million people died from epidemics, famine, and battles; 2 million, who made up the political, financial and scientific elite, emigrated. But the most terrible consequence was that the belief in the superiority of violence and the possibility of neglecting human life - this is the name of achieving bright ideals - took root in people's minds. The Bolsheviks won then, but the support that fed them from the people was more than conditional, because people chose their lesser two evils. At that time, the statehood and sovereignty of Russia was preserved, but the limited nature of the recognition of Bolshevik power threatened with new terrible upheavals. Then came the period of the NEP (March 1921), accompanied by ups and downs in the economy due to unforeseen contradictions in the NEP policy. In 1925, the Communist Party proclaimed a course towards industrialization, the initial stage of which fell on 1926-1928. Since October 1917, the Bolsheviks tried to subdue the Russian Orthodox Church, which gradually began to give up its anti-Bolshevik positions. In 1927, a "Declaration" was signed, in which a demand was made for clergymen who did not accept the new ways to step back from their duties, which naturally caused a new wave of indignation in the ranks of believers. The Bolsheviks also paid great attention to culture, having carried out a cultural revolution, which mainly concerned the eradication of the views of the old intelligentsia and the formation of the Soviet intelligentsia, which would faithfully serve the new government and be loyal to the regime. Reformation was also carried out in the field of education, a new public Soviet school was founded, in which much attention was paid to the formation in students of a "class approach" to assessing everything that is happening, as well as the past. On December 30, 1922, the declaration "Treaty on the Formation of the Union of Soviet Socialist Republics" was adopted, and a union government was formed - the Council of People's Commissars. From that moment on, there was an intensive development of the one-party system in the USSR. In 1932, the first five-year plan for the development of the national economy of the USSR, or the first five-year plan, was adopted. Since that moment, the country has become a huge construction site. At the same time, a system of card distribution of consumer goods was introduced. A milestone that left a mark on history was the collectivization of the peasantry and the spread of dispossession. January 5, 1930 is considered the beginning of this event. In 1935, a new version of the agricultural artel was already adopted. The result of collectivization was a famine in the country, to overcome which then a lot of effort was put. In the 1930s The main foreign policy direction of the USSR was relations with Germany. The influence of fascism was already felt in Europe. Stalin pursued a cautious dual policy towards Germany and Japan. These two states most of all posed a danger to the USSR at that moment. In 1939, a "Non-Aggression Pact" was signed between Germany and Russia. However, Hitler, who had captured almost all of Europe by 1940, by the beginning of 1941 had a detailed Barbarossa Plan to attack the USSR. So, on June 22, 1941, the Great Patriotic War began, which lasted until May 1945. A long, exhausting war claimed millions of lives of both the Soviet people and enemy troops. Until December 1941, the offensive of the German troops was little reflected by the Russians. The German army was huge, since it included not only Germans, but also people from previously captured states: Italians, French. That is why the Great Patriotic War was one of the important stages of the Second World War, and its outcome had to decide a lot not only in Russia, but throughout the world. In December 1941, Soviet troops launched a powerful counteroffensive near Moscow, and in January 1942, the United Nations Declaration on the Joint Fight against Fascist Aggression was signed in Washington. Russia had a more clearly defined hope for victory. But until the end of the summer of 1942, the Russian army was waiting for failure. Only on November 19, 1942, a radical turning point occurred in the course of the war. Back in the summer, Donbass was occupied, Sevastopol fell, and the assault on Stalingrad began. And on February 2, 1943, the remnants of the group that kept Stalingrad surrounded, consisting of 330 thousand soldiers, surrendered. On July 5, 1943, the Wehrmacht attacked the Kursk Bulge, and the Battle of Kursk did not stop until August. After these two grandiose victories, something broke in the work of the German military machine. In 1944, the Leningrad blockade was finally broken, which began at the very beginning of the war and lasted 900 days. Then, one by one, the largest cities were liberated from the Germans. The first and second Ukrainian fronts broke through to the border with Romania, later, under the command of the troops of Marshal Rokossovsky, Belarus was liberated, later Moldova, Transcarpathian Ukraine and the Baltic states. Thus, the state border of the USSR from the Barents to the Black Sea was restored. Tangible support was then provided by the troops of England and the United States, which, having landed in the north of France, liberated it from the western occupation of the fascist troops. Their path lay in Berlin. All of 1944 and early 1945. The Red Army marched across the Union in a wave of victories and liberations. By April 1945, the capital of the Third Reich was blocked by soldiers of the Soviet army. On April 30, the red banner of Victory fluttered over the defeated Reichstag. In just a few days, Budapest, Koenigsberg, Vienna, Prague and other major cities and world capitals were liberated. On May 9, 1945, an act of unconditional surrender of Germany was signed with representatives of the German command. It was Victory Day. The USSR summed up the decisive result of the entire Second World War: it was the deliverance of the world from fascist enslavement that seriously threatened it. The Soviet-German front was the main one in the entire war. Both sides lost most of their soldiers and weapons here. The damage to the USSR was colossal - about a third of the national wealth. But these losses cannot be compared with human losses: 27 million people died on the fronts of the Great Patriotic War. As offensive as it may be, these losses were not only the result of the great power of the fascist troops, but also the result of the disregard for human lives of the Soviet leaders. History has not seen such a number of ill-conceived and technically unsupported offensives as during the war. And one of the main results of the war was the growing opposition of the capitalist countries to the Soviet Union. This confrontation largely predetermined the fate of the Soviet Union. In addition, it began in the atomic era, which also had its significance, because immediately after the victory over Germany, the world began to balance on the brink of a third World nuclear war. Moreover, the threat to Russia came primarily from the recently friendly United States. The last years of Stalin's rule passed under the sign of the Cold War: the USSR tried to transfer all of Europe to the Soviet regime, and Europe, in turn, united with the United States, tried to eradicate Soviet power even in Russia and achieve the dominance of capitalism. At the same time, the United States, under the presidency of Truman, declared that they were a contender for world domination. Any threats were used up to the use of atomic weapons against Russia. Its first tests were already carried out in 1945. Then two atomic bombs were dropped on the Japanese cities of Hiroshima and Nagasaki. There was a lot of controversy about the use of nuclear weapons, there were proposals from both the United States and the USSR. The parties did not yield to each other. The success of the USSR in this struggle was that, starting from 1944, the "socialist camp" was actively formed by establishing a communist regime in Hungary, Czechoslovakia, Bulgaria, Yugoslavia, Albania, Poland, Romania and other countries. The situation was especially with Germany, from which one could expect anything. In 1949, the Federal Republic of Germany was organized and its constitution adopted. A few months later, the USSR formed a second state - the German Democratic Republic. It was on the territory of those lands that were occupied by the Soviet army. Established in 1945, the United Nations became a tribune where world issues were resolved quite fiercely. It was originally created to suppress the voice of the USSR. However, the protection of the right of veto in the Security Council by representatives of the Soviet government made it possible for the USSR to further actively express its opinion in defense of the sovereignty of small states or "third world countries", where Stalin tried to strengthen the position of communism. Nevertheless, no matter how much the question of establishing the world domination of one of the regimes was raised, it remained “frozen”: either because of the lack of arguments in defense of the parties, or from an overabundance of them and an understanding of the futility of the struggle. Nevertheless, Stalin's main task was to resurrect the country from the ashes and prevent the emergence of undesirable moods among the people, in connection with which people who represented a "danger to society", namely those who returned from German concentration camps and captivity, were isolated from the public. May 5, 1953 JV Stalin died. Power was concentrated in the hands of his successors G. M. Malenkov, L. P. Beria and N. S. Khrushchev. The fight developed rapidly. In June 1953, L.P. Beria was arrested for conspiracy with imperialist intelligence services, and later L.P. Beria was shot; in 1955, Malenkov retired. So, from September 1953, N. S. Khrushchev became the first secretary of the CPSU Central Committee. He was engaged in the liquidation of "Stalinism" in the USSR, carried out various reforms, raising Russia economically, and gave Crimea to Ukraine. The most memorable event that occurred during his reign and related to foreign policy was overcoming the Caribbean crisis, when the whole world watched the actions of D. Kennedy, F. Castro and N. S. Khrushchev in Cuba, balancing on the brink of nuclear war. By the end of Khrushchev's leadership in the USSR, the country was brought out of the stupor of the past era and raised from its knees. However, this time was remembered by "personnel leapfrog", an attempt to introduce a "leveling" between high government officials and ordinary people; many thousands of officers were left without salaries, peasants and workers were tired of fighting for a "bright future", while the future was getting worse. Therefore, in 1964, Khrushchev was removed from all posts, accused of "voluntarism and subjectivism," and L. I. Brezhnev became the first secretary of the Central Committee, and A. N. Kosygin became chairman of the Council of Ministers. L. I. Brezhnev served as General Secretary until 1982. Russia followed the path of development of a directive economy, but, despite all the steps taken, it lagged far behind the countries of Western Europe. Even the development of such industries as cosmonautics and the military industry was limited by technical capabilities. The "advantages of developed socialism" over already "decaying capitalism" were promoted in every possible way. It was in connection with this that the new Constitution of the USSR was adopted in 1977, the preamble of which stated the fact that a "developed socialist society" had been built, although this was far from the case, and, moreover, the building of socialism regressed rather than progressed. . In 1982, Brezhnev's place was successively occupied by Yu. V. Andropov, and after his death in 1984, by K. U. Chernenko. He died in 1985. And his post was taken by MS Gorbachev. The post of chairman of the Council of Ministers of the USSR was taken by N. I. Ryzhkov. From that moment began the last stage in the history of the USSR - "perestroika": at the head of all tasks and plans was the prevention of the collapse of "state socialism" through the implementation of cautious, "soft" reforms, mainly related to the economic sphere of the union. In April 1985, the government proclaimed a direction to accelerate socio-economic development. However, the lack of the necessary equipment led to an increase in the number of accidents at enterprises, the largest of which was the accident at the Chernobyl nuclear power plant (April 1986). The country introduced a "dry law" and the principle of combating "unearned income". In the summer of 1987, the rights of enterprises were expanded, and in the summer of 1988, a number of laws were adopted that opened the way to private property. At the same time, the "shadow economy" began to develop with the laundering of a huge amount of money. In 1990, a resolution "on the concept of transition to a regulated market economy" was adopted, which provided for demonopolization and decentralization, the establishment of banks and joint-stock companies. There was a gap in the mechanism of reforming the credit system and pricing policy, which further led to the impossibility of the final implementation of plans, the half-heartedness of results. In 1988, not without fear, the government decided to undertake radical political reform. Censorship was relaxed, and people were given hitherto unknown freedom of action and voice. This soon entailed the spread of previously banned literature, films, programs, etc. People began to understand the conditions in which they lived, and many opponents of the Soviet regime appeared who were no longer afraid to make themselves known. The number of party members in the country dropped from 21 to 15 million people over the course of several months. Soon, other republics that were part of the Union realized that better development could only be achieved if they left the Soviet Union. The Baltic republics, and after them the Russian Federation, declared the superiority in power of their laws over the laws of the USSR. A new government position was introduced - the President of the USSR, which was occupied by M. S. Gorbachev, after which he had to enter into negotiations with the leaders of the republics. The negotiations were to be devoted to concluding a new Union Treaty. It was not supported, and after some time a compromise agreement was presented, granting much more rights to individual states and reducing the importance of the center in governing the Union. However, the signing of the agreement never happened. On August 19, when Gorbachev was vacationing in Crimea, the State Committee for the State of Emergency was established. It was announced that the government structures had been disbanded and the party's activities had been stopped. The country froze in anticipation. Only the President of the RSFSR, B. N. Yeltsin, who was elected by popular vote in June 1991, managed to organize a “path”, which, however, was not of particular national importance. On August 22, members of the State Emergency Committee were arrested on charges of attempting a coup. Immediately after that, the activities of the CPSU on the territory of the Russian Federation were banned. The Baltic republics hastened to secede from the Union. Gorbachev tried to fight for the Union Treaty in order to prevent the uncontrolled disintegration of the Union and irreversible disasters for millions and millions of compatriots. These actions were useless. December 8, 1991 B. N. Yeltsin, L. M. Kravchuk and S. S. Shushkevich announced the dissolution of the USSR. Soon the Commonwealth of Independent States (CIS) was created. It was the famous "Belovezhskaya agreement". On December 21, 8 more states joined the CIS, and on December 25, MS Gorbachev resigned. Thus the Union of Soviet Socialist Republics ceased to exist. 2. The formation of Soviet medicine The historical events of 1917 brought ruin not only to the political and economic spheres of life. They affected the life of the population, and, of course, the general state of people's health. At the beginning of the Soviet period, with the coming to power of the Bolsheviks and the establishment of a new regime, a wave of epidemics of cholera, typhus, smallpox and other diseases swept the country. The situation was aggravated by the widespread shortage of qualified personnel, equipment and medical equipment, and medicines. There were very few hospitals, preventive medical institutions. The civil war left a deep mark in history, bringing with it devastation in the industrial activity of the country, agriculture. A wave of hunger swept across the country. In agriculture, there was not only enough seed, but also fuel for agricultural machinery. Communication between settlements was reduced to a minimum, there was not enough water even for cooking and quenching thirst, not to mention other household needs. Cities and countryside literally "overgrown with mud", and this already served as a threat of epidemics. HG Wells, who visited the Union in 1920, was shocked by what he saw compared to what he had seen 6 years earlier. It was a picture of complete collapse, the country that appeared to his eyes was the wreckage of a great empire, a huge shattered monarchy, fallen under the yoke of cruel senseless wars. At that time, the death rate increased 3 times, the birth rate halved. Only an organized healthcare system could save the country from extinction, help in the fight against diseases and epidemics. Such a system began to actively form in 1918. To create a developed structure that could effectively serve all segments of the population, it was necessary to combine all types of departmental medicine under a single state control: zemstvo, city, insurance, railway and other forms. Thus, the formation of a unified health care system attracted more and more people and was of a "collective nature" - they literally recruited from the world one by one. This "gathering" of medicine took place in several stages. The first phase fell on October 26, 1917, when the Medical and Sanitary Department was formed. It was created under the Military Revolutionary Committee of the Petrograd Soviet of Workers' and Soldiers' Deputies, headed by M. I. Barsukov. The main task of the department was to unite and involve in the work of all doctors who recognized the new government; it was also necessary to radically change the medical and sanitary business in the country and organize qualified assistance to workers in enterprises and soldiers in the active troops, as well as those in reserve. Since the reform had to be carried out everywhere in order to cover more area, medical and sanitary departments and medical colleges began to be created locally. The tasks facing the latter were of a public nature, so on January 24, 1918, the Council of People's Commissars signed a decree establishing the Council of Medical Colleges. This council became the highest medical body of the workers' and peasants' government. A. N. Vinokurov became the head of the body, V. M. Bonch-Bruevich (Velichkina) and I. M. Barsukova were appointed his deputies. In order for the people to know about the active work of the Council, on May 15, 1918, the first issue of the News of Soviet Medicine was published under the Council of People's Commissars of the RSFSR. It was the first Russian medical public publication, which then appeared regularly. The Council of Medical Colleges saw its main task in fulfilling the following conditions: continuing the widespread organization of medical and sanitary departments, consolidating the initiated reforms regarding the transformation of military medicine, strengthening, developing sanitary affairs and strengthening epidemic control throughout the country. However, in order to act on the scale of the whole country and objectively monitor the results of the work carried out, it was necessary to hold the All-Russian Congress of Representatives of the Medical and Sanitary Departments of the Soviets. The congress was held on June 16-19, 1918. It raised not only the organization and work of the People's Commissariat of Health, which were the most important at that time, but also questions of insurance medicine, the question of combating epidemics, and questions about the tasks of local medicine. The result of the work of the congress was the adoption of a decision on the creation of the People's Commissariat of Health, which was to become the main body of health and be in charge of all medical and sanitary affairs. On June 26, 1918, a project for the creation of the People's Commissariat of Health was presented. On July 9, the draft was also published for the general public, and on July 11, the Council of People's Commissars signed a decree "On the Establishment of the People's Commissariat of Health." The first collegium of the People's Commissariat of Health of the RSFSR was created, in which V. M. Velichkina (Bonch-Bruevich), R. P. Golubkov, E. P. Pervukhin, Z. P. Solovyov, P. G. Dauge were appointed, and the first commissioner of health was appointed N. A. Semashko. Z. N. Solovyov became his first deputy. In July 3, the People's Commissariat of Health was renamed the People's Commissariat of Health of the USSR by decree of the All-Russian Central Executive Committee and the Council of People's Commissars. G. N. Kaminsky became its first head. N. A. Semashko Nikolai Alexandrovich Semashko (1874-1949) made a huge contribution to the development of not only Soviet, but also world medicine. Semashko's career did not start with brilliant success: he graduated from Kazan University, after which he worked for 3 years as a zemstvo doctor in the Oryol province, and then in Nizhny Novgorod. The revolution in February 1905 ended for him with arrest, imprisonment for 10 months, and then 10 years of emigration in France, Switzerland and Serbia. In the summer of 1917, at the age of 43, he returned to Moscow with a group of other emigrants. He took part in the medical arrangement of the country from the moment the idea of creating a state healthcare system arose: first he headed the medical and sanitary department of the Moscow Council, and later became the first People's Commissar of Health of the RSFSR. He managed the People's Commissariat for Health for 11 years, in the most difficult years for the country, when there was a bloody Civil War, epidemics raged in the Union. He also took part in the development of anti-epidemic programs, seriously stated the need to create a program for the protection of motherhood and childhood and the need to develop Soviet medicine by improving and expanding the network of research institutes. Under him, sanitary-resort business began to develop intensively, the system of higher medical education was transformed. N. A. Semashko made a huge contribution to the development of hygiene in the USSR, opening in 1922 the Department of Social Hygiene at the Medical Faculty of Moscow State University. He himself was the head of this department for 27 years. In 1927-1936. the first edition of the Great Medical Encyclopedia was created and published, the initiator of which was N. A. Semashko. From 1926 to 1936 he headed the children's commission of the All-Russian Central Executive Committee. He put a lot of effort into studying the sanitary and hygienic situation after the war. N. A. Semashko became one of the founders and one of the first academicians and members of the Presidium of the USSR Academy of Medical Sciences. He was director of the Academy of Pedagogical Sciences from 1945 to 1949. Since 1945, he held the title of Academician of the Academy of Pedagogical Sciences of the RSFSR. He also became the founder of the Institute for the Organization of Public Health and the History of Medicine of the USSR Academy of Medical Sciences, after its creation he led it from 1947 to 1949. This institute bore his name for a long time, later it was renamed the National Research Institute of Public Health of the Russian Academy of Medical Sciences. Nikolai Alexandrovich Semashko, despite the great responsibility that lies on his shoulders and the large number of positions he holds, managed to leave his mark on the development of physical culture and sports, as he became the first chairman of the organization in charge of this area of medicine, and also headed the board of the All-Union hygienic society (1940-1949). Throughout his life, he wrote scientific works and works, of which there are more than 250. All of them were devoted to theoretical, organizational and practical issues of hygiene and health care in general, which earned him immortal memory among the people. 3. P. Solovyov Zinovy Petrovich Solovyov (1876-1928), in addition to his high positions in the health sector, is known for the fact that in 1925 he initiated the creation of the All-Union Pioneer Camp "Artek" on the Black Sea coast, which exists to this day. He left behind many scientific works in which he raised questions and actively developed programs to overcome difficulties in the development of medical science and higher medical education in the USSR. G. N. Kaminsky Grigory Naumovich Kaminsky (1895-1938), before being appointed the first People's Commissar of Health of the USSR, served for 2 years as People's Commissar of Health of the RSFSR (1934-1935) and the USSR (1935-1937). He was the organizer of the All-Union State Sanitary Inspectorate. In 1935, based on his developments, a program was adopted to improve medical care and services for the city and rural population. He contributed to the transfer of the chemical and pharmaceutical industry to the department of the People's Commissariat of Health of the RSFSR. He left a deep mark in the development of medicine as a science and in medical education, he also became one of the organizers of VNEM in Moscow and Leningrad. Special thanks to G. N. Kamensky could be rendered for assistance in organizing the first international congresses. However, his activity in the state field was short-lived, the period of his active work was only 4 years, since on June 25, 1937 he was arrested and shot, after he spoke at the Plenum of the Central Committee of the All-Union Communist Party of Bolsheviks with a condemning speech against the policy of repression, many of his comrades-in-arms were arrested and shot with him. Later they were all posthumously rehabilitated. 3. Principles of medicine in the USSR. Higher medical education Four basic principles predominated in the then organized health care system. First, medicine was supposed to be of a state nature. Secondly, medicine should have a preventive direction. Thirdly, medicine had to involve the population for active participation in the protection of public health. Fourthly, medicine had to propagate the need for the unity of scientific medicine and public health preventive measures. In principle, the ideas were not new, because they began to be formulated even before 1917. Even S. P. Botkin, G. E. Rein and their older colleagues - Johann Peter Frank, Hippocrates and other scientists - had already predicted that the future belongs to a preventive (preventive) medicine. But it was only in the era of the beginning of the Soviet period that all these principles could be combined into clear tasks and implemented. The most important principle of Soviet medicine was the need to give it a state character. To do this, it was necessary to bring it under a single center of management, state financing, and also to ensure the direct participation of the highest state authorities in the preparation and approval of public health programs. Medicine had to acquire two new qualities - free and generally accessible. Previously, such principles of medical care were not practiced. The result in the creation of a well-coordinated healthcare system was the approval of the People's Commissariat of Health. This was in 1918. A little later, the "Decree on the People's Commissariat of Health" was issued, in which the centralized management of the health care system was already clearly fixed. It was then that benefits for medical care were introduced, the network of medical and preventive institutions was expanded, which, first of all, became available to workers in hazardous enterprises, trade union members, the disabled, and Red Army soldiers; all this made medicine accessible to the general population, it became common for people to turn to a polyclinic doctor in case of malaise, whereas earlier, under similar conditions, people often died from the fact that even the initial manifestations of the disease due to the lack of medical care could turn into severe disease. The second principle of Soviet medicine - the preventive direction - has achieved, perhaps, the most significant success. Various bodies were established to oversee the sanitary and hygienic situation in the country: a unified state sanitary service, a system of sanitary and epidemiological stations, etc. Finally, it was realized that the severe epidemic situation in the country does not lie in some global causes, but in the absence of elementary working conditions, poor nutrition at enterprises and, as a result, the deterioration of life due to lack of time and money for workers. The situation began to be actively corrected, and constant sanitary control was introduced not only at enterprises, but also in the private life of people: constant home visits to sanitary doctors urged people to comply with sanitary and hygienic standards, because medical workers had the right to go to court for violation of them which had dire consequences. Then for the first time they started talking about the need for the complete elimination of individual infectious and viral diseases. The People's Commissariat of Health and the Council of People's Commissars allocated huge sums of money for the implementation of these plans. The results were not long in coming: soon such contagious diseases as plague, cholera, smallpox were eliminated throughout the Union. The measures were so effective that not only in peacetime, but also during the Great Patriotic War, there were no cases of epidemics, which until then was unheard of. Already after the war, anti-epidemic measures also led to the elimination or reduction of the number of such diseases as typhus (relapsing, typhoid, typhus), paratyphoid, and malaria. People began to get sick with acute intestinal infections much less. All this had a lot of positive aspects, but there were also disadvantages: since special attention was paid specifically to infectious diseases, in the near future the country had to face the problem of increased incidence of diseases of the cardiovascular system among people, and also came to the fore oncological diseases. Immediately the question arose about the retraining of sanitary-resort institutions and the necessary medical examination of the entire population of the country. The involvement of the workers themselves, the intelligentsia and the peasants themselves in the measures for health care became simply necessary, especially during the years of the Civil War and intervention. The problem was that medicine had lost its professionalism due to an acute shortage of qualified personnel. The fact is that most doctors of that time did not share the principles of the new form of government: many of them emigrated, many declared sabotage, many died on the fronts and in the fight against epidemics. The population remained on mutual medical assistance: people themselves began to organize sanitary detachments at enterprises and promoted a healthy lifestyle. Various wall newspapers and publications were published, the most famous of which was "Windows of ROSTA", in the creation of which V. V. Mayakovsky took part. After the relative stabilization of the situation, the government began to pay the most attention to the development of higher medical education and the training of qualified personnel. Only a few years later, when the ranks of qualified medical workers were replenished, medicine returned to the mainstream of professionalism, and the participation of the general population in public medical education ceased to be a necessity. At that time, it was necessary to work on the unification of practical activities in the field of health and medical science. As a science, medicine was going through a difficult period: due to the general devastation, doctors-scientists were cut off from the whole world, deprived of the opportunity to study foreign medical literature, to conduct scientific discussions with colleagues from other countries. There was a severe shortage of equipment in the laboratories. There were no normal working conditions - the laboratories were not heated, they had no electricity. However, in spite of everything, scientists continued to carry out experimental work, moreover, of world significance. The great representatives of Russian medicine: V. M. Bekhterev, A. A. Kisel, N. I. Burdenko, E. N. Pavlovsky, I. P. Pavlov continued to work on the same enthusiasm, starving and suffering hardships. It was at that time that compulsory vaccination against certain diseases was introduced, effective methods of combating tuberculosis were invented, poliomyelitis was eliminated, and the mechanisms of transmission of many transmissible diseases were discovered. Throughout the country, despite the difficult economic and political situation, a mass organization of scientific research institutes and laboratories of national importance was carried out. In 1918, the Scientific Medical Council was established, which was engaged in the development of higher medical education, forensic medical examination, the compilation of the state pharmacopoeia, and many other issues. With the active participation of the council, the State Institute of Public Health was opened, which included 8 research institutes dealing with issues of sanitary and hygienic conditions, tropical diseases, microbiology, etc. Throughout Russia from 1918 to 1927. more than 40 research institutes were opened, among which was the Saratov Institute of Microbiology and Epidemiology (1918). Science and practice merged together, because new scientific discoveries were immediately introduced into practical use, and observation and the fight against mass diseases helped to create new scientific principles and tasks. In the field of higher medical education, an innovation was that since 1930 all the medical faculties of the country separated and became medical institutes, of which there were 1935 throughout the country by 55. They included pharmaceutical, pediatric, dental faculties, which contributed to the formation of the first medical universities, as well as residency in clinical departments and postgraduate studies. A similar development of the healthcare system in the USSR could serve as an example for many other countries (Great Britain, Cuba, China, etc.). 4. Medicine during the Great Patriotic War. The development of medicine in the post-war period From 1941 to 1945 The Great Patriotic War was going on, which became the bloodiest in the entire history of mankind. More than 27 million soldiers and civilians died. But many survived and survived thanks to the actions of Soviet military doctors. The initial period of the war was especially difficult in terms of medical support: there were not enough personnel, medicines, and equipment. In this regard, early graduations of fourth-year students from military medical academies and medical institutes were organized. Thanks to this, by the second year of the war, the army was provided with medical personnel in all specialties by an average of 95%. With the help of these people, soldiers and home front workers, mothers, children and the elderly received medical care. The chief surgeon of the Red Army was N. N. Burdenko, the chief surgeon of the Navy was Yu. Yu. Dzhanelidze. Also, many famous people worked at the fronts, who received awards for their activities, memory and glory after the war. Thanks to the coordinated actions of doctors, numerous evacuation hospitals were organized, specialized medical care was improved for soldiers wounded in the head, neck, stomach, chest, etc. Scientific work did not stop, which in the pre-war period led to the production of blood substitutes and the invention of methods for preserving and transfusing blood. All this later helped save thousands of lives. In the war years, penicillin was tested, domestic sulfonamides and antibiotics were invented, which were used to combat sepsis and heal purulent, difficult-to-heal wounds. The main successes of medicine in the postwar years include a thorough study of the sanitary situation and the effective elimination of problems in this area, as well as the opening of the first USSR Academy of Medical Sciences, whose president was N. N. Burdenko. This happened on June 30, 1944, before the end of the war. The USSR Academy of Medical Sciences is now called RAMS (Russian Academy of Medical Sciences), its research centers are located in many of the largest cities in Russia. In them, scientists are engaged in the study of issues in all areas of theoretical and practical medicine. Further from 1960 to 1990. Soviet medicine experienced successive periods of ups and downs. In the 1960s developed a new branch of medicine - space medicine. This was due to the development of cosmonautics, the first flight of Yu. A. Gagarin on April 12, 1961, and other events in this area. Also in the early 1960s. large hospitals (for 300-600 or more beds) began to be built throughout the country, the number of polyclinics grew, children's hospitals and sanatoriums were created, and new vaccines and drugs were introduced into practice. In therapy, separate specialties began to stand out and develop (cardiology, pulmonology, etc.). Surgery advanced by leaps and bounds, as the principles of microsurgery, transplantation and prosthetics of organs and tissues were developed. In 1965, the first successful living donor kidney transplant was performed. The operation was performed by Boris Vasilyevich Petrovsky. At the same time, research was carried out in the field of heart transplantation (artificial, and then animal). Here, Valery Ivanovich Shumakov, who was the first to perform such operations (first on a calf, and then on a man), should be especially singled out. In the field of medical education, reforms unfolded in 1967-1969: then a system of seven-year training of medical personnel was introduced. The system of improvement of doctors began to develop intensively. In the 1970s Russia was ahead of the whole world in terms of the number of doctors per 10 population. However, there was a problem of shortage of personnel with secondary medical education. Due to the lack of funding for secondary medical educational institutions, it was not possible to recruit the required number of personnel. In the mid 1970s. Diagnostic centers were actively opened and equipped, maternal and child health was improved, and much attention was paid to cardiovascular and oncological diseases. Despite all the achievements, by the end of the 1970s. Soviet medicine experienced a period of decline due to insufficient funding and underdevelopment of certain state health programs. In the 1980s continued to actively study the issues of cardiology, oncology, leukemia, implantation and prosthetics of organs. In 1986, the first successful heart transplant was performed. The author of the work was Valery Ivanovich Shumakov. The ambulance system was also actively developed, automated control systems "ambulance" and "hospital" were created. A grandiose task in the field of public health in 1983 was the universal, nationwide medical examination and specialized treatment of the population. It was not possible to carry it out to the end - there was neither a clear plan nor means for this. Thus, the main problem of health care at the end of the Soviet period was the discrepancy in the scope of the planned reforms. It was necessary to introduce new methods of financing, to attract private and state structures. Therefore, despite all the colossal scientific and practical work carried out, the government has not achieved the expected changes and results in terms of healthcare. This was partly due to the approaching collapse of the USSR and the weakening of the influence of power structures. LECTURE No. 10. The development of medicine at the end of the XNUMXth century. International cooperation in the field of health 1. The development of healthcare in the late XX - early XXI centuries Either due to the political situation in the country, or due to some other reasons, the healthcare system during the years of the country's transition from the socialist to the democratic-capitalist system underwent strong transformations, which initially did not have the best effect on the health of the population. The departure of the dictatorship into oblivion was accompanied by an unnecessarily abrupt transition from excessive centralization to liberalism in all respects and directions, including medicine. In the light of deep social and economic reforms, there was not enough work, housing conditions became limited, and health care ceased to fulfill its functions as it was expressed in the dawn of the Soviet period. Funding has been drastically reduced, making health care unavailable to all segments of the population, reducing the influence of government agencies and guarantees in this regard, and, as a result, the standard of living and the main vital indicators of health of large groups of the population have declined. The reason for the insufficient receipt of money in the "health treasury" was funding "on a residual basis", which was surprising: medicine receded into the background, ceased to be one of the most important development courses. The technical equipment of the health care base has deteriorated, the quality of medical care has inexorably declined, and the level of preventive work among the population has greatly decreased. Scientific and medical research, which had no support from the state, was carried out in a much smaller volume. All this led to the fact that in an incredibly short period of time the demographic state of the country was disturbed: against the background of a more than 2-fold decrease in the birth rate, the death rate increased 1,5 times. Although the reasons for this lay not only in the insufficiency of the healthcare system: the forensic situation worsened, which law enforcement agencies could not cope with. A situation was created in the country that had not been remembered since the post-war years - sociologists and demographers registered a clear picture of depopulation. Thus, at the beginning of 1990, the resources allocated to medicine were used extremely inefficiently and incompletely, since there was no clear structure for the provision of medical care. In addition, there was a clear bias towards the development of expensive types of medicine, and the system for the development of public, high-quality and financially easy preventive care did not find a way out. The resulting imbalance between what the population needed and what was actually provided to them led to people's distrust in the health care system, it was considered secondary. The situation demanded an immediate resolution through a clear, directed and effective reform. The reform of the health care system began in 1991. It put forward completely new principles for the elimination of centralization and monopolization of the public health sector. Laws on compulsory health insurance, the introduction of market mechanisms and the development of a network of channels for financing medical and preventive and research institutions were also promoted. In 1991, the Law on Compulsory and Voluntary Health Insurance was adopted, the main expected results of which were the partial elimination of the problems of financing the medical industry and relief for patients representing the largest groups of the population. The hopes placed on reform did not materialize. The health insurance system is still unfinished, however, with its precise development, many problems in the financial system of providing the medical industry can be solved. Until 1996, health care reforms were supported by only a small circle of enthusiasts, not finding support from the state government. The incomplete and underdeveloped nature of the reforms led to a sharp decline in the volume and quality of medical care, and public and free medical care was not guaranteed. In addition, the excessive development of commercial medicine has led to the emergence of corruption in this area. Health care in its relation underwent state regulation, and not central planning, as before. After a long stagnation, in 1996-1997, the situation began to improve somewhat. This improvement began with the adoption of the concept of the development of health care and medical science. When adopting this concept, the Government of the Russian Federation approved and fixed the course for a new strategy for reforms in the healthcare system. Since then, the main task in the field of medicine has been to unite all existing health systems by establishing close contacts between individual sectors, as well as establishing a balance in the processes of centralization and decentralization, public administration and self-government. Also, the boundaries between state institutions and private estates were established, and consequently, a system of private supplies to the medical services market developed. A line was established between the financing of public health structures and the financing of medical needs and requirements. The fact that "health is not when you are treated and recover, but when you do not get sick" still remained relevant. In this regard, the most important task, after providing the necessary medical care, was to provide a full range of preventive methods in order to maintain the health of the healthy. This was especially important in connection with the ever-increasing technogenic situation, the discovery and study of new viruses and bacteria, as well as factors that cause non-infectious diseases. A special role here was played by the accident at the Chernobyl nuclear power plant, which has not yet been forgotten, and its consequences were still too pronounced. In this regard, preventive control over the population was strengthened, annual medical and preventive examinations at enterprises and institutions were strictly regulated, the criteria for which depended on the type of activity. A system for identifying various occupational pathologies was developed, the state vaccination calendar was improved, which was amended in 1996 - a mandatory vaccination against hepatitis B was introduced due to the widespread spread of this infection, both concomitant with HIV infection and separately. In the new economic and social structure of post-Soviet Russia, the priority of human values and the value of human life itself, the impossibility of donating it in the name of fulfilling any state tasks, was affirmed. These changes prompted the idea of revising the text of "The Oath of the Doctor of the Soviet Union" (1971) and "The Oath of the Doctor of Russia" (beginning of 1990). The issue was considered both from ethical and state-legislative points of view, as a result of which, in 1991, the State Duma of the Russian Federation adopted a law on amendments to Article 60 of the Fundamentals of the Legislation of the Russian Federation on the Protection of Citizens' Health. In accordance with this law, persons who received a diploma of higher medical education in connection with the graduation from a medical higher educational institution on the territory of the Russian Federation took the Doctor's Oath, for violation of which they were criminally and civilly liable under the legislation of the Russian Federation (Fundamentals of the legislation of the Russian Federation on health protection citizens." The modern "Doctor's Oath", which is given by a graduate of any higher medical educational institution in Russia, is a combination of the fundamental principles of the "Hippocratic Oath" and the best traditions of Russian higher education, which are presented in the "Faculty Pledge". This is the content of the modern "Doctor's Oath" (approved by the State Duma of the Russian Federation in 1999). "Having received the high title of a doctor and embarking on a professional career, I solemnly swear: 1) honestly fulfill their medical duty, devote their knowledge and skills to the prevention and treatment of diseases, the preservation and strengthening of human health; 2) to be always ready to provide medical care, keep medical secrets, treat the patient attentively and carefully, act solely in his interests, regardless of gender, race, nationality, language, origin, property and official status, place of residence, attitude to religion, beliefs , belonging to public associations, as well as other circumstances; 3) show the highest respect for human life, never resort to euthanasia; 4) keep gratitude and respect for their teachers, be demanding and fair to their students, promote their professional growth; 5) treat colleagues kindly, turn to them for help and advice, if the interests of the patient require it, and never refuse colleagues help and advice; 6) constantly improve their professional skills, preserve and develop the noble traditions of medicine." Today, the development of practical and scientific medicine has reached its peak. However, all new discoveries and research are now more than ever associated with almost all branches of the national economy, the technical sector. The connection with the natural sciences, of course, prevails. Achievements of science and technology not only help the development of medicine. Now all technical innovations are tested for safety for human health and the environment. These measures began to be taken at a time when it was impossible not to notice the impact of technical production on nature and man, because humanity has repeatedly faced the threat of a global man-made disaster, and its local manifestations are undoubtedly known to almost everyone. Today, humanity has begun to seriously think about the creation of environmentally friendly fuels, the construction of factories for the safe disposal of man-made waste. Food containing chemical additives, carcinogens, transgenes and artificial colors and flavors is less and less welcome. The concepts of modern natural science are comprehensively considered in the course of study at various departments of medical universities. Compared with medical education of the Soviet period, modern medical education has gone ahead not only in connection with the study of discoveries and achievements in a purely clinical mainstream of medicine, but also because great importance has been attached to the study of issues and theories that were previously considered pure casuistry. Synthesized and harmonized the knowledge given to us by naturalists and scientists of past centuries, and the achievement of perfect technical and computer analysis. This gave modernity new ideas about the theory of evolution: Darwin's theory received modern additions and took on the form of a modern synthetic theory of evolution, which includes additions from the chromosome theory of heredity, etc. at the level of formation of immune complexes, but also on their subcellular and submolecular structure and ability to form. Probably, such a science as pharmacology has now reached the highest development in its direction, thanks to which medicine has been enriched with new highly effective drugs and prophylactic agents, immunomodulators, biologically active additives, vitamins and their complexes, designed for use by different age and gender groups to achieve the best results. All this became possible due to the discovery of previously unknown mechanisms of interaction of drugs with the body through endogenous ligands, neuromodulators, individual receptors, ion channels, presynaptic receptors, secondary transmitters. Genetic engineering methods are widely used in the creation of new generation drugs that are distinguished by a protective and stimulating effect on the body, in particular on the immune system and its links, high bioavailability and minimization of side effects. In fact, it has become possible to create drugs whose components are not alien to the body, and, integrating into the genetic apparatus of the body's cells, they improve the body's defense systems. Students of modern medical universities are widely taught such branches of science as psychoanalysis, which is studied in the course of general and medical psychology, psychiatry, and in the departments of nervous diseases. Great importance is given to the study of such phenomena as stress, the general adaptation syndrome, because the participation of these processes in the occurrence of many diseases of endogenous origin has been proven. For the first time, these conditions were mentioned in 1936 by the Canadian physician and scientist Hans Selye. He spoke about such factors as stress factors, about their nervous influence on the sympathoadrenal and hypothalamic-pituitary-adrenal systems, identified three stages of stress, which can result in serious mental and psychosomatic diseases. Many of his works have been translated into Russian. Among them are such works as "Essays on the Adaptation Syndrome" (1960), "At the Level of the Whole Organism" (1972), "Stress without Distress" (1979), "From Dream to Discovery" (1987). .). The problems of genetic engineering, as a rule, are discussed from the socio-ethical side. Modern students, as a rule, get an idea about them at the departments of general biology, genetics, medical law and medical ethics. To this day, there are disputes about how such achievements of genetic engineering as cloning are linked to the ethical standards of life. The subsequent cloning of an animal (Dolly the Sheep) opened up new horizons in the study of not only the organism, its functioning, but also the issues of life and death, because for the first time mankind had the opportunity to make a person's life infinite due to the periodic reproduction of its copies. However, the fact that such experiments still contradict what nature has given us (namely, a certain life cycle, limited by time frames from birth to death, varying for each person individually) - does not allow this scientific achievement to be made commonplace. At the end of XX - beginning of XXI centuries. more and more the doctrine of a healthy lifestyle began to gain momentum. This subject has the scientific name "valeology" ("sanology") and is taught in universities and institutes along with public health sciences and medical statistics in the departments of public health and health. The extraordinary popularity of the study of a healthy lifestyle is given by the fact that being healthy and leading a healthy lifestyle has become very fashionable. In this regard, sports activities at an amateur level have become very common, and a system of fitness centers has developed. This also includes private clinics that develop new principles of dietetics based on computer diagnostics of the state of the whole organism, blood group. Associating the causes of overweight or underweight with these criteria, clinic specialists select the most suitable diets that have a minimum of undesirable effects and give the best possible result for a given organism. The latest achievements in medicine have led to the development of another of its branches - medical cosmetology and plastic surgery. The first of them is becoming increasingly relevant today, because using the latest methods, people have received another, albeit rather conditional, way to stop time or create an ideal body for themselves. Initially, such changes were carried out by rather crude surgical interventions, which subsequently had a lot of undesirable effects. Later, non-surgical, so-called injection and skin methods of chemical, biological, physical, thermal effects on the body began to be widely used, which, in combination with the correct principles of diet and physical activity, give a result that is not much different from the results of surgical intervention. However, the development of surgery must be said separately: in addition to plastic methods used to eliminate physical “imperfections”, which are actually a physiological norm, people just don’t like their appearance, nowadays methods are widely used that save people from real physical deformities, returning them an attractive appearance and thereby relieving them of social and psychological problems with others and themselves. New technologies of functional diagnostics, such as ultrasound, computed tomography, magnetic resonance imaging, radio-pharmacological methods, angiocardiography, began to be actively introduced into practical medicine. These methods make it possible to diagnose diseases of various organs and systems at the very beginning of their occurrence and thereby prevent their further progressive development and choose the most correct, short and effective course of treatment. In addition, thanks to these methods, it became possible to carry out pre-diagnosis of diseases, i.e., the determination of pathological and pre-pathological changes in tissues and organs, due to which active prevention of certain diseases became possible, based not on empirical, but on objective data. Due to the tense demographic situation in the country, much attention has been paid to the creation of institutions such as family planning centers. In these centers, based on a general examination of the physical and biochemical parameters of the organisms of potential mothers and fathers, pathologies are identified that cause problems in conceiving children, the most effective methods of treating infertility are selected, and recently such actions as determining the optimal timing and dates have become possible. for conception for each couple individually and even "selection" of the sex of the unborn child. These programs are actively supported by government laws on additional funding for large families. All this is being done to eliminate the problem of depopulation, or simply the extinction of the nation. In order to effectively and comprehensively introduce modern achievements of science and technology into medical practice, in 1998 the Government of the Russian Federation approved the target federal program "High-Tech Medicine", which provided for the development of surgery of the cardiovascular system, neurosurgery, transplantology, obstetrics and gynecology, traumatology and orthopedics, disease prevention. The program was designed for a period from 1999 to 2006. At the end of the meeting, its results were taken into account, and feedback was made on the effective implementation of activities on the main points of the program. In addition to all the measures taken, the necessary attention should be paid to the state of the environment, since active human activity has a detrimental effect on the quality of air, water, and soil. These environments are an integral part of human life, and therefore their excessive pollution leads to diseases that can be caused by natural sources of infections, poisoning of drinking water and inhaled air, which is inextricably linked with the occurrence of various allergic reactions and atypical phenomena, poisoning, the appearance of an increasing the number of cancers. According to the WHO, 20% of diseases that are non-infectious in nature and of unclear etiology are the result of living in non-ecological habitats, another 20% are caused by a hereditary factor, and they, in turn, are the result of environmental pollution with mutagens, carcinogens, radioactive substances and the spread of harmful substances. habits. Among the latter, the most common in Russia are smoking, youth beer drinking, and drug use. Bad habits can also be attributed to an unhealthy lifestyle, which causes 50% of diseases. A very serious problem associated with drug use and promiscuity has become the increase in the number of HIV-infected people and people suffering from viral hepatitis B, C, D and E. Thus, only 10% of all diseases are associated with the quality of medical and social care. Although on a national scale this is also a lot. We must not forget about oncological diseases, which in some cases are also the result of the action of pathogenic environmental factors. In terms of prevalence, cancer is in second place after diseases of the cardiovascular system. About 2 million people die from tumors every year, and another 2 million are registered. It must be said that the spread of oncological diseases across continents and climatic zones is not the same, i.e., in a certain climatic zone, a certain type of tumor is more common (for example, in Japan - stomach cancer, in Africa - lung cancer, in the equatorial zone - melanoma etc.). According to the World Health Organization, men are more likely to develop cancer of the lungs, stomach, and rectum, while women are more likely to develop cancer of the breast, uterus, and rectum. Therefore, today more and more oncological centers are being opened in the world, and quite a lot of emphasis is being placed on the development of such a branch of medicine as oncology. Cancer is a widespread disease that kills thousands of people. Today, there is an active development of drugs that can cure cancer, and numerous methods are offered to get rid of this disease, but none of them guarantees a 100% cure. In the modern world, in which a person lives and is aware of its quality, there is a gradual reassessment of values, as a result of which humanity has finally understood the importance of health. In order not to lose this value, it is necessary to protect health by all known methods, both at the individual and at the social levels. 2. International cooperation in the field of healthcare. History, modern development No matter how countries differ in terms of the level of cultural development, socio-economic development, nevertheless, in the field of health care, the tasks for all are more or less common, and the actions aimed at fulfilling these tasks ultimately lead to one goal - to preserve the health of all nations. the globe. Due to the commonality of all these processes, physicians of various directions gradually, at different times, came to a common idea about uniting into international medical organizations and movements. There were many such societies and they were created at different times. However, the leading ones in our time are the following: the International Committee of the Red Cross, the League of Red Cross and Red Crescent Societies, the Public Movement "Physicians of the World for the Prevention of Nuclear War" and, of course, the World Health Organization. International Committee of the Red Cross The history of the emergence of this organization has its roots in the distant 1862, during the Franco-Italian-Austrian war. It was then that a young Swiss journalist, Henri Dunant, who wanted to be interviewed by Napoleon III, Emperor of France, came to him. Napoleon III was constantly in the center of hostilities. Then it was located in Lombardy, in the town of Solferino. It was June 24, 1859, when Henry Dunant first saw the consequences of hostilities with his own eyes: as a result of a bloody battle, thousands of the wounded and killed lay right on the ground, burned by the sun. The journalist was struck by the fact that no one helped them. What Henri Dunant saw shocked him. Having no medical education and no idea about the rules for providing medical care, Henri Dunant, together with four French doctors and several students, launched actions to help the wounded and injured. After some time, he was joined by women and tourists living nearby. For several weeks, the work to save human lives was in full swing. Returning from the theater of operations to Geneva, Henri Dunant told the world about the terrible consequences of military battles. He presented this information in his book, in which he called for the creation of social movements to help the wounded and injured in the wars. In 1862, the book was published and immediately received support from not only citizens, but also from the governments and monarchs of various countries. Henri Dunant also put forward the idea that it is necessary to provide assistance to the victims during the wars, regardless of their rank, nationality, because he saw how selflessly and indifferently the sisters of mercy treated the rest of what was happening during the Crimean War and in 1854 in Sevastopol. Thus, on the initiative of the Geneva Society for the Benefit of the People, in 1863 a Permanent International Committee for Relief for the Wounded was established. The committee included 5 citizens of Switzerland, including Henri Dunant. The committee promoted the creation of such societies throughout the world. And in October 1863, under his leadership, a congress was held, which included unofficial delegates from 16 countries of the world. The activities of the Committee were approved, at the same time the emblem of the movement was adopted - a red cross on a white background. Later, Islamic states such as Turkey adopted the Red Crescent as their emblem. The Committee received worldwide support, approved by the governments of various states, on August 22, 1864, when the Interstate Geneva Convention was signed, according to which the number of the wounded and sick in active armies was to be improved, regardless of whether they belonged to "their own" or "enemy" camp. In turn, the people who were supposed to provide medical care were supposed to be inviolable and not be considered as supporters or opponents of the army. The emblem of the Red Cross has become a sign of protection for medical personnel. Russia was one of the earliest and most active participants in the movement. She proposed not to use explosive bullets during the hostilities of 1868 (St. Petersburg, International Conference). Later, also at the initiative of Russia, at conferences in Brussels (1874) and Prague (1899), conventions on the rules of land warfare and the protection of the wounded in naval wars were pleasant. In 1874, it was proposed to withdraw from use weapons that cause especially dangerous injuries. In 1876, the "Committee of Five" was renamed the International Committee of the Red Cross and continued to put forward its proposals, promoting and putting them into practice during a series of conferences. The achievements associated with the actions of the International Committee of the Red Cross cannot be overestimated, however, he could not prove that waging wars (at least in relation to human life) is unlawful, he could only humanize wars, that is, reduce the suffering they bring people. Now the International Committee of the Red Cross is a society consisting only of representatives of Switzerland, performing the role of a neutral mediator in various kinds of armed conflicts. This body has inviolability in the provision of assistance during the war, both to wounded soldiers and civilians. League of Red Cross and Red Crescent Societies This movement appeared in 1919 with the unification of the national societies of the Red Cross and Red Crescent. The International Committee of the Red Cross and the League of Red Cross and Red Crescent Societies are united under the name "International Red Cross". The mission of the League of Red Cross and Red Crescent Societies is to supervise the activities of National Red Cross and Red Crescent Societies and to encourage the creation of new societies. The League of Red Cross and Red Crescent Societies today includes about 180 national societies. All of them develop humanitarian activities and alleviate human suffering in places of military operations. The motto of the League of Red Cross and Red Crescent Societies is "World Peace". The League of Red Cross and Red Crescent Societies and the International Committee of the Red Cross are headquartered in Geneva and unite under the leadership of the International Conference of the Red Cross. The conference is held once every 1 years. All Red Cross organizations that make up the conference are recognized as non-governmental and cannot be persecuted and repressed by the ruling political organizations. The International Red Cross condemns the use of nuclear weapons, atomic energy, and means of mass destruction for military purposes. He also opposes all manifestations of racism, fascism, nationalism, which has become widespread in our time, the skinhead movement (skin-head). All these factors are regarded as sources of international wars and international tension. The International Red Cross calls for general disarmament and the elimination of war from the life of all peoples. Russia and the Russian Red Cross Society fully support the activities of the International Red Cross to preserve the health of the planet's population and strengthen peace throughout the world. When military operations occur in other countries, Russia actively organizes humanitarian support, sends specialists there to provide qualified medical care, and teams to search for those missing as a result of earthquakes, floods, landslides, avalanches, and extensive fires. World Health Organization The World Health Organization is one of the most important agencies of the United Nations (UN). April 7, 1948 is considered the official day of the creation of the World Health Organization. On this day, the charter of the World Health Organization was approved by the members of the United Nations. The main idea of the Charter was "the achievement by all peoples of the highest possible level of health." The desire for such cooperation was caused by recurrent epidemics and pandemics. A semblance of international cooperation in the field of medicine and health care was created as early as the 1346th century. (1348-XNUMX), when a plague pandemic raged on the planet, claiming tens of millions of lives. This pandemic has gone down in history as the Black Death. Even then, measures were organized to limit the spread of the disease - quarantines, infirmaries, etc. At the national level, the effectiveness of such activities was low. Then international councils on health and sanitation began to be created. In 1851, the First International Sanitary Conference was held in Paris, by the decision of which the International Quarantine Charter and the International Sanitary Convention were adopted, which regulated the maximum quarantine periods for especially dangerous diseases: plague, smallpox, etc. In the same place, in 1907, the International Bureau of Public Hygiene was established, which was engaged in the dissemination of information relating to public health, especially dangerous infections and measures to combat them. Russia took part in the creation of the International Bureau of Public Hygiene until 1917, and in 1926 returned there in the person of the representative of the Soviet Union A. N. Sysin. In 1922, the International Bureau of Public Hygiene became a participant in the creation of the first international standard - diphtheria toxoid, and in 1930 a department at the State Serum Institute in Copenhagen became responsible for maintaining this standard. The International Bureau of Public Hygiene existed until 1950 and became the basis for the creation of the World Health Organization. In 1923, after the end of the First World War, the Health Organization of the League of Nations was created. Its creation was associated with the aggravation of the epidemiological situation in Europe: epidemics of cholera, typhoid, smallpox, and plague raged everywhere. The circle of questions covered by the Health Organization of the League of Nations was much wider than that covered by the International Bureau of Public Hygiene. The Health Organization of the League of Nations fought for "the adoption of all measures of an international scale for the prevention and control of the disease." The Health Organization of the League of Nations was engaged in the standardization of biological and medicinal products, the unification of the pharmacopoeia of various nations, the dissemination of information on the progress or regression of especially dangerous infections and the development of measures to combat them. The Health Organization of the League of Nations became the founder of a number of important expert commissions on sanitary statistics and the registration of cases of various diseases (malaria, cancer, leprosy, etc.). Also, this organization was engaged in the accounting of drugs, developed measures for the widespread introduction of normal nutrition. Scientists worked in the expert commissions - representatives of various nationalities, who went to different countries to help local doctors and scientists in creating quarantine regimes, ways to combat various diseases. The Health Organization of the League of Nations was the publisher of the Weekly Bulletin and the Weekly of Epidemic Diseases. These publications talked about the state of the epidemiological situation in various countries in terms of the incidence of various diseases, and also stated the demographic indicators of the birth and death rates, which helped to draw conclusions about the health of nations. In 1946, the Health Organization of the League of Nations ceased to exist, and was replaced in 1948 by the World Health Organization. The initiators of the creation of this organization were the countries - winners in the Second World War. The order establishing the World Health Organization was issued by the United Nations Special Agency for Health. The constitution of the World Health Organization proclaimed the principles necessary "for the happiness, harmony and security of all peoples". The main value was recognized as human health, which was given the definition adopted in all world health organizations - a state of complete physical, mental and social well-being, and not just the absence of disease or physical defects. The founding day of the World Health Organization is celebrated around the world as Health Day. The first congress of the World Health Assembly, which is the supreme body of the World Health Organization, took place on June 24, 1948. By its completion, the number of states that are members of the World Health Organization had increased from 26 to 55. The congress was held in Geneva. Dr. Brock Chitolne was elected as the first director-general of the World Health Organization. N. A. Vinogradov, B. D. Petrov, M. D. Kovrigina were appointed delegates from the Soviet Union to the First Assembly of the World Health Organization. At later dates, D. D. Venediktov, Yu. P. Lisitsyn, S. V. Kurashov, O. P. Shchepin, D. A. Orlov, and many others took part in subsequent assemblies. O. V. Barayan, N. I. Grashchenkov, I. D. Ladny, N. F. Izmerov, V. K. Lepakhin were appointed assistants to the Director General of the World Health Organization in different periods. At present, many outstanding scientists of our country are consultants to the World Health Organization. The World Health Organization has a regional structure that includes six regions: American - in Washington, European - in Copenhagen, headquarters of the Eastern Mediterranean - in Alexandria, African - in Brazzaville, headquarters of Southeast Asia - in New Delhi, headquarters of the Western Pacific - in Manila. To date, the World Health Organization has more than 190 states in its membership, with the combined efforts of which more than one and a half thousand projects are implemented every year, which are aimed at solving a wide variety of tasks: combating various diseases, training highly qualified personnel, improving the environmental situation, protecting mothers and child, international drug control, etc. The World Health Organization constantly organizes various symposiums and international conferences in Russia. Thus, in 1978 in Alma-Ata, at the initiative of the Soviet Union, an international conference on primary health care was held, in which representatives from more than 130 countries and 70 various international organizations were present. At the end of the conference, the "Magna Carta of Public Health of the 1991th Century" was written. In 1994 and XNUMX conferences and meetings were held to address health problems at the present stage. On the basis of Russian reference centers and laboratories, the World Health Organization is developing various international programs to combat epidemic situations. In general, Russia is one of the leaders in international cooperation in the field of healthcare. Movement "Physicians of the World for the Prevention of Nuclear War" The greatest and at the same time the most terrible discovery of mankind was the discovery of nuclear energy. The question of the use of nuclear weapons has always been very acute in the arena of world affairs, because from the moment this "world destroyer" was received, a real threat of extinction hung over humanity. Russia was the initiator of the elimination of weapons of mass destruction back in 1946, when the Soviet Union proposed signing a convention banning the use, production and storage of nuclear weapons. However, the danger of self-destruction hung over the world for a long time. Today, there are about 15 MT of nuclear weapons on the entire planet. In terms of equivalent explosive power, this is analogous to a million bombs dropped on Hiroshima and Nagasaki (August 1945). The power and scale of destruction can be compared with the result of 6 "Second World Wars". Doctors come to a common opinion that if a nuclear war breaks out today, half of the world's population will instantly die, the remaining half will experience all the "charms" of the consequences of a nuclear war - from radiation sickness and mass mutations to nuclear winter. And then it will be unknown who to envy - the living or the dead. Even before the receipt of nuclear energy, people who were directly involved in its discovery (V. I. Vernadsky, Niels Bohr - Nobel Prize winner) wrote that if humanity does not realize what power is given to them, then a nuclear catastrophe will occur and there will be a threat of omnicide - universal self- and mutual destruction. In 1980, the movement "Physicians of the World for the Prevention of Nuclear War" was founded, which included Professor Bernard Louis of Harvard University in the USA and Academician of the USSR Academy of Medical Sciences E. I. Chazov. In March 1981, the first congress of the new organization was held, where figures were given for possible human losses in the event of a nuclear war. In a short time, this movement gained immense popularity all over the world; in 1981, the Soviet Committee of the same name was organized. It has been proven that the mere existence of nuclear weapons on Earth already poses a threat: their presence can act like a detonator in an explosion. By the end of the 1980s. doctors around the world have sounded a serious alarm: according to their calculations, about 2,2 billion dollars are spent every day on weapons around the world, while, for example, to completely eliminate malaria in the world, only a fifth of this amount is required - 450 million. dollars. Other figures were also striking: there are 10 times more soldiers than doctors on earth. At all times, a reasonable solution to all the problems facing humanity was required. However, in the XX-XXI centuries. the range of these problems is so wide that it is not known whether mankind will cope with them. Today, no state develops in isolation, each is economically and politically connected with others. And only a general unification of forces and their direction to preserve the planet and its population will help to keep humanity from self-destruction. Author: Bachilo E.V.
▪ Foreign literature of the XX century in brief. Part 1. Cheat sheet
Artificial leather for touch emulation
15.04.2024 Petgugu Global cat litter
15.04.2024 The attractiveness of caring men
14.04.2024
▪ Running with a virtual opponent ▪ Power miniblock for high current POL converters ▪ Biodiesel with nanoparticles ▪ Samsung Galaxy S III display better than Apple iPhone 5 display
▪ section of the site Grounding and grounding. Selection of articles ▪ article Measures to prevent industrial injuries. Basics of safe life ▪ article by Joseph Henry. Biography of a scientist
Home page | Library | Articles | Website map | Site Reviews
www.diagram.com.ua |
We recommend interesting articles Section 
See other articles Section 
Latest news of science and technology, new electronics:
All languages of this page