History of the formation and development of social medicine. History of the development of medicine Stages of formation and development of medical science

INTRODUCTION

Social medicine occupies one of the main places in the training of a social worker in modern society. It is an independent discipline, both in the structure of medical knowledge and in the system of social practice.

The subject of social medicine is public health. This is a complex, internally determined and structured concept. It includes various aspects of the state of society and the factors that determine its form and content. The subject of social medicine also includes the concept of public health.

Public health has a specific socio-medical meaning, due to various types of violations of the social structure, for example, mental epidemics, criminal crowds, suicide, demographic shifts in society, criminalization of social relations, etc.

The health of society is, first of all, moral and deontological assessments, from the point of view of a social doctor, of the state of society as a whole. This also includes outright public fraud surrounding the health of society as a whole and its individual citizens.

The “Fundamentals of the legislation of the Russian Federation on the protection of the health of citizens” states that the right of citizens to the protection of health is ensured by the protection of the natural environment, the creation of favorable conditions for work, life, recreation, education and training of citizens, the production and sale of high-quality food products, as well as the provision of affordable food to the population. medical and social assistance.

So, the subject of social medicine is public health and the health of society, non-identical concepts that reflect social conditions and processes in society from a medical point of view.

The state healthcare system that has developed in Russia was formed in the first decades of the 20th century. Therefore, in order to understand the changes taking place in it, it is necessary to turn to the history of the creation and functioning of the health care system in Soviet Russia and the USSR.

1. STAGES OF DEVELOPMENT OF SOCIOLOGY OF MEDICINE

Different authors attribute the emergence of the sociology of medicine to different dates. The German scientist M. Suss believes that the first sociological analysis of the place of health care in society was carried out in the work of the famous author of works on political economy W. Petty “Political Arithmetic” (1690). Professor K. Winter dates the beginning of medical sociology to the middle of our century, and Soviet authors I.V. Vengrova and Yu.A. Shilinis associate the beginning of the sociology of medicine with the name of McIntyre (1895).

There are five stages in the development of social medicine:

1. Early period (emergence of the discipline) XVII - XIX centuries.

2. Period of formation (beginning of the 20th century - before World War 1)

3. Period of formation (20s - 40s of the XX century, the period between World Wars I and II)

4. The period of development as an independent discipline (50-80s of the XX century)

5. The current period of the state of science (from the 90s to the present).

Let's focus on the last two.

1.1 The period of development as an independent discipline

The sociology of medicine was considered by many scientists as a part of sociology, as a part of medicine, as a science “at the intersection” of sociology and medicine.

After much discussion, the specialty received its modern name “sociology of medicine.”

At the IV World Sociological Congress “Society and Sociology” in Milan (Italy) in 1959, a section on the sociology of medicine was first organized, chaired by Corresponding Member of the USSR Academy of Sciences I.I. Grashchenkov, who presented the report “Health and Social Well-Being”.

Based on the generalized materials of the World Congresses of Sociologists (50-60s of the XX century), the following groups of issues were considered in the field of sociology of medicine: the role of environmental factors in the mechanism of occurrence, development and outcome of diseases (urbanization, sanitary conditions at work, state of prevention ); analysis of the causes of diseases in various social groups; assessment of various preventive measures; analysis of the activities of treatment and preventive institutions; the role of society in the morbidity of the population.

In domestic science in the 50-60s. on the pages of periodicals, at meetings of scientific societies, departments, scientific discussions were held on current topics related to the sociology of medicine: on social problems of medicine; about the role and interaction of the social and biological in medicine; about the role and place of social hygiene; criticism of bourgeois medical sociology and social hygiene; philosophical problems of medicine; dialectical materialism and medicine; public health and sociology, sociological problems of modern medicine.

1.2 The modern period of the state of science

The impetus for the rapid development of the sociology of medicine was the scientific and technological revolution and the associated change in the social and natural ecology of human existence. The rapid penetration of scientific and technological progress into all spheres of public life, the involvement of millions of people in its orbit has led to a radical change in people’s lifestyles, their psychology, established behavioral stereotypes, and ideas about illness and health.

A fundamentally important stage in the development of the sociology of medicine in Russia was the introduction, starting in 2000, of the corresponding code and name of the discipline in the Nomenclature of Specialties of Scientific Workers: 14.00.52.; "Sociology of Medicine"; branches of science in which an academic degree is awarded - medical, sociological.

This was the natural outcome of a "decade of sociology" in health care. This is how we can determine the significantly increased number of sociological studies in the 90s on a wide variety of problems in medicine in general and healthcare in particular.

Work is being carried out to systematize, improve the methodological apparatus, train personnel and plan sociological research. Training has begun at the Department of Economics and Sociology of Health Care at the MMA named after. I.M. Sechenov.

Currently, the department's computer database contains a bibliographic list of about 4,000 titles, reflecting all areas of research in the sociology of medicine as a modern scientific discipline.

Modern sociology of medicine is the science of medicine as a social institution, the functioning and development of this institution through its constituent elements, studying the social processes occurring in this institution.

Based on the sociological concept of health of the WHO Charter, which defines health as a state of complete physical, mental and social well-being, and not just the absence of disease and disability, and at the same time, an essential condition for health is the ability to live harmoniously in a constantly changing environment. It is possible to single out the factors of integration of medicine and sociology that contribute to the formation of the sociology of medicine in Russia as an independent scientific discipline: the state of social anomie in society in the context of a return to the principles of a market economy; the need for sociological understanding of the role and place of the health care system in society, the use of sociological research methods in health care; change in demographic processes and the structure of morbidity (aging of the population, natural decline, chronicity of diseases, etc.); the need to use sociological approaches to study and treat diseases.

2. MAIN DIRECTIONS OF DEVELOPMENT OF SOCIAL MEDICINE

public medicine.

Deals mainly with clients – legal entities. Deals with the problems of health of labor collectives, forecasting and sociometrics of changes in psychosomatic statuses and, accordingly, the functioning of members of labor collectives. It solves the problems of protecting and maintaining public health in various working situations, as well as changes in the status of the workforce. Public medicine is directly involved in the prevention and suppression of modern mental epidemics, in whatever area they develop - be it politics, ideology, religion, pseudo-culture.

Public medicine.

The main reasons why people turn to a public doctor are problems and situations that have arisen after a person has suffered a disease, personal tragedy, violence, terror; to prevent such by studying and understanding the problems and situations that the client may encounter. The public doctor also helps the client solve any problems and tasks that may cause illness in him or his relatives.

Sociological medicine.

This direction arose as an independent branch of social medicine in connection with scientific and practical achievements, primarily in the field of medicine, medical genetics, and medical electronic technology. On the other hand, sociological medicine studies and analyzes phenomena that are incomprehensible to doctors and biologists, such as global aging of the population and a sharp increase in the number of people suffering from Alzheimer's disease.

Military social medicine.

Military social medicine should study:

a) the moral and psychophysical state of each and every person participating in campaigns, in hostilities, and after hostilities.

b) various parameters of assessments of people and the area where the fighting took place.

Military social medicine is currently in the stage of formation and development of research methods and assistance to persons who are healthy from the point of view of clinical medicine, but with a pronounced decrease in the quality of life and an adaptation syndrome, manifested by physical and mental stigmas, as well as the stigma of mutation.

2.1 Barriers to development

Since the time of the great campaigns against the Gentiles and the conquest of foreign lands, there have always been such terrible phenomena as devastation, famine, human casualties, loss of shelter, disability or labor demand, and much more. The devastation concerned ideology and morality. In such conditions, any specific medical problem turned out to be socially burdened. The most terrible thing that wars and revolutions bring with them is the destruction of the socio-psychological protection of the population in general, and specific people in particular.

2. The formation of Soviet medicine

The historical events of 1917 brought devastation not only to the political and economic spheres of life. They affected both the life of the population and, of course, the general health of people. At the beginning of the Soviet period, with the Bolsheviks coming to power and the establishment of a new regime, a wave of epidemics of cholera, typhoid, smallpox and other diseases swept across the country. The situation was aggravated by the widespread shortage of qualified personnel, equipment and medical equipment, and medicines. There were very few hospitals and 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 famine 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 monarchy shattered to smithereens, fallen under the yoke of cruel senseless wars. At that time, the mortality rate had tripled and the birth rate had 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 take shape 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 “collection” 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 attract to work all doctors who recognized the new government; it was also necessary to radically change the health care system in the country and organize qualified assistance to workers in enterprises and soldiers in the active forces, 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 on the creation of 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. So that the people knew about the active work of the Council, on May 15, 1918, the first issue of Izvestia of Soviet Medicine was published under the Council of People's Commissars of the RSFSR. This was the first Russian medical public publication, which was then published 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 reforms begun regarding the transformation of military medicine, strengthening, developing sanitary affairs and strengthening epidemic control throughout the country.

However, in order to act on a nationwide scale and objectively monitor the results of the work done, it was necessary to hold an 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 issues of the organization and work of the People's Commissariat of Health, which were the most important at that time, but also issues of insurance medicine, the issue of combating epidemics, and questions about the tasks of local medicine.

The result of the congress was the decision to create the People's Commissariat of Health, which was to become the main health authority and be in charge of all medical and sanitary matters. On June 26, 1918, a project for the creation of the People's Commissariat of Health was presented. On July 9, the project was 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 board of the People's Commissar of Health of the RSFSR was created, in which there were V. M. Velichkina (Bonch-Bruevich), R. P. Golubkov, E. P. Pervukhin, Z. P. Solovyov, P. G. Dauge, and the first commissioner of health was appointed N. A. Semashko. His first deputy was Z. N. Soloviev. In July 1936, the People's Commissariat of Health, by decree of the All-Russian Central Executive Committee and the Council of People's Commissars, was renamed the People's Commissariat of Health of the USSR. Its first head was G. N. Kaminsky.

N. A. Semashko

Nikolai Aleksandrovich Semashko (1874–1949) made a huge contribution to the development of not only Soviet, but also world medicine.

Semashko’s career did not begin 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 to 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 development 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 of Health for 11 years, during the most difficult years for the country, when there was a bloody Civil War and 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, the sanitary and resort business began to develop intensively, and 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 Faculty of Medicine 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 creation of which was initiated by N. A. Semashko. From 1926 to 1936 he headed the children's commission of the All-Russian Central Executive Committee.

He put especially much 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 of Healthcare Organization and History of Medicine of the USSR Academy of Medical Sciences, after its creation he headed 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 Aleksandrovich Semashko, despite the great responsibility resting on his shoulders and the large number of positions he held, managed to leave his mark in 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).

All his life he wrote scientific papers 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 an immortal memory among the people.

3. P. Solovyov

Zinovy ​​Petrovich Solovyov (1876–1928), in addition to the high positions he held in the healthcare sector, is known for the fact that in 1925 he initiated the creation of the children's health-improving 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 medicine 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 provision and services to the city and rural population. He contributed to the transfer of the chemical and pharmaceutical industry to the People's Commissariat of Health of the RSFSR. He left a deep mark on 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 could be given to G. N. Kamensky for his assistance in organizing the first international congresses.

However, his activity in the public sphere 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 made a condemning speech at the Plenum of the Central Committee of the All-Union Communist Party of Bolsheviks (Bolsheviks) against the policy of repression, Many of his comrades were arrested and shot with him. Later they were all posthumously rehabilitated.

Robert Lanza was able to ride the tidal wave of discoveries generated by the revelation of the secrets of DNA. Historically, at least three major stages can be distinguished in the development of medicine in human society. At the first stage, which lasted tens of thousands of years, medicine was dominated by superstition, witchcraft and rumors. Most children died at birth, and life expectancy ranged from 18 to 20 years. During this period, some useful herbs and chemicals, such as aspirin, were discovered, but there was no scientific method for finding new drugs and treatments. Unfortunately, any means that truly helped became closely guarded secrets. To make money, the “doctor” had to please rich patients, and keep the recipes for his potions and spells in deep secret.

During this period, one of the founders of the now famous Mayo Clinic kept a personal diary while visiting patients. There he frankly wrote that in his black doctor's suitcase there were only two effective remedies: saw and morphine. He used the saw to amputate affected organs, and morphine for pain relief during amputation. These tools worked flawlessly.

Everything else in the black suitcase, the doctor sadly noted, was snake oil and quackery.

The second stage in the development of medicine began in the 19th century, when the germ theory of diseases appeared and ideas about hygiene were formed. Life expectancy in the United States in 1900 was 49 years. With tens of thousands of soldiers dying on the battlefields of World War I in Europe, there was a need for real medical science, for real experiments with reproducible results that were then published in medical journals. European kings watched in horror as their best and brightest subjects died, and demanded real results from doctors, not empty tricks. Now doctors, instead of pleasing wealthy patrons, fought for recognition and fame through articles in reputable peer-reviewed journals. This set the stage for the promotion of antibiotics and vaccines that increased life expectancy to 70 years or more.

The third stage of development is molecular medicine. Today we are witnessing the merging of medicine and physics, we see how medicine penetrates deep into matter, to atoms, molecules and genes. This historical transition began in the 1940s when Austrian physicist Erwin Schrödinger, one of the founders of quantum theory, wrote the sought-after book What is Life? He rejected the idea that there was some mysterious spirit, or life force, that is inherent in all living beings and which actually makes them alive. Instead, the scientist reasoned, all life is based on a certain code, and this code is contained in a molecule. Having discovered it, he assumed that he would unravel the mystery of existence. Physicist Francis Crick, inspired by Schrödinger's book, teamed up with geneticist James Watson to prove that this fabulous molecule is DNA. In 1953, one of the most important discoveries of all time was made - Watson and Crick discovered the structure of DNA, which has the shape of a double helix. The length of one strand of DNA in its unraveled form is about two meters. This thread is a sequence of 3 billion nitrogenous bases, which are designated by the letters A, T, C, G (adenine, thymine, cytosine and guanine) and carry encoded information. By deciphering the exact sequence of nitrogenous bases in the chain of a DNA molecule, you can read the book of life.

The rapid development of molecular genetics eventually led to the emergence of the Human Genome Project, a major milestone in the history of medicine. The ambitious program to sequence every gene in the human body cost approximately $3 billion and involved the work of hundreds of scientists around the world. The successful completion of the project in 2003 marked the beginning of a new era in science. Over time, each person will have a personal genome map on an electronic medium like a CD-ROM. This map will record all approximately 25,000 genes of a given person, and it will become a kind of “instructions for use” for everyone.

Nobel laureate David Baltimore summarized all of the above in one phrase: “Today’s biology is an information science.”

Periodization of world history and history of medicine. The main stages of the development of medicine.

Sources for studying the history of medicine - a brief description of historical medical sources.

Museums of the history of medicine in Russia, the CIS countries and abroad. Museum of History of SSMU.

HISTORY OF MEDICINE is a science that studies achievements in the field of healing, medicine and medical activities of the peoples of the world throughout the history of mankind (from ancient times to the present day).

How is the subject of teaching divided into general And private.

General history of medicine is engaged in identifying the main patterns of the historical development of healing and studying the main problems of medicine.

Private history of medicine contains information about the development of individual medical specialties concerning the life and work of outstanding doctors and medical scientists, the scientific achievements of their schools, and the history of the most important discoveries in the field of medicine.

Periodization and chronology of the history of medicine is based on the periodization of world history accepted in modern historical science, according to which the world-historical process is divided into 5 main periods:

* primitive society

* ancient world

* middle Ages

* new time

* recent (modern) history

Sources for studying history Medicines are divided into several main groups:

ü Real (material) - these are archaeological finds

(skulls, bones, coins, medals, coats of arms, seals)

ü Ethnographic - rituals, customs, beliefs

ü Oral and folklore - songs, tales, ballads, legends

ü Linguistic - images in speech form that show

through the word they express the kinship of entire groups and peoples

ü Written - clay tablets, papyri, drawings on stones and

rocks, manuscripts, printed works of doctors, historians, philosophers,

celebrities and statesmen, archival materials

ü Film and photo documents

By the way. There is one

Museum of the History of Medicine of the First Moscow State Medical University named after. THEM. Sechenov, there are also in Berlin, Philadelphia, Tambov: D

No. 2 General historical situation. Characteristics of the era. Kievan Rus IX – XIV centuries.

In the second half of IX. V. in the vast lands of Eastern Europe

formed Old Russian state with the main city of Kyiv

under the control of Rurik of Varangian /862-879/, known as " Kievan Rus".

Kyiv begins to develop especially rapidly during the reign of Vladimir the Great(980 - 1015). In order to strengthen the unity of Kievan Rus and increase its influence in the international arena, Prince Vladimir baptized Rus' in 988. Christianity brought significant political benefits to Kievan Rus and served as an impetus for the further development of writing and culture. Under Vladimir the Great, the first stone church was built in Kyiv - the Church of the Tithes.

In the 11th century, under the rule Yaroslav the Wise, Kyiv becomes one of the largest centers of civilization in the Christian world. St. Sophia Cathedral and the first library in Rus' were built. Kyiv was one of the most prosperous craft and trade centers in Europe.

However, after the death of the prince Vladimir Monomakh(1125) the process of fragmentation of the more or less unified Kyiv state begins. By the middle of the 12th century. Kievan Rus splits into many independent principalities. External enemies were quick to take advantage of the situation. In the autumn of 1240, countless hordes of Batu, the grandson of Genghis Khan, appeared under the Kyiv walls. The Mongol-Tatars managed to take the city after a protracted and bloody battle .

In the 15th century Kyiv was granted Magdeburg a right that ensured much greater independence of the city in matters of international trade and significantly expanded the rights of the urban classes - artisans, merchants and townspeople. In 1569, after the signing of the Union of Lublin, Poland and Lithuania united into one state, known in history as the Polish-Lithuanian Commonwealth, and gradually established their dominance in Ukraine. The cruelty and arbitrariness of foreigners led to numerous uprisings of the Ukrainian people.

No. 3. What was the significance of Russia’s adoption of Christianity for the development of medicinal science?

An important event in the history of Rus' was the adoption of Christianity as the state religion in 988 by Prince Vladimir.

The experience of traditional medicine was summarized in numerous herbalists and medical books, which for the most part were compiled after the adoption of Christianity in Rus' and the spread of literacy.

Among the most famous healers who practiced at the monastery were people such as the Monk Alimpius, who became famous for treating people with severe cases of leprosy. To treat skin diseases, he used icon paints that apparently contained various medicinal substances. Also, Saint and Blessed Agapius was a monk of the Lavra. He is known for curing the grandson of Yaroslav the Wise, who later became the prince of Rus', and in history

The monasteries in Kievan Rus were to a large extent the successors of Byzantine education. Some elements of medicine also penetrated their walls and were combined with the practice of Russian folk healing, which made it possible to engage in medical activities. The Patericon (chronicle of the Kiev-Pechersk Monastery, XI-XIII centuries) contains information about the appearance of their own doctors in monasteries and the recognition of secular doctors. Among the monks there were many artisans who were good at their profession; There were also Lechts among them. Was

Well, tell me that the bathhouse was adopted from Byzantium, and the medicines were mainly of herbal origin; Dozens of plant species were used for medicinal purposes. Archaeological finds show that the Russian soil abounded in medicinal plants and provided a rich choice for medicinal use. This circumstance was noted by Western European writers. Plants that were unknown in Western Europe were used.

Medicine in the Old Russian state of Kievan Rus. Ideas about the causes of diseases among Russians. The most ancient types of medical activities. Radical and non-radical methods of treatment.

Page 201 textbooks

Saved 1) Traditional healing- paganism and witchcraft. 2) after the adoption of Christianity it developed monastic medicine. 3) Since the reign of Yaroslav the Wise, secular (worldly) medicine

1) Folk healers began to be called lechtsami, who passed on their experience from generation to generation.

The experience of traditional healing was summarized in herbalists And hospitals. They treated with medicines made from plants and minerals, and also used the healing properties of narzan.

2) About the monastery, tell me that in the religious consciousness, illness was considered as a punishment or “inhabitation” of demons.

The hospital at the first created monastery was very popular - Kiev-Pechersk Lavra (the ascetic monks Anthony, Agapit, Alimpiy became famous)

3) Secular... Well, she assumed paid treatment, paid that is... The Armenian doctor practiced this.

Foreign medicine, its influence on the development of healing in the Old Russian state

In addition to Russian doctors, foreign doctors also practiced in Kyiv and other large cities - Greeks, Syrians, Armenians, who had their own houses with medicinal “cellars” (pharmacies). And naturally, both Russian and foreign doctors were involved in the medical care of princes, boyars, as well as princely warriors, who formed the basis of state power in the ancient Russian principalities.

So, at the court of Vladimir Monomakh, an Armenian physician served (he knew how to determine the disease by the pulse and appearance of the patient), Peter the Syrian...

Rank, serf, living, stable.

Especially many orders were created by Ivan IV Vasilyevich “The Terrible” (1533-1584) –

Local, Streltsy, Foreign, Pushkar, Robber, Ambassador, etc.

Medical Sciences. The role of the Petrine Academy of Sciences and its first president

Samoilovich, N. M. Maksimovich - Ambodik, M. V. Lomonosov and others

General historical situation. Characteristics of the era. Medicine in Russia in

First half of the 19th century.

In the first half of the 19th century. medicine in Russia developed in

conditions of the decomposition of the feudal-serf system, the formation

niya and growth of capitalist relations. Expanded

international trade. Russian household goods /bread, knives, flax/ and

industrial goods were supplied to the markets of Western countries

Europe and Central Asia. Development of industry, development of new

land and population growth created a need for specialists.

A number of new universities opened: in Dorpat (Yuryev, now Tartu,

1802), Kazan (1804), Kharkov (1805), St. Petersburg (1819) and Kyiv (1834).

The new universities were given a liberal charter in 1804, providing

which promoted the autonomy of institutions, the election of rector, deans, pro-

professors. However, government and management reforms

the first years of the reign of Alexander I Pavlovich (I801 -1825) were very

were soon liquidated.

Napoleon's invasion of Russia confronted the country with a formidable

danger, caused an unprecedented patriotic surge. Professors and

university teachers and doctors took an active part in

defense of the Motherland. Huge work to create hospitals and evacuate

wounded were done by H.I. Loder (1753-1832); directly in the fields

battles worked I.E. Dyadkovsky (1784-1841) and many other great

ny scientists.

After Patriotic War of 1812 there was a period of reaction,

characteristic of the second half of the reign of Alexander I and all

reign of Nicholas I Pavlovich (1825-1855). In 1817 the Ministry

public education was renamed Ministry

spiritual affairs and public education. In 1820 she was appointed

government audit of universities. In Kazan, educational

in the district it was conducted by the district trustee M.L. Magnitsky, who arranged

the real defeat of Kazan University: he demanded

professors renouncing “disastrous materialism”, prohibited autopsy

corpses, closed the anatomical museum, all of whose preparations were

ceremonies and buried in accordance with church rites. Despite

However, Russian universities remained centers of advanced science.

The leading centers of medical science were the Faculty of Medicine

Moscow University and Medical-Surgical Academy. For

Each of the centers was characterized by isolation that arose in

connection with the tasks facing these institutions.__

29. Formation of fundamental sciences of medical and biological profile. The role of A.M. Filomafitsky in the formation of physiology as a science (Dyadkovsky, Inozemtsev).

Filomafitsky is one of the first representatives of the experimental direction of physiology in Russia. He was a supporter of practical rather than theoretical training. Conducted experiments to study reflexes (cough, secretion of gastric juice. For the first time in Russia he used microscope for research blood cells.. Sought to connect physiology with the practical problems of medicine.

Didn't accept electrical theory nervous excitement, emphasized the difference between electricity and “nervous living principle.” Ahead of existing views, he believed that the source of heat in a living organism is metabolism. He spoke about the processes of oppression and inhibition of reflex reactions in brain.

Essays

Physiology, Published for the Guidance of Its Listeners, is the first original and critical summary of experimental physiological knowledge.

"Treatise on blood transfusion(as the only means in many cases to save a dying life

Together with N. I. Pirogov developed the intravenous method in 1847 anesthesia.

Characteristics of the first stage of development of Soviet healthcare (1917-1940). The formation of Soviet medicine during the October Revolution and the Civil War, the restoration of the national economy and the construction of the foundations of socialism in the USSR.

Since 1917, in our country, health issues have become a national task, which was ensured by state leadership and funding of health services and medical science.
The hardships of the revolution, civil war, devastation, famine, imperfect organization of health care, and lack of doctors determined the list of urgent tasks of this period: the construction of a new system for organizing health care services in the Red Army; epidemic control; attracting medical workers to active work and creating the necessary institutions to provide medical care to the population; protection of motherhood and infancy.
On October 26 (November 8), 1917, a medical and sanitary department headed by M.I. Barsukov was formed under the Military Revolutionary Committee of the Petrograd Soviet of Workers' and Soldiers' Deputies. This department was tasked with beginning the reorganization of the medical and sanitary affairs in the country, as well as organizing medical assistance to the rebels.
On January 24, 1918, by decree of the Council of People's Commissars of the RSFSR, the medical boards of all Commissariats were united into the Council of Medical Colleges, which became the highest medical body in the country.
On July 11, the Council of People's Commissars adopted a decree "On the establishment of the People's Commissariat of Health." N.A. Semashko was appointed People's Commissar of Health, Z.P. Solovyov was his deputy, the NK.Z board included: V.M. Bonch-Bruevich (Velichkina), A.P. Golubkov, P.G. Dauge , E.P. Pervukhin.
Medical and sanitary departments of the Soviets were created locally, which carried out the decisions of the central authorities in the field of health care in their territories.
To organize medical care for soldiers of the Red Army, by decree of the All-Russian Central Executive Committee in October 1919, a special committee for assistance to wounded and sick Red Army soldiers was created. A large role in coordinating all issues belongs to Z.P. Solovyov; in January 1920, he headed the Main Military Sanitary Directorate of the Workers' and Peasants' Red Army. In 1919, he was elected chairman of the Executive Committee of the Russian Red Cross Society. The hospital base was brought closer to the sites of hostilities, and medical workers were mobilized. Special measures were taken to combat epidemics, especially typhus, both among the troops and among the civilian population. Mass preventive care was combined with health education, for which effective forms were found.
The Decree of the All-Russian Central Executive Committee of December 22, 1917 “On sickness insurance” obligated sickness funds to provide free care to the insured - workers, employees and members of their families - which marked the beginning of the implementation of the principle of free, generally available and qualified medical care for workers. Health insurance funds, which had certain funds, created a number of large outpatient clinics, hospitals and clinics.
In December 1918, the entire pharmacy network was nationalized, and a pharmaceutical department was organized in the People's Commissariat of Health.
The People's Commissariat of Health established a section to combat tuberculosis and a subsection to combat sexually transmitted diseases. A new type of medical and preventive institutions began to be created - dispensaries (anti-tuberculosis and venereology). In 1919, the First All-Russian Congress to combat social diseases took place in Moscow.

The number of medical institutions increased, including the number of dispensaries. In connection with the introduction of the NEP, the need arose to restructure the work of healthcare based on new conditions. Most medical institutions were transferred from the state to the local budget, which was not sufficient everywhere. This led to the closure of a number of institutions and the introduction of fees for treatment. However, soon the III All-Russian Congress of Health Departments proclaimed the inviolability of the basic principles of health care - state character and free of charge. Towards the end of this period, an increase in the number of medical institutions begins to be observed again, not only in cities, but also in rural areas.
The epidemic situation in the country continued to be difficult. As a result of enormous efforts, the epidemic was localized. During these years, much attention was paid to the fight against malaria: the Central Malaria Commission was organized under the People's Commissariat of Health in 1921, and malaria stations and points were established locally. A systematic fight against smallpox began, also enshrined in decrees: “On compulsory smallpox vaccination” (October 1924, as a supplement to the 1919 decree), obliging revaccination. The decree “On measures to improve water supply, sewerage and sanitation” was important. In June 1921, a decree was issued according to which the entire matter of sanitary protection of homes was concentrated in the People's Commissariat of Health.
The shortage of doctors and other medical personnel was especially acute during these years. New medical faculties of universities began to open.
By the end of this period, there were some trends towards improving the health of the population: morbidity and mortality from highly infectious diseases decreased, overall mortality decreased to 20.3 per 1000 population, and life expectancy gradually began to increase.

With the beginning of the first five-year plans, the country's economic policy set a course for industrialization and collectivization. Forced industrialization and economic growth in conditions of a shortage of capital led to an increase in the gap between the economic and social aspects of development. With a significant increase in capital investment in industry, the share of spending on the social sphere and healthcare decreased. Clinical examination is declared the main method of treatment and preventive care.

The so-called residual principle of healthcare financing operating in the country led to a serious weakening of attention to health issues and, as a consequence, a reduction in allocations, a halt in the growth of the network, and a decrease in the number of treatment and preventive institutions. Since 1934-1935 the network of medical institutions at industrial enterprises decreased, the quality of care for workers decreased, and morbidity rates with temporary disability increased. The unsatisfactory work of health authorities probably also had an impact. Therefore, G.N. Kamensky and M.F. Boldyrev, who replaced him in 1937 as People’s Commissar of Health of the USSR, were given serious tasks to eliminate the identified shortcomings in health care. The construction of health care in the Union republics began. For each republic, a mandatory network of medical districts, staffed by doctors, was approved. A budget for health care institutions was provided. The medical and pharmaceutical industries are being created.

Modern times.

Medicine and healthcare during the years of the post-war restoration of folk culture

economy and further development of socialist society (1945 - early 1960s

Elimination of the severe consequences of war. Recovery in the shortest possible time

material and technical base of healthcare. A wide range of measures to ensure a high level of health care for the population, reducing

research on morbidity and mortality, construction of new medical facilities,

sanitary supervision over the reconstruction and construction of populated areas, etc.

Advances in the field of health care by the end of the fourth five-year plan (1946 - 1950). Dal-

The most recent development of medicine and healthcare in the fifth (1951-1955) and sixth (1956-

1960) five-year plans. Resolution of the Central Committee of the CPSU and the Council of Ministers of the USSR “On measures to

further improvement of medical care and public health

USSR” (1960) - a theoretical generalization of the experience of the Soviet state in creating

and improving the socialist health care system.

Criticism: the state of health of I.V. Stalin (death of Bekhterev), residual prin-

health care financing principle, repressions of the 1930s (1937) and 1940-50s

Dov. “The Case of Doctors.” Books - “Bison” by D. Granin, “Children of Arbat” by A. Rybakov.

The state’s attitude towards genetics is “Genetics is the corrupt girl of imperialism.”

The works of N. I. Vavilov, traveling around the world and collecting a collection of seeds (which was

preserved during the Great Patriotic War during the siege of Leningrad).

The fight against Lysenko. He was buried in a common grave at the Saratov cemetery.

Stage II: early 1960s - 1990s

As we overcome external and internal negative influences, in new situations

cultural-historical conditions (1960-90s), the previous forms of state-

political structure and previous methods of managing society are increasingly appearing

showed their inefficiency and demanded significant reform (democratic

tization). This involved the implementation of a whole range of measures aimed at eliminating

liquidation of the former

Soviet medical science and practice. Residual financing principle

healthcare. The state of health of the first person in the state. Human rights

activities of A. D. Sakharov.

Stage IV: 1990s – 2009s

Adoption of the law on health insurance of citizens. System of compulsory medical insurance and voluntary medical insurance.

Legislation in the field of protecting the health of citizens.

Expansion of patient rights (certificate of incapacity for work, choice of doctor, place of treatment and

etc.). Introduction of paid services. Standards of medical care. Quality issue

54. Soviet therapeutic schools. Outstanding Soviet therapists

The preventive and physiological direction, the foundations of development, which were shown above using examples of the achievements of biomedical and hygienic sciences, have widely penetrated into clinical medicine. Soviet clinical medicine developed continuously based on the traditions of G.A. Zakharyina, S.P. Botkin, on the principles of individualization in the approach to the patient, the unity and integrity of the body, the connection of the clinic with physiology and pathology.

One of the central problems of the preventive direction in the clinic was the doctrine of premorbid conditions and the fight against them. Particularly great achievements in the creation of this scientific direction belong to Maxim Petrovich Konchalovsky (1875-1942). M.P. Konchalovsky graduated from the Faculty of Medicine of Moscow University in 1899, and defended his doctoral dissertation in 1912. In 1918, he was elected professor of the hospital therapeutic clinic, which he led until the end of his life.

The basis of M. P. Konchalovsky’s views was the understanding of the body as a single whole, united by the nervous system. M. Konchalovsky paid special attention to the natural healing powers of nature in the treatment of patients.

The largest therapist was a student of G.F. Lang - Alexander Leonidovich Myasnikov (1899-1965), academician of the USSR Academy of Medical Sciences. After graduating from the 1st Moscow State University in 1922, he worked under the leadership of G.F. Langa in Leningrad. In 1932 he was elected head of the department of therapy at the Novosibirsk Medical Institute. From 1938 to 1940 Head of the Department of the Leningrad Medical Institute; from 1940 to 1948 - Department of the Naval Medical Academy in Leningrad. Since 1948 - Director of the Institute of Therapy of the USSR Academy of Medical Sciences. A.L. Myasnikov published more than 200 scientific works, including 9 monographs and 4 textbooks on internal diseases. His major works are devoted to the development of the clinic and treatment of liver diseases, descriptions of the affected organ in malaria and brucellosis, studies of arterial hypertension, arteriosclerosis, and coronary heart disease. A.L. Myasnikov put forward a concept about the relationship between hypertension and atherosclerosis, which considers them as a single pathology.

The essence of hypertension was revealed back in 1922 by teacher A.L. Myasnikova - G.F. Lang /1875-1948/, who identified this disease as a separate nosological form. He considered the main factors in the development of hypertension to be functional changes in the cerebral cortex, which boil down to disturbances in the relationship between the processes of inhibition and excitation. Soviet scientists not only figured out the mechanism of cardiovascular diseases and proposed means of treatment and prevention, but also studied their clinic in detail. Therapists V.P. Samples /1851-1920/ and N.D. Strazhesko (187b-1952) was the first in the world, even before the use of electrocardiography, to diagnose myocardial infarction based on clinical manifestations. New classifications of diseases of the cardiovascular system (G.F. Lang, 1935) and heart failure (N.D. Strazhesko, V.Kh. Vasilenko) were developed. The combination of therapeutic and preventive issues of studying pathological processes as an expression of changes in the whole organism turned out to be fruitful for research in other areas of the clinic. This is the creation of the concept of gastritis and peptic ulcer disease as a general disease of the body (M.P. Konchalovsky, N.D. Strazhesko, R.A. Lauria), the study of kidney diseases (S.S. Zimnitsky, F.G. Yanovsky, M.S. Vovsi, E.M. Tareev), liver (A.L. Myasnikov).

Scientific activity

While working on his dissertation, he used an original method of injecting urinary tubules and blood vessels, thanks to which he showed the absence of direct communication between these formations. For the first time he described the features of the histological structure of the kidney: capsule, convoluted tubule, vascular glomerulus.

The dissertation went through several editions in Europe and was widely cited in the 19th century.

The role of the capsule and the space formed by it in the mechanism of urine formation became clear after the work of the English researcher Bowman. In Russian-language literature, this structure is usually called the Shumlyansky-Bowman capsule.

Konstantin Ivanovich Shchepin(1728-1770) - Russian doctor and botanist of the 18th century.

He developed a scientifically based system for training doctors and compiled training programs for hospital schools. Contrary to custom, lectures were given in Russian, and he introduced compulsory teaching of anatomy on corpses.

In the field of botany, he was one of the first Russian florist-systematists.

Biography

Early years. Education

Shchepin was born in 1728 in the village of Molotnikovo near the town of Kotelnich, Vyatka province. Shchepin's parents were peasants. By the time he entered the Khlynov Slavic-Latin school in Vyatka, his father had become a sexton of the Kotelnik church.

Thanks to his abilities, Shchepin already stood out from the circle of his peers at school. Teachers, observing Shchepin's success, advised him to continue his studies at the academy. After graduating from a rhetoric class, 14-year-old Shchepin in 1742, on the advice of Vyatka Bishop Varlaam (Skamnitsky), overcame a huge distance, almost walked to Kyiv and entered the Kyiv Theological Academy. The duration of study at this educational institution was not precisely defined and could last from three to ten years. Shchepin was immediately enrolled in the second grade, and two months later was transferred to the third. Wide horizons opened up for Shchepin within the walls of the academy; he became one of the first students of the famous school. In 1743, in the fifth grade, his successes were assessed with the highest mark of “excellent.” He mastered the Latin language perfectly, walked ahead of other students, and therefore could confidently expect to subsequently take an honorable place as a professor at this academy. But at this time in Kyiv there was only talk about the then famous V. G. Barsky, who had recently returned from abroad. His notes about his life abroad were copied in numerous copies and were read in great demand; his stories about the impressions he endured and the miracles he saw worried not only students, but also most of Kyiv society; It is quite clear that Shchepin was also fascinated by them and decided to visit abroad at all costs. In 1748, having passed the philosophy class and abandoned the theology class that completed his education, Shchepin, at his request, was sent to Italy.

Without acquaintances and friends, without money, young Shchepin was in Italy. He visited Florence, listened to lectures on philosophy, medicine, natural science and mathematics at the Universities of Padua and Bologna, then moved to Greece and in May 1751 ended up in Constantinople. Following Barsky's example, he learned English and Greek in Constantinople: 200. It is known from the archives that Shchepin became interested in medicine in Bologna back in 1748. M. P. Bestuzhev-Ryumin and M. I. Vorontsov recommended Shchepin to the Academy of Sciences. The archives of the Academy of Sciences contain copies of Shchepin’s student certificates, where it is recorded that Shchepin listened to lectures by many outstanding scientists of that time.

At the Academy, Shchepin studied under the guidance of Stepan Petrovich Krasheninnikov and after three months of hard study he was promoted from adjutant to translator. During the joint work of Krasheninnikov and Shchepin, a strong and long friendship arose between them, which was interrupted only by the death of Krasheninnikov. Shchepin helped Krasheninnikov in researching the flora of the St. Petersburg province:191, and after the death of the academician, he raised his orphaned son for some time.

At the insistence of Krasheninnikov, Shchepin was sent abroad to study botany in Leiden and Uppsala, he was assigned an annual allowance of 360 rubles. On May 30, 1753, Shchepin left Kronstadt for Holland. After landing in Amsterdam, Shchepin went to The Hague. From 1753 to 1754 he studied at Leiden University. But, in connection with the death of Krasheninnikov at the end of 1755, new circumstances at the Academy of Sciences changed his plans: in 1756 he made a request to the chief doctor and life physician of P. Z. Kondoidi on his admission to the medical department. After the consent of the Academy and upon the return of the money spent on his education, on August 31, 1756, Shchepin was sent to Leiden with a decree transferring him to the Medical Chancellery to prepare for a professorship, and his business trip was continued: 200. Shchepin wrote in detail to the Medical Office about his stay in Leiden.

In Leiden, Shchepin entered the medical faculty of the university there, graduated 2 years later and on May 9, 1758 defended his doctoral dissertation on the topic “On plant acid.” It talks about the importance of diet and plant acids in food for health and longevity. Shchepin’s judgment was based on observations of the lifestyle of Russian peasants and soldiers, as well as the experience of traditional medicine. Physical labor, plant foods containing acids and kvass, prudent and rare consumption of meat - this is what, according to Shchepin, contributes to longevity. He attached particular importance to moderate nutrition and food containing plant acids. The doctor’s teaching on the prevention of scurvy and the treatment of patients with this disease is of interest. At that time, science did not have knowledge about vitamins and their physiological role. Shchepin noticed that Russian peasants, consuming sauerkraut, rye bread and pine needle infusion in winter, do not suffer from scurvy. He believed that the plant acid they contained prevented disease. On this basis, he proposed a method for the treatment and prevention of scurvy. Shchepin was the first to point out the supposed acid contained in plants as an anti-scorbutic factor. Shchepin was the first to discuss the problem of the preventive value of diet.

In the same year, he published an addition to his dissertation entitled “Botanical Notes on Some Plants.” Among the plants mentioned in the last work, Shchepin described a new genus of plants and in memory of S.P. Krasheninnikov, who was his first teacher of botany and always awakened the brightest memories in him, named it Crassina. In Leiden, another of his essays was published - "On Russian Kvass" (1761).

The money issue was acute for Shchepin, since transfers from Russia were often delayed and were not as large as Shchepin wanted. The director of the Medical Chancellery, P.Z. Kondoidi, who set the goal of making Shchepin a qualified doctor of medicine, did not stop at the costs. He decided to send Shchepin to other countries to expand his medical knowledge. In the program given to him, the task was set not only to study medicine and surgery, but natural science in the broad sense - physics, chemistry. He should have, among other things, paid attention to the “mining business” in England and France:112. In June 1758, Shchepin visited Amsterdam and Utrecht, on the first of July he was in Rotterdam, and from there he sailed to England. Shchepin stayed in England for two months, and at the end of 1758 he returned from London to Holland. Shchepin did not take away anything useful from his trip to England. A trip to Paris turned out to be somewhat more fruitful, where he stayed for about seven months from October 1758 to May 1759. Shchepin attended a course of lectures in Paris, took a course in surgical operations, and studied anatomy and midwifery. On June 28, 1759, he left Amsterdam through Denmark (in Copenhagen he got acquainted with the royal cabinet of natural history) and Sweden (in Uppsala, by chance, he met Carl Linnaeus, who hospitably received him and gave him several books of his composition as a parting gift) to St. Petersburg. In August, already a doctor of medicine, Konstantin Ivanovich Shchepin set foot on his native land.

Development of physiology

The final formation of Sechenov’s physiological school dates back to 1863-1868. For a number of years he and his students studied the physiology of intercentral relations. The most significant results of these studies were published in his work “Physiology of the Nervous System” (1866).

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1 . History of medicine: first steps

The beginnings of healing arose in the earliest stages of human existence: “Medical activity is the same age as the first man,” wrote I. P. Pavlov. The sources of our knowledge about diseases and their treatment in those distant times are, for example, the results of excavations of settlements and burials of primitive man, the study of individual ethnic groups, which, due to the special conditions of their history, are now at a primitive level of development. Scientific data undoubtedly indicate that people did not have any “perfect” health at that time. On the contrary, primitive man, who was completely at the mercy of the surrounding nature, constantly suffered from cold, dampness, hunger, got sick and died early. Preserved from pre-historic. periods, human skeletons bear traces of rickets, dental caries, healed fractures, joint lesions, etc. Some information. diseases, eg. malaria, were “inherited” by man from his ancestors - great apes. Tibetan M. teaches that “the mouth is the gateway of all diseases” and that “the first disease was stomach disease.”

From observations and experience of thousands of years, passed down from generation to generation, rational healing was born. The fact that any accidentally applied means or techniques were beneficial, eliminating pain, stopping bleeding, alleviating the condition by inducing vomiting, etc., made it possible to resort to their help in the future if similar circumstances arose. Empirically discovered methods of treatment and protection from diseases were consolidated in the customs of primitive man and gradually formed folk medicine and hygiene. Among these to lay down. and preventive measures were the use of medicinal plants, the use of natural factors (water, air, sun), some surgical techniques (removal of foreign bodies, bloodletting), etc.

Primitive man did not know the natural causes of many of the phenomena he observed. Thus, illness and death seemed to him unexpected, caused by the intervention of mysterious forces (witchcraft, the influence of spirits). Lack of understanding of the surrounding world and helplessness before the forces of nature forced people to resort to spells, incantations and other magical techniques in order to establish contact with otherworldly forces and find salvation. Such “treatment” was carried out by healers, shamans, and sorcerers, who by fasting, intoxication, and dancing brought themselves to a state of ecstasy, as if transported to the world of spirits.

Ancient medicine inherited both magical forms of healing, and rational techniques, healing remedies of folk medicine. Great importance was attached to dietetics, massage, water procedures, and gymnastics. Used surgical. methods, for example, in cases of difficult childbirth - cesarean section and fetal destruction operations (embryotomy), etc. An important place was given to the prevention of diseases (“Pull out the disease before it touches you”), from which many hygienic regulations followed. character, including diet, family life, attitude towards pregnant women and nursing mothers, prohibition of drinking intoxicating drinks, etc.

In the early stages of the slave system, medicine emerged as an independent profession. The so-called has received widespread development. temple M.: medical functions were performed by priests (for example, in Egypt, Assyria, India). The medicine of Ancient Greece, which reached its peak, was reflected in the cults of the deified physician Asclepius and his daughters: Hygieia - the guardian of health (hence hygiene) and Panakia - the patroness of medicine. affairs (hence the panacea).

The medical art of this period reached its peak in the work of the great ancient Greek physician Hippocrates (460-377 BC), who turned observation at the patient’s bedside into the actual medical method of research, described the external signs of many diseases, and pointed out the importance of lifestyle and the role of the environment, primarily climate, in the origin of diseases, and the doctrine of the main types of physique and temperament in people substantiated an individual approach to the diagnosis and treatment of the patient. He is rightly called the father of medicine. Of course, treatment in that era did not have a scientific basis; it was based not on clear physiological ideas about the functions of certain organs, but on the doctrine of the four liquid principles of life (mucus, blood, yellow and black bile), changes in which supposedly lead to disease .

The first attempt to establish the relationship between the structure and functions of humans. body belongs to the famous Alexandrian doctors Herophilus and Erasistratus (3rd century BC), who performed autopsies and experiments on animals.

The Roman physician Galen had an exceptionally great influence on the development of medicine: he summarized information on anatomy, physiology, pathology, therapy, obstetrics, hygiene, medicine, in each of these medical sciences. industries introduced a lot of new things and tried to build a scientific system of medicine.

1.1 History of Medicine: Middle Ages

In the Middle Ages, mathematics in Western Europe received almost no further scientific development. The Christian Church, which proclaimed the primacy of faith over knowledge, canonized the teachings of Galen, turning it into an indisputable dogma. As a result, many of Galen’s naive and speculative ideas (Galen believed that blood is formed in the liver, spreads throughout the body and is completely absorbed there, that the heart serves to form in it a “vital pneuma” that maintains the warmth of the body; he explained the processes taking place in the body by the action of special intangible “forces”: pulsation forces, thanks to the cut the arteries pulsate, etc.) have turned into an anatomical and physiological. the basis of M. In the atmosphere of the Middle Ages, when prayers and holy relics were considered more effective means of treatment than medicine, when dissecting a corpse and studying its anatomy was recognized as a mortal sin, and an attempt on authority was seen as heresy, the method of Galen, . an inquisitive researcher and experimenter, was forgotten; only the “system” he invented remained as the final “scientific” basis of M., and “scientific” scholastic doctors studied, quoted and commented on Galen.

Accumulation of practical honey. Observations, of course, continued into the Middle Ages. In response to the requests of the time, special ones arose. institutions for the treatment of the sick and wounded, identification and isolation of infectious patients were carried out. The Crusades, accompanied by the migration of huge masses of people, contributed to devastating epidemics and led to the emergence of quarantines in Europe; Monastery hospitals and infirmaries were opened. Even earlier (7th century), large hospitals for the civilian population arose in the Byzantine Empire.

In 9--11 centuries. scientific medical center thoughts moved to the countries of the Arab Caliphate. We owe Byzantine and Arab medicine the preservation of the valuable heritage of medicine of the Ancient World, which they enriched with descriptions of new symptoms, diseases, and medicines. A native of Central Asia, a versatile scientist and thinker, Ibn Sina (Avicenna, 980-1037) played a major role in the development of medicine: his “Canon of Medical Science” was an encyclopedic body of medical knowledge.

In the ancient Russian feudal state, along with monastic medicine, folk medicine continued to develop. Common medical books contained a number of rational instructions on the treatment of diseases and household hygiene, herbalists (zelniki) described medicinal plants

1.2 Medicine in the XVI-XIXcentury

Slow but steady development of honey. knowledge begins in Western Europe in the 12th-13th centuries. (which was reflected, for example, in the activities of the University of Salerno). But it was only during the Renaissance that the Swiss-born physician Paracelsus came out with a decisive criticism of Galenism and propaganda of the new M., based not on * authorities, but on experience and knowledge. Considering the cause to be chronic. diseases chemical disorder transformations during digestion and absorption, Paracelsus introduced the treatment. practice various chemical substances and mineral waters.

At the same time, the founder of modern anatomy, A. Vesalius, rebelled against the authority of Galen; based on system-tich. Anatomizing corpses, he described the structure and functions of the human body. Transition from scholasticism. to the mechanical and mathematical consideration of nature had a great influence on the development of M. English. the doctor W. Harvey created the doctrine of blood circulation (1628), laying the foundation for this. foundations of modern physiology. W. Harvey's method was no longer only descriptive, but also experimental, using mathematical calculations. A striking example of the influence of physics on medicine is the invention of magnifying devices (microscope) and the development of microscopy.

In the field of practical medicine, the most important events of the 16th century. were the creation of Italian. doctor G. Fracastoro, teachings about contagious (infectious) diseases and the development of the first scientific foundations of surgery in France. doctor A. Pare. Until this time, surgery was the stepdaughter of European medicine and was dealt with by Ch. arr. barbers, whom certified doctors looked down on. The growth of industrial production attracted attention to the study of prof. diseases. At the turn of the 17th-18th centuries. Italian physician B. Ramazzini (1633-1714) initiated the study of industrial pathology and occupational hygiene. In the second half of the 18th and first half of the 19th century. The foundations of military and naval hygiene were laid. The works of the Russian doctor D. Samoilovich on the plague, published in the second half of the 18th century, allow us to consider him one of the founders of epidemiology.

Conditions for theoretical generalizations in the field of medicine were created by the progress of physics, chemistry and biology at the turn of the 18th and 19th centuries: the discovery of the role of oxygen in combustion and respiration, the law of conservation and transformation of energy, the beginning of the synthesis of organic. substances (1st half of the 19th century), development of the doctrine of nutrition, study of chemistry. processes in a living organism, which led to the emergence of biochemistry,” etc.

Development of clinical M. was promoted by the development in the 2nd half of the 18th - 1st half of the 19th century. methods of objective examination of the patient: percussion (L. Auenbrugger, J. Corvisart, etc.), listening (R. Laennec, etc.), palpation, laboratory diagnostics. Clinical comparison method. observations with the results of post-mortem autopsies, used in the 18th century. J. Morgagni, and then M.F.K. anatomy, to-rye allowed to establish the localization (place) of the disease and the material substrate of many diseases.

Exceptional influence on M.'s development was rendered by use in many countries of a method of a vivisection - experiment on animals - for studying of the normal and broken functions. F. Magendie (1783-1855) opened the era of the consistent use of experiment as a natural scientific method of understanding the laws of activity of a healthy and sick organism. C. Bernard (1813--1878) in the mid-19th century. continued this line and pointed out the paths along which experimental medicine was successfully advancing a century later. By studying the effects of medicinal substances and poisons on the body, C. Bernard laid the foundations of experimental pharmacology and toxicology. To appreciate the significance of the development of the science of medicine, it is enough to remember what kind of crude empiricism dominated here at that time. Both in the 16th and 18th centuries. arsenal to treat means, regardless of what views the doctor held, was limited to bloodletting, enemas, laxatives, emetics and a few more, but quite effective drugs. About the supporter of endless bloodletting, the famous Frenchman. doctor F. Brousset (1772-1838) said that he shed more blood than the Napoleonic wars combined.

In Russia, the works of N. P. Kravkov made a fundamental contribution to the development of experimental pharmacology.

Physiology and its experimental method, together with pathological anatomy, have transformed various fields of clinical medicine on scientific foundations. German scientist G." Helmholtz (1821-1894) brilliant experiments showed the importance of physical and chemical methods as the basis of physiology; his work on the physiology of the eye and the invention of the eye mirror, along with previous physiological studies of the Czech biologist J. Purkinje, contributed to rapid progress ophthalmology (the doctrine of eye diseases) and its separation from surgery as an independent section of M.

Back in the 1st half of the 19th century. The theoretical foundations were laid by the works of E. O. Mukhin, I. E. Dyadkovsky, A. M. Filomafitsky and others. and experimental foundations for the development of physiological. directions in domestic medicine, but its special flourishing occurred in the 2nd half of the 19th and 20th centuries. I.M. Sechenov’s book “Reflexes of the Brain” (1863) had a decisive influence on the formation of materialism. views of doctors and physiologists. Most fully and consistently physiological. the approach and ideas of nervism were used in clinical practice. medicine by S. P. Botkin, the founder of the scientific direction of domestic internal medicine, and A. A. Ostroumov. Along with them, clinical therapy brought world fame to Russian therapy. the school of G. A. Zakharyin, which perfected the method of questioning the patient. In turn, the views of S. P. Botkin had a deep influence on I. P. Pavlov, whose works on the physiology of digestion were awarded the Nobel Prize, and the doctrine he created about higher nervous activity determined ways to solve many problems in both theoretical and clinical medicine .

Numerous students and ideological successors of I. M. Sechenov (N. E. Vvedensky, I. R. Tarkhanov, V. V. Pashutin, M. N. Shaternikov, etc.) and I. P. Pavlova developed the advanced principles of materialistic physiology in various medical and biological disciplines.

In the middle and especially in the 2nd half of the 19th century. From therapy (or internal medicine, which initially covered all medicine, except surgery and obstetrics), new scientific and practical branches sprang up. For example, pediatrics, which previously existed as a branch of practical healing, is being formalized into an independent scientific discipline, represented by departments, clinics, and societies; its outstanding representative in Russia was N. F. Filatov. Neuropathology and psychiatry are turning into scientific disciplines based on successes in the study of the anatomy and physiology of the nervous system and the clinical activities of F. Pinel, J. M. Charcot (France), A. Ya. Kozhevnikova, S. S. Korsakov, V. M. Bekhtereva and many other scientists in different countries.

Along with curative medicine, preventive medicine is developing. The search for not only an effective, but also a safe method of preventing smallpox led to the English. physician E. Jenner to the discovery of the smallpox vaccine (1796), the use of the cut made it possible in the future to radically prevent this disease through smallpox vaccination. In the 19th century the Viennese physician J. Semmelweis (1818-1865) established that the cause of puerperal fever lies in the transfer of an infectious principle by the instruments and hands of doctors, introduced disinfection and achieved a sharp reduction in the mortality rate of women in labor.

The works of L. Pasteur (1822-1895), who established the microbial nature of infectious diseases, marked the beginning of the “bacteriological era”. Based on his research, Eng. surgeon J. Lister (1827-1912) proposed an antiseptic method (see Antiseptics, asepsis) for treating wounds, the use of which made it possible to sharply reduce the number of complications from wounds and surgical interventions. Openings in German doctor R. Koch (1843-1910) and his students led to the spread of the so-called etiological direction in medicine: doctors began to look for the microbial cause of diseases. Microbiology and epidemiology have developed in many countries, and pathogens and vectors of various infectious diseases have been discovered. The method of sterilization with flowing steam developed by R. Koch was transferred from the laboratory to surgery. clinic and contributed to the development of asepsis. The description of “tobacco mosaic disease” (1892) by domestic scientist D.I. Ivanovsky marked the beginning of virology. The shadow side of the general enthusiasm for the successes of bacteriology was the undoubted overestimation of the role of the pathogenic microbe as the cause of human diseases. The activity of I. I. Mechnikov is associated with the transition to studying the role of the organism itself in inf. process and elucidation of the causes of immunity to the disease - immunity. Most of the prominent microbiologists and epidemiologists in Russia at the end of the 19th and beginning of the 20th century. (D.K. Zabolotny, N.F. Gamaleya, L.A. Tarasovich, G.N. Gabrichevsky, A.M. Bezredka, etc.) worked together with I.I. Mechnikov. German scientists E. Behring and P. Ehrlich developed a chemical theory of immunity and laid the foundations of serology - the study of the properties of blood serum (see Immunity, Serum).

The successes of natural science determined the use of experimental research methods in the field of hygiene, the organization in the 2nd half of the 19th century. hygienic departments and laboratories. Through the works of M. Pettenkofer (1818-1901) in Germany, A. P. Dobroslavin and F. F. Erisman in Russia, the scientific basis of hygiene was developed.

Industrial revolution, urban growth, bourgeois revolutions of the late 18th century - first half of the 19th century. determined the development of social problems of M. and the development of public hygiene. In the middle and 2nd half of the 19th century. Materials began to accumulate that testified to the dependence of workers’ health on working and living conditions.

1.3 Development of medicine in the 20th centuryeke

Decisive steps to transform crafts and arts into science were made by M. at the turn of the 19th and 20th centuries. under the influence of the achievements of natural sciences and technology. progress. The discovery of x-rays (V. K. Roentgen, 1895-1897) marked the beginning of x-ray diagnostics, without a cut it is now impossible to imagine an in-depth examination of the patient. The discovery of natural radioactivity and subsequent research in the field of nuclear physics led to the development of radiobiology, which studies the effect of ionizing radiation on living organisms, led to the emergence of radiation hygiene, the use of radioactive isotopes, which in turn made it possible to develop a research method using the so-called. labeled atoms; radium and radioactive preparations began to be successfully applied not only in diagnostic, but also in to lay down. purposes (see Radiation therapy).

Another research method that fundamentally enriched the possibilities of recognizing heart arrhythmias, myocardial infarction and a number of other diseases was electrocardiography, which became part of clinical practice. practice after work physiologist V. Einthoven, domestic physiologist A. F. Samoilov and others.

A huge role in technical The revolution that seriously changed the face of Moscow in the 2nd half of the 20th century was played by electronics. Fundamentally new methods have appeared for recording the functions of organs and systems with the help of various receiving, transmitting, and recording devices (for example, the transmission of data on the work of the heart and other functions is carried out even at a cosmic distance);

controlled devices in the form of artificial kidneys, hearts, lungs replace the work of these organs, for example. during surgery operations; electrical stimulation allows you to control the rhythm of a diseased heart and bladder function. Electron microscopy has made it possible to magnify tens of thousands of times, which makes it possible to study the smallest details of cell structure and their changes. Honey is actively developing. cybernetics (see Medical cybernetics). Of particular importance is the problem of using electronic computers for diagnosis. Created automatically. systems for regulating anesthesia, breathing and blood pressure during operations, active controlled prostheses, etc.

Influence of technical progress also affected the emergence of new branches of aviation. Thus, with the development of aviation in the early 20th century. aviation M was born. Human space flights. ships led to the emergence of space. M. (see Aviation and space medicine).

The rapid development of M. was due not only to discoveries in the field of physics and technical. progress, but also the achievements of chemistry and biology. In clinical New chemicals have entered practice. and physical-chemical research methods, deepened understanding of chemistry. the foundations of life, including painful processes.

Genetics, the foundations of which were laid by G. Mendel, established the laws and mechanisms of heredity and variability of organisms. An outstanding contribution to the development of genetics was made by owls. scientists N. K. Koltsov, N. I. Vavilov, A. S. Serebrovsky, N. P. Dubinin and others. genetic The code contributed to the deciphering of the causes of hereditary diseases and the rapid development of medical genetics. The success of this scientific discipline has made it possible to establish that environmental conditions can contribute to the development or suppression of a hereditary predisposition to disease. Methods for express diagnostics, prevention and treatment of a number of hereditary diseases have been developed, medical genetics has been organized. advisory assistance to the population (see Medical and genetic consultation).

Immunology 20th century. has outgrown the framework of the classical doctrine of immunity to information. diseases and gradually covered the problems of pathology, genetics, embryology, transplantation, oncology, etc. The discovery of human blood groups by K. Landsteiner and J. Jansky (1900-- 1907) led to the use in practice. M. blood transfusion. In close connection with the study of immunological. processes, there was a study of various forms of perverted reactions of the body to foreign substances, begun by the discovery of the French. scientists J. Richet (1902) the phenomenon of anaphylaxis. Austrian pediatrician K. Pirquet introduced the term allergy and proposed (1907) allergic. skin reaction to tuberculin as a diagnostic test. test for tuberculosis. In the 2nd half of the 20th century. The study of allergies - allergology - has grown into an independent branch of theoretical science. and clinical medicine.

At the beginning of the 20th century. German doctor P. Ehrlich proved the possibility of synthesizing according to a given plan drugs that can affect pathogens; They laid the foundations of chemotherapy. The era of antimicrobial chemotherapy practically began after the introduction to treatment. practice of streptocide. Since 1938, dozens of sulfonamide drugs have been created, saving the lives of millions of patients. Even earlier, in 1929, in England, A. Fleming established that one of the types of mold secretes an antibacterial substance - penicillin. In 1939--1941. H. Flory and E. Chain developed a method for producing persistent penicillin, learned to concentrate it and established production of the drug on an industrial scale, marking the beginning of a new era of the fight against microorganisms - the era of antibiotics. In 1942, a domestic one was obtained in the laboratory of Z. V. Ermolyeva penicillin. In 1943, streptomycin was obtained in the USA by S. Vaksman. Subsequently, many antibiotics with different spectrums of antimicrobial action were isolated.

What emerged in the 20th century developed successfully. doctrine of vitamins discovered by Russian. scientist N.I. Lunin, the mechanisms of development of many vitamin deficiencies were deciphered and ways to prevent them were found. Created at the end of the 19th century. French Scientist S. Brown-Sekar and others. The doctrine of the endocrine glands has become an independent medical science. discipline - endocrinology, the range of problems, which, along with endocrine diseases, includes hormonal regulation of functions in a healthy and sick body, chemical synthesis of hormones. The discovery of insulin in 1921 by Canadian physiologists Banting and Best revolutionized the treatment of diabetes mellitus. The isolation of a hormonal substance from the adrenal glands in 1936, which was later named cortisone, as well as the synthesis (1954) of the more effective prednisolone and other synthetic analogues of corticosteroids led to the therapeutic use of these drugs for diseases of the connective tissue of the blood, lungs, skin, etc. ., i.e. to the widespread use of hormone therapy for non-endocrine diseases. The development of endocrinology and hormone therapy was facilitated by the work of the Canadian scientist G. Selye, who put forward the theory of stress and general adaptation syndrome.

Chemotherapy, hormonal therapy, radiation therapy, the development and use of psychotropic drugs that selectively affect the central nervous system, the possibility of surgical intervention on the so-called. open heart, deep in the brain and on other organs of the human body previously inaccessible to the surgeon’s scalpel, they changed M.’s face and allowed the doctor to actively intervene in the course of the disease.

2. Hippocrates

The earliest biographers of Hippocrates wrote no earlier than 200 years after his death and, of course, it is difficult to count on the reliability of their reports. We could obtain much more valuable information from the testimony of contemporaries and from the writings of Hippocrates themselves.

The testimony of contemporaries is very scarce. This includes, first of all, two passages from Plato’s dialogues “Protagoras” and “Phaedrus”. In the first of them, the story is told on behalf of Socrates, conveying his conversation with the young man Hippocrates (this name - literally translated “horse tamer” - was quite common at that time, especially among the equestrian class). According to this passage, in the time of Plato, who was about 32 years younger than Hippocrates, the latter enjoyed wide fame and Plato ranks him along with such famous sculptors as Polykleitos and Phidias.

Even more interesting is the mention of Hippocrates in Plato’s dialogue “Phaedrus”. There Hippocrates is spoken of as a doctor with a broad philosophical bent; It is shown that in the era of Plato, the works of Hippocrates were known in Athens and attracted the attention of wide circles with their philosophical dialectical approach.

Of course, over the course of 24 centuries, the famous doctor experienced more than just praise and surprise: he also experienced criticism, which reached complete denial, and slander. A sharp opponent of the Hippocratic approach to disease was the famous doctor of the Asclepiad methodological school (1st century BC), who, among other things, said a sharp word about “Epidemics”: Hippocrates, they say, shows well how people die, but does not show how to cure them. Of the IV century doctors, younger contemporaries of Hippocrates, some mention his name in connection with criticism of his views. Galen, in his commentary on Hippocrates’ book “On the Joints,” writes: “Hippocrates was criticized for the method of realigning the hip joint, pointing out that it fell out again...”

Another piece of evidence directly mentioning the name of Hippocrates comes from Diocles, the famous physician of the mid-4th century, who was even called the second Hippocrates. Criticizing one of Hippocrates’ aphorisms, which states that diseases corresponding to the season pose less danger, Diocles exclaims: “What are you saying, Hippocrates! Fever, which, due to the qualities of matter, is accompanied by heat, unbearable thirst, insomnia and all that is observed in summer, will be more easily endured due to the suitability of the season, when all sufferings are aggravated, than in winter, when the strength of movements is moderated, the severity decreases and the whole disease becomes softer."

Thus, from the testimony of writers of the 4th century, the closest in time to Hippocrates, one can draw confidence that he really existed, was a famous doctor, teacher of medicine, and writer; that his writings are distinguished by a broad dialectical approach to man and that some of his purely medical positions were already criticized.

It remains to consider what materials for biography can be extracted from the works that have come down to us under the name of Hippocrates. They can be divided into two unequal groups.

The first includes essays of a business nature, having one or another relation to medicine: they are the majority. The second includes the correspondence of Hippocrates, the speeches of him and his son Thessalus, and decrees. There is very little biographical material in the works of the first group; in the second, on the contrary. There is a lot of it, but, unfortunately, the correspondence is recognized as entirely fraudulent and not trustworthy.

First of all, it should be noted that in none of the books of the “Hippocratic Collection” is the name of the author presented, and it is very difficult to determine what was written by Hippocrates himself, what was written by his relatives, and what by outside doctors. However, it is possible to identify several books that bear the stamp of Hippocrates’ personality, as they are accustomed to presenting it, and from them one can get an idea of ​​the places where he worked and where he visited on his travels. Hippocrates was undoubtedly a periodeut doctor, i.e. he did not practice in his city, where, due to the excess of doctors of a certain school, there was nothing to do, but traveled around different cities and islands, sometimes holding the position of public doctor for several years. In the books “Epidemics” 1 and 3, which are considered authentic by the vast majority, the author describes the state of the weather at different times of the year and the appearance of certain diseases on the island of Thasos over the course of 3, and maybe 4 years. Among the case histories appended to these books, in addition to patients in Thasos, there are patients from Abdera and a number of cities in Thessaly and Propontis. In the book: “About airs, waters and localities”, the author advises, having come to an unfamiliar city, to get acquainted in detail with the location, water, winds and climate in general in order to understand the nature of emerging diseases and their treatment. This directly points to a doctor - a periodeut. From the same book it is clear that Hippocrates, from his own experience, knows Asia Minor, Scythia, the eastern coast of the Black Sea near the river Phasis, and also Libya.

In "Epidemics" the names of Alevadov, Diseris, Sim, Hippolokh, known from other sources as noble people and princes, are mentioned. If a doctor was called to treat a groom, a slave or a maid, it only meant that the owners valued them. That, in essence, is all that can be extracted from the medical books of Hippocrates in terms of his biography.

It remains to consider the last source of Hippocrates' biography: his correspondence, speeches, letters of invitation, decrees - a variety of historical material placed at the end of his writings and included in the Hippocratic Collection as an integral part of it.

In the old days, all these letters and speeches were believed, but historical criticism of the 19th century deprived them of all trust, recognizing them as forged and composed, like most other letters that have come to us from the ancient world, for example, Plato. German philologists suggest that the letters and speeches were composed in the rhetorical school of Kos in the 3rd and subsequent centuries, perhaps in the form of exercises or essays on given topics, as was the practice at that time. That the letters of Hippocrates were planted is proven by some anachronisms, historical inconsistencies and, in general, the entire style of the letters, so it is difficult to object to this. But, on the other hand, it is also impossible to deny any historical value of these writings: such an attitude is primarily the result of hypercriticism, which especially flourished in the 19th century among learned historians and philologists. It should not be forgotten - and this is the most important thing - that in fact the data given, for example, in the speech of Thessalus, are chronologically the earliest, in comparison with which biographies written many hundreds of years after the death of Hippocrates cannot count. That huge amount of details and small details concerning persons, places and dates that give credibility to the story could hardly be simply fictional: in any case, they have some kind of historical background.

The most interesting historical materials are contained in the speech of Thessalus, the son of Hippocrates, delivered in the Athenian national assembly, where he acted as ambassador from his native city of Kos, and, enumerating the services that his ancestors and himself had rendered to the Athenians and the general city cause, tried to avert the impending war and the defeat of Fr. Scythe. From this speech we learn that the ancestors of Hippocrates, on the father of the Asklepiad, on the mother were Heraclides, i.e. the descendants of Hercules, as a result of which they were in family relations with the Macedonian court and the Thessalian feudal rulers, which makes the stay of Hippocrates, his sons and grandsons in these countries quite understandable.

In addition to this speech, there are also stories of no less interest about the merits of Hippocrates himself.

We should also dwell on the correspondence of Hippocrates, which occupies most of the appendices to the Collection. It has, undoubtedly, already been framed and composed, but it contains a large number of details, both everyday and psychological, giving the letters an imprint of some kind of freshness, naivety and such a flavor of the era that, after several centuries, it is difficult to invent. The main place is occupied by correspondence regarding Democritus and with Democritus himself.

Such are the biographical materials of a heterogeneous nature that depict to us the life and personality of Hippocrates; This is how it seemed to the ancient world and passed down into history.

He lived in the era of cultural flourishing of Greece, was a contemporary of Sophocles and Euripides, Phidias and Polycletus, the famous sophists, Socrates and Plato, and embodied the ideal of the Greek doctor of that era. This doctor must not only be fluent in the art of medicine, but also be a physician-philosopher and a physician-citizen. And if Schulze, a medical historian of the 18th century, in search of historical truth, wrote: “So, the only thing we have about Hippocrates of Kos is the following: he lived during the Peloponnesian War and wrote books about medicine in Greek in the Ionian dialect,” then on it can be noted that there were quite a few such doctors, since many doctors wrote in the Ionian dialect at that time, and it is completely unclear why history put Hippocrates in first place, consigning the rest to oblivion.

If for his contemporaries Hippocrates was, first of all, a doctor-healer, then for posterity he was a doctor-writer, the “father of medicine.” The fact that Hippocrates was not the “father of medicine” hardly needs to be proven. And whoever seems undoubted that all the “works of Hippocrates” were really written by him himself, can with a certain right claim that the true paths of medicine were paved by him, especially since the works of his predecessors have not reached us. But in reality, the “works of Hippocrates” are a conglomerate of works by various authors, of various directions, and it is only difficult to single out the true Hippocrates from them. To single out the “genuine Hippocrates” from the multitude of books is a very difficult task and can only be solved with a greater or lesser degree of probability. Hippocrates entered the medical field when Greek medicine had already achieved significant development; He also brought a great revolution into it as the head of the Kos school, and can rightfully be called a reformer of medicine, but his significance does not extend further. To find out this meaning, it is necessary to dwell a little on the development of Greek medicine.

Its origins are lost in antiquity and are associated with the medicine of the ancient cultures of the East - Babylonian and Egyptian. In the laws of the Babylonian king Hammurabi (about 2 thousand years BC) there are paragraphs relating to doctors performing eye operations, defining a large fee and at the same time great responsibility for an unsuccessful outcome. Bronze eye instruments have been found during excavations in Mesopotamia. The famous Egyptian Ebers papyrus (mid-20th century BC) gives a huge number of recipes for various diseases and rules for examining the patient. The specialization of Egyptian doctors occurred in ancient times, and we now know that the Cretan-Mycenaean culture developed in close contact with Egypt. During the Trojan War (dating back to this culture), the Greeks had doctors who dressed wounds and treated other illnesses; they were respected, for “an experienced physician is more precious than many other people” (Iliad, XI). It should be noted that medicine in Greece from time immemorial was of a secular nature, while in Babylon and Egypt doctors belonged to the class of priests: it was based on empiricism and in its basis was free from theurgy, i.e. invocations of gods, spells, magical techniques, etc.

Of course, in each region there were, in addition, special objects and places associated with the cult of various gods (trees, springs, caves), to which unfortunate sick people flocked, hoping for healing - a phenomenon common to all countries and eras. Cases of healing were recorded on special tables that were hung in temples, and in addition, the sick brought offerings to the temple - images of the affected parts of the body, which were found in large numbers during excavations; these records in temples were previously given great importance in the education of doctors; they allegedly formed the basis of the “Kosian forecasts”, and from there, according to the geographer Strabo, Hippocrates drew his medical wisdom.

In the fifth century, by the time of Hippocrates, there were doctors of various categories in Greece: military doctors, specialists in the treatment of wounds, as mentioned in the book: “On the Doctor”, court doctors - life physicians who existed at the court of the kings: Persian, or Macedonian.

Doctors are public in most democratic republics, and, finally, doctors are periodeuts, who were connected to certain places: they moved from city to city, practicing at their own peril and risk, but sometimes they transferred to the service of the city. Public doctors were elected by the people's assembly after a preliminary examination, and their merits were increased by a golden wreath, the right of citizenship and other insignia, as evidenced by inscriptions found during excavations.

Where did all these doctors come from? “The Hippocratic Collection” gives complete information on this issue: along with doctors - healers and charlatans, doctors who learned late, "real doctors are persons who received an education from a young age in the bowels of a certain school and are bound by a certain oath. From other sources, starting with Herodotus and ending with Galen, we know that in the 6th and 5th centuries. in Greece there were famous schools: Crotonian (southern Italy), Cyrene in Africa, Knidos in Asia Minor in the Asia Minor city of Knidos, Rhodes on the island of Rados, and Kos. The Cnidus, Kos and Italian schools are reflected in the “Hippocratic Collection”. The Cyrene and Rhodian schools disappeared early, leaving no noticeable trace.

The venerable Knidian school, continuing the tradition of Babylonian and Egyptian doctors, identified complexes of painful symptoms and described them as separate diseases.

In this regard, Cnidus doctors achieved great results: according to Galen, they distinguished 7 types of bile diseases, 12 bladder diseases, 3 consumption, 4 kidney diseases, etc.; They also developed methods of physical research (listening). The therapy was very varied, with a large number of complex prescriptions, face-to-face diet instructions and widespread use of local remedies, such as cauterization. In a word, they developed specific pathology and therapy in connection with medical diagnosis. They did a lot in the field of women's diseases.

But also in relation to pathophysiology and pathogenesis, the Knid school owes the merit of a clear formulation of humoral pathology in the form of the doctrine of 4 main body fluids (blood, mucus, black and yellow bile): the predominance of one of them causes a certain disease.

The history of the Kos school is inextricably linked with the name of Hippocrates; The main direction of the school is attributed to him, since we did not have sufficient information about the activities of his ancestors, doctors, and his numerous descendants, apparently, only followed in his footsteps. Hippocrates, first of all, acts as a critic of the Cnidian school: its desire to fragment diseases and make accurate diagnoses, its therapy. It is not the name of the disease that is important, but the general condition of the patient. As for therapy, diet and the regimen in general, they must be of a strictly individualizing nature: everything needs to be taken into account, weighed and discussed - only then can prescriptions be made. If the Knido school, in search of places of disease, can be characterized as a school of private pathology, catching painful local processes, the Kos school laid the foundations of clinical medicine, at the center of which is an attentive and caring attitude towards the patient. The above determines the role of Hippocrates as a representative of the Kos school in the development of medicine: he was not the “father of medicine,” but can rightfully be called the founder of clinical medicine. Along with this, the Kos school is fighting against all kinds of charlatans of the medical profession, the requirements from the doctor are in accordance with his dignity of behavior, i.e. the establishment of a certain medical ethics and, finally, a broad philosophical view. All this taken together makes clear the significance of the Kosk school and its main representative, Hippocrates, in the history of healing and medical life.

It should be added that surgery played a large role in Hippocrates’ activities: wounds, fractures, dislocations, as evidenced by his surgical writings, perhaps the best of all, where, along with rational reduction techniques, mechanical methods and machines, the latest achievements of that time, are widely used.

Another specialty of Hippocrates and, apparently, the entire Kos school was acute febrile diseases such as tropical fevers, which are still extremely widespread in Greece, claiming many victims. These “epidemics”, “acute diseases” are given a lot of attention in the works of Hippocrates and his descendants. But this is not enough: Hippocrates and the Kos school made an attempt to put these acute and epidemic diseases into the general course of natural phenomena, to present them as a result of location, water, winds, precipitation, i.e. climatic conditions, connecting them with the seasons and the constitution of the inhabitants, which is again determined by environmental conditions - a grandiose attempt, not fully resolved to this day, which, in all likelihood, gave the philosopher Plato a reason to highly value the physician Hippocrates.

It remains to say a few words about the Italian and Sicilian schools. What their practical activities were, no information has been preserved about this: their doctors are known more as medical theorists. The Italian school went down in history as a school of theoretical speculative constructions, as an anticipation of the future, but in terms of its historical significance in no way can it be placed along with the purely medical schools - Knidsa and Kos.

3. Hippocratic collection

The total number of books in the Collection is determined differently. Depending on whether some books are considered independent or a continuation of others; Littre, for example, has 53 works in 72 books, Ermerins - 67 books, Diels - 72. Several books are apparently lost; others are routinely planted. These books are arranged in editions, translations and histories of medicine in a very different order - in general, following two principles: either by their origin, i.e. supposed authorship - such, for example, is the arrangement of Littre in his edition and Fuchs in the History of Greek Medicine - or according to their content.

The writings of Hippocrates probably would not have reached posterity if they had not ended up in the Alexandrian library, founded by the successors of Alexander the Great, the Egyptian kings - the Polomeans in the newly founded city of Alexandria, which was destined to long be a cultural center after the fall of Greek independence. This library consisted of learned men: librarians, grammarians, critics who assessed the merits and authenticity of works and included them in catalogues. Scientists from different countries came to this library to study certain works, and many centuries later Galen looked at the lists of Hippocrates’ works stored in it.

Herophilus of Alexandria, a famous physician of his time who lived around 300 BC, composed the first commentary on Hippocrates' Prognostics; his student Bakhiy from Tanagra continued the work of his teacher - this proves that in the 3rd century. The Hippocratic collection was part of the Alexandrian library. From Herophilus begins a long series of commentators on the Hippocratic collection, the culminating point of which is Galen (2nd century AD). It is to the latter that we owe the main information about them, since their writings have not reached us. Apparently, these comments were grammatical in nature, i.e. explained words and phrases whose meaning was unclear or had been lost by that time. These comments were then related to one or more books. Galen points out that only two commentators completely covered all the works of Hippocrates, these are Zeucis and Heraclides of Thera (the latter himself a famous physician), both belonging to the school of empiricists. From the whole mass, a commentary by Apollo of Kittius, an Alexandrian surgeon (I century BC), on the book “On the Reduction of Joints.” This commentary was accompanied by drawings in the manuscript.

Galen, who, according to the generally accepted opinion, gave the synthesis of all ancient medicine, a great practitioner and at the same time a theoretician-anatomist, experimental physiologist and, in addition, a philosopher, whose name passed through the centuries along with the name of Hippocrates, paid a lot of attention to the writings of his famous predecessor . In addition to 2 books: “On the Dogmas of Hippocrates and Plato,” he gave, in his own words, comments on 17 books of Hippocrates, of which 11 have reached us in full, in parts 2 books, 4 have not reached us. The “Dictionary of Difficult Words” has also reached us in parts Hippocrates"; the books “On Anatomy” of Hippocrates, about his dialect and (which is more to be regretted) about his original works have not arrived.

Galen, who was a great erudite and read most of the ancient commentators, pronounces a devastating verdict on them mainly because they, neglecting the medical point of view, focused attention on grammatical explanations: they pretend to understand mysterious passages that no one understands, especially regarding provisions , which are clear to everyone, they do not understand them. The reason is that they themselves do not have medical experience and are ignorant of medicine, and this forces them not to explain the text, but to adjust it to a fictitious explanation.