History of medicine. Development of medicine in the Russian Empire in the mid-19th - early 20th centuries Medical discoveries of the 19th century

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A characteristic feature of the development of medicine in Russia in the first half of the 19th century. - construction of large hospitals, often with charitable funds, as well as the emergence of specialized medical institutions and clinics. Thus, in Moscow in 1802, the Golitsyn Hospital began to operate. The opening of the Mariinsky Hospital (St. Petersburg) dates back to 1806 for the treatment of the poor population, where in 1819 an eye department was organized.

An exemplary medical institution in Moscow was the Hospice House of Count N.P. Sheremetev (1810). His hospital became the clinical base of the Moscow branch of the Medical-Surgical Academy. At the beginning of the century, construction of the 1st City and Novo-Ekaterininskaya hospitals began with city funds. In 1834, the first children's hospital in Russia was opened in St. Petersburg. The emergence of specialized children's medical institutions contributed to the separation of pediatrics into an independent medical discipline.

Two medical science centers

At the beginning of the century, two main centers of medical science and the formation of medical personnel emerged in Russia - the St. Petersburg Medical-Surgical Academy and Faculty of Medicine of Moscow University.

At the Medical-Surgical Academy, such areas as surgery, anatomy, and topographic anatomy were developed. Within its walls the first Russian anatomical school was formed, the creator of which was P.A. Zagorsky (1764-1846), and the first Russian surgical school I.F. Bush (1771-1843).

Professors at Moscow University dealt primarily with issues of general pathology, therapy, and physiology.

The most prominent representatives of Russian medical science of the first half of the 19th century. were professors at the Faculty of Medicine of Moscow University M.Ya. Mudrov(1776-1831) and professor of the department of anatomy, physiology, forensic medicine E.O. Mukhin (1766-1850).

As a result of the establishment of medical faculties at universities in Dorpat (1802), Vilna (1803), Kazan (1804), Kharkov (1805), Kyiv (1841), the network of higher educational medical institutions significantly expanded.

Played a particularly important role in the development of medical education Medical-Surgical Academy in St. Petersburg, which from the very beginning of its existence became a school for training highly qualified personnel. The academy's students stood out among other doctors for their better training, especially in surgery.

In 1808, the Moscow Medical and Surgical Academy was opened. By the time it merged in 1845 with the medical faculty of Moscow University, it had graduated more than 2 thousand doctors and hundreds of pharmacists.

In 1802-1803 in Russia there were 1,625 doctors with 1,893 full-time positions. About half of the doctors worked in the military and naval departments.

An important role for the development of Russian clinical medicine of the 19th century was played by the development of anatomy as a basis for clinical theory and practice and the formation of topographic anatomy as a basis for clinical anatomy. The main problems of surgery in the first half of the 19th century were: non-use of antiseptics, surgeons’ ignorance of anatomy, and non-use of anesthesia. All this taken together paved the way for the successful activities of N.I. Pirogov.

In 1843–1844 Pirogov used the method of freezing corpses and making fine cuts of their parts and organs, which preserve the topography of the organs of a living person. Pirogov improved the methods of teaching and researching anatomy, introduced the principles of layer-by-layer preparation in the study of arteries and fascia, and various anatomical areas. With this, N.I. Pirogov radically changed the idea of ​​surgical anatomy; he was an experimental surgeon: he performed many surgical operations, such as anesthesia, cutting the Achilles tendon, and others, with extensive use of experiment.

During the Crimean War, N.I. Pirogov went to the front, where he collected a lot of unique material, which formed the basis of another classic work by Pirogov, “The Beginnings of General Military Field Surgery, Taken from Observations of Military Hospital Practice and Memoirs” (1865 -1866).

Nikolai Ivanovich Pirogov, being a first-class surgeon, was an excellent organizer and innovator in the field of medicine and healthcare.

The founder of the first domestic surgical school was I.F. Bush, a surgeon from St. Petersburg and the author of the first original Russian textbook on surgery.

If we turn to Western Europe, then even in the first half of the 19th century. surgery bore the imprint of medieval traditions, as if the craft training of surgeons. Many who were considered surgeons did not know anatomy. Now let's look at the connection between anatomy and surgery in Russia. Already at the end of the 18th and first half of the 19th centuries. Surgery in Russia developed in close connection with anatomy. The separation of surgery and anatomy occurred in the middle of the 19th century.

Surgical interventions during this period of development of medical science in Russia were not very common. They were limited to the external parts and limbs of the human body. Various departments were created in hospitals: along with departments for internal diseases, these were therapeutic departments; departments for external diseases were created, for patients with surgical diseases.

One of the first doctors who laid the foundations of pediatrics was Stepan Fomich Khotovitsky. Khotovitsky was the first to give a full course of lectures on childhood diseases. In 1847, a fundamental work was published, which became the first manual on pediatrics in Russia and was called “Pediatrics”.

The first half of the 19th century gave the world the greatest galaxy of medical scientists who influenced the entire development of further medical science in Russia.

For most European countries, the 19th century was the period of the establishment and flourishing of capitalism, the period of industrial capitalism, the “zenith of capitalism.” In the last third of the 19th century, a number of countries entered the last stage of capitalism - imperialism. The 19th century for Western European countries was characterized by rapid industrial growth: old, pre-existing industries expanded, and new industries emerged. Industry developed rapidly, and steam and electricity were widely used. The technical basis of production required increasing mastery of the natural resources and forces of nature, the study of the laws of nature and their use in the service of developing industry.

Many facts of the development of natural science and medicine in the 19th century clearly reflected the demands of the ruling class of capitalist society, often even a direct order of the bourgeoisie. On the other hand, the working class, growing under capitalism, through its struggle for economic demands to improve working and living conditions (working hours, wages, medical care, etc.), forced 19th-century medicine to take them into account. Born under the pressure of the proletariat, a new form of organizing medical care - social insurance - prompted doctors to reconsider a number of settings, and, in addition to medical issues, the influence of the labor movement was reflected in the development of hygienic disciplines.

During the period of capitalism, the bourgeoisie showed a dual nature of its attitude towards science and technology. Even in the ascending period of the history of capitalism, the bourgeoisie acted as the bearer of scientific and technological progress insofar as without this progress it was impossible to enrich itself and increase the exploitation of the working masses. The bourgeois is interested in the development of science because it can increase the production of surplus value. The thirst for profit is the driving motive of bourgeois society and its “civilization,” based on private property and oppression of the people. In an antagonistic society, the achievements of science and technology serve primarily to enrich the propertied classes. Capitalists were very willing to use science when it served their purposes of increasing profits. They resorted to it with great reluctance and belatedness in order to apply it for the benefit of society, such as for the purposes of health and education. The capitalists categorically refused to use science when it came to studying and perhaps changing the system from which they drew their wealth."

The bourgeoisie, which was in a period of growth in the 19th century, was interested in the progress of natural science, the development of productive forces and supported materialism in natural science, but these phenomena manifested themselves differently in different European countries. During the preparation for the French Revolution at the end of the 18th century, the bourgeoisie of France supported materialism. In Prussia, Austria and Russia in the first half of the 19th century, feudal orders still reigned; Many French nobles fled there from the revolution. In 1815, at the Congress of Vienna, the Holy Alliance was created, which aimed to fight the French bourgeoisie in politics and materialism in ideology. The bearers of reactionary ideology at that time were the remnants of feudal lords, nobles, and aristocrats, and therefore the idealistic reaction of that time is called the “aristocratic reaction.” From the middle of the 19th century, after the revolutionary uprisings of the workers in 1848, especially after the Paris Commune (1871), the bourgeoisie ceased to support materialist philosophy and switched to reactionary philosophy. At first, reactionary philosophy had little impact on natural science. In the last decade of the 19th century, during the era of imperialism, the philosophical reaction also affected natural science. The bourgeoisie began to support religion even in natural science. In the 20th century, naturalists also began to support religion.

The 19th century was very rich in the field of medicine: during it new methods were created and many great discoveries were made. The development of medicine in the 19th century clearly reflected the connections of medicine with the natural sciences and technology, with social phenomena, the dual and changing nature of the attitude towards science and materialist philosophy on the part of the ruling class of capitalist society - the bourgeoisie, which by that time had come to political power in the main countries of Western Europe.

The influence of these numerous factors was reflected in the activities and views of a number of major representatives of medicine of the capitalist period and determined the associated duality of their views, inconsistency and internal discord among some of them. Many famous scientists - naturalists and doctors - reflected the ideological attitudes of the bourgeoisie in their views and showed ambivalence. Many scientists were major figures in their scientific specialty, creators of actual achievements and discoveries. At the same time, in their worldview, in their theoretical generalizations, they either nominally abandoned philosophy, were weak philosophers, inconsistent materialists, dualists, eclectics, or switched to outright idealism. Misunderstanding by prominent biologists and physiologists of the 19th century of life as a special new form of movement of matter with properties and patterns inherent only in the organic form of matter (in which the patterns of mechanics, physics, chemistry remain in a living, “removed” form, not as leading, defining patterns, but as secondary ones) forms of movement) led natural scientists, when trying to theoretically generalize their major and important experimental discoveries, to the dead end of mechanism, agnosticism and vitalism.

Percussion and auscultation. Clinical medicine at the end of the 18th century and especially in the 19th century began to use new discoveries in the natural sciences, increasingly relying on data from anatomy and especially pathological anatomy, followed by the gradual development of experimental physiology.

Viennese physician Leopold Auenbrugger (1722-1809) discovered and developed the percussion method. In 1761, he published an essay in Latin, “A New Method for Discovering Diseases Hidden within the Chest Cavity by Percussing a Person’s Chest.” In his small book, Auenbrugger wrote: “I propose... a new method I have found for detecting breast diseases. It consists of tapping breasts - Leopold Auenbrugger (1722-1809). “th box of a person, which, due to the changed sound of tones, gives an idea of ​​​​its internal state. I described all this on the basis of tappings that I repeated many times, which invariably testified to the correctness of my conclusions: there is no vanity and desire to rise in this work of mine.” Results Auenbrugger tested his research on corpses, and his main principles have retained their significance to this day.

Like many major discoveries, percussion has experienced a changing fate. Auenbrugger's work did not attract widespread attention, and only a few recognized the value of the new proposal and began to apply it. In Russia, the operator and teacher of surgery at the St. Petersburg military land hospital, Ya. A. Sapolovich, used tapping to determine chest diseases in the last years of the 18th century. For example, using this method, he was the first in Russia to identify effusion in the pleural cavity and perform paracentesis. Most prominent doctors of the late 18th century greeted Auenbrugger's proposal with disdain and ridicule. The doctors of Vienna declared Auenbrugger crazy and persecuted him. Percussion was consigned to oblivion, and only many years after the publication of Auenbrugger’s book, during the era of the French bourgeois revolution, in the conditions of advanced France for that time, the doctor Jean-Nicole Corvisart (1755-1821), having become acquainted with Auenbrugger’s work and spending 20 years of testing studies of percussion, in 1808 he published a French translation of Auenbrugger’s work, accompanying it with case histories that complemented the conclusions of this author. In 1818, Corvisart added an article on percussion to his essay on heart disease. In this way he contributed to the introduction of percussion as a diagnostic method.

The next important step in the development of clinical medicine - the discovery of auscultation - is the merit of the French doctor Rene

Laennec (1781-1826), pathologist, clinician and teacher at the Medical School in Paris. Laennec sought, like Morgagni, to connect autopsy data with changes observed during the patient’s life, in order to more accurately recognize diseases in this way.

The idea of ​​listening to the heart and lungs of Laennec was prompted by the study of the works of Hippocrates, namely the place where Hippocrates described listening to the chest during empyema. At first, Laennec listened by directly placing his ear on the patient's chest, later he moved on to listening with a stethoscope. The use of a stethoscope allowed Laennec to hear the sounds of the heart much more clearly and distinctly than by directly applying his ear to the heart area. “I then thought,” wrote Laennec, “that this method could represent a useful method of research, applied not only to the study of the heartbeat, but also all those movements that can produce sound phenomena in the chest cavity, and therefore to the study of breathing, voice, wheezing, movement of fluid accumulated in the pleura or peritoneum.” Guided by such thoughts, Laennec developed his new research method for 3 years with rare observation and patience, examined patients, studied the slightest phenomena that he detected with a stethoscope!, performed autopsies, compared their data with clinical phenomena and improved the method of auscultation.

Laennec characterized not only the physical data obtained during the study of patients, but also described in detail the pathological picture in a number of diseases: bronchiectasis, emphysema, pleurisy, pneumothorax, pulmonary infarction, pulmonary tuberculosis. Laennec was the first to coin the term tuberculosis. The names of Laennec and Bayle are associated with the first isolation of lung cancer from the group of tuberculous lung lesions.

In 1819, Laennec published an essay “On mediocre auscultation or recognition of diseases of the lungs and heart, based mainly on this new method of research,” in which he developed a new method and created diagnostics, clinical and anatomical pathology of the respiratory system. He thought about the close connection between pathological anatomy and the clinic.

When listening, Laennec attached great importance to the stethoscope and, comparing auscultation with the ear with auscultation with a stethoscope, gave preference to the latter. To achieve a stethoscope design that would best suit the purposes of auscultation, Laennec conducted a series of experiments. The most suitable material for a stethoscope turned out to be different types of light wood and reeds. Laennec described hearing breathing, voice, coughing, wheezing, and a metallic sound. He captured a variety of sound phenomena that occur during the standing of the respiratory organs, determined the meaning of each of them, and gave an explanation to almost everyone based on clinical observations or autopsies. Having no predecessors, Laennec achieved high perfection in the development of auscultation on his own. In the next three quarters of the 19th century, only pleural friction noise and the division of moist rales into voiced and voiceless were added to the auscultatory phenomena that Laennec studied. Laennec's semiotics of heart disease failed; he could not understand either the conditions of origin of heart sounds or the conditions of development of cardiac and arterial murmurs. Many issues related to cardiac auscultation required the work of a number of researchers for their study and were clarified only in the second half of the 19th century.

The methods of percussion and auscultation after Corvisart and Laennec did not immediately gain general recognition and widespread use. However, advanced Russian doctors soon mastered these new methods and applied their value to the treatment of diseases of the circulatory and respiratory organs.

St. Petersburg professor F. Houdin, in his “Academic Readings on Chronic Diseases,” the first original general textbook on internal medicine in Russian, described percussion. P. A. Tchaikovsky, returning from Paris in 1822, began to use percussion and auscultation at the Medical-Surgical Academy and described them in his book “General Pathological Semiotics” (1825), and in 1828 he devoted a special work to the issue of the stethoscope . In the last years of his life, M. Ya. Mudrov also changed auscultation. G.I. Sokolsky in 1835 published a special work “On the Study of Hearing Diseases” and in 1838 in the essay “The Study of Chest Diseases” he presented the results of these research methods that he widely used.

In 1820-1824. V. Herbers cue and his students used percussion and auscultation among the methods they taught to students. The introduction and further promotion of percussion and auscultation methods was facilitated by the Czech clinician Skoda, who worked in Vienna, but in Western Europe they slowly entered medical practice. N.I. Pirogov wrote when he was in 1833-1836. in France, doctors already used percussion and auscultation, but in Germany, even in the best clinics, no one used these methods when examining patients.

In 1838 in Berlin [...], and in Vienna, Skoda was ridiculed and subjected to sarcastic blows for auscultation and percussion by many professors, doctors and students. Having seen this abroad, young Russian doctors fully appreciated the merit of their teacher [...], who in 1836 at the St. Petersburg Medical-Surgical Academy publicly taught them the technical techniques of objective diagnosis. Only by the 60s of the 19th century did percussion and auscultation become widespread in Germany.

Application of experiment in physiology. At the turn of the 18th-19th centuries, there was a rapid development of natural science. Research in mathematics, physics, chemistry and biology led to a restructuring of the foundations of scientific medicine. The enormous successes of the natural sciences determined the development of medical science for decades to come. “...The physical and natural sciences, apparently, have acquired leading importance everywhere,” wrote Kabanis, “...only by bringing all other sciences and arts closer and closer to them, can we count on the fact that the latter will also , finally, illuminated in some way by an equal light.” “Everything in the present state of medicine heralds its approach to a great revolution. The rapid improvements which have taken place... in many branches of the natural sciences foretell to us what must and will happen in medicine." The application of physics, chemistry and biology to the analysis of medical problems, the use of their methods at the bedside, in the hospital, and in the teaching of medicine, increased the level of knowledge of the doctor, facilitated the recognition of the disease, its treatment and prevention. The development of technical applications of the natural sciences and the creation of synthetic chemistry expanded the medical arsenal of the doctor. The progress of the natural sciences has created new, much deeper foundations for theoretical generalizations in the field of medicine.

The French physician C. Bichat (1771 -1802) developed Morgagni’s position and in the first half of the 19th century, through his works, contributed to the further development of pathological anatomy and comparative anatomy. Bisha sought not only to find out the localization of painful phenomena in individual parts of the body and organs, but also traced their manifestation deeper, down to individual tissues. Bisha localized the disease process not in the organ, but in the pathologically altered tissue. He understood the disease as a process of a mainly local nature. Bisha emphasized the importance of his anatomical research for the clinic. “If the structure of the organs is the same, then they have the same function, the same diseases, the same outcome of diseases and the same treatment.” The factual material collected in Bisha's works, the doctrine he created about body tissues and the application of experiment had a great influence on the development of medicine.

In the 19th century, especially in the second half, experiments on animals became widespread in medicine when solving problems of physiology and pathology. Earlier, in the 17th and 18th centuries, the use of the experiment was sporadic. Physiologists have developed a method of acute physiological experiment. In the 19th century, physiology approached clinical issues and served as the foundation for the development of experimental medicine in the mid-19th century. The 19th century was a time of widespread use of experimentation in pathology, pharmacology and microbiology. At the same time, the pathoanatomical direction was developing, which, penetrating the clinic, in turn influenced the development of clinical medicine. The new method of physiological experiment and cellular science formed the basis for the development of theoretical and clinical medicine in the 19th century. In the second half of the century, this was joined by the influence of biological chemistry and microbiology.

Physiologists during the 17th and 18th centuries experimented a lot on the central nervous system. But the methodology of these experiments invariably remained primitive and was reduced to vigorous mechanical interventions.

G. Prochazka in his essay “On the Structure of Nerves” raised the question of the functional significance of the morphological difference between the anterior and posterior roots of the spinal nerves and pointed out the analogy between the minor and major roots of the trigeminal nerve, on the one hand, and between the anterior and posterior spinal roots, on the one hand another. Later, the English surgeon and physiologist Charles Bell (1774-1842) initiated an experimental study of the distribution of sensory and motor fibers between the anterior and posterior roots of the spinal nerves. Experimental proof of the different conductivity of the spinal nerve roots, carried out at the beginning of the 19th century by Bell and the French physiologist Magendie, was one of the key points not only in the physiology of the nervous system, but also in all experimental physiology as the basis of modern medicine. In his experimental work, Bell abandoned the primitive methodology characteristic of the previous period of experimental science and the resulting idea of ​​the relative “ease” of experimenting on the brain. In a freshly killed animal, Bell exposed the spinal cord and, by mechanical stimulation of the spinal nerves, established that irritation of the dorsal roots did not produce any visible motor effect, but irritation of the anterior roots caused convulsive contraction of the corresponding muscles. The results of the experiment allowed Bell to talk about the different functions of the anterior and posterior roots and the motor function inherent in the anterior roots.

The further development of the experimental direction in physiology in the first half of the 19th century was facilitated by Francois Magendie (1783-1855), who studied many phenomena. Magendie considered experience to be the only source of flour knowledge. In 1836-1842. Magendie published his main works devoted to the study of the physical phenomena of life, function and diseases of the nervous system and its physiological and clinical studies. Magendie confirmed the above discovery of Charles Bell and experimentally proved that the anterior roots of the spinal cord are motor, and the dorsal roots are sensitive, receptor. Magendie understood the scientific task of physiologists as a reform of medical science on the basis of physics and chemistry through the widespread addition of the experimental method. In accordance with this, Magendie gave a mechanical explanation of life processes based on the laws of physics and chemistry alone. For example, he explained the essence of blood circulation based only on the laws of hydraulics. Magendie called his physiology course “Lectures on the physical manifestations of life*.” Being a good operator, Magendie developed and improved the technique of vivisection (experiments on animals). Magendie fought against all theories, believing that “theories are nothing more than words.” He diligently avoided introducing theoretical generalizations in the presentation of his observations and experiments and believed that the facts, when simply compared, explain themselves.

Magendie’s decisive denial of everything that goes beyond the limits of experience in the process of scientific knowledge is especially expressed in the phrase attributed to him: “When I experiment, I have only eyes and Johann Muller (1801-1858). I have ears and no brain at all.

Fact, and mainly fact, discovered experimentally, was for Magendie the entire content of scientific knowledge.

The German naturalist, the son of a shoemaker, Johann Muller (1801 -1858), who had extensive knowledge in various branches of the natural sciences, left a major mark in the development of comparative, normal and pathological physiology. Müller trained a number of scientists; his students were Lieberkühn, Schwann, Ludwig, Virchow, Dubois-Reymond, Helmholtz. As a result of his numerous studies, Müller made many special discoveries in biology, anatomy and physiology. He studied the structure and functions of the organs of vision, hearing, sound and speech in humans and animals, traced the development of the nervous system in various animals, and established certain stages of development of the genitourinary system. Müller studied blood, gave a correct idea of ​​blood cells, noted the colorlessness of blood in some invertebrates, and analyzed the composition of blood, lymph, and chyle. Müller's attention was drawn to the structure of the glands; he noted that it is generally similar in different glands. Müller was one of the first to develop physiological chemistry (chemistry of lymph, blood, etc.). In his physiological research, he proceeded from vitalistic views and took an idealistic position.

Müller studied the physiology of the sense organs and put forward the “law of specific energy of the sense organs.” The main provisions of the “law” boil down to the following: there are no sensations produced by external causes, there are only sensations in the state of our nerves caused by external causes. The same internal or external cause causes different sensations in different sense organs, according to the nature of each organ, namely, what a certain sensory nerve is capable of feeling. Sensation of the sense organs is not the transmission of the quality or state of external objects to consciousness, but the transmission to consciousness of the quality and state of the sensory nerve caused by external causes. These qualities, different in different sensory nerves, are the energy of the sense organs.

I. Muller did not understand the dependence of the body's reactions on the external environment. According to I. Muller, the qualitative features of the body's reactions are determined not by the properties of the stimuli, but by the specific features of the reacting systems themselves. Environmental stimuli, according to Muller, provide only reasons for already predetermined reactions. Each sense organ has its own “specific energy”. The specific energy of organs or tissues, representing the qualitative side of the response, was thought by Müller as a certain initial and permanent property. The concept of the idea of ​​development is alien to the “Law of Specific Energy”. According to I. Muller, the specificity of the response is not the result of historical differentiation of tissues in connection with the adaptation of the organism to the environment, but the result of the action of vital force. Muller's philosophical generalizations were influenced by the epistemology and agnosticism of the idealist philosopher Kant. Müller's provisions were widely used by reactionary idealistic philosophy. Müller's idealistic concept dominated the second half of the 19th century. Müller's view led directly to agnosticism. Müller's students - Helmholtz, Dubois-Reymond - continued to develop these Kantian ideas.

V. I. Lenin in his work “Materialism and Empirio-Criticism” revealed the deep reactionary content of Muller’s theoretical positions and wrote: “In 1866, L. Feuerbach attacked Johann Muller, the famous founder of modern physiology, and ranked him among the physiological idealists.” The idealism of this physiologist consisted in the fact that, exploring the significance of the mechanism of our sense organs in their relation to sensations, pointing out, for example, that the sensation of light is obtained through various types of influence on the eye, he was inclined to derive from this the denial that our sensations are images of objective reality This tendency of one school of naturalists towards “physiological idealism, that is, to an idealistic interpretation of the known results of physiology, L. Feuerbach captured extremely accurately.” The connection between physiology and philosophical idealism, mainly of the Kantian kind, was then exploited for a long time by reactionary philosophy. Müller, its idealistic foundations and agnosticism were in the 19th century one of the sources that fed idealistic philosophy with natural scientific data.

In the development of physiology in Russia in the first half of the 19th century, A. M. Filomafitsky (1807-1849), who was the founder of experimental physiology in Russia, played a major role. After graduating from the medical faculty of Kharkov University, the professorial institute in Dorpat (Tartu) (1828-1832) and traveling abroad, A. M. Filomafitsky taught physiology at Moscow University from 1836. He highly valued the experimental method and wrote: “If we want to get a concept of life, then there is only one path before us - the path of experience and observation. There are two ways of knowledge - the path of speculation and the path of experience. The first is taken by natural philosophers who are carried away by the play of imagination and invent explanations for phenomena. This path dulls healthy criticism, which requires verification by experience.” A. M. Filomafitsky considers the main method of studying life phenomena to be experimental.

In A. M. Filomafitsky we find deep optimism and faith in the future of genuine experimental science. He pointed out: “It may be that those living are not yet destined to achieve the final goal in this field, but we do not know where the limit of our knowledge is and how far our desire can lead us in exploring the mystery of life, and therefore we should never stop on the path of experience and observations, but always move forward.”

A. M. Filomafitsky conducted experiments on animals when teaching physiology, and used them in his scientific research. He emphasized the guiding importance of physiology for a doctor: “For a long time medicine would have been covered in the darkness of ignorance if physiology... had not shed its light on various areas of medical science.”

A. M. Filomafitsky published the textbook “Physiology for the guidance of his listeners” in three volumes (1836). The book was written in a living language without the use of foreign or Latinized Russian words, which were replete with the scientific literature of that time. In his textbook, A. M. Filomafitsky critically assessed various theories, rejected the unscientific conclusions of many “indestructible” authorities and substantiated his positions with his own observations and experiments. In the textbook, A. M. Filomafitsky presented the results of his experimental work and challenged the opinion of many authoritative physiologists, including the famous Muller.

In 1848, A. M. Filomafitsky published “A Treatise on Blood Transfusion (as the only means in many cases to save a dying life),” which summarized the results of his many years of research. A. M. Filomafitsky conducted many blood transfusion experiments on dogs, built his own apparatus and solved the questions: from which animal can blood be taken to save another, what kind of blood should be transfused (arterial or venous), what precautions are needed when transfusing blood. A. M. Filomafitsky has priority in the issue of physiological and chemical transformations in body tissues as a source of animal heat; he carried out original work on the study of the physiology of respiration and the nervous system. Together with surgeons F.I. Inozemtsev and N.I. Pirogov, A.M. Filomafitsky played a major role in the study and substantiation of the physiological effect of anesthesia, which was just entering surgical practice.

Introduction of anesthesia. The expansion of surgical interventions was facilitated by improvements in the methods of pain relief and control of wound infection in the 19th century. Anesthesia during surgical operations has been known in medicine for a long time and was used either in the form of various mechanical techniques or in the form of intoxicants, mainly of plant origin. Of the mechanical methods of pain relief, a more durable, although limited, place was occupied by the method of temporary compression of nerve trunks, proposed in 1784 by the English surgeon Moore. Chemical methods of pain relief played a significantly important role in the history of surgery. In the medical monuments of the slave period (India, Babylon, Greece) there are numerous indications that doctors used substances of plant origin (Indian hemp juice, extracts from mandrake root, opium) for pain relief. Mandrake has remained the mainstay of pain relief during surgery for centuries; For the same purpose, the patient was given alcoholic drinks before the operation. These techniques did not provide good pain relief. In the 17th and 18th centuries, the only painkillers (“painkillers” in the language of that time) in surgery and therapy were the internal use of opium, intoxication with vodka and partly hashish. In 1839, the French surgeon Velpeau wrote: “To avoid pain during surgical operations is a chimerical desire, the satisfaction of which is now impermissible to strive for. A cutting instrument and pain in operative surgery are two concepts that cannot be presented to patients separately from one another.”

The English chemist Humphrey Devy in 1800 described the phenomena of intoxication and convulsive laughter “that occur when inhaling nitrous oxide, calling nitrous oxide laughing gas. Devy established the analgesic effect of nitrous oxide and ether and suggested the possibility of using nitrous oxide and ether for anesthesia during surgical operations, but for a long time his proposals remained unused.It was only in 1844 that nitrous oxide was used as an anesthetic in dental practice (Wales).

Ether as an anesthetic was first used in dental practice. Ether anesthesia was used by the American doctor Jackson and the dentist Morton. On the advice of Jackson, Morton, on October 16, 1846, first used inhalation of ether vapor for anesthesia during tooth extraction. Having obtained favorable results when removing teeth under ether anesthesia, Morton suggested that Boston surgeon John Warren try ether anesthesia for major operations. Warren removed a neck tumor under ether anesthesia, Warren's assistant amputated the mammary gland. In October - November 1846, Warren and his assistants performed a number of major operations under ether anesthesia: resection of the lower jaw, amputation of the hip. In all these cases, inhalation of ether provided complete anesthesia.

Within 2 years, ether anesthesia entered the practice of surgeons in different countries. One of the first countries where surgeons began to widely use ether anesthesia was Russia. Leading Russian surgeons of that time (in Moscow F.I. Inozemtsev, in St. Petersburg N.I. Pirogov) in 1847 began to provide anesthesia during operations. In the same 1847, N.I. Pirogov was the first in the world to use ether anesthesia when providing assistance to the wounded on the battlefield during the battles near Salt (Dagestan). “Russia, having gone ahead of Europe,” wrote N. I. Pirogov, “shows to the entire enlightened world not only the possibility in application, but the undeniable beneficial effect of treatment of the wounded on the battlefield itself.”

Foreign surgeons limited themselves to the empirical use of ether anesthesia. In France, for example, in pursuit of profit, doctors began to widely use anesthesia at home for patients, without taking into account the general condition of the patient, as a result of which in some cases anesthesia caused complications and death of the patient. Domestic scientists led by A. M. Filomafitsky and N. I. Pirogov scientifically studied the effect of narcotic drugs.

At the suggestion of A. M. Filomafitsky, a commission was established, which, through experiments on animals and observations in humans, clarified the main issues relating to the use of ether anesthesia.

In 1847, the French physiologist Fleurance drew attention to chloroform, discovered by Soubeyrand in 1830. Taking advantage of Fleurance's instructions, the English surgeon and obstetrician Simpsoi conducted experiments with chloroform and proved its superiority as an anesthetic agent over sulfuric ether.

Based on his experiments, A. M. Filomafitsky wrote the work “Physiological view on the use of ethers, chloroform and gasoline to dull sensitivity”; it established contraindications, dosage and other conditions for the use of ether and chloroform. Concluding this work (published after his death), A. M. Filomafitsky wrote: “Every doctor can now safely use anesthesia to dull pain and thereby fulfill his main task - to alleviate the suffering of the patient.” Somewhat earlier, in 1847, in a journal article “On the use of ether vapor in Moscow,” A. M. Filomafitsky sharply condemned the French physiologist Magendie, who at a meeting of the Paris Medical Academy spoke out against the use of ether, called this remedy immoral and even irreligious, believing , that by rendering insensible by the action of ethereal vapors, we take away the patient’s self-awareness and free will and “thereby subject him to our arbitrariness.” In this dispute between two physiologists, which broke out during their meeting with a new phenomenon for their time - ether anesthesia, we see a vivid example of the opposition of a rational, materialistic attitude to ether anesthesia in Russia in the person of A. M. Filomafitsky and N. I. Pirogov, who began experimental study of a new factor, and the mystical, idealistic, full of religious prejudices attitude towards it of such a prominent physiologist as Magendie.

Engels was unfamiliar with the works of M.V. Lomonosov, who published them starting in the 40s of the 18th century. In them he destroyed the metaphysical view of matter and motion. The first of these works (“Elements of Mathematical Chemistry”) was written by M. V. Lomonosov in 1741, i.e. 14 years before Kant published the cosmogonic hypothesis. The works of M. V. Lomonosov dealt a serious blow to the metaphysical view of nature and revealed the universal connection of natural phenomena.

Modern M. has developed as a result of a long historical process; M.'s state has always been determined by the degree of development of society, the socio-economic system, the achievements of natural science and technology, and the general level of culture. This article primarily examines the development of mathematics as a complex of scientific disciplines; about medical practice and healthcare organization, see also the article and others.

Main branches of medicine

Medicine, as a complex of scientific disciplines, consists of three groups: the so-called biomedical disciplines; clinical disciplines; medical, social and hygienic disciplines.

The group of clinical disciplines that study human diseases, their treatment and prevention is particularly large and ramified; it includes therapy) (so-called internal diseases), the sections of which are cardiology, rheumatology, pulmonology, nephrology, gastroenterology, hematology, clinical endocrinology, geriatrics); phthisiology; pediatrics; neuropathology; psychiatry; dermatology and; balneology, physiotherapy and exercise therapy; medical radiology and medical radiology; dentistry; obstetrics and gynecology; surgery; traumatology and orthopedics; anesthesiology and resuscitation; neurosurgery; oncology; urology; otorhinolaryngology; ophthalmology and others. The criteria for identifying independent clinical disciplines are heterogeneous: the predominant localization of the diseases being studied in one organ or one organ system (for example, neuropathology, ophthalmology); age (for example, pediatrics) and gender (obstetrics and gynecology) characteristics of the patient; characteristics of the causative agent of the disease and the nature of the pathological process (for example, phthisiology), diagnostic and therapeutic methods (for example, radiology, surgery, physiotherapy). Each of the clinical disciplines includes sections on methods of examining the patient and signs of diseases - semiotics, which becomes the basis of machine diagnostic methods.

The group of medical, social and hygienic disciplines that study the impact of the external environment on the body and measures to improve the health of the population includes social hygiene and healthcare organization; general hygiene, hygiene of families and adolescents, communal hygiene, radiation hygiene, occupational hygiene; epidemiology and medical geography; This group includes medical deontology and so on.

History of medicine

The emergence of medicine and its development until the 16th century

The rudiments of healing and hygienic knowledge were born from observations and experience at the earliest stages of human existence and were entrenched in the customs and techniques of treatment and protection from diseases, which also constituted hygiene. A significant role among preventive and therapeutic measures was played by the use of the forces of nature (water), empirically found medicines of plant and animal origin.

Initially, diseases were viewed as a living being external and hostile to humans, penetrating the body and causing a painful state. Helplessness in the face of the forces of nature and lack of understanding of the world around us led to the emergence of ideas about evil spirits possessing a person, and the use of a number of magical means and treatment methods (spells, incantations, prayers, etc.), which contained the rudiments of psychotherapy. Shamanism developed; priestly, temple M. arose.

Written monuments of the Ancient East (ancient Egyptian medical papyri; Hammurabi laws; Manu laws and Ayurveda in India and others) indicate that in ancient states the conditions for the activities of doctors were regulated by law, up to the size of fees for treatment and the establishment of various degrees of liability for causing damage to the patient.

Doctors and priests, along with mystical, magical forms of healing, used rational healing techniques and healing remedies of traditional medicine. Great importance was attached to dietetics, hygiene regulations, massage, water procedures, and gymnastics. Surgical methods were used: craniotomy, in cases of difficult childbirth - cesarean section and embryotomy, and so on. Ancient Chinese medicine used more than 2,000 medicines, among which ginseng, mercury, rhubarb root, camphor, and others occupied a special place. A unique method of acupuncture dates back several thousand years.

Extensive information about the medicine of the peoples who lived in the 1st millennium BC. e. on the territory of Central Asia, Iran, Azerbaijan and Afghanistan, contains “Avesta” (9th century BC - 3rd century AD) - the holy book of Zoroastrianism. During that period, the first ideas about human anatomy and physiology were formed. An important place was given to the prevention of diseases (“Pull out the disease before it touches you”), from which many hygienic instructions followed, including about family life, about relationships, about the prohibition of drinking, and more.

The medicine of Ancient Greece used the information accumulated by the ancient Eastern peoples. The tendency towards differentiation of knowledge was reflected in the cults of the deified physician Asclepius and his daughters: Hygieia, the guardian of health (hence hygiene) and Panacia, the patroness of medicine (hence Panacea). Treatment was carried out in temple “asclepeions” and home hospitals. The training of doctors took place according to the type of apprenticeship. There were doctors at home (for the nobility) and traveling doctors (serving merchants and artisans). There were also so-called community doctors to provide free treatment to poor citizens and take measures against it.

Earlier than others, the Crotonian medical school was formed, whose representative Alcmaeon of Croton (late 6th - early 5th centuries BC) developed a doctrine of the pathogenesis of diseases, based on the idea of ​​the body as a unity of opposites: health - harmony, - disharmony of the body and its inherent properties . The principle of treatment in this school - “the opposite cures the opposite” - formed the basis for the therapeutic views of subsequent medical schools. The doctrine of pathogenesis was further developed in the Cnidus school (1st half of the 5th century BC), which developed one of the variants of the humoral (from the Latin humor - liquid) doctrine, according to which the essence of diseases lies in the disorder of the correct mixing of body fluids under the influence one or another external reason.

Various variants of humoral teaching emerged in the medicine of the states of the Ancient East, but it was most clearly formulated by Hippocrates, who determined the direction of development of medicine for many centuries. Hippocrates isolated medicine as a science from natural philosophy, turned observation at the patient’s bedside into his own medical method of research, and pointed out the importance of lifestyle and the role of the external environment in the etiology of diseases, the doctrine of the main types of physique and temperament in people substantiated an individual approach to the diagnosis and treatment of the patient.

A successful attempt to lay the foundation for the science of the structure and functions of the human body was made in the 3rd century BC. e. Alexandrian doctors Herophilus, and then Erasistratus, who provided the first experimental evidence that the brain is an organ of thinking, established differences between sensory and motor nerves, described the membranes, convolutions and ventricles of the brain, and so on.

The physician of Pergamon and Ancient Rome, Claudius Galen, a native of Asia Minor, had an exceptional influence on the development of medicine. In the 2nd century AD e. he summarized information on anatomy, physiology, pathology, pharmacology and pharmacognosy (galenic preparations), therapy, obstetrics, hygiene; M. introduced a lot of new things into each of these branches and tried to build a scientific system of medical art. Galen was the first to introduce the vivisection experiment on animals into medicine with the goal of systematically studying the connections between the structure and functions of the organs and systems of the human body. He showed that knowledge of anatomy and physiology is the scientific basis for diagnosis, therapeutic and surgical treatment and hygienic measures. The teleological orientation of Galen's writings contributed to the fact that his legacy in a transformed form (“Galenism”) received the support of the church and dominated the literature of the West and East for many centuries.

Elements of sanitation and public hygiene, which were available in all states of the Ancient World, reached a high level in Rome, as evidenced by the remains of water supply, sewerage and baths. In Rome, for the first time, sanitary and military medical organizations arose, as well as a special service of city doctors, and there was sanitary legislation.

In the Byzantine Empire, large hospitals for the civilian population arose during this period. Devastating epidemics and wars led to the creation in Europe of monastic hospitals and infirmaries.

In the ancient Russian feudal state, along with monastic medicine, folk medicine continued to develop. Common medical books contained a number of rational instructions on the treatment of diseases and household hygiene, and herbalists (zelniki) - descriptions of medicinal plants. Among the folk healers there was a specialization: “bone setters”, “full-time” and “keel” (for hernia) doctors, “stone cutters”, “kamchuny” (for the treatment of aches and pains), “renal” (for), “chepuchin” (for) healers, midwives, grandmothers - healers of children and others.

Doctors of the East played a major role in the development of medicine: al-Razi (known in Europe under the name Rhazes); Ibn Sina (Avicenna) - author of the “Canon of Medical Science”, an encyclopedic body of medical knowledge, and Ismail Djurdzhani (12th century), who reflected the achievements of Khorezm M.; Armenian doctor Mkhitar Heratsi and others. The medical faculties of universities that arose in Europe in the 11th - 12th centuries could not contribute to rapid medical progress, since they were dominated by scholasticism, the influence of which was less felt in the universities of Salerno, Padua, Bologna (Italy), Krakow, Prague and Montpellier ( France). The Spanish physician Arnaldo de Vilanova (13th - 14th centuries) and many others fought against scholasticism and for experimental knowledge.

Medicine in the 16th - 19th centuries

During the Renaissance, the Swiss-born physician Paracelsus tried to rethink the past, criticized Galenism and humoral pathology, and promoted experimental knowledge. While studying alchemy, he laid the foundation for a major trend in medicine - iatrochemistry. Considering the cause of chronic diseases to be a disorder of chemical transformations and absorption, Paracelsus introduced various chemicals and mineral waters into medical practice. His most prominent follower was Jan Baptist van Helmont, who described the processes of fermentation in gastric digestion.

The founder of modern anatomy, Andreas Vesalius (16th century), rebelled against the authority of Galen and, based on the systematic anatomy of corpses, described the structure and functions of the human body. Mathematics was greatly influenced by the development and promotion of the experimental method of research by the materialist philosopher Francis Bacon and the development of mechanics. William Harvey described it in 1628 and thereby laid the foundation for a new branch of human knowledge - physiology. Santorio Santorio, using the scales he built, studied metabolism in the human body, developed the doctrine of solidary pathology (from the Latin solidus - dense), according to which a painful condition is a consequence of a violation of the movement of the smallest particles of the body; together with Giovanni Alfonso Borelli and Rene Descartes, he laid the foundation for the iatromechanical direction in mathematics (iatrophysics). A striking example of the influence of physics on medicine is the invention of magnifying devices (microscope) and the development of microscopy. Anthony van Leeuwenhoek described living microscopic creatures in 1676, marking the beginning of microbiology. Italian biologist and physician Marcello Malpighi discovered capillary blood circulation using a microscope.

In the field of practical medicine, the most important events of the 16th century were the creation of the doctrine of contagious (infectious) diseases (Girolamo Fracastoro) and the development of the fundamentals of surgery (Ambroise Paré).

In the 18th century, the descriptive period of the development of medicine moved into its final stage - primary systematization. Numerous medical “systems” arose that tried to explain the cause of diseases and indicate the principle of their treatment. The German doctor G. Stahl put forward the doctrine of animism (from the Latin anima - soul), according to which the painful process is a series of movements performed by the soul to remove substances that have penetrated into it and are harmful from the body; his compatriot F. Hoffmann argued that life lies in movement, and mechanics is the cause and law of all phenomena. French doctors T. Bordeaux and P. Barthez came up with the doctrine of “vital force” (vitalism). Luigi Galvani and Alessandro Volta explored "animal electricity" and electric shock treatment; F. A. Mesmer, familiar with these works, created the doctrine of “animal magnetism” (mesmerism). The system of homeopathy was founded by the German physician Samuel Hahnemann. The Scotsman W. Cullen developed the theory of “nervous pathology”, based on the recognition of the dominant role of the “nervous principle” in the life of the body; his student, the English doctor J. Brown, built a metaphysical system that recognized disturbances in the state of excitability as the main factor in the occurrence of diseases, from which the task of treatment followed - to reduce or increase excitement. The French scientist and physician Francois Joseph Victor Brousseau created a system of “physiological medicine” that connects the origin of diseases with excess or lack of stomach irritation and uses it as the main therapeutic method.

Supporters of speculative metaphysical systems based on the absolutization of any discovery or principle were opposed by representatives of experimental knowledge. Distrust of “systems” was manifested in the call of the English physician, one of the founders of clinical medicine, Thomas Sydenham, and the Italian physician G.B. Montano to study diseases through their careful observation. The method of observation at the patient's bedside formed the basis for the clinical and pedagogical activities of Herman Boerhaave, Christoph Wilhelm Hufeland, Semyon Gerasimovich Zybelin, Matvey Yakovlevich Mudrov and many others. Physician-philosophers of the 17th - 18th centuries Hendrik De Roy, Julien Offrede La Mettrie, Pierre Jean Georges Cabanis, and later followers of Mikhail Vasilyevich Lomonosov - F. G. Politkovsky, K. I. Shchepin, Justin Evdokimovich Dyadkovsky and others used the achievements of natural science to criticize speculative systems and substantiate materialistic ideas about the body and disease.

The growth of industrial production has attracted attention to the study of occupational diseases. At the turn of the 17th - 18th centuries, the Italian physician and founder of occupational hygiene Bernardino Ramazzini initiated the study of industrial pathology and occupational hygiene. In the 2nd half of the 18th - 1st half of the 19th centuries, John Pringle and James Lind in England, D.P. Sinopeus, A.G. Bacherakht in Russia laid the foundations of military and naval hygiene (military hygiene). J. Graunt and W. Petty (England) developed statistical methods for studying social science. An in-depth analysis of the causes of high morbidity and mortality, problems of protecting public health was given in their works by M. V. Lomonosov and S. G. Zybelin. The Austrian doctor Johann Peter Frank, who worked in Russia for several years, the Hungarian doctor Z. G. Husti and others developed the concept of “medical police,” which was the first attempt to systematize and regulate the rules of state sanitary supervision, public and personal hygiene. Numerous medical-topographic descriptions and sanitary-statistical studies conducted at the end of the 18th - first half of the 19th centuries in Russia, Germany, England and other countries established the dependence of the health of various population groups on working and living conditions.

The development of clinical medicine in the 2nd half of the 18th - 19th centuries was facilitated by the development of new methods for objective examination of the patient: percussion (Leopold Auenbrugger; Jean Nicolas Corvisart; Ya. O. Sapolovich, Russia, and others), auscultation (Rene Théophile Hyacinthe Laennec, Joseph Skoda and others), palpation, endoscopy, laboratory diagnostics. The method of comparing clinical observations with the results of post-mortem autopsies, applied by Giovanni Battista Morgagni, Marie François Xavier Bichat, M. Bailey (Great Britain), Rudolf Virchow, Karl Rokitansky, I. Skoda, Nikolai Ivanovich Pirogov, Alexei Ivanovich Polunin and many others, gave birth to new disciplines - pathological anatomy and histology, which made it possible to establish the localization and material substrate of many diseases.

The use of the experimental research method in many countries to study normal and impaired body functions had an exceptional impact on the development of medicine. Thus, the Czech I. Prohaska, Efrem Osipovich Mukhin, and the English physiologist M. Hall studied the body’s reactions to the influence of pathogens and gave the most complete descriptions of reflex acts; Scottish anatomist, physiologist and surgeon Charles Bell and French physiologist Francois Magendie experimentally proved that the anterior roots of the spinal cord are centrifugal, motor, and the posterior roots are centripetal, sensitive, etc. The English surgeon John Hunter is considered the founder of experimental pathology. The combination of pathoanatomical and experimental research methods, the deep development of human anatomy and physiology contributed to the creation of the natural science anatomical and physiological foundations of surgery.

The conditions for theoretical generalizations in the field of metabolism were created by the progress of physics, chemistry and biology at the turn of the 18th and 19th centuries: the discovery of the role of oxygen in combustion and respiration, the law of conservation and transformation of energy, the beginning of the synthesis of organic substances (1st half of the 19th century), which was a blow to vitalism, the development of the doctrine of completeness by the German chemist Justus Liebig, the study of chemical processes in a living organism, which led to the development of biochemistry, etc.

The largest discovery of the 19th century was the development of the cellular theory of the structure of organisms (Jan Evangelista Purkynė, Matthias Jacob Schleiden, Theodor Schwann and others), which allowed R. Virchow to create the theory of cellular pathology, according to which disease is a purely local process, its essence is morphological changes in cellular elements; The most important task of medicine is to determine the place “where the disease sits.” This approach at one time played a positive role: the concept of disease began to be associated with certain changes in the structure of cells and organs, the doctrine of cell degeneration arose, and many forms (See Tumors) of other diseases were described. However, R. Virchow, and especially his students and followers, could not resist universalizing the patterns they discovered. The result was an understanding of the animal organism as a federation of “cellular states”; the entire human pathology was reduced to the pathology of the cell.

Many of R. Virchow’s contemporaries not only did not accept this theory, but criticized its basic principles and recognized anatomical-localistic thinking as limited at a time when it still seemed unshakable. Synthetic thinking, reflecting the complex connections between the organism and the environment, was facilitated by the successes of evolutionary theory (Darwinism). Recognition of the kinship between humans and animals has led doctors to increasingly use animal experiments to understand the patterns of human life in conditions of health and illness. In the mid-19th century, C. Bernard worked on the creation of experimental medicine, combining physiology, pathology, and therapy. With many studies of the effects of drugs, substances and on the body, C. Bernard laid the foundations of experimental pharmacology and toxicology.

German hygienists Max Rubner and K. Flügge laid the scientific foundations for the sanitary assessment of air, water, soil, housing and clothing. Hygienic food standards were given a physiological basis (Karl Voith, M. Rubner). Significant advances have been made in the field of occupational health and occupational pathology.

The industrial revolution, urban growth, and bourgeois revolutions of the late 18th and first half of the 19th centuries determined the development of social problems of medicine and the development of public hygiene. In the mid-19th century, materials accumulated that testified to the dependence of the health of workers, and especially the developing working class, on working and living conditions; attempts were made to scientifically justify public health measures; The terms “social hygiene” and “social hygiene” were proposed. German doctors Z. Neumann, R. Virchow, and R. Leibusscher put forward the idea of ​​medicine as a social science. In Great Britain, representatives of public health and factory inspection (S. Smith, John Simon, E. Greenhow and others) conducted sanitary surveys of working conditions, living conditions, and nutrition of workers and substantiated the need for public health laws (1848, 1875 and others). Karl Marx and Friedrich Engels used sanitary survey materials to criticize capitalism and substantiate conclusions about the disastrous impact of capitalist exploitation on the health of the proletariat.

In Russia, social medicine was formed in the 2nd half of the 19th century. The main platform for the propaganda of her ideas were “Moscow Medical Newspaper”, “Modern Medicine”, “Archive of Forensic Medicine and Public Hygiene”, “Health”, “Doctor” and other Medical journals. A major role in its formation was played by the Society of Russian Doctors in memory of N.I. Pirogov, the Russian Society for the Preservation of Public Health, societies of doctors in St. Petersburg, Moscow, Kazan, Kharkov and other Medical Societies.

A unique phenomenon, the only example in history of organized medical care for the rural population under capitalist conditions, was Zemstvo medicine with its sanitary organization. Sanitary doctors Ivan Ivanovich Molleson, V. O. Portugalov, E. A. Osipov. P. I. Kurkin, M. S. Uvarov, Nikolai Ivanovich Tezyakov, Pyotr Filippovich Kudryavtsev, Andrei Ivanovich Shingarev and others conducted comprehensive sanitary and statistical studies of the health of peasants and agricultural workers. Similar studies among the factory population were carried out by F. F. Erisman, A. V. Pogozhev, Evstafiy Mikhailovich Dementiev, V. A. Levitsky, S. M. Bogoslovsky and others.

Russian public doctors collected material indicating the unhygienic living conditions of workers, high morbidity and mortality of the population. Their works were used by Vladimir Ilyich Lenin as serious indictments against autocracy and capitalist relations.

Development of medicine in the 20th century

At the turn of the 19th and 20th centuries, under the influence of rapidly developing natural sciences and technological progress, diagnostics and treatment were enriched and improved. The discovery of X-rays (by the German physicist Wilhelm Conrad Roentgen, in 1895 - 1897) marked the beginning of radiology. The capabilities of X-ray diagnostics have been expanded by the use of contrast agents, methods of layer-by-layer X-ray images (tomography), mass X-ray examinations (fluorography), methods based on the use of advances in radio electronics (X-ray television, X-ray cinematography, X-ray electrocymography, medical electroradiography, etc.).

The discovery of natural radioactivity and subsequent research in the field of nuclear physics led to the development of radiobiology, which studies the effects on living organisms. Russian pathophysiologist E. S. London used autoradiography (1904) and published the first monograph on radiobiology (1911). Further research led to the emergence of radiation hygiene, the use of radioactive isotopes for diagnostic and therapeutic purposes, which, in turn, made it possible to develop the method of labeled atoms; radium and radioactive drugs began to be successfully used for medicinal purposes.

A profound technical revolution took place in medicine at that time. The introduction of electronics was of great importance. Fundamentally new methods have emerged for recording the functions of organs and systems using various sensing, transmitting and recording devices (transmission of data on the work and other functions are carried out even over cosmic distances); controlled devices in the form of an artificial kidney, artificial heart and lungs perform the work of these organs, for example, during surgical operations; electrical stimulation makes it possible to control the rhythm of a diseased heart, cause emptying of the bladder, etc. Electron microscopy, combined with the technique of preparing sections up to 0.02 microns thick, made it possible to magnify tens of thousands of times. The use of electronics is accompanied by the development of quantitative methods that make it possible to accurately and objectively monitor the progress of a biological process.

Medical cybernetics is actively developing. The problem of programming differential signs of diseases and using computers to make a diagnosis has acquired particular importance. Automatic systems for regulation, breathing and level during operations, active controlled ones, etc. were created. Outstanding successes in physics, polymer chemistry, and the creation of new technology have a huge impact on medical science and practice.

An important result of technological progress is the emergence of new branches of medicine. Thus, with the development of aviation at the beginning of the 20th century, aviation aviation was born; its founders were: in Russia Nikolai Alekseevich Rynin, in France R. Molyneux, in Germany E. Koshel. Human flights on spaceships led to the emergence of space technology.

Chemistry and physical chemistry had a significant influence on the development of medicine. New chemical and physicochemical research methods were created and used, and the study of the chemical foundations of life processes advanced. At the beginning of the 20th century, I. K. Bang (Sweden) developed methods for determining various substances in small quantities of the substrate under study (serum, etc.), which expanded diagnostic capabilities.

As a result of studies aimed at deciphering the chemistry of pathological conditions, it was found that various diseases are caused by disturbances in certain processes of chemical transformations in the metabolic chain. After Linus Carl Pauling and others established that changes in structure lead to a certain disease - sickle cell anemia (1949), data were obtained according to which the molecular basis of diseases in some cases manifests itself in defective amino acid molecules. Studying the mechanisms of metabolism regulation at various levels has made it possible to create new treatment methods.

Genetics has had a great influence on medicine, establishing the laws and mechanisms of heredity and variability of organisms. The study of hereditary diseases led to the emergence of medical genetics. The successes of this scientific discipline have helped to understand the interaction of hereditary and environmental factors and to establish that environmental conditions can contribute to the development or suppression of a hereditary predisposition to disease. Methods for express diagnosis, prevention and treatment of a number of hereditary diseases were developed, and advisory assistance to the population was organized. Research in the field of genetics of microorganisms, including biochemical and molecular genetics, opens up new prospects for M.

Immunology of the 20th century outgrew the framework of the classical doctrine of immunity to and gradually embraced the problems of pathology, genetics, embryology, transplantation, oncology, etc. The fact established in 1898 - 1899 by I. I. Mechnikov’s collaborators J. Bordet and N. N. Chistovich was that the introduction of foreign erythrocytes and serum proteins stimulates the production of antibodies), marked the beginning of the development of non-infectious immunology. The subsequent study of pitotoxic antibodies became the basis for the formation of immunopathology, which studies many diseases, the nature of which is associated with disorders of immunological mechanisms. The discovery of the laws of isohemoagglutination by the Austrian immunologist Karl Landsteiner (1900 - 1901) and the Czech physician Jan Jansky (1907) led to the use in practical medicine and the formation of the doctrine of tissue isoantigens (see). The study of the laws of inheritance of antigens and other immunity factors has given rise to a new branch - immunogenetics. The study of embryogenesis showed the importance of immune phenomena in tissue differentiation.

In the 40s of the 20th century, it became clear that the process of rejection of foreign tissue during transplantation is explained by immunological mechanisms. In the 50s, immunological tolerance was discovered: organisms developing from embryos that were exposed to certain antigens, after birth, lose the ability to respond to them by producing antibodies and actively rejecting them. This has opened up prospects for overcoming immunological tissue incompatibility during tissue and organ transplantation. Tumor immunology emerged in the 1950s; Radiation immunology, immunohematology, methods of immunodiagnosis, immunoprophylaxis, and immunotherapy have been developed.

In close connection with the study of immunological processes, research took place on various forms of perverted reactions of the body to foreign substances. The discovery of the phenomenon of anaphylaxis by the French scientist J. Richet, the French bacteriologist M. Arthus and the Russian pathologist Gavriil Petrovich Sakharov of the phenomenon of serum anaphylaxis and anaphylactic shock (1903 - 1905), etc. laid the foundation for the doctrine of anaphylaxis. The Austrian pediatrician K. Pirke introduced the term “allergy” and proposed (1907) an allergic reaction to tuberculin as a diagnostic test for (pirke reaction). The general patterns of the evolution of allergic reactions were revealed by Nikolai Nikolaevich Sirotinin; Mikhail Aleksandrovich Skvortsov and others described their morphology.

At the beginning of the 20th century, P. Ehrlich proved the possibility of synthesizing, according to a given plan, drugs capable of affecting pathogens, and laid the foundations of chemotherapy. In 1928, English microbiologist Alexander Fleming discovered that one type of mold secretes an antibacterial substance - penicillin. In 1939 - 1940, pathologist Howard Walter Flory and biochemist Ernst Boris Chain developed a method for producing persistent penicillin, learned to concentrate it and established production of the drug on an industrial scale, laying the foundation for a new method of combating microorganisms - antibiotic therapy. IN THE USSR domestic penicillin was obtained in 1942 in the laboratory of Zinaida Vissarionovna Ermolieva; in the same year, G. F. Gause and others obtained a new antibiotic, gramicidin. In 1944 in the USA Z. Vaksman received streptomycin. Subsequently, many were identified that had a different spectrum of antimicrobial action.

The doctrine of (vitaminology), which arose in the 20th century, successfully developed; it was established that all of them are involved in the function of various enzyme systems, the pathogenesis of many vitamin deficiencies was deciphered and ways to prevent them were found. Created at the end of the 19th century by the French physiologist and neurologist Charles Edouard Brown-Séquard and others, the doctrine of the endocrine glands turned into an independent medical discipline - endocrinology. The discovery revolutionized treatment. The discovery of female sex hormones played an important role in the development of endocrinology and gynecology. The isolation of a hormonal substance from the adrenal glands in 1936, which was later named cortisone, and the synthesis (1954) of more effective prednisolone and others led to the therapeutic use of corticosteroids. Modern endocrinology is no longer limited to the study of the pathology of the endocrine glands; Her problems include issues of hormone therapy for non-endocrine diseases, and hormonal regulation of functions in a healthy and sick body. The development of endocrinology and hormone therapy was facilitated by the work of the Canadian pathologist Hans Selye, who put forward the theory of the general adaptation syndrome.

Chemotherapy, hormone therapy, the development and use of drugs that affect the central nervous system (psychopharmacology), and other effective treatment methods have changed the face of clinical M. and allowed the doctor to actively intervene in the course of the disease.

Among the disciplines that have emerged from the clinic of internal diseases, cardiology is of particular importance. Its formation was facilitated by the clinical and experimental direction of research (in domestic medicine - in the works of D. D. Pletnev and others). The rapid development of cardiology owes much to the work of J. Mackenzie (Great Britain), who published a classic work on (1908); A. Vaquez, the most prominent French cardiologist of the early 20th century; Paul Dudley White (USA) and many others. At the beginning of the 20th century, V. M. Kernig, Vasily Parmenovich Obraztsov and N. D. Strazhesko, and then J. B. Herrick (USA) gave a classic description of the clinic. Mikhail Vladimirovich Yanovsky, with his doctrine of the “peripheral (arterial) heart,” drew attention to the importance of the vascular part of the system. Pathophysiologist Semyon Sergeevich Khalatov and pathomorphologist Nikolai Nikolaevich Anichkov put forward a “cholesterol theory” of origin. Modern cardiology is a complex discipline: its problems are developed not only by therapists, but also by surgeons, physiologists, biochemists, etc.

Another example of the formation of a new complex discipline is hematology, which studies. Important stages in its development are associated with the development of new research methods, in particular bone marrow puncture (M. I. Arinkin, USSR, 1927), radioisotope methods (L. Laita, Great Britain, 1952) and others. The use of the method of cultivating hematopoietic tissue allowed the histologist Alexander Aleksandrovich Maksimov in the 20s to develop a unitary theory of hematopoiesis, according to which the ancestor of all forms of blood cells is a lymphocyte-like cell; this theory is confirmed in modern morphological studies of so-called stem cells. Major practical achievements of this branch of therapy are the method of treating so-called malignant anemia with raw liver (American hematologist William Parry Murphy and pathophysiologist and hematologist George Richards Minot, USA, 1926) and vitamin B12, as well as combined cytostatic therapy. Hematology is one of the clinical disciplines where the methods of natural sciences - mathematical, genetic and others - are most widely used.

Intensive development of surgery took place in various directions. The ever-increasing scale of wars led to the formation of military field surgery, the increase in injuries - the development of traumatology and orthopedics. The work of ophthalmologist and surgeon Vladimir Petrovich Filatov in the field of plastic surgery has received worldwide recognition. The works of neurosurgeon Harvey Williams Cushing, neurologist and neurosurgeon Wilder Graves Penfield, Andrei Lvovich Polenov, Nikolai Nilovich Burdenko and others contributed to the formation of neurosurgery. The development of surgical methods for treating diseases of the genitourinary system (in Russia by Sergei Petrovich Fedorov and others) led to the budding of urology.

In 1923 - 1930, Soviet surgeon Alexander Vasilyevich Vishnevsky developed a method of local anesthesia with novocaine. Anesthesia methods continued to be improved, making them more effective and safe; in the 2nd quarter of the 20th century, anesthesiology became an independent specialty. The improvement of pain relief methods was facilitated by the use of curare drugs, which relax muscles, the method of hypothermia, developed experimentally and then introduced into the clinic by A. Laborie and P. Hugenard (France, 1949 - 1954), etc.

Modern anesthesia and antibacterial therapy ensured the development of heart and lung surgery. The Soviet physiologist Sergei Sergeevich Bryukhonenko in 1925 designed an artificial circulation device, which was successfully used to bring experimental animals from a state of clinical death and during heart surgery in the experiment. Modern models of cardiopulmonary bypass machines (CAB) are used in operations on the so-called open heart of a person. The successes of cardiac surgery, the foundations of which were laid by H. Soutter, R. Brock (Great Britain), C. Bailey, D. Harken (USA) in the 2nd half of the 40s, led to the fact that the traditionally “therapeutic” group of congenital and rheumatic diseases began to be equally treated as surgical diseases. The development of cardiac surgery in the USSR is associated with the names of surgeons: Alexander Nikolaevich Bakulev, Pyotr Andreevich Kupriyanov, Boris Vasilyevich Petrovsky, Alexander Alexandrovich Vishnevsky, E. N. Meshalkin and others. Abdominal surgery continued to develop, the major representatives of which in the USSR were the following surgeons: Ivan Ivanovich Grekov, Sergei Ivanovich Spasokukotsky, Alexey Vasilievich Martynov, Sergei Sergeevich Yudin, Andrei Grigorievich Savinykh and many others.

At the beginning of the 20th century, oncology began to take shape, the founders of which in the USSR were Nikolai Nikolaevich Petrov and Pyotr Aleksandrovich Herzen. In 1903, the French scientist A. Borrell put forward the viral theory; in 1911, F. Rous discovered the chicken sarcoma virus in the USA; in 1945, Lev Aleksandrovich Zilber proposed a virogenetic theory, according to which a tumor virus acts as a transforming agent that hereditarily changes cells - this theory is gaining increasing recognition.

Microbiology developed rapidly. In 1921, microbiologist and hygienist Albert Calmette and C. Guerin proposed a vaccine. Subsequently, the method of specific prevention using vaccines and serums was crucial in the fight against, and some others. The scientific basis for the fight against infectious diseases was the research of D.K. Zabolotny, Vladimir Aaronovich Khavkin and others on the epidemiology of the plague, and the development of the doctrine of leptospirosis, rickettsiosis and much more. Thanks to the discovery of filterable viruses in 1892 by Dmitry Iosifovich Ivanovsky and subsequent research by Martin Beijerinck and others, virology took shape.

Medicine faces important tasks in studying the nature of diseases and malignant tumors, ways of their prevention and treatment; development of problems of molecular biology of viruses, chemotherapy and prevention, immunology and many others. It is of great importance to take into account the ever-increasing impact of environmental factors, scientific and technological progress on human health and ability to work, anticipate the consequences of these impacts and develop scientifically based measures to improve the health of the external environment.

The growing importance of medical science and healthcare as a branch of the national economy and an expanding sphere of human activity is also manifested in the field of international relations. An example of this is the agreements between the USSR and the USA, France and other countries (1971 - 1973) on issues of environmental protection, joint research on problems of cardiology, oncology and other topical issues. Soviet medical scientists participated in the activities of international scientific societies, associations, international medical journals, specialized UN organizations, especially. The development of scientific cooperation was facilitated by the holding of international medical congresses, conferences and symposia in the USSR. (Yu. P. Lisitsyn, Yu. A. Shilinis, A. D. Ado, P. E. Zabludovsky. Under the general editorship of B. V. Petrovsky)

Literature on medicine

• General works - Resolutions of the CPSU and the Soviet government on the protection of public health, [compiled by P. I. Kalyu and N. N. Morozov], M., 1958;
• Glazer G., Main features of modern medicine, translation from German, M., 1962;
• his, Dramatic Medicine, translation from German, 2nd ed., [M.], 1965: Levit M. M., Medical periodicals of Russia and the USSR (1792 - 1962), M., 1963;
• Lisitsyn Yu. P., Modern theories of medicine, M., 1968: Kelanowski T., Propaedeutics of medicine, translation from Polish, M., 1968;
• Petrovsky B.V., The health of the people is the most important asset of a socialist society, M., 1971;
• Scientific medical societies of the USSR, edited by M. V. Volkov, M., 1972.

Literature on the history of medicine

• Lozinsky A. A., On the history of some of the most important medical systems of the 18th and 19th centuries, St. Petersburg, 1905;
• Oganesyan L. A., History of medicine in Armenia from ancient times to the present day, 2nd ed., parts 1 - 5, Er., 1946 - 1947;
• Koshtoyants H. S., Essays on the history of physiology in Russia, M. - L., 1946;
• Yudin T.I., Essays on the history of Russian psychiatry, M., 1951;
• History of medicine, vol. 1, edited by B. D. Petrov, M., 1954;
• Kanevsky L. O., Lotova E. I., Idelchik H. I., Main features of the development of medicine in Russia during the period of capitalism (1861 - 1917), M., 1956;
• Glazer G., Researchers of the human body from Hippocrates to Pavlov, translation from German, M., 1956;
• Fedotov D. D., Essays on the history of Russian psychiatry, vol. 1, M., 1957;
• Lushnikov A.G., Clinic of internal diseases in Russia in the first half of the 19th century, M., 1959;
• his, Clinic of Internal Diseases in Russia, M., 1962: his, Clinic of Internal Diseases in the USSR, M., 1972;
• Zabludovsky P. E., History of domestic medicine, parts 1 - 2, M., 1960 - 71;
• Borodulin F. P., History of medicine. Selected lectures, M., 1961;
• Multanovsky M.P., History of Medicine, M., 1961;
• Petrov B. D., Essays on the history of domestic medicine, M., 1962;
• History of Medicine of the USSR, edited by B. D. Petrov, M., 1964;
• The main stages of the development of medicine in Georgia, vol. 1 - 2, Tb., 1964 - 69;
• Arkhangelsky G.V., History of neurology from its origins to the 20th century, M., 1965 (lit.);
• Essays on the history of Russian public medicine, edited by P. I. Kalyu, M., 1965;
• Diepgen P., Geschichte der Medizin. Diehistorische Entwicklung der Heilkunde und des ?rztllchen Lebens, Bd 1 - 2, V., 1949 - 55;
• Sigerist N. E., A history of medicine, v. 1, N.Y., 1955;
• Major R. H., A history of medicine, v. 1 - 2, Oxf., 1955;
• Aschoff L., Diepgen P., Goerke N., Kurze ?bersichtstabelle zur Geschichte der Medizin, 7. Aufl., B. -, 1960;
• Garrison F. N., An introduction to the history of medicine…, 4 ed., Phil. - L., ;
• Geschichte der Medizin, B., 1968;
• Talbott J. N., A biographical history of medicine. Excerpts and essays on the men and their work, N. Y. - L., 1970;
• Bari?ty M., Coury Ch., Histoirede la m?decine, P., 1971.

Dictionaries on medicine

• Zmeev L.F., Russian doctors writers, v. 1 - 3, St. Petersburg, 1886 - 1889;
• Lakhtin M. Yu., Brief biographical dictionary of famous doctors of all times, St. Petersburg, 1902;
• Medical Faculty of Kharkov University for the first 100 years of its existence. (1805 - 1905), Har., 1905 - 1906;
• Biographical dictionary of professors of the 1st Leningrad, former Women's, Medical Institute named after. acad. I. P. Pavlova for 50 years. 1897 - 1947, [L.], 1947;
• English-Russian medical dictionary. 2nd ed., M., 1969;
• Arnaudov G.D., Medical terminology in five languages: Latinum, Russian, English, Français, Deutsch, translation from Bulgarian, 3rd ed., Sofia, 1969;
• Medical dictionary. English. Russian. French. German. Latin. Polish, edited by B. Zlotnicki, Warsaw, 1971;
• Pagel J., Biographisches Lexikon hervorragenden ?rzte des 19. Jahrhunderts, W. - B., 1900;
• Biographisches Lexikon der hervorragender ?rzte aller Zeiten und V?lker, 2. Aufl., Bd 1 - 5, V. - W., 1929 - 1934;
• Fischer I., Biographisches Lexikon der hervorragenden ?rzte der letzten f?nfzig Jahre, Bd 1 - 2, V. - W., 1932 - 1933;
• Binet L., Medecins, biologists et chirurgiens, P., ;
• Sigerist H. E., The great doctors: a biographical history of medicine, L., 1971.

Bibliography

• Russian D. M., Bibliographic index of Russian literature on the history of medicine from 1789 to 1928, M., 1928;
• his, History of general and domestic medicine and health care. Bibliography. (996 - 1954), M., 1956;
• KeIIy E. S., Encyclopedia of medical sources, Bait., 1948;
• Index zur Geschichte der Medizin,… Bd 1 - 2, V. - M?nch., 1953 - 1966;
• Garrison F., Morton L., A medical bibliography, 3 ed., ;
• Pauly A., Bibliographic des sciences m?dicales, ;
• Cunningham E. R., A bibliography of the reference works and histories in medicine and the allied sciences, in the book: Handbook of medical library practice, Chi., 1956;
• Bishop W., Bibliography of international congresses of medical sciences. Oxf., ;
• Thornton J. L., A select bibliography of medical biography, 2 ed., L., 1970.

Find something else interesting:

In the first half of the 19th century. The maturation of capitalist relations in Russia took place against the background of the further decomposition of the feudal-serf system. The revolutionary ideology and the Decembrist movement that took shape under these conditions had a significant impact on the development of Russian culture, science, and education. By the beginning of the 19th century. In Russia there were two higher medical educational institutions: the Faculty of Medicine of Moscow University and the St. Petersburg Medical-Surgical Academy - two centers of medical science and the formation of scientific medical schools. At Moscow University, issues of general pathology, therapy and physiology were developed mainly: the Medical-Surgical Academy occupied a leading place in the development of domestic anatomy, topographic anatomy and surgery.

The new University Charter of 1835, issued under Nicholas I, prohibited the autonomy of universities and subjected them to the authority of trustees appointed by the tsarist government.

A great contribution to the development of materialistic natural science was made by the professor of pathology and therapy at Moscow University, materialist philosopher Justin Evdokimovich Dyadkovsky. Developing the doctrine of disease, he proceeded from the idea of ​​the unity and integrity of the body and the surrounding nature, recognized the leading role of the central nervous system, and thus became a representative of early nervism in Russian science.

The largest representative of therapy in Russia in the first half of the 19th century. was a graduate of Moscow University, Matvey Yakovlevich Wise. His system of clinical examination and individual approach to patients (“treat not the disease, but the patient”) brought him fame as an outstanding therapist of the first quarter of the 19th century. When examining patients, he was one of the first in Russia to use the methods of palpation, percussion and auscultation. During the Patriotic War of 1812, together with professors from the Faculty of Medicine of Moscow University, M. Ya. Mudrov went to Nizhny Novgorod, where he provided assistance to the wounded and sick.

M. Ya-Mudrov also made a significant contribution to the development of military hygiene

Second half of the 19th century. became the heyday of Russian medical schools. In the field of therapy, two scientific clinical schools occupied a special place: the school of S. P. Botkin, which laid the foundation for the experimental direction in domestic clinical medicine (at the Military Medical Academy), and the school of G. A. Zakharyin, which personified the art of clinical practice (at Moscow University ).

N.I. Pirogov/A. studied within the walls of the medical faculty of Moscow University. P. Chekhov, S. P. Botkin.

Sergei Petrovich Botkin (1832-- 1889) created the largest scientific therapeutic school in Russia and laid the foundation for the functional clinical-experimental direction in the first domestic medicine (Fig. 135). The diverse scientific and practical activities of S. P. Botkin enriched Russian clinical medicine . He was the first to describe the clinical picture of a number of diseases; isolated infectious hepatitis (Botkin's disease); showed the possibility of studying renal hypertension experimentally; contributed a lot of new things to the study of rheumatism, diseases of the heart, blood vessels, and kidneys.

For the first time in Russia, S. P. Botkin organized several laboratories at the clinic he led: general clinical, chemical, bacteriological and physiological. S. P. Botkin’s role in the development of public medicine was great: in organizing the fight against infectious diseases and high mortality rates, in the construction of hospitals , the development of school hygiene, etc.

Zemstvo medicine in the Russian Empire began to develop after the zemstvo reform of 1864, i.e., the introduction of zemstvo-economic self-government in 34 (out of 89) provinces of the country. Until 1864, there was practically no medical care provided to the rural population of Russia. There were hospitals only in provincial and district towns. The level of medical care in them was extremely low, and the mortality rate was very high.

Leading zemstvo doctors waged a tireless struggle for free (at the expense of the zemstvo) health care. However, this was completely achieved only in some parts of the provinces.

Along with zemstvo medicine, health care services in the urban centers of Tsarist Russia also developed.

An important milestone in the history of Russian medicine was the formation and development of women's medical education. Under the influence of the revolutionary situation of 1859-1861. and the abolition of serfdom in Russia, the struggle for higher female medical education became an integral part of the struggle for social equality of women. At the beginning of the 20th century, the training of medical personnel in Russia was carried out at the medical faculties of Moscow, Kiev, Kharkov universities, at the Military Medical Academy, and the Psychoneurological Institute in St. Petersburg, at the Higher Women's Courses in Moscow, Kyiv, and Odessa and at women's medical institutes in St. Petersburg and Kharkov. The total number of students was about 8,600, and about 1,000 doctors graduated annually (Fig. 137). However, for a country with a population of 160 million, this was not enough.

At the turn of the 19th and 20th centuries, the rapid development of natural sciences began. The discovery of the electron (1897) and the creation of quantum theory supplanted previous ideas about the atom as the simplest indivisible particle of matter. New data on the structure of matter and its properties had a revolutionary impact on philosophy and natural science, including medicine, which was enriched with new methods of research and treatment. The discovery of X-ray radiation expanded the possibilities of examining healthy and sick organisms and marked the beginning of a new medical discipline - radiology. New ones emerged as separate branches of medicine and independent teaching subjects: neuropathology, psychiatry, dermatology with venereology, infectious diseases and epidemiology, pediatrics and others .