History of 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. It 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 concept of public health also belongs to the subjects of social medicine.
Public health has a specific socio-medical meaning, due to various types of violations of the social structure, for example, mental epidemics, criminal mobs, 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 around 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 health protection is ensured by the protection of the natural environment, the creation of favorable working conditions, life, recreation, education and training of citizens, the production and sale of good-quality food, as well as the provision of affordable 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 health care 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
The emergence of the sociology of medicine is attributed by different authors to different dates. The German scientist M. Suss believes that for the first time a sociological analysis of the place of healthcare in society was carried out in the work of the well-known 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 (the birth of discipline) XVII - XIX centuries.
2. The period of formation (the beginning of the 20th century - before World War 1)
3. The period of formation (20s - 40s of the XX century, the period between I and II World Wars)
4. The period of development as an independent discipline (50-80s of the XX century)
5. The modern period of the state of science (from the 90s to the present).
Let's focus on the last two.
1.1 Period of development as an independent discipline
The sociology of medicine was considered by many scientists as part of sociology, as part of medicine, as a science "at the junction" of sociology and medicine.
After long discussions, 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 of the sociology of medicine was organized for the first time, and 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 the onset, development and outcome of diseases (urbanization, sanitary conditions in production, the state of ); analysis of the causes of diseases in various social groups; evaluation of various preventive measures; analysis of the activities of medical institutions; the role of society in the incidence 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 topical topics related to the sociology of medicine: on the social problems of medicine; about the role and interaction of 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 the way of life of people, their psychology, the prevailing stereotypes of behavior, ideas about illness and health.
A fundamentally important stage in the development of the sociology of medicine in Russia was the introduction, starting from 2000, of the corresponding code and name of the discipline into the Nomenclature of Specialties of Scientific Workers: 14.00.52 .; "Sociology of Medicine"; branches of science in which a degree is awarded - medical, sociological.
This was the natural outcome of a "decade of sociology" in health care. Thus, one can define the significantly increased number of sociological studies in the 1990s on the most diverse problems of medicine in general and public health in particular.
Work is underway to systematize, improve the methodological apparatus, train personnel and plan sociological research. Training has begun at the Department of Economics and Sociology of Health at the MMA. I.M. Sechenov.
Currently, the department's computer database contains a bibliographic list of about 4000 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, which studies the social processes taking place 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.
It 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 has emerged 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, for example, the 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 one participating in campaigns, in combat operations, 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. Formation of Soviet medicine
The historical events of 1917 brought ruin not only to the political and economic spheres of life. They affected the life of the population, and, of course, the general state of people's health. At the beginning of the Soviet period, with the coming to power of the Bolsheviks and the establishment of a new regime, a wave of epidemics of cholera, typhus, smallpox and other diseases swept the country. The situation was aggravated by the widespread shortage of qualified personnel, equipment and medical equipment, and medicines. There were very few hospitals, preventive medical institutions. The civil war left a deep mark in history, bringing with it devastation in the industrial activity of the country, agriculture. A wave of hunger swept across the country. In agriculture, there was not only enough seed, but also fuel for agricultural machinery. Communication between settlements was reduced to a minimum, there was not enough water even for cooking and quenching thirst, not to mention other household needs. Cities and countryside literally "overgrown with mud", and this already served as a threat of epidemics. HG Wells, who visited the Union in 1920, was shocked by what he saw compared to what he had seen 6 years earlier. It was a picture of complete collapse, the country that appeared to his eyes was the wreckage of a great empire, a huge monarchy shattered to smithereens, fallen under the yoke of cruel senseless wars. At that time, the death rate increased 3 times, the birth rate halved.
Only an organized healthcare system could save the country from extinction, help in the fight against diseases and epidemics. Such a system began to actively form in 1918.
To create a developed structure that could effectively serve all segments of the population, it was necessary to combine all types of departmental medicine under a single state control: zemstvo, city, insurance, railway and other forms. Thus, the formation of a unified health care system attracted more and more people and was of a "collective nature" - they literally recruited from the world one by one. This "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 involve in the work of all doctors who recognized the new government; it was also necessary to radically change the medical and sanitary business in the country and organize qualified assistance to workers in enterprises and soldiers in the active troops, as well as those in reserve.
Since the reform had to be carried out everywhere in order to cover more area, medical and sanitary departments and medical colleges began to be created locally. The tasks facing the latter were of a public nature, so on January 24, 1918, the Council of People's Commissars signed a decree establishing the Council of Medical Colleges. This council became the highest medical body of the workers' and peasants' government. A. N. Vinokurov became the head of the body, V. M. Bonch-Bruevich (Velichkina) and I. M. Barsukova were appointed his deputies. In order for the people to know about the active work of the Council, on May 15, 1918, the first issue of the News of Soviet Medicine was published under the Council of People's Commissars of the RSFSR. It was the first Russian medical public publication, which then appeared regularly. The Council of Medical Colleges saw its main task in fulfilling the following conditions: continuing the widespread organization of medical and sanitary departments, consolidating the initiated reforms regarding the transformation of military medicine, strengthening, developing sanitary affairs and strengthening epidemic control throughout the country.
However, in order to act on the scale of the whole country and objectively monitor the results of the work carried out, it was necessary to hold the All-Russian Congress of Representatives of the Medical and Sanitary Departments of the Soviets. The congress was held on June 16-19, 1918. It raised not only the organization and work of the People's Commissariat of Health, which were the most important at that time, but also questions of insurance medicine, the question of combating epidemics, and questions about the tasks of local medicine.
The result of the work of the congress was the adoption of a decision on the creation of the People's Commissariat of Health, which was to become the main body of health and be in charge of all medical and sanitary affairs. On June 26, 1918, a project for the creation of the People's Commissariat of Health was presented. On July 9, the draft was also published for the general public, and on July 11, the Council of People's Commissars signed a decree "On the Establishment of the People's Commissariat of Health." The first collegium of the People's Commissariat of Health of the RSFSR was created, which included V. M. Velichkina (Bonch-Bruevich), R. P. Golubkov, E. P. Pervukhin, Z. P. Solovyov, P. G. Dauge, and appointed the first commissioner of health N. A. Semashko. Z. N. Solovyov became his first deputy. 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. G. N. Kaminsky became its first head.
N. A. Semashko
Nikolai Alexandrovich Semashko (1874–1949) made a huge contribution to the development of not only Soviet, but also world medicine.
Semashko's career did not start with brilliant success: he graduated from Kazan University, after which he worked for 3 years as a zemstvo doctor in the Oryol province, and then in Nizhny Novgorod. The revolution in February 1905 ended for him with arrest, imprisonment for 10 months, and then 10 years of emigration 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 arrangement of the country from the moment the idea of creating a state health care 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, in the most difficult years for the country, when there was a bloody Civil War, epidemics raged in the Union. He also took part in the development of anti-epidemic programs, seriously stated the need to create a program for the protection of motherhood and childhood and the need to develop Soviet medicine by improving and expanding the network of research institutes. Under him, sanitary-resort business began to develop intensively, the system of higher medical education was transformed.
N. A. Semashko made a huge contribution to the development of hygiene in the USSR, opening in 1922 the Department of Social Hygiene at the Medical Faculty of Moscow State University. He himself was the head of this department for 27 years.
In 1927–1936 the first edition of the Great Medical Encyclopedia was created and published, the initiator of which was N. A. Semashko. From 1926 to 1936 he headed the children's commission of the All-Russian Central Executive Committee.
He put a lot of effort into studying the sanitary and hygienic situation after the war. N. A. Semashko became one of the founders and one of the first academicians and members of the Presidium of the USSR Academy of Medical Sciences. He was director of the Academy of Pedagogical Sciences from 1945 to 1949. Since 1945, he held the title of Academician of the Academy of Pedagogical Sciences of the RSFSR. He also became the founder of the Institute for the Organization of Public Health and the History of Medicine of the USSR Academy of Medical Sciences, after its creation he led it from 1947 to 1949. This institute bore his name for a long time, later it was renamed the National Research Institute of Public Health of the Russian Academy of Medical Sciences.
Nikolai Alexandrovich Semashko, despite the great responsibility that lies on his shoulders and the large number of positions he holds, managed to leave his mark on the development of physical culture and sports, as he became the first chairman of the organization in charge of this area of medicine, and also headed the board of the All-Union hygienic society (1940–1949).
Throughout his life, he wrote scientific works and works, of which there are more than 250. All of them were devoted to theoretical, organizational and practical issues of hygiene and health care in general, which earned him immortal memory among the people.
3. P. Solovyov
Zinovy Petrovich Solovyov (1876–1928), in addition to his high positions in the healthcare sector, is known for the fact that in 1925 he initiated the creation of the Artek All-Union Pioneer Camp for children on the Black Sea coast, which exists to this day. He left behind many scientific works in which he raised questions and actively developed programs to overcome difficulties in the development of medical science and higher medical education in the USSR.
G. N. Kaminsky
Grigory Naumovich Kaminsky (1895–1938), before being appointed the first People's Commissar of Health of the USSR, served for 2 years as People's Commissar of Health of the RSFSR (1934–1935) and the USSR (1935–1937). He was the organizer of the All-Union State Sanitary Inspectorate. In 1935, based on his developments, a program was adopted to improve medical care and services for the city and rural population. He contributed to the transfer of the chemical and pharmaceutical industry to the department of the People's Commissariat of Health of the RSFSR. He left a deep mark in the development of medicine as a science and in medical education, he also became one of the organizers of VNEM in Moscow and Leningrad.
Special thanks to G. N. Kamensky could be rendered for assistance in organizing the first international congresses.
However, his activity in the state field was short-lived, the period of his active work was only 4 years, since on June 25, 1937 he was arrested and shot, after he spoke at the Plenum of the Central Committee of the All-Union Communist Party of Bolsheviks with a condemning speech against the policy of repression, many of his comrades-in-arms were arrested and shot with him. Later they were all posthumously rehabilitated.
Robert Lanza has managed to ride the tidal wave of discoveries generated by the unraveling of the mysteries 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, superstition, witchcraft and rumors reigned in medicine. 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 remedies that really helped became closely guarded secrets. To make money, the “doctor” had to cater to wealthy patients, and keep the recipes for his potions and spells in deep secrecy.
During this period, one of the founders of the now famous Mayo Clinic, visiting patients, kept a personal diary. There he frankly wrote that in his black medical case there were only two effective means: saw and morphine. He used the saw to amputate the affected organs, and morphine for pain relief during amputation. These tools worked flawlessly.
Everything else in the black suitcase, the doctor remarked sadly, is snake fat 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. In Europe, tens of thousands of soldiers died on the battlefields of the First World War, and there was a need for real medical science, for real experiments with reproducible results, which were then published in medical journals. European kings watched in horror as their best and smartest subjects perished, and demanded real results from doctors, not empty tricks. Now doctors, instead of catering to wealthy patrons, fought for recognition and fame with articles in respected peer-reviewed journals. Thus, a platform was prepared for the promotion of antibiotics and vaccines, which increased life expectancy to 70 years or more.
The third stage of development is molecular medicine. Today we are witnessing the fusion of medicine and physics, we see how medicine penetrates deep into matter, to atoms, molecules and genes. This historic transition began in the 1940s, when the Austrian physicist Erwin Schrödinger, one of the founders of quantum theory, wrote the much-requested book What is Life? He rejected the idea that there is some kind of mysterious spirit, or life force, which 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 the molecule. Having discovered it, he assumed that he would unravel the mystery of being. Physicist Francis Crick, inspired by Schrödinger's book, joined forces 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 revealed the double helix structure of DNA. The length of one DNA strand in untangled form is about two meters. Such a thread is a sequence of 3 billion nitrogenous bases, which are denoted by the letters A, T, C, G (adenine, thymine, cytosine and guanine) and carry encoded information. Having deciphered the exact sequence of nitrogenous bases in the chain of a DNA molecule, one can read the book of life.
The rapid development of molecular genetics eventually led to the emergence of the Human Genome Project, a milestone in the history of medicine. The shock program of sequencing all the genes of the human body cost about $3 billion and included 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 map of the genome on an electronic medium like a CD-ROM. This map will contain all approximately 25,000 genes of a given person, and it will become a kind of “instruction for use” for everyone.
Nobel laureate David Baltimore summarized all of the above in one sentence: "Today's biology is an information science."
Periodization of world history and the history of medicine. The main stages in the development of medicine.
Sources for studying the history of medicine - a brief description of historical and medical sources.
Museums of the history of medicine in Russia, CIS countries and abroad. Museum of the 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 matter divided into general and private.
General history of medicine engaged in identifying the main patterns of the historical development of healing and the study of 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, 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 the Study of History Medicines are divided into several main groups:
ü Real (material) are archaeological finds
(skulls, bones, coins, medals, emblems, seals)
ü Ethnographic - rituals, customs, beliefs
ü Oral and folklore - songs, legends, ballads, legends
ü Linguistic - images in speech form, which are shown -
yut through the word kinship of entire groups and peoples
ü Written - clay tablets, papyri, drawings on stones and
rocks, manuscripts, printed works of doctors, historians, philosophers,
scientists and statesmen, archival materials
ü Film and photographic documents
By the way. There is such
Museum of the History of Medicine of the First Moscow State Medical University. THEM. Sechenov, there are also in Berlin, Philadelphia, Tambov: D
№2 General historical situation. characteristics of the era. Kievan Rus IX-XIV centuries.
In the second half of IX. in. in the vast lands of Eastern Europe
formed Old Russian state with the main city of Kyiv
under the control of Rurik Varangian / 862-879 /, known as " Kievan Rus".
Kyiv begins to develop especially rapidly during the reign Vladimir the Great(980 - 1015). In order to strengthen the unity of Kievan Rus and increase its influence in the international arena, Prince Vladimir in 988 baptized Rus. Christianity brought significant political benefits to Kievan Rus and served as an impetus for the further development of writing and culture. Under Volodymyr 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 Russia were built. Kyiv was among the most prosperous craft and trade centers in Europe.
However, after the death of the prince Vladimir Monomakh(1125) the process of fragmentation of a more or less unified Kievan state begins. By the middle of the XII century. Kievan Rus breaks up into many independent principalities. External enemies were not slow 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 XV century. Kyiv was granted Magdeburg a right that ensured a much greater independence of the city in matters of international trade and significantly expanded the rights of urban estates - artisans, merchants and burghers. In 1569, after the signing of the Union of Lublin, Poland and Lithuania united into one state, known in history as the Commonwealth, and gradually established their dominance in Ukraine. The cruelty and arbitrariness of foreigners led to numerous uprisings of the Ukrainian people.
Number 3. What was the significance of the adoption of Christianity by Russia for the development of pharmacology
An important event in the history of Russia was the adoption of Christianity as the state religion in 988 by Prince Vladimir.
The experience of traditional medicine was summarized in numerous herbal and medical books, which for the most part were compiled after the adoption of Christianity in Russia and the spread of literacy.
Among the most famous healers who practiced in the Lavra were such people as the Monk Alimpiy, who became famous for treating people with the most severe cases of leprosy. For the treatment of skin diseases, he used icon paints, which apparently contained various medicinal substances. Also the holy and blessed Agapios was a monk of the Lavra. He is known for curing the grandson of Yaroslav the Wise, who later became the prince of Russia, and in history
Monasteries in Kievan Rus were to a large extent the successors of Byzantine education. Some elements of medicine also penetrated their walls, combined with the practice of Russian folk medicine, which made it possible to engage in medical activities. Paterik (Chronicle of the Kiev-Pechersk Monastery, XI-XIII centuries) contains information about the appearance of their doctors in the monasteries and the recognition of secular doctors. Among the monks there were many artisans who were well versed in their profession; among them were doctors. Was
Well, tell me that the bath was adopted from Byzantium, and the medicines were mainly of plant origin; dozens of plant species were used for medicinal purposes. Archaeological finds show that the Russian land abounded with medicinal plants and provided a rich choice for medicinal use. This circumstance was noted by Western European writers. Plants were used that were not known in Western Europe.
Medicine in the Old Russian state of Kievan Rus. Ideas about the causes of diseases among the Russians. Ancient types of medical activity. Radical and non-radical methods of treatment.
Page 201 textbooks
Saved 1) folk medicine- paganism and quackery. 2) after the adoption of Christianity, developed monastic medicine. 3) Since the reign of Yaroslav the Wise in Russia, secular (secular) medicine
1) Folk healers began to be called healers, who have passed on their experience from generation to generation.
The experience of folk medicine was summarized in herbalists and clinics. They treated with medicines from plants and minerals, and also used the healing properties of narzan.
2) About the monastery, tell me about the fact that in the religious consciousness, the disease was considered as a punishment or "invasion" of demons.
The hospital at the first created monastery was very popular. Kiev-Pechersk Lavra (monks-ascetics Anthony, Agapit, Alimpiy became famous)
3) Secular... Well, she assumed reimbursable treatment, that is, paid, that is... The Armenian Lechec practiced this way.
Foreign medicine, its influence on the development of healing in the Old Russian state
In addition to Russian doctors, foreign doctors 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 combatants, who formed the basis of state power in the ancient Russian principalities.
So, at the court of Vladimir Monomakh, an Armenian doctor served (he knew how to determine the disease by the pulse and appearance of the patient), Peter the Siryanin ...
Bit, kholopy, rich, stable.
Especially many orders were created by Ivan IV Vasilyevich "The Terrible" (1533-1584) -
Local, Streltsy, foreign, Pushkar, robbery, embassy, etc.
Medical Sciences. The role of the Petrovsky 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 XIX 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 items /bread, knives, linen/ and
industrial goods were supplied to the markets of Western countries
Europe and Central Asia. Industrial development, development of new
land and population growth created a need for specialists.
A number of new universities opened: in Dorpat (Yuriev, now Tartu,
1802), Kazan (1804), Kharkov (1805), Petersburg (1819) and Kyiv (1834).
New universities were given a liberal charter of 1804, providing
who claimed the autonomy of institutions, the election of the rector, deans, pro-
professors. However, the reforms of the state structure and management
the first years of the reign of Alexander I Pavlovich (I801 -1825)
were soon eliminated.
Napoleon's invasion of Russia put the country in front of a formidable
danger, caused an unprecedented patriotic upsurge. professors and
university teachers, doctors took an active part in
defense of the motherland. Huge work to create hospitals and evacuation
the wounded were done by H.I. Loder (1753-1832); directly on the fields
battles worked I.E. Dyadkovsky (1784-1841) and many other major
scientists.
After Patriotic War of 1812 reaction time has come
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
county it was conducted by county trustee M.L. Magnitsky, who arranged
genuine destruction of Kazan University: he demanded
professors of rejection of "disastrous materialism", banned the autopsy
corpses, closed the anatomical museum, all preparations of which were
reprimanded and buried in accordance with church rites. Despite
On this, 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 - biological profile. The role of A.M. Filomafitsky in the development 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 education. Conducted experiments to study reflexes (cough, secretion of gastric juice. For the first time in Russia, he used microscope for research blood cells.. Tried 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 inhibition and delay of reflex reactions in brain.
Compositions
"Physiology Published for the Guidance of Its Listeners" is the first original and critical summary of empirical physiological knowledge.
"Treatise on blood transfusion(as the only means in many cases to save a fading life
Together with N. I. Pirogov developed in 1847 a method of intravenous anesthesia.
Characteristics of the first stage in the development of Soviet health care (1917-1940). The formation of Soviet medicine during the October Revolution and the Civil War, the restoration of the national economy and the building of the foundations of socialism in the USSR.
Since 1917, in our country, health issues have become a state task, which was provided by state leadership and funding of health services and medical science.
The hardships of the revolution, the civil war, devastation, famine, the imperfect organization of medical care, the lack of doctors determined the list of urgent tasks of this period: the construction of a new system for organizing the medical service in the Red Army; epidemic control; involvement of medical workers in active work and the creation of the necessary institutions for the provision of 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 instructed to begin the reorganization of the medical and sanitary affairs in the country, as well as to organize medical assistance to the rebels.
On January 24, 1918, by a decree of the Council of People's Commissars of the RSFSR, the medical boards of all Commissariats were merged into the Council of Medical Boards, 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. Soloviev was appointed his deputy, the board of the People's Commissariat of Health included: V.M. Bonch-Bruevich (Velichkina), A.P. Golubkov, P.G. Dauge , E.P. Pervukhin.
On the ground, medical and sanitary departments of the Soviets were created, which carried out the decisions of the central authorities in the field of health care in their territories.
To organize medical care for the Red Army soldiers, by a decree of the All-Russian Central Executive Committee in October 1919, a special committee was created to help the wounded and sick Red Army soldiers. 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 places of hostilities, 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 Insurance in Case of Sickness” obliged the sickness funds to provide free assistance to the insured - workers, employees and members of their families, which marked the beginning of the implementation of the principle of free, generally accessible and qualified medical care for workers. Health insurance funds, which had certain funds, created a number of large outpatient clinics, hospitals and polyclinics.
In December 1918, the entire pharmacy network was nationalized, and a pharmaceutical department was organized in the People's Commissariat of Health.
In the People's Commissariat of Health, a section for the fight against tuberculosis and a subsection for the fight against venereal diseases were organized. Treatment-and-prophylactic establishments of a new type, dispensaries (anti-tuberculosis and venereological), began to be created. In 1919, Moscow hosted the First All-Russian Congress to Combat Social Diseases.
The number of medical institutions increased, including the number of dispensaries. In connection with the introduction of the NEP, it became necessary to restructure the work of health care, 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. By the end of this period, an increase in the number of medical institutions is again noted, not only in cities, but also in rural areas.
The epidemic situation in the country continued to be difficult. As a result of huge efforts, the epidemics were localized. During these years, much attention was paid to the fight against malaria: in 1921, the Central Malaria Commission was organized under the People's Commissariat for Health, 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 an addition to the decree of 1919), obliging revaccination. The Decree “On Measures to Improve Water Supply, Sewerage and Sanitation” was of great importance. In June 1921, a decree was issued, according to which the entire business of sanitary protection of dwellings was concentrated in the People's Commissariat of Health.
The lack of doctors and other medical personnel was especially acute in these years. New medical faculties of universities began to open.
By the end of this period, there were some trends towards improving the health status of the population: morbidity and mortality from acutely contagious diseases decreased, overall mortality decreased to 20.3 per 1,000 population, life expectancy gradually began to increase.
With the beginning of the first five-year plans, the country's economic policy took a course towards industrialization and collectivization. Forced industrialization and economic growth in the face 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 investment in industry, the share of spending on the social sphere and healthcare has been declining. Clinical examination is proclaimed to be the main method of treatment and preventive care.
The so-called residual principle of health care financing operating in the country led to a serious weakening of attention to health issues and, as a result, a reduction in appropriations, a halt in the growth of the network, and a decrease in the number of medical institutions. Starting from 1934-1935. the network of medical institutions at industrial enterprises decreased, the quality of service for workers decreased, and the incidence rate with temporary disability increased. Probably, the unsatisfactory work of the health authorities also affected. 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 sites provided with doctors was approved. A budget for health care institutions was provided. The medical and pharmaceutical industries are being created.
The latest time.
Medicine and health care during the years of the post-war restoration of national ho-
economy and further development of socialist society (1945 - early 1960s
Elimination of the grave consequences of the war. Recovery in the shortest possible time ma-
material and technical base of healthcare. A wide range of measures to ensure a high level of medical and sanitary services for the population, reducing
morbidity and mortality, the construction of new medical facilities,
sanitary supervision over the reconstruction and construction of settlements, etc.
Progress in the field of public health by the end of the fourth five-year plan (1946 - 1950). Dal-
the most recent development of medicine and health care in the fifth (1951-1955) and sixth (1956-
1960) five-year plans. Decree 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 protection
USSR” (1960) - a theoretical generalization of the experience of the Soviet state in creating
and improvement of the socialist health care system.
Criticism: the state of health of I. V. Stalin (the death of Bekhterev), the residual
health care financing system, the repressions of the 1930s (1937) and 1940-50s
dov. "Doctors' Case". Books - "Zubr" by D. Granin, "Children of the Arbat" by A. Rybakov.
The state's attitude to 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).
Fight with 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 con-
concrete historical conditions (1960-90s), the former forms of state-
political structure and the old methods of managing society are increasingly manifested
expressed their inefficiency and demanded substantial reform (democratic
tization). This involved the implementation of a whole range of measures aimed at
quidation of the former
Soviet medical science and practice. Residual funding principle
healthcare. The state of health of the first person in the state. human rights
activity of A. D. Sakharov.
Stage IV: 1990s - 2009s
Adoption of the law on medical insurance of citizens. CHI and VHI system.
Legislation in the field of protecting the health of citizens.
Expansion of the rights of the patient (disability certificate, choice of doctor, place of treatment and
etc.). Introduction of paid services. Medical care standards. Quality issue
54. Soviet therapeutic schools. Outstanding Soviet therapists
The preventive and physiological direction, the foundations of development, which were shown above on the examples of the achievements of the biomedical and hygienic sciences, have also widely penetrated into clinical medicine. Soviet clinical medicine developed successively 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. In the creation of this scientific direction, especially great merits belong to Maxim Petrovich Konchalovsky (1875-1942). M.P. Konchalovsky in 1899 graduated from the medical faculty of Moscow University, in 1912 he defended his doctoral dissertation. In 1918 he was elected professor of the hospital therapeutic clinic, which he led until the end of his life.
The views of M. P. Konchalovsky were based on the understanding of the body as a single whole, united by the nervous system. M. Konchalovsky gave a special place in the treatment of patients to the natural healing forces of nature.
The largest therapist was a student of G.F. Langa - Alexander Leonidovich Myasnikov (1899-1965), Academician of the USSR Academy of Medical Sciences. At the end of the 1st Moscow State University in 1922, he worked under the guidance of G.F. Lang 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 has published more than 200 scientific papers, including 9 monographs and 4 textbooks on internal medicine. His capital works are devoted to the development of a clinic and treatment of liver diseases, descriptions of the affected organ in malaria and brucellosis, studies of arterial hypertension, arteriosclerosis, coronary heart disease. A.L. Myasnikov put forward the concept of the relationship between hypertension and atherosclerosis, which considers them as a single pathology.
The essence of hypertension was revealed as early as 1922 by the teacher A.L. Myasnikov - G.F. Lang /1875-1948/, who identified this disease as a separate nosological form. He considered the main in the development of hypertension to be functional changes in the cerebral cortex, reduced to disturbances in the relationship between the processes of inhibition and excitation. Soviet scientists not only elucidated the mechanism of cardiovascular diseases and proposed means of treatment and prevention, but also studied their clinic in detail. Therapists B.P. Obraztsov /1851-1920/ and N.D. Strazhesko (187b-1952) for the first time in the world, even before the use of electrocardiography, myocardial infarction was diagnosed on the basis of 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 prophylactic 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 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 applied an original method of injection of urinary tubules and blood vessels, due 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 urination 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 physician and botanist of the 18th century.
Developed a science-based system for training doctors, compiled training programs for hospital schools. Lectures, contrary to custom, were held in Russian, introduced the obligatory teaching of anatomy on corpses.
In the field of botany, he was one of the first Russian systematic florists.
Biography
Early years. Education
Shchepin was born in 1728 in the village of Molotnikovo near the town of Kotelnich in the 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 in the boiler house church.
Thanks to his abilities, Shchepin already stood out from his peers at school. The teachers, watching Shchepin's progress, advised him to continue his studies at the academy. After graduating from a rhetoric class, the 14-year-old Shchepin in 1742, on the advice of the Vyatka Bishop Varlaam (Skamnitsky), having overcome a huge distance, almost reached Kyiv on foot and entered the Kyiv Theological Academy. The term 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. For Shchepin, wide horizons opened up within the walls of the academy, he became one of the first pupils of the famous school. In 1743, in the fifth grade, his progress was rated with the highest mark of "exceeding". He perfectly mastered the Latin language, went ahead of other students, and therefore could safely expect to later take the honorary position of professor at this academy. But at that time in Kyiv there was only talk about the then famous V. G. Barsky, who had recently returned from abroad. His notes about life abroad were copied in many copies and read like hot cakes; his stories about the impressions he had endured and the miracles he had seen excited not only students, but also most of Kyiv society; it is quite clear that Shchepin was also fond of them and decided to go abroad at all costs. In 1748, having passed the philosophy class and refusing the theology class that was completing his education, Shchepin was sent to Italy at his request.
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 University of Padua and Bologna, then moved to Greece and in May 1751 ended up in Constantinople. Following the example of Barsky, 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, which record that Shchepin listened to lectures by many prominent scientists of that time.
At the Academy, Shchepin studied under the guidance of Stepan Petrovich Krasheninnikov, and after three months of hard work he was elevated from adjutant to translator. In the course of the joint work of Krasheninnikov and Shchepin, a strong and long friendship arose between them, interrupted only by the death of Krasheninnikov. Shchepin assisted Krasheninnikov in researching the flora of the Petersburg province :191 and after the academician's death 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 the University of Leiden. 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 asked the chief doctor and life physician 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 in Leiden was sent a decree on his transfer to the Medical Office to prepare for a professorship, and his business trip was continued: 200. Shchepin wrote to the Medical Office in detail about his stay in Leiden.
In Leiden, Shchepin entered the medical faculty of the local university, after 2 years he graduated from it and on May 9, 1758 he defended his doctoral dissertation on the topic "On vegetable 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 way of life of the peasants and soldiers of Russia, as well as the experience of traditional medicine. Physical labor, vegetable food containing acids, and kvass, prudent and rare consumption of meat - this, according to Shchepin, contributes to longevity. He attached particular importance to moderate nutrition and food containing vegetable acids. Of interest is the doctor's teaching on the prevention of scurvy and the treatment of patients with this disease. At that time, science did not have knowledge about vitamins and their physiological role. Shchepin noted that the peasants of Russia, eating sauerkraut, rye bread and infusion of needles in winter, do not get sick with scurvy. He believed that the plant acid contained in them prevented the disease. On this basis, he proposed a method for the treatment and prevention of scurvy. Shchepin was the first to point out the alleged acid contained in plants as an antiscorbutic factor. Shchepin was the first to discuss the problem of the preventive value of the diet.
In the same year he published an addendum to his dissertation entitled "Botanical remarks on certain plants". Among the plants mentioned in the last essay, 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, called him 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 Office, P. Z. Kondoidi, who set out to make a qualified doctor of medicine out of Shchepin, did not stop at the costs. He decided to send Shchepin to other countries to improve his medical knowledge. In the program given to him, the task was set not only to study medicine and surgery, but natural science in a broad sense - physics, chemistry. He had, among other things, to pay 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 learned nothing useful from his trip to England. Somewhat more fruitful was the journey to Paris, where he stayed for about seven months from October 1758 to May 1759. Shchepin listened to a course of lectures in Paris, underwent a course of surgical operations, studied anatomy and midwifery. On June 28, 1759, he left Amsterdam through Denmark (in Copenhagen he got acquainted with the royal cabinet of natural science) and Sweden (in Uppsala, by chance, he met Carl Linnaeus, who hospitably received him and gave him a parting book of his composition) to 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 at the earliest stages of human existence: “Medical activity is the same age as the first person,” wrote IP 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 still at a primitive level of development. Scientific data unequivocally testify that a person did not possess 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, fell ill and died early. Preserved from pre-historic. periods, the skeletons of people bear traces of rickets, dental caries, fused fractures, joint damage, etc. Some inf. diseases, eg. malaria, were "inherited" by man from his ancestors - great apes. Tibetan M. teaches that “the mouth is the gate of all diseases” and that “the first disease was stomach disease”.
From the observations and experience of thousands of years, passed down from generation to generation, rational healing was born. The fact that any accidental remedy or technique was 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 found methods of treatment and protection against diseases were fixed in the customs of primitive man and gradually made up 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 (extraction of foreign bodies, bloodletting), etc.
Primitive man did not know the natural causes of many of the phenomena he observed. So, illness and death seemed to him unexpected, due to the intervention of mysterious forces (witchcraft, the influence of spirits). Misunderstanding of the surrounding world, helplessness before the forces of nature forced to resort to spells, conspiracies and other magical techniques in order to establish contact with otherworldly forces and find salvation. Such “treatment” was carried out by healers, shamans, sorcerers, who by fasting, intoxication, dancing brought themselves to a state of ecstasy, as if transported into the world of spirits.
Ancient medicine inherited both magical forms of healing, and rational methods, 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 - caesarean section and operations for the destruction of the fetus (embryotomy), etc. An important place was given to the prevention of diseases (“pull out the disease before it touches you”), from which many hygienic prescriptions followed. nature, including the diet, family life, attitude towards pregnant women and nursing mothers, the prohibition of drinking intoxicating drinks, etc.
In the early stages of the slave system, medical practice emerged as an independent profession. The so-called so-called temple M.: priests performed medical functions (for example, in Egypt, Assyria, India). The medicine of Ancient Greece, which reached a high flourishing, was reflected in the cults of the deified physician Asclepius and his daughters: Hygieia - the guardian of health (hence hygiene) and Panakia - the patroness to lay down. affairs (hence the panacea).
The medical art of this period reached its peak in the activities of the great ancient Greek physician Hippocrates (460--377 BC), who turned observation at the patient's bedside into a proper medical research method, described the external signs of many diseases, pointed out the importance of lifestyle and the role of the environment, primarily climate, in the origin of diseases, and by the doctrine of the main types of physique and temperament in people, he 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 not based 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 to which supposedly lead to illness. .
The first attempt to establish the relationship between the structure and functions of the human. The 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 M.: he summarized information on anatomy, physiology, pathology, therapy, obstetrics, hygiene, pharmacology, in each of these honey. branches introduced a lot of new things and tried to build a scientific system of medicine.
1.1 History of Medicine: The 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 the naive and speculative ideas of Galen (Galen believed that blood is formed in the liver, carried throughout the body and completely absorbed there, that the heart serves to form a “vital pneuma” in it that maintains body heat; he explained the processes occurring in the body by the action of special intangible "forces": the forces of pulsation, thanks to which the arteries pulsate, etc.) have turned into 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 medicines, when the opening of a corpse and the study of its anatomy were recognized as a mortal sin, and an attack on authorities was considered as heresy, Galen's method,. inquisitive researcher and experimenter, was forgotten; only the “system” invented by him remained as the final “scientific” basis of M., and the “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 demands of the time, special institutions for the treatment of the sick and wounded, the 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 appearance of quarantines in Europe; monastery-tsy and infirmaries were opened. Even earlier (7th century), large hospitals for the civilian population arose in the Byzantine Empire.
In the 9th-11th centuries. scientific medical center thoughts moved to the countries of the Arab Caliphate. We owe to Byzantine and Arab M. the preservation of the valuable heritage of M. of the Ancient World, which they enriched with a description of new symptoms, diseases, medicines. A native of Central Asia, a versatile scientist and thinker Ibn-Sina (Avicenna, 980--1037) played an important role in the development of medicine: his “Canon of Medicine” was an encyclopedic body of medical knowledge.
In the ancient Russian feudal state, folk medicine continued to develop along with monastic medicine.
1.2 Medicine in the XVI-XIXcentury
Slow but steady development of honey. knowledge begins in Western Europe in the 12-13 centuries. (which was reflected, for example, in the activities of the Salerno University). But only in the Renaissance, the Swiss-born physician Paracelsus came out with a strong criticism of Galenism and propaganda of the new M., based not on * authorities, but on experience and knowledge. Considering the cause of chronic diseases chemical disorder transformations at digestion and absorption, Paracelsus introduced in to lay down. practice various chem. substances and mineral waters.
At the same time, A. Vesalius, the founder of modern anatomy, rebelled against the authority of Galen; on the basis of the system-tych. Anatomy of corpses, he described the structure and functions of the human body. The transition from the scholastic to the mechanical and mathematical consideration of nature had a great influence on the development of M. Engl. doctor W. Garvey created the doctrine of blood circulation (1628), laying the so. foundations of modern physiology. W. Harvey's method was no longer only descriptive, but also experimental, using mathematical calculation. A vivid example of the influence of physics on medicine is the invention of magnifying instruments (microscope) and the development of microscopy.
In the field of practical M., the most important events of the 16th century. were the creation of ital. doctor J. Frakastoro teachings about contagious (contagious) diseases and the development of the first scientific foundations of surgery fr. doctor A. Pare. Till this time the surgery was the stepdaughter of European M. and hl was engaged in it. arr. barbers, who were looked down upon by qualified doctors. The growth of industrial production drew attention to the study of prof. diseases. At the turn of the 17th - 18th centuries. ital. the doctor B. Ramazzini (1633-1714) laid the foundation for the study of industrial pathology and occupational health. 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 physician D. Samoilovich on the plague, published in the second half of the 18th century, make it possible to consider him one of the founders of epidemiology.
Conditions for theoretical generalizations in the field of M. 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, and the beginning of the synthesis of organic. substances (1st half of the 19th century), the development of the doctrine of good nutrition, the study of chemical. processes in a living organism, which led to the emergence of biochemistry”, etc.
Clinical development. M. contributed to the development in the second half of the 18th - the first 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, applied in the 18th century. J. Morgagni, and then M. F. K. Bisha, R. Virchow, K. Rokitansky, N. I. Pirogov and many others, as well as the development of the cellular theory of the structure of organisms, gave rise to new disciplines - histology and pathological. 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 application of the experiment as a natural scientific method for understanding the laws of activity of a healthy and diseased organism. C. Bernard (1813-1878) in the middle of the 19th century. continued this line and pointed out the ways in which the experimental M. was successfully advancing a century later. By studying the effect of medicinal substances and poisons on the body, C. Bernard laid the foundations of experimental pharmacology and toxicology. In order to appreciate the significance of the development of the science of medicines, it is enough to recall what crude empiricism prevailed here at that time. Both in the 16th and 18th centuries. arsenal to treat means, regardless of what views the doctor adhered to, was limited to bloodletting, klisters, laxatives, emetics, and a few more, but quite effective drugs. About the supporter of endless bloodletting, the famous French. 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 first half of the 19th century. the works of E. O. Mukhin, I. E. Dyadkovsky, A. M. Filomafitsky and others laid down the theoretical. and experimental foundations for the development of physiological. directions in domestic medicine, but its special heyday falls on the 2nd half of the 19th and 20th centuries. The book of I. M. Sechenov “Reflexes of the brain” (1863) had a decisive influence on the formation of materialistic. views of doctors and physiologists. Most fully and consistently physiological. approach and ideas of nervism were used in clinical. medicine by S. P. Botkin, the founder of the scientific direction of domestic internal medicine, and A. A. Ostroumov. Along with them, the world fame of Russian therapy brought clinical. the school of G. A. Zakharyin, which perfected the method of questioning the patient. In turn, the views of S. P. Botkin had a profound influence on I. P. Pavlov, whose works in the physiology of digestion were awarded the Nobel Prize, and the doctrine of higher nervous activity he created determined the ways of solving many problems of 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 and others) and I. P. Pavlov developed the advanced principles of materialistic physiology in various biomedical disciplines.
In the middle and especially in the second half of the 19th century. from therapy (or internal M., edges initially covered all M., except for surgery and obstetrics) new scientific and practical branches branch off. For example, pediatrics, which existed before as a branch of practical medicine, is being formed 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 on the basis of 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. Kozhevnikov, S. S. Korsakov, V. M. Bekhterev 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 disease led the English. doctor E. Jenner to the discovery of an anti-smallpox vaccine (1796), the use of a cut made it possible to radically prevent this disease in the future by smallpox vaccination. In the 19th century the Viennese doctor I. Semmelweis (1818-1865) established that the cause of puerperal fever lies in the transfer of the contagious beginning with the instruments and hands of physicians, introduced disinfection and achieved a sharp reduction in the death rate of women in childbirth.
The work of L. Pasteur (1822-1895), who established the microbial nature of infectious diseases, marked the beginning of the “bacteriological era”. Based on his research, surgeon J. Lister (1827-1912) proposed an antiseptic method (see Antiseptics, asepsis) for treating wounds, the use of which made it possible to drastically reduce the number of complications in wounds and surgical interventions. German discoveries. 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 been developed in many countries, pathogens and carriers of various infectious diseases have been discovered. The fluid steam sterilization method developed by R. Koch was transferred from the laboratory to the surgical. clinic and contributed to the development of asepsis. The description by the domestic scientist D.I. Ivanovsky of the “mosaic disease of tobacco” (1892) marked the beginning of virology. The shadow side of the general enthusiasm for the successes of bacteriology was an undoubted overestimation of the role of the pathogenic microbe as the cause of human diseases. The transition to the study of the role of the organism itself in inf. is connected with the activity of II Mechnikov. process and finding out the reasons for the emergence of immunity to the disease - immunity. Most of the prominent microbiologists and epidemiologists of Russia in the late 19th - early 20th century. (D. K. Zabolotny, N. F. Gamaleya, L. A. Tarasovich, G. N. Gabrichevsky, A. M. Bezredka and others) worked together with I. I. Mechnikov. German scientists E. Behring and P. Erlich developed a chemical. the theory of immunity and laid the foundations of serology - the doctrine of the properties of blood serum (see Immunity, Serum).
Advances in natural science determined the application of experimental research methods in the field of hygiene, the organization in the second half of the 19th century. hygienic departments and laboratories. The works of M. Pettenkofer (1818-1901) in Germany, A.P. Dobroslavin and F.F. Erisman in Russia developed a scientific basis for hygiene.
The industrial revolution, the growth of cities, the bourgeois revolutions of the late 18th century - the first half of the 19th century. led to the development of social M.'s problems and development of public hygiene. In the middle and second half of the 19th century. materials began to accumulate, testifying to the dependence of the health of workers on working and living conditions.
1.3 The development of medicine in the XX 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 the natural sciences and technical. 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, Russian physiologist A.F. Samoilov and others.
A huge role in technical The revolution that seriously changed the face of mathematics in the second 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 the diseased heart, the function of the bladder. Electron microscopy has made it possible to magnify tens of thousands of times, which makes it possible to study the smallest details of the 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.
The 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 flights to space. 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 the clinical practice included new chemical. and fiz.-chem. research methods, deepened understanding of chemical. the foundations of vital, 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 Medico-genetic consultation).
Immunology 20th century has outgrown the framework of the classical doctrine of immunity to inf. diseases and gradually covered the problems of pathology, genetics, embryology, transplantation, oncology, etc. The discovery by K. Landsteiner and Ya. Jansky of human blood groups (1900-1907) led to the use in practice. M. blood transfusion. In close connection with the study of immunological processes there was a research of various forms of the perverted reaction of an organism to alien substances begun by discovery fr. scientists Zh. Richet (1902) the phenomena of anaphylaxis. Austrian pediatrician K. Pirke introduced the term allergy and suggested (1907) allergic. skin reaction to tuberculin as diagnostic. tuberculosis test. In the 2nd half of the 20th century. the doctrine of allergies - allergology - has grown into an independent section of the theoretical. and clinical the 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 act on pathogens; they laid the foundations of chemotherapy. The era of antimicrobic chemotherapy practically began after introduction to lay down. streptocide practice. Since 1938, dozens of sulfa drugs have been created that have saved the lives of millions of patients. Even earlier, in 1929, in England, A. Fleming found that one of the types of mold secretes an antibacterial substance - penicillin. In 1939-1941. X. Flory and E. Chain developed a method for obtaining resistant penicillin, learned how to concentrate it and set up the production of the drug on an industrial scale, marking the beginning of a new era in the fight against microorganisms - the era of antibiotics. In 1942, in the laboratory of 3. V. Ermolyeva, a domestic penicillin. In 1943, streptomycin was obtained by S. Waksman in the USA. Subsequently, many antibiotics with a different spectrum of antimicrobial activity were isolated.
Successfully developed emerged in the 20th century. the doctrine of vitamins, open Rus. scientists 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-Se-car and others. the doctrine of the endocrine glands has become an independent honey. discipline - endocrinology, the circle of problems, which, along with endocrine diseases, includes hormonal regulation of functions in a healthy and diseased organism, the chemical synthesis of hormones. The discovery of insulin in 1921 by Canadian physiologists Banting and Best revolutionized the treatment of diabetes. The isolation in 1936 from the adrenal glands of a hormonal substance, which was later called cortisone, as well as the synthesis (1954) of a more effective prednisolone and other synthetic analogues of corticosteroids led to the therapeutic use of these drugs in 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 the general adaptation syndrome.
Chemotherapy, hormone 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, in the depths of the brain and on other organs of the human body that were not previously accessible to the scalpel of the surgeon, changed the face of M., allowed the doctor to actively intervene during 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, above all, two passages from Plato's dialogues Protagora and Phaedra. In the first of them, the story is told from the perspective of Socrates, who conveys his conversation with the young man Hippocrates (this name - literally translated “horse tamer” - was quite common at that time, especially among the horsemen). According to this passage, in the time of Plato, who was about 32 years younger than Hippocrates, the latter was widely known and Plato puts him along with such famous sculptors as Polikleitos and Phidias.
Of even greater interest is the mention of Hippocrates in Plato's dialogue Phaedrus. There, Hippocrates is spoken of as a physician 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, not only praise and surprise fell to the share of the famous doctor: he experienced both criticism, which reached complete denial, and slander. A sharp opponent of the Hippocratic approach to diseases was the famous physician of the methodical school Asklepiad (1st century BC), who, among other things, said a sharp word about the "Epidemics": Hippocrates, they say, shows well how people die, but does not show how to cure them. Of the doctors of the 4th century, younger contemporaries of Hippocrates, some mention his name in connection with criticism of his views. Galen, in his commentary on the book of Hippocrates "On the Joints", writes: "Hippocrates was reproached for the way the hip joint was set, indicating that it falls out again ...".
Another testimony with a direct mention of the name of Hippocrates belongs to Diocles, a famous physician of the middle of the 4th century, who was even called the second Hippocrates. Criticizing one of the aphorisms of Hippocrates, where it is argued that diseases corresponding to the season are less dangerous, Diocles exclaims: “What are you talking about, Hippocrates! Fever, which, due to the qualities of matter, is accompanied by heat, unbearable thirst, insomnia, and all that occurs in summer, will be more easily tolerated due to the season, when all sufferings are aggravated, than in winter, when the force of movements is moderated, the sharpness decreases and the whole disease becomes softer."
Thus, from the testimony of writers of the 4th century, closest in time to Hippocrates, one can be sure that he really existed, was a famous doctor, teacher of medicine, writer; that his writings are distinguished by a broad dialectical approach to man and that some of his purely medical positions were already criticized even then.
It remains to consider what materials for a biography can be extracted from the writings 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 is the correspondence of Hippocrates, speeches of him and his son Thessalus, 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 completely false and not trustworthy.
First of all, it should be noted that the name of the author is not presented in any of the books of the Hippocratic Collection, and it is very difficult to determine what was written by Hippocrates himself, whether by his relatives or by outside doctors. However, it is possible to single out several books that bear the stamp of the personality of Hippocrates, as they are used 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 doctor of the periodoist, 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 a public doctor for several years. In Epidemics 1 and 3, which are recognized by the vast majority as genuine, 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 for 3, and maybe 4 years. Among the case histories attached 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 periodist. 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 the historical criticism of the 19th century deprived them of all confidence, recognizing them as false and composed, like most other letters that have come down to us from the ancient world, for example, Plato. German philologists suggest that the letters and speeches were composed in the rhetorical school of the island 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 proved by some anachronisms, historical inconsistencies, and in general the whole 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 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 cited, for example, in Thessalus' speech, 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 regarding persons, places and dates that give credibility to the story could hardly be just 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 an ambassador from his native city of Kos, and, listing the merits that his ancestors and he himself had rendered to the Athenians and the citywide cause, tried to avert the impending war and the destruction of Spit. From this speech, we learn that the ancestors of Hippocrates, according to the father of Asclepias, according to the mother, were Heracleides, i.e. the descendants of Hercules, as a result of which they were related to the Macedonian court and the Thessalian feudal lords, which makes it quite understandable that Hippocrates, his sons and grandsons were in these countries.
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 planted 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 coloring of the era that after several centuries it is difficult to invent. The main place is occupied by correspondence about Democritus and with Democritus himself.
Such are biographical materials of a heterogeneous nature, depicting the life and personality of Hippocrates; this is how it seemed to the ancient world and passed into history.
He lived in the era of the cultural heyday 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 a perfect master of the art of medicine, but also be a doctor-philosopher and a doctor-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 it can be seen that there were many such doctors, since many doctors wrote in the Ionian dialect at that time, and it is completely incomprehensible why history put Hippocrates in the first place, consigning the rest to oblivion.
If for contemporaries Hippocrates was, first of all, a healer, then for posterity he is a doctor-writer, "the father of medicine." That Hippocrates was not the "father of medicine" hardly needs to be proven. And whoever seems certain that all the "works of Hippocrates" were really written by himself, he can assert with a certain right that the true paths of medicine were laid by him, especially since the writings of his predecessors have not come down to us. But in reality, the “works of Hippocrates” are a conglomerate of works by various authors, various trends, and it is only difficult to single out the true Hippocrates from them. Selecting the “genuine Hippocrates” from the many books is a very difficult task and can be solved only with a greater or lesser degree of probability. Hippocrates entered the medical field when Greek medicine had already reached a significant development; he introduced into it, as the head of the Kos school, a great revolution, and can rightfully be called a reformer of medicine, but his significance does not extend beyond. To find out this meaning, it is necessary to dwell a little on the development of Greek medicine.
Its beginnings are lost in antiquity and are associated with the medicine of the ancient cultures of the East - Babylonian and Egyptian. The laws of the Babylonian king Hammurabi (about 2 thousand years BC) contain paragraphs relating to doctors performing eye operations, with the definition of a large fee and, at the same time, great responsibility for an unsuccessful outcome. Bronze eye tools have been found during excavations in Mesopotamia. The famous Egyptian papyrus Ebers (mid-twentieth century BC) gives a huge number of prescriptions for various diseases and the rules for examining the patient. The specialization of Egyptian physicians dates back to time immemorial, 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 physicians who bandaged wounds and treated for other ailments; they were respected, because "an experienced doctor is more precious than many other people" (Iliad, XI). basis was free from theurgy, i.e. invocations of gods, spells, magic tricks, 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 the unfortunate patients flocked, hoping for healing - a phenomenon common to all countries and eras. Cases of healing were recorded on special tables that were hung out in temples, and in addition, patients brought offerings to the temple - images of the affected parts of the body, found in many during excavations, these records in temples used to attach great importance to the education of doctors; they allegedly formed the basis of the "Kos forecasts", and from there, according to the testimony of the geographer Strabo, Hippocrates also drew his medical wisdom.
In the fifth century, by the time of Hippocrates, in Greece there were doctors of various categories: military doctors, specialists in the treatment of wounds, as mentioned in the book: “On the Doctor”, court doctors - life doctors who existed at the court of kings: Persian, or Macedonian.
Doctors are public in most democratic republics, and, finally, periodeutic doctors who were connected by certain places: they moved from city to city, practicing at their own peril and risk, but sometimes 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 distinctions, as evidenced by the inscriptions found during excavations.
Where did all these doctors come from? The Hippocratic Collection provides complete information on this issue: along with doctors - healers and charlatans, late learned doctors, real doctors are people who have received education from a young age in the depths 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. famous schools existed in Greece: Crotonian (southern Italy), Cyrenian in Africa, Knidos in Asia Minor in the Asia Minor city of Knidos, Rhodes on the island of Rados, and Kos. The Hippocratic Collection reflects the schools of Cnidus, Cossus and Italian. Cyrene and Rhodes schools disappeared early, leaving no noticeable trace.
The venerable school of Cnidus, continuing the tradition of the Babylonian and Egyptian physicians, singled out complexes of painful symptoms and described them as separate diseases.
In this regard, the Cnidian doctors achieved great results: according to Galen, they distinguished 7 types of diseases of the bile, 12 of the bladder, 3 of consumption, 4 of kidney diseases, etc.; they also developed methods of physical research (listening). The therapy was very varied, with many complex prescriptions, face-to-face dietary advice, and extensive use of local remedies such as moxibustion. In a word, they developed particular pathology and therapy in connection with medical diagnosis. They have done a lot in the field of women's diseases.
But also in relation to pathophysiology and pathogenesis, the Cnidian school deserves the merit of a distinct formulation of humoral pathology in the form of a doctrine of 4 basic 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 data on the activities of his ancestors of doctors, and his numerous descendants, apparently, only followed in his footsteps. Hippocrates, first of all, acts as a critic of the Knidos school: its desire to crush 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 should be strictly individualizing in nature: everything must be taken into account, weighed and discussed, - then only appointments can be made. If the Cnidian school, in search of places of disease, can be characterized as a school of private pathology, catching painful local processes, the Kosian school laid the foundations of clinical medicine, at the center of which is an attentive and careful attitude to the patient. The foregoing defines the role of Hippocrates as a representative of the Kos school - in the development of medicine: he was not the "father of medicine", but he can rightly 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 Koska school and its main representative Hippocrates in the history of healing and medical life.
It should be added that surgery played an important role in the activities of Hippocrates: wounds, fractures, dislocations, as evidenced by his surgical writings, perhaps the best of all, where, along with rational methods of reduction, mechanical methods and machines are widely used, the latest achievements of that time.
Another specialty of Hippocrates and, apparently, of the entire Kos school, was acute febrile illnesses 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 Cossian school made an attempt to bring these acute and epidemic diseases into the general course of natural phenomena, to present them as the result of location, water, winds, precipitation, i.e. climatic conditions, to connect 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 appreciate the doctor Hippocrates.
It remains to say a few words about the Italian and Sicilian schools. What was their practical activity, no information has been preserved about this: their doctors are known more as medical theorists. The Italian school has gone down in history as a school of theoretical speculative constructions, as an anticipation of the future, but in its historical significance it can in no way be placed along with the purely medical schools, Knides and Kos.
3. Hippocratic collection
The total number of books in the Collection is defined differently. Depending on whether some books are considered independent or continuations of others; Littre, for example, has 53 works in 72 books, Ermerins 67 books, Diels 72. Several books appear to have been lost; others are routinely planted. They arrange these books in editions, translations and histories of medicine in the most varied order - in general, following two principles: either according to their origin, i.e. supposed authorship - such, for example, is the location of Littre in his edition and Fuchs in the History of Greek Medicine - or by 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 Polomei in the newly founded city of Alexandria, which was destined to be a cultural center for a long time after the fall of Greek independence. This library consisted of scholars: librarians, grammarians, critics who evaluated the merits and authenticity of works and entered them into catalogs. Scientists from different countries came to this library to study certain works, and many centuries later, Galen considered the lists of the works of Hippocrates stored in it.
Herophilus of Alexandria, a famous doctor in his time, who lived about 300 BC, compiled the first commentary on Hippocrates' Prognostics; his disciple Bakhiy from Tanagra continued the work of his teacher - this proves that in the III 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 (II century AD). To the latter we owe the main information about them, since their writings have not come down to us. Apparently, these comments were of a grammatical nature, i.e. explained words and phrases, the meaning of which was unclear or lost by that time. Then these comments were related to one or more books. Galen points out that only two commentators completely covered all the writings of Hippocrates, these are Zeukis and Heraclid theranus (the latter is himself a famous doctor), both belonging to the school of empiricists. From the whole mass, the commentary of Apollo of Kittius, an Alexandrian surgeon (I century BC), on the book On the Adjustment of the Joints. This commentary was supplied with drawings in the manuscript.
Galen, who, according to generally accepted opinion, gave a synthesis of all ancient medicine, a great practitioner and at the same time an anatomist theorist, an experimental physiologist and, moreover, a philosopher, whose name has passed through the centuries along with the name of Hippocrates, paid much 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 come down to us in full, in parts of 2 books, 4 have not survived. Hippocrates"; the books “On Anatomy” by Hippocrates, about his dialect and (which can be more regretted) about his original writings, did not reach.
Galen, who was a great erudite and read most of the ancient commentators, pronounces a devastating sentence on them, mainly because they, neglecting the medical point of view, focused on grammatical explanations: they pretend to understand mysterious passages that no one understands, and that concerns the 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 in medicine, and this forces them not to explain the text, but to adjust it to a fictitious explanation.
