Учебное пособие (Методичка) по Истории Медицины. И.Ю.Худоногов

He created classic works on syphilis of the heart and lungs, on gallstone disease, on hemorrhages, on the use of calomel in hypertrophic cirrhosis. He is the author of original studies on the role of the nervous system in the occurrence of chlorosis and hemorrhoids. He developed the differential diagnosis of pulmonary tuberculosis and syphilitic pneumonia.

G.A. Zakharyin widely introduced methods of objective examination of patients – percussion and auscultation. He brought up a brilliant constellation of students and followers, among whom the therapist A.A. Ostroumov, neuropathologist A.Ya. Kozhevnikov, gynecologist V.F. Snegirev, pediatrician N.F. Filatov and others were.

V.P. Obraztsov (student of S.P. Botkin) was the founder of the Kiev Therapeutic Scientific School, made a significant contribution to the development of clinical examination methods and to the study of diseases of the cardiovascular and digestive systems. He developed a deep sliding palpation of the abdominal organs, proposed an original method of direct rcussion of the thoracic and abdominal organs with one finger, which made it possible to more accurately determine the boundaries of the organs.

“Moscow Medical Journal” and “Moscow Medical Newspaper” were published in Moscow.

Infectious diseases, pediatrics, neuropathology, gynecology, ophthalmology, dermatovenerology, otorhinolaryngology and bacteriology stand out as independent disciplines.

By the beginning of the 20th century, clinical medicine was enriched by the achievements of various fields of natural science, which contributed to its further improvement.

Questions for self-control:

1. What was the historical situation in Russia in the second half of the 19th - early 20th centuries?

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2.What influence did the materialistic, philosophical views of N.G. Chernyshevsky, N.A. Dobrolyubova, D.I. Pisarev on the development of domestic sciences and medicine?

3.What medical, scientific and social activities of S.P. Botkina left the deepest mark in the history of Russia?

4.Who is G.). Zakharyin and how was his clinical teaching different?

5.What merits did A.A. Ostroumov and V.P. Samples before domestic therapy, and how did they affect its development?

6.Who and why developed the ideas of nervism in Russian clinical medicine, what was the significance of the scientific contribution of the outstanding predecessors of I.P. Pavlov in his work?

7.What is the differentiation of clinical disciplines, and what achievements in the

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Theme 12. Development of hygiene and public medicine in Russia

(second half of the XIX – early XX century)

Hygiene was absent in a number of independent medical sciences until the middle of the 19th century, and the corresponding special subject was not included in the professional training of doctors. Hygiene was taught as part of toxicology, pathology, pharmacology, and other disciplines.

The main factors that determined the formation of hygiene as a science in Russia in the middle of the 19th century were: 1) the economic development of the country - the growth of industry, cities, the influx of population into cities and the associated deterioration of living and working conditions; 2) the demands of the working class to improve the living conditions of the population, including sanitary conditions; 3) incessant epidemics that caused the need for sanitary measures, the implementation of which required scientific justification.

The successes of natural science were conditions conducive to the development of hygiene; it made it possible to create hygienic laboratories – the basis of experimental hygiene.

German physician Max Pettenkofer (1818-1901) was the founder of experimental hygiene. He developed objective methods for the hygienic assessment of air, soil, water, and together with K. Voith, he established hygienic food standards. The first department of hygiene was founded by him in 1865 in Munich.

The development of hygiene in Russia in the second half of the 19th century is associated with the activities of many outstanding hygienists: A.P. Dobroslavin, V.A. Subbotin, F.F. Erisman, A.I. Jacobiy, I.P. Skvortsov, G.V. Khlopin, P.N. Diatroptov, M. Ya. Kapustin, N.K. Ignatov and others. They laid the foundations of hygienic science and developed the most important directions for the development of domestic hygiene.

Alexei Petrovich Dobroslavin (1842-1889), a professor at the St. Petersburg Medical-Surgical Academy, was one of the founders of Russian hygiene.

After graduating from the Medical-Surgical Academy in St. Petersburg (1865) and successfully defending his doctoral dissertation (1868) A.P. Dobroslavin worked

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for two years in the laboratories of M. Pettenkofer and K. Voith. Upon his return, he headed the first department of hygiene in Russia at the St. Petersburg MedicalSurgical Academy in 1871. An experimental laboratory for scientific research and practical training was created at the department.

Physiology and food hygiene were the most important directions of A.P. Dobroslavin and his school. His works contain a methodology for the study of food, set out the issues of nutrition and sanitary control in this area using various research methods. He developed food layouts, diets for various populations and diets for patients in various medical institutions.

A.P. Dobroslavin devoted himself to issues of communal and school hygiene. He defended the need for the use of the latest methods of cleaning cities, building pneumatic sewerage systems, supplying cities with filtered water, building schools and hospitals in accordance with hygienic requirements. He used the latest research methods for that time, this made it possible turn hygiene in Russia into a precise experimental scientific discipline.

A.P. Dobroslavin is the author of first hygiene textbooks in Russia: “Hygiene. Public Health Course”, “Course of Military Hygiene”. He made a great contribution to the development of public social medicine in Russia. On his initiative, in 1878, the “Russian Society for the Preservation of National Health” and the scientific and practical journal “Zdorovye (Health)” (of which he was editor for 10 years) were founded. Together with S.P. Botkin A.P. Dobroslavin took part in the work of a commission under the Medical Council of the Ministry of Internal Affairs, which was engaged in improving sanitary conditions and reducing mortality in Russia.

The progressive features of domestic hygiene were expressed in the activities of Professor Fedor Fedorovich Erisman (1842-1915). Swiss by birth, born and died in Zurich, F.F. Erisman lived for more than a quarter of a century in Russia, which he considered his second homeland.

His activity in Russia in 1869 F.F. Erisman started out as an ophthalmologist. He examined the eyesight of more than four thousand students of St. Petersburg

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schools in order to identify the causes of myopia. The first major research by F.F. Erisman's study was to investigate the influence of school conditions (lighting, dustiness of premises, overwork) and school furniture on the origin of myopia in children. In addition to school hygiene, he also paid attention to issues of communal hygiene. For the first time F.F. Erisman published materials about the ugly unsanitary state of the basement dwellings and bed-houses in St. Petersburg, had been strongly considered it necessary to improve the city sewage system.

Improving his professional training, F.F. Erisman worked for several years in the laboratories of M. Pettenkofer and K. Voith. Returning from abroad, he took part in the Russian-Turkish war of 1877-1878. After the end of the war, F.F. Erisman, together with sanitary doctors E.M. Dementyev and A.V. Pogozhev for 6 years carried out an in-depth sanitary and hygienic survey of factories and plants in the Moscow province. 1,080 enterprises were surveyed with a total of 114,000 workers.

In 1882 F.F. Erisman, approved in the degree of Doctor of Medicine, headed the Department of Hygiene at Moscow University. Throughout his career, F.F. Erisman developed experimental hygiene, linking its objectives with social demands. He took an active part in the design and construction of a water supply system, sewerage, irrigation systems, the construction of a hospital camp, actively participated in the work of the Pirogov Society, was the organizer of the Hygienic Institute. The city sanitary station at the institute was established in 1891. The work of the station consisted in the systematic analysis of food products of the Moscow markets and drinking water to control and develop standards for their quality. F.F. Erisman believed that the main task of hygienists is “…to remove from people harmful influences that doom thousands of people to premature death…”. While still working as a doctor in the Moscow zemstvo, he came to the conclusion that the state should finance measures to improve the health of populated areas, eliminate sanitary deficiencies, and train hygienists. His main merit is the creation of the fundamental principles of public hygiene and the sociohygienic direction of medicine. The progressive social activities of the scientist

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caused discontent with the government in 1896, when F.F. Erisman spoke out in support of a group of revolutionary-minded students, he was fired from the university and forced to leave Russia. The scientist spent the last years of his life in Switzerland, but he always spoke warmly about Russia and the people with whom he worked. F.F. Erisman created a large school of hygienists, among whom were G.V. Khlopin, S.F. Bubnov, V.E. Ignatov and others.

Hygiene issues were covered in such magazines as “Archive of Forensic Medicine and Public Hygiene”, “Health”, “Doctor” and others. The first hygienic society in Russia was called the “Russian Society for the Preservation of National Health” and was founded in St. Petersburg in 1877, then (1892) the “Moscow Hygienic Society” appeared. A characteristic feature of the activities of the majority of Russian hygienists in pre-revolutionary Russia consisted of a combination of an experimental direction based on natural science with a social orientation traditional for Russian doctors.

In the second half of the 19th century Russia, due to the fall of serfdom and the development of capitalist relations, significant changes in the organization of medical care took place both the city and in the countryside. Zemsky medicine,

which arose along with introduction of “zemstvo self-government” in 34 (out of 89) provinces, mainly central ones, was a particularly striking social phenomenon, an example of organized medical care for the rural population under capitalism.

“Zemstvo self-government”, introduced in 1864, was intended, on the one hand, to calm down the more moderate part of society, to divert public attention from the struggle for genuine self-government. On the other hand, the tsarist government sought to compensate the ruling class - the local nobility - for the damage caused to it by the abolition of serfdom, to strengthen its shaky position with new rights and advantages.

According to the “Regulations on Zemstvo Institutions” (1864), they received 519 hospitals, a large part of which were listed only on paper, 33 asylums for the insane, 23 orphanages, as well as the organization of smallpox vaccination. There

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was no precise regulation of the duties of the zemstvos. Many zemstvo leaders objected to inviting doctors to permanent service and considered it possible, for reasons of economy, to attract priests, teachers or paramedics for this. However, constant epidemics of cholera, smallpox, typhus forced the zemstvos to increase appropriations for medical needs, invite doctors, create temporary first-aid posts, and then turn them into permanent ones.

In the early years, zemstvo medicine was represented by a traveling system of medical care: a doctor who lived in a city or a county at an outpatient clinic had to visit the county's paramedics posts from time to time (once a month or less), which were headed by paramedics. Most zemstvo doctors had a negative attitude towards the traveling system and demanded its abolition at medical conventions in the 1870s and 1880s. Gradually, this system (through a mixed one) was replaced by a stationary one. In the mixed form, permanent medical centers already existed, doctors left them only in emergency cases: in case of poisoning, difficult childbirth, severe injuries, epidemics. appearance in zemstvos of two or more doctors per district made it possible to divide its territory into sections in accordance with the number of doctors and the introduction of permanent (stationary) placement of in certain points of the district.

Thus, the system of medical care, which later grew into a district-territorial one, was first born. The emergence of a doctor's section in the countryside – for the first time in the history of world health care – is one of the major achievements of the zemstvo medicine.

The medical plot was supposed to include a district hospital, which integrated: 1) a hospital (for 5-10 beds) with maternity and syphilitic departments; 2) an infectious barrack; 3) an outpatient clinic for receiving incoming patients. a premise for a pharmacy, an apartment for a doctor, a house for staff were also envisaged.

Along with the zemstvo medical section in zemstvo medicine, zemstvo uyezd and provincial hospitals were formed. They arose as a result of the reorganization of the orders of public charity in the county and provincial centers. The structure of the provincial hospitals included such divisions as prosectura, operating rooms of a

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new type; the staff of doctors and other medical personnel was expanded. Despite the long-term struggle of the leading zemstvo doctors, completely free assistance was provided only in a small part of the provinces and counties. By the beginning of the 20th century, payments for inpatient care had been abolished in 215 out of 359 counties.

From among the zemstvo doctors, a galaxy of major representatives of medicine

emerged: S.I. Spasokukotsky, A.G. Arkhangelsky, A.F. Shafranovsky, V.I.

Yakovenko and others. Leading scientists F.F. Erisman, P.I. Dyakonov, N.V. Sklifosovsky, V.F. Snegirev, N.F. Filatov and others systematically provided assistance to zemstvo doctors.

An important role in the development of zemstvo medicine was played by provincial and district congresses of zemstvo doctors. The first district congress was held in 1871 in the Tver province. Congresses of doctors in memory of N.I.

doctor as “the main figure among Russian doctors”.

Severe sanitary living conditions of the rural population, high morbidity, mortality, epidemics forced zemstvos pay special attention to sanitary issues. The society of Kazan doctors was one of the first to try to create zemstvo sanitary bodies. The members of this society were such well-known sanitary doctors as N.I. Molleson, E.A. Osipov, N.I. Tezyakov and others. Sanitary organizations were created with great difficulties, nevertheless, the positions of sanitary doctors also appeared. Zemsky doctor Ivan Ivanovich Molesson (1842-1902) became the first sanitary doctor in Russia (1872).

The zemstvo sanitary organization included the provincial sanitary bureau, headed by a doctor who supervised all sanitary and anti-epidemic affairs. The staff of the provincial sanitary bureau included positions such as physician statistician, vaccination physician and epidemiologists. The provincial sanitary bureau also supervised the county sanitary councils and sanitary guardianship.

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In addition to providing medical and sanitary assistance to the population, the leading figures of zemstvo medicine created a sanitary description of localities, studied the morbidity of the population, examined and described the life and work of peasants, agricultural laborers in the southern provinces, workers in factories located in rural areas, examined schoolchildren, were engaged in the dissemination of hygienic knowledge. The results of medical and sanitary activities in the zemstvo were first presented at the Medical and Hygienic Exhibition in Dresden (1911) and the All-Russian Hygienic Exhibition in St. Petersburg (1913).

The historical experience of the development of zemstvo medicine shows the enormous work carried out in difficult conditions by domestic doctors. Russian zemstvo medicine, which had a number of significant shortcomings, represented, on the whole, an advanced form of organization of medical work, in comparison with the state of medicine in the countryside in other countries. In 1934, the medical area, which was the main organizational form of zemstvo medicine and its great merit, was recommended by the Hygienic Commission of the League of Nations to other countries for organizing assistance to the rural population. The organizational forms developed by zemstvo medicine were largely adopted by urban and factory medicinethe turn of the 19th-20th centuries.

Questions for self-control:

1.What circumstances led to the development of scientific hygiene in Russia in the second half of the 19th century?

2.What role did the journals covering the issues of hygiene play in the development of domestic medicine, what was the reason for their high relevance and demand?

3.When and why did the “Society for the Protection of Public Health” appear in Russia, and what are the results of its activities?

4.How and why did the emergence of courses and departments of hygiene in Russian universities take place?

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5.What are the main directions of scientific and practical activities carried out by A.P. Dobroslavin?

6.What are the main directions of scientific, practical and social activities carried out by F.F. Erisman?

7.What social orientation was characteristic of the activities of the first domestic hygienists and why?

8.For what reason arose zemstvo medicine in the Russian Empire, and what are its characteristic features?

9.What forms of zemstvo medicine (traveling, mixed or stationary) were most common in the Russian Empire, and what did it depend on?

10.What are the most prominent representatives of zemstvo medicine left the deepest mark in the history of domestic medicine?

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