Development of surgery during the Renaissance. History of medicine Scientific achievements of the Renaissance

Chapter 4 Medicine of the era of early and developed feudalism (V-XV centuries) Feudalism replaced the slave system, and in countries where there was no established slavery, it replaced the primitive communal system: in China in the 3rd century BC. e., in Transcaucasia - in the 4th century AD. e., in the Western Roman Empire - in the 5th century AD.

In the Middle Ages in Western Europe, there was a distinction between doctors who received medical education at universities and were engaged only in the treatment of internal diseases, and surgeons who did not have a scientific education, were not considered doctors and were not allowed into the class of doctors.
According to the guild organization of the medieval city, surgeons were considered artisans and were united in their own professional corporations. So, for example, in Paris, where the antagonism between doctors and surgeons was most pronounced, surgeons united in the “Brotherhood of St. Kosma,” while doctors were part of a medical corporation at the University of Paris and very zealously guarded their rights and interests.

There was a constant struggle between doctors and surgeons. Doctors represented official medicine of that time, which still continued to follow blind memorization of texts and behind verbal disputes was still far from clinical observations and understanding of the processes occurring in a healthy or sick body.

Craftsman surgeons, on the contrary, had rich practical experience. Their profession required specific knowledge and vigorous action in the treatment of fractures and dislocations, the removal of foreign bodies, or the treatment of the wounded on the battlefields during numerous wars and crusades.

"long-" and "short-sleeved" surgeons

There was a professional gradation among surgeons. A higher position was occupied by the so-called “long-sleeved” surgeons, who were distinguished by their long clothes.
They had the right to perform the most complex operations, such as stone cutting or hernia repair. Surgeons of the second category (“short-skinned”) were mainly barbers and were engaged in “minor” surgery: bloodletting, tooth extraction, etc.

The lowest position was occupied by representatives of the third category of surgeons - bathhouse attendants, who performed simple manipulations, such as removing calluses. There was also a constant struggle between different categories of surgeons.

Official medicine stubbornly resisted recognizing the equal rights of surgeons: they were forbidden to cross the boundaries of their craft, perform medical procedures and write prescriptions.
Surgeons were not allowed into universities. Surgery training took place within the workshop, initially on the principles of apprenticeship. Then surgical schools began to open.
Their reputation grew, and in 1731, already during the period of modern history, in Paris, despite the desperate resistance of the medical faculty of the University of Paris, the first surgical academy was opened by the decision of the king.

In 1743 it was equated to the Faculty of Medicine. At the end of the 18th century, when the reactionary University of Paris was closed as a result of the French bourgeois revolution, it was surgical schools that became the basis on which higher medical schools of a new type were created.

Thus ended in Western Europe the centuries-long struggle between scholastic medicine and innovative surgery, which grew out of practical experience.

Surgery in Western Europe did not have scientific methods of pain relief until the middle of the 19th century; all operations in the Middle Ages caused severe suffering to patients. There were also no correct ideas about wound infection and methods of wound disinfection. Therefore, most operations in medieval Europe (up to 90%) ended in the death of the patient as a result of sepsis.

With the advent of firearms in Europe in the 14th century. the nature of the wounds has changed greatly: the open wound surface has increased (especially with artillery wounds), the suppuration of wounds has increased, and general complications have become more frequent.
All this began to be associated with the penetration of “gunpowder poison” into the wounded body. An Italian surgeon wrote about this Johannes de Vigo(Vigo, Johannes de, 1450-1545) in his book "The Art of Surgery" ("Arte Chirurgica", 1514), which went through more than 50 editions in various languages ​​of the world.

De Vigo believed that the best way to treat gunshot wounds was to destroy gunpowder residues by cauterizing the wound surface with a hot iron or a boiling composition of resinous substances (to avoid the spread of “gunpowder poison” throughout the body). In the absence of pain relief, such a cruel method of treating wounds caused much more suffering than the wound itself.

Ambroise Pare and the revolution in medieval surgery

The revolution of these and many other established ideas in surgery is associated with the name of the French surgeon and obstetrician Ambroise Paré(Pare, Ambroise, 1510-1590).
He did not have a medical education. He studied surgery at the Hoteluieu hospital in Paris, where he was an apprentice barber. In 1536, A. Pare began serving in the army as a barber-surgeon.

A. Pare's first work on military surgery “A way to treat gunshot wounds, as well as wounds inflicted by arrows, spears, etc.” was published in 1545 in colloquial French (he did not know Latin) and was republished in 1552.

In 1549 Paré published "A Guide to Removing Babies, Both Living and Dead, from the Womb". Being one of the most famous surgeons of his time, Ambroise Paré was the first surgeon and obstetrician at the court of Kings Henry VI, Francis II, Charles IX, Henry III and the chief surgeon of the Hotel Dieu, where he once studied the surgical craft.

Paré's outstanding merit is his contribution to the teaching of the treatment of gunshot wounds.
In 1536, during a campaign in Northern Italy, the young army barber Ambroise Paré did not have enough hot resinous substances with which to fill his wounds.
Having nothing else at hand, he applied a digestive of egg yolk, rose oil and turpentine oil to the wounds and covered them with clean bandages.
"I couldn't sleep all night, - Paré wrote in his diary, - I was afraid to find my wounded, whom I had not cauterized, dying from poisoning. To my amazement, early in the morning I found these wounded cheerful, well-slept, with wounds not inflamed and not swollen.
At the same time, others, whose wounds were filled with boiling oil, I found feverish, with severe pain and with swollen edges of the wounds. Then I decided never to burn the unfortunate wounded so cruelly again.”.
This was the beginning of a new, humane method of treating wounds.

At the same time, along with brilliant works on orthopedics, surgery, and obstetrics, Paré wrote an essay "About Freaks and Monsters", in which he cited many medieval legends about the existence of animal people, fish people, sea devils, etc. This indicates contradictions in the views of outstanding figures of the most complex transitional era of the Renaissance.

The activities of Ambroise Paré largely determined the development of surgery as a science and contributed to the transformation of an artisan surgeon into a full-fledged medical specialist. The transformation of surgery associated with his name was continued by his numerous followers and successors in different countries.

Compilation based on the book: T.S. Sorokina, “History of Medicine”

In the Middle Ages in Western Europe, surgeons did not have a scientific education, were not considered doctors and were not allowed into the class of doctors. They were considered artisans and united in their own professional corporations (in Paris, surgeons united in the “Brotherhood of St. Cosmas”, and doctors who received medical education at universities and were engaged only in the treatment of internal diseases were part of the medical corporation at the University of Paris).

There was a tireless struggle between doctors and artisan surgeons. Doctors represented official medicine of that time; they continued to memorize texts and were far from understanding clinical observations and understanding the processes occurring in a healthy or sick body. Surgeons, on the contrary, had rich practical experience. There was a professional gradation among them. The highest position was occupied by “long-haired” surgeons (distinguished by long clothes). They had the right to perform the most complex operations, for example, hernia repair or stone cutting. Surgeons of the second category - “short-skinned” (barbers) were engaged in “minor” surgery: Bloodletting, tooth extraction, etc. The lowest position was occupied by bathhouse attendants, who performed the simplest manipulations, for example, removing calluses. There was a constant struggle between different categories of surgeons.

Official medicine stubbornly resisted the recognition of surgeons. They were not allowed into universities. Surgery training took place within the workshop, initially on the principles of apprenticeship. Then surgical schools began to open. In 1731, in Paris, by decision of the king, the first Surgical Academy was opened. In 1743 it was equated to the Faculty of Medicine. Thus, in Western Europe, the centuries-long struggle between scholastic medicine and innovative surgery, which grew out of practical experience, ended.

Surgery did not have scientific methods of pain relief until the middle of the 19th century, so all operations caused severe suffering to patients. There were no correct ideas about wound infection and methods of wound disinfection. Therefore, 90% of operations in medieval Europe ended in the death of the patient as a result of sepsis.

With the advent of firearms in Europe in the 14th century. the nature of the wounds has changed greatly: the open wound surface has increased (especially with artillery wounds), the suppuration of wounds has increased, and general complications have become more frequent. All this began to be associated with the penetration of “gunpowder poison” into the wounded body. The Italian surgeon Johannes de Vigo (1450-1545) wrote about this in his book “The Art of Surgery” (“Arte Chirurgica”, 1514), which went through more than 50 editions in various languages ​​of the world. De Vigo believed that the best way to treat gunshot wounds was to destroy gunpowder residues by cauterizing the wound surface with a hot iron or a boiling composition of resinous substances (to avoid the spread of “gunpowder poison” throughout the body). In the absence of pain relief, such a cruel method of treating wounds caused much more suffering than the wound itself.

The revolution of these and many other established ideas in surgery is associated with the name of the French surgeon and obstetrician Ambroise Paré (1510-1590). He did not have a medical education. He studied surgery at a Paris hospital, where he was an apprentice barber. In 1536, A. Pare began serving in the army as a barber-surgeon. His first work on military surgery was “A Method for Treating Gunshot Wounds, as well as Wounds Inflicted by Arrows, Spears, etc.” was published in 1545 in colloquial French (he did not know Latin) and was republished in 1552. In 1549, Paré published “A Manual for the Extraction of Infants, Both Living and Dead, from the Womb.” Being one of the most famous surgeons of his time, Ambroise Paré was the first surgeon and obstetrician at the court of Kings Henry II, Francis II, Charles IX, Henry III and the chief surgeon of the Hotel Dieu, where he once studied the surgical craft.

Paré's outstanding merit is his contribution to the teaching of the treatment of gunshot wounds. In 1536, during a campaign in Northern Italy, the young army barber Ambroise Paré did not have enough hot resinous substances with which to fill his wounds. Having nothing else at hand, he applied a digestive of egg yolk, rose oil and turpentine oil to the wounds and covered them with clean bandages. “I couldn’t sleep all night,” Paré wrote in his diary, “I was afraid to find my wounded, whom I had not cauterized, dying from poisoning. To my amazement, early in the morning I found these wounded cheerful, well-slept, with wounds not inflamed and not swollen. At the same time, others, whose wounds were filled with boiling oil, I found feverish, with severe pain and with swollen edges of the wounds. Then I decided never to burn the unfortunate wounded so cruelly again.” This was the beginning of a new, humane method of treating wounds.

At the same time, along with brilliant works on orthopedics, surgery, and obstetrics, Pare wrote the essay “On Freaks and Monsters,” in which he cited many medieval legends about the existence of animal people, fish people, sea devils, etc. This indicates contradictions in the views of outstanding figures of the most complex transitional era of the Renaissance.

The activities of Ambroise Paré largely determined the development of surgery as a science and contributed to the transformation of an artisan surgeon into a full-fledged medical specialist. The transformation of surgery associated with his name was continued by his numerous followers and successors in different countries.

Studied at three universities. At 23 he received his doctorate in medicine in Padua, and soon became a master of the University of Padua. Anatomizing human corpses, I became convinced that Galen’s views on the structure of the body were largely erroneous because they are based on the study of the anatomy of monkeys and other animals. Fixed 200 Galen bugs. He correctly described the skeleton, its muscles, and many of its internal organs, established the absence of a hole in the heart septum, described the heart valves, and thus created the prerequisites for the following justification of the circular movement of blood. I presented my observations in an anatomical table, incl. 6 engravings, Improving the teaching of anatomy, he published a short anatomy textbook “Extraction”. Vesalius' work "On the structure of the human body". In seven books. It not only summarized the achievements in the field of anatomy over the previous centuries, Vesalius enriched science with his own reliable data obtained as a result of numerous dissections of the human body, corrected a large number of mistakes of his predecessors and, most importantly, brought all this knowledge into a system for the first time, i.e. made a science out of anatomy. The first volume is devoted to the study of bones and joints, the second - the anatomy of muscles, the third - blood vessels, the fourth - the peripheral nervous system, the fifth - the abdominal organs, the sixth - the structure of the heart and lungs, the seventh - the brain and sensory organs. The text is accompanied by 250 figures. The frontispiece depicts the moment of dissection: in the center of the group is Vesalius, around are scientists and public figures, numerous students - a total of 48 real historical characters. Among them - Colombo, Miguel Servet, Girolamo Fracastro, Paracelsus, kings, clergy

Question 33-W. Harvey, “On the movement of the heart and blood in animals” and its influence on standing and development.

English doctor, physiologist, embryologist. At 21 he graduated from Cambridge University, 24 - in Padua he graduated from the Faculty of Medicine and received the degree of Doctor of Medicine. At home, he became a professor at the Department of Anatomy, Physiology, and Surgery in London. Harvey mathematically calculated and experimentally substantiated the theory of blood circulation, according to which blood moves in one direction, in a circular pattern in small and large circles, certainly returning to the heart. According to Harvey, at the periphery, blood passes from arteries to veins through anastomoses and through tissue pores; during Harvey’s lifetime, microscopic technology had not yet been used in physiology and he could not see capillaries. After many years of testing, he outlined the theory in the essay “Anatomical study of the movement of the heart and blood in animals.” He came under fierce attack from the church and many scientists. Decarts was the first to recognize the theory, then Galileo, Santorio, and Boreli. Pavlov saw in it not only the “fruit of rare value” of scientific thought, but also noted the “feat of courage and selflessness” of its author.

Question 34-Development of the experimental method in science and medicine (F. Bacon)

English philosopher, politician. Not being a doctor, he largely determined the paths for the further development of medicine. His philosophical treatise “The Great Revolt of the Sciences,” dedicated to the formation of science and scientific knowledge, was not completed. Its second part, “the new Organon,” was published in 1602. He formulated three goals of medicine: maintaining health, curing diseases, and prolonging life. Science seemed to him to be the main means of solving social problems of society. Therefore, he was a supporter of the union of science and power. The main tools of knowledge are feeling, experience, experiment and what follows from them. Hegel wrote about him - he completely rejected the scholastic way of reasoning on the basis of completely abstract abstractions, blindness to everything that we have before our eyes.” In the field of medicine, he put forward a number of ideas that were implemented by the cat. Subsequent generations of scientists studied. Bacon largely determined the ways of forming philosophical thinking and the development of the sciences of the coming modern era.

Question 35 - A. Pare, an outstanding surgeon of the feudal era.

He had no medical education. He studied surgery at a Paris hospital, where he was an apprentice barber. There was a barber-surgeon in the army. In northern Italy there were not enough resinous substances, cat. He filled the wounds, replaced them by applying a digestive of egg yolk, rose and turpentine oils to the wounds and covered them with clean bandages. I was afraid of this, but in the morning I found my patients cheerful, well-rested, with wounds not inflamed or swollen. After that, I no longer began to cauterize the wounds with oil. The teaching on the treatment of gunshot wounds became an outstanding achievement of the couple. The first work was a method of treating gunshot wounds, as well as wounds inflicted by arrows, spears, etc. In 1549, “a manual for removing babies, as well as dead ones, from the womb.” Pare was the first surgeon at the court of Kings Henry 2, Francis 2, Charles 9, Henry 3. He improved the technique of surgical operations, re-described the rotation of the fetus on the leg, used ligation of blood vessels instead of twisting and cauterizing them, improved the technique of trephination, designed a number of new surgical instruments and orthopedic devices, incl. Artificial limbs and joints. Works on surgery, orthopedics, obstetrics. Essay “On Freaks and Monsters.” In the cat. He cited many medieval legends about the existence of animal people, fish people, and sea devils.

Question 36

B. Ramazzini is an Italian doctor, the founder of occupational pathology and occupational hygiene as a branch of medicine. As a city doctor in different parts of Italy, and then a professor at universities in Modena and Padua, he did not disdain to visit the most unsightly workshops and study the secrets of mechanical crafts. “In different localities there are different crafts and that in connection with them different diseases can arise.” Ramazzini summarized his many years of research in the classic treatise “On the Diseases of Craftsmen,” which was translated into many European languages ​​and reprinted over 25 times. It describes working conditions and illnesses of workers in more than 60 professions. Ramazzini analyzed the causes of diseases, proposed possible methods of treating and preventing them, and insisted on improving the working conditions of manufacturing workers. This work provided materials and impetus for the study of industrial pathology.

Question 37 – Founder of experimental hygiene. Max Petterkofer.

Professor at the University of Munich. He introduced an experimental research method into hygiene. He developed objective methods for the hygienic assessment of air, clothing, and soil, dealt with water supply hygiene, and established hygienic standards and diets. He attached particular importance to soil hygiene, proved the importance of draining it and carrying out hygienic measures to remove sewage and improve the health of populated areas. Thanks to his activities in Munich and other German cities, the incidence of intestinal infections has decreased. However, he somewhat overestimated her factor. This was especially evident in relation to the causes of cholera. Adhering to the “soil theory,” he opposed Koch’s bacteriological theory. He did not deny the existence of a living pathogen, but he also did not believe in the simplicity of the mechanism of its transmission. There are territorial and temporal factors that favor the emergence of an epidemic, he argued. I couldn’t test it on animals - cholera is a human disease. And I decided to experiment on myself. 7 approx. 1892 drank a culture of Vibrio cholerae. Luckily, I didn't get sick. This confirmed him even more in his opinion. Today we know that he was formally on the wrong path. He did not take any precautions in the experiment; he led his usual lifestyle. Putting the entire population of the city at risk of infection.

Question 38

G. Boerhaave (Burhaave) - doctor, chemist and botanist, professor who headed the departments of medicine and botany, chemistry and practical medicine, the founder of clinical medicine. Giving priority to medical practice, he argued that clinical medicine is medicine that observes patients at their bedside; there he studies the means to be used. Therefore, it is necessary to visit and see the patient. Burgaw combined a thorough examination of the patient with a physical substantiation of the diagnosis and anatomical studies. He was the first to use an improved Fahrenheit thermometer in clinical practice, used a magnifying glass to examine patients, and kept detailed records of medical histories. Boerhaave's clinical school played an exceptional role in the development of European and world medicine.

Question 39

Giovanni Batista Morgagni, a student of Antonio Valsalva, professor of anatomy and surgery at the University of Bologna, became a doctor of medicine at the age of 19. At the age of 24, he headed the department of anatomy at the University of Bologna, and 5 years later the department of practical medicine at the University of Padua. Carrying out autopsies of the dead, Morgagni compared the changes he discovered in the affected organs with the symptoms of diseases that he observed during the patient’s life as a practicing physician. Having summarized the collected material (700 autopsies) and the works of his predecessors, Morgagni published a classic 6-volume study “on the locations and causes of diseases discovered through dissection.” Morgagni showed that each disease causes certain changes in a specific organ and identified the organ as the site of localization of the disease process . Bringing anatomy closer to classical medicine, Morgagni created the first scientifically based classification of diseases. T. O he laid the foundation for a new clinical and anatomical direction in medicine.

Question 40

L. Auenbrugger is a Viennese doctor who first proposed the percussion method. For 7 years, he carefully studied the sounds made when tapping the chest in a healthy and sick body. He systematically compared his clinical observations with the data of pathoanatomical autopsies and in 1761 he outlined the results of his research on 95 pages of his essay “a new discovery that allows, based on the data of tapping the human chest, as a sign, to detect chest diseases hidden in the depths.”

R. Laennec - while a student at the University of Paris, began work on the study of consumption. Pathoanatomical autopsies of those who died from this disease revealed specific formations in various organs, which Laennec called tubercles. They arose and developed without external signs, and when the symptoms of the disease appeared, it was no longer possible to save the patient. Listening with the ear attached to the chest did not give noticeable results. In 1816 Laennec saw a solution to the problem. He glued his first stethoscopes from thick paper, then began to carve them from different types of wood. R. Laennec studied the clinical picture and pathomorphology of portal cirrhosis, established the specificity of the tuberculosis process, and studied the clinical picture and diagnosis of lung diseases.

Question 41

K. Rokitansky – Viennese potologist. His three-volume “manual of pathological anatomy” was compiled on the basis of more than 20 thousand autopsies using macro and microscopic research methods. Rokitansky considered the main cause of painful changes to be a violation of the composition of body fluids. At the same time, he considered the local pathological process as a manifestation of a general disease. The understanding of disease as a general reaction of the body was the positive side of his concept in the mid-19th century. Rokitansky’s humoral pathology came into conflict with new factual data (the use of a microscope dramatically expanded the possibilities of morphological analysis in normal and pathological conditions.

Question 42

R. Virchow is a German doctor, pathologist and public figure. Guided by the theory of cellular structure, he first applied it to the study of a diseased organism and created the theory of cellular pathology. According to Virchow, the life of a whole organism is the sum of the lives of autonomous cellular territories, the material substrate of the disease is the cell, all pathology is the pathology of the cell. The theory of cellular pathology was a step forward compared to Bichat's theory of tissue pathology and Rokitansky's humoral pathology. It quickly gained universal recognition and had a positive impact on the subsequent development of medicine.

Question 43

L. Pasteur is a French scientist, chemist and microbiologist, founder of scientific microbiology and immunology. Major discoveries: the enzymatic nature of lactic acid (1857), alcoholic (1860) and butyric acid (1861) fermentation, studies of diseases of wine and beer (since 1857), refutation of the hypothesis of spontaneous generation (1860), study of diseases of silkworms (1865), foundations of ideas about artificial immunity (using the example of chicken cholera, 1880), the creation of a vaccine against anthrax (1881), through the artificial application of virulence of microorganisms, the creation of an anti-rabies (rabies) vaccine (1885).

R. Koch is a German scientist, one of the founders of bacteriology. Studying specific pathogens of various diseases, Koch created a laboratory, bacteriological and determined a research strategy. He developed solid nutrient media for growing pure bacterial cultures and formulated criteria for the relationship between a pathogen and an infectious disease. finally established the etiology of anthrax (1876), discovered the causative agents of tuberculosis (1882) and cholera (1883). He studied plague and malaria, trachoma, tropical dysentery, and relapsing fever. While studying tuberculosis, he obtained tuberculin, a glycerol extract of a pure culture of tuberculosis microbacteria, which turned out to be a valuable diagnostic tool

Question 44

Achievements and directions of development of hygiene in Russia in the 19th century:

1) A.P. Dobroslavin is the first domestic professor of hygiene. Doctoral dissertation “materials for the physiology of metamorphosis” (metamorphosis), began teaching a course in hygiene at the St. Petersburg Medical-Surgical Academy and created the first department of hygiene in our country, an experimental hygienic laboratory was created, he is the author of the first textbooks on hygiene in Russia. His scientific works are devoted to the study of metabolism, food hygiene and military hygiene. On his initiative, the “Russian Society for the Protection of Public Health” and the hygienic magazine “Health” were created.

2) F.F. Erisman is an outstanding Russian hygienist, one of the founders of scientific hygiene in Russia. He paid great attention to school hygiene and home hygiene, fought for the improvement of sewage systems, and was the first to publish materials on the unsanitary condition of basement dwellings and shelters. He created the first hygiene manual in our country (1872-1877), carried out the world's first comprehensive social and hygienic study of industrial living conditions. Proletariat in the Moscow province. Creation of a large school of Russian hygienists

3) G.V. Khlopin is a professor, created a scientific hygienic school and made a significant contribution to the development of toxicology, school, public and communal hygiene.

Question 45

1) traditional medicine: sorcerers, witches, wizards, enchantresses practiced healing. People considered them to be intermediaries between man and the forces of nature. The scope of their activities included: magical actions, medicinal witchcraft. Later, folk healers began to be called lechtsy. Their work was paid. They passed on their medical secrets from generation to generation through father to son (family schools). In medical practice, remedies of plant, animal and mineral origin were used. Subsequently, the experience of folk healing was generalized in herbalists and medical books.

2) monastic medicine - and with them, monastic hospitals began to develop in Rus' after the adoption of Christianity. The disease was accepted as a punishment, or the result of the possession of demons. Healing is spiritual forgiveness. Old Russian monastic hospitals were centers of enlightenment: they taught medicine, collected Greek and Byzantine manuscripts, supplemented them; in monasteries they treated the wounded, those suffering from contagious, nervous and mental diseases, and the seriously ill (they were often tonsured as monks).

3) secular medicine: based on the experience of traditional healing

4) sanitary work: in ancient Rus' there were water pipes and water collectors. It is reported that there were hospitals; an integral part of medical and sanitary life was the bathhouse (it was also used as a place where they delivered babies, adjusted dislocations, did bloodletting, massages, treated colds, joint diseases, etc.) during epidemics, measures were taken to limit sick places , organized outposts and abatis.

Question 46

Special medical books from Kievan Rus have not reached us, but their existence is very likely. This is evidenced by the general level of culture of Kievan Rus and the presence of biological and medical issues in books of general content that have come down to us from Kievan Rus. The Shestodneva, for example, contains a description of the structure of the body and the functions of its organs: the lungs (“ivy”), bronchi (“proluki”), heart, liver (“estra”), and spleen (“tear”) are described. The granddaughter of Vladimir Monomakh, Eupraxia-Zoya, who married the Byzantine emperor, left the composition “Ointments” in the 12th century, in which she reflected the medical experience of her homeland. Written sources from the time of Kievan Rus show familiarity with the use of herbal medicines and their effect on the body Many ancient manuscripts contain miniature drawings, which the historian figuratively called “windows through which one can see the vanished world of Ancient Rus'.” The miniatures depict how the sick were treated, the wounded were treated, how hospitals were set up at monasteries, and drawings of medicinal herbs are shown. instruments, prosthetics. Since the 11th century, miniatures have reflected public, food and personal hygiene, as well as sanitation of the Russian people.

The introduction of Christianity influenced the development of ancient Russian medicine. The Orthodox religion, borrowed from Byzantium, transferred the established connection between churches and monasteries with treatment to Kievan Rus. The “Charter of Grand Duke Vladimir Svyatoslavich” (late 10th or early 11th century) pointed to the doctor, his distinguished and legalized position in society, classifying the doctor as “church people, almshouse.” The charter also determined the legal status of doctors and medical institutions, placing them in the category subject to church court. This codification is significant: it gave authority to the lechs and provided the clergy with supervision over them. Medical law was approved for certain individuals and institutions.

The monasteries in Kievan Rus were to a large extent the successors of Byzantine education. Some elements of medicine also penetrated their walls and were combined with the practice of Russian folk healing, which made it possible to engage in medical activities. Among the monks there were many artisans who were good at their profession; There were also Lechts among them.

Since the 11th century, following the example of Byzantium, hospitals began to be built at monasteries in Kievan Rus (“bathhouse buildings, doctors and hospitals provide healing to all who come free of charge”). Hospitals at monasteries were intended to serve not only the monastery, but also the surrounding population. The monasteries tried to concentrate healing in their own hands and declared persecution of traditional medicine. but could not defeat traditional medicine.

Question 47

In the vast Kiev state, medicine continued to develop along with culture. Ancient Rus' knew several forms of medical care: private craft medical practice, medical guardianship and hospital care. In connection with the development of crafts in Kievan Rus of the 10th-13th centuries, folk medicine received further development. In Kyiv and Novgorod there were healers, that is, people for whom healing was a profession. The medical profession was of a craft nature and was understood as a special type of craft. Healing was carried out by secular people - men and women, as well as the clergy (mainly monks in monasteries after the adoption of Christianity). Healing was considered an honorable occupation. The bearers of medical knowledge were folk doctors and artisans. They passed on their practical experience from generation to generation, using the results of direct observation and experience of the Russian people, as well as various methods and techniques of healing the numerous tribes that make up the vast Russian state. The practice of artisan doctors was paid and therefore was available only to the wealthy segments of the population. City doctors ran shops selling medicines. Medicines were mainly of plant origin

Question 48

Formation of the Moscow state: after the expulsion of the Golden Horde and the unification of Russian lands around Moscow during the reign of Ivan 3, the Great Principality of Moscow became a large and powerful state in Europe.

Apothecary order: in the period between 1581 and 1620, an apothecary order was organized on the territory of the Kremlin, initially it was conceived as a court institution for managing the sovereign's medical and pharmaceutical business and until the 18th century it was called “the sovereign's closest apothecary order”; over time, its functions expanded significantly .

The first medical school: was opened in the pharmacy department in 1654, during the war with Poland. Students collected herbs, worked in a pharmacy and in a regiment, studied Latin, pharmacy, diagnosis of diseases and methods of treating them. The training lasted from 4-6 years. The training was visual and conducted at the patient's bedside. Anatomy was studied using bone preparations and anatomical drawings. There were no textbooks; they were replaced by herbalists and medical doctors, as well as medical histories. Functions of a pharmacy order: management of pharmacies, pharmaceutical gardens, collection of medicinal raw materials, invitation to serve in the court of doctors, checking their educational documents, conducting exams for doctors and pharmacists who arrived in Russia, monitoring their work and payment, training and distributing doctors to positions, checking histories diseases, selection of doctors for the Streltsy regiments and supply of troops with medicines, organization of some quarantine measures, medical examination, collection and storage of herbalists, medical books and other medical books, training of Russian doctors, procurement and sale of vodka, wine, beer and honey (the main source financing)

Question 49

The country's trade gates often opened the way to terrible epidemics. In our country, such gates were Pskov and Ngovgorod. Frequent epidemics of endemic diseases led to the introduction of protective measures in Rus': 1) at first this was expressed in the isolation of the sick and the cordoning off of disadvantaged places, the dead were buried in the same place where he died, communication with plague-ridden houses ceased 2) when the epidemic covered the entire city, outposts were organized on the roads, rubble was created in the forests 3) to destroy the infection in houses, they used freezing, burning, fumigation, ventilation, and washing. 4) the dying began to be buried outside the city limits 5) during the pestilence, the import and export of all goods, as well as work in the fields, ceased. This led to crop failures and famine, which followed epidemics, cinnamon and other diseases appeared, which brought a new wave of deaths

Question 50

Traditional medicine: A significant place in the medical clinics of this time was given to surgery. Among the cutters were chiropractors, bloodletters, and dentists. In Rus', operations of skull drilling, abdominal cutting, and amputation were carried out. The patient was put to sleep using mandrake, poppy or wine. The tools were carried through the fire. The wounds were treated with birch water, wine, ash, and stitched with flax, hemp fibers or threads from animal intestines

Secular medicine: provided medical care at home or in a Russian bathhouse. There was practically no inpatient care. Hospitals continued to be built at the monasteries. In the 17th century, civil hospitals were first created in Rus', intended both for treating patients and for teaching medicine. Foreign doctors were respected and honored. The 15th-17th centuries in Rus' were the time of the formation of pharmacies and pharmacy business, the creation of the first hospitals in cities, the beginning of the training of Russian doctors, and the emergence of the state medical organization. Affairs

Question 51

Reforms of Peter I

1) established in Moscow a course of lectures for boyars on anatomy with demonstrations on corpses.

2) 1707 - foundation of the first hospital school in Russia at the General Hospital in Moscow

3) before Peter 1, there was not a single higher medical school in Russia. Educational institution

4) military decree (1716) - determined the number of doctors, field doctors, barbers and field pharmacists in various units of the army

5) 1722 - decree on hospitals, marked the beginning of the development of anatomical sections of the dead and forensic autopsies

6) 1724 – establishment of the Academy of Sciences in St. Petersburg, by decree of Peter the Great

7) In 1718, land and admiralty military hospitals were opened in St. Petersburg and in 8) 1720 - an admiralty hospital in Kronstadt.

9) In 1721, the Admiralty Regulations, compiled with the participation of Peter I, were published, where a special section defined the tasks and forms of work in naval hospitals. 10) In 1735, a special “General Regulation on Hospitals” was published.

Question 52

Hospitals and hospital schools appeared in Russia at the end of the 17th – beginning of the 18th centuries. in the era of Peter I. Peter understood that healthcare in Russia was at a very low stage of development (high infant mortality, epidemics, shortage of doctors). Therefore, he began the construction of sea and land hospitals, and with them - hospital schools where doctors were trained. The first hospital was opened in Moscow in 1707. It was a land hospital, and a hospital school was opened with it, which was designed for 50 students. Further, hospitals and hospital schools under them were opened in St. Petersburg, Revel, Kronstadt, Kyiv, Yekaterinburg, etc. The hospital schools had a fairly high level of teaching and high quality educational programs. There was no such system in medical education in any European country. The hospitals had specially equipped rooms for clinical classes, teaching anatomy, and the basics of obstetrics. Teaching anatomy necessarily included dissections. The activities of hospital schools were subject to general rules and guidelines (“General Regulations on Hospitals”). At the end of the hospital school, students took an exam that included theoretical knowledge, clinical knowledge, and what is today called practical skills. Medical libraries were organized in hospitals. In hospitals, pathological and anatomical research was mandatory - autopsies of corpses. In 1786, hospital schools were reorganized into medical-surgical schools. These schools paved the way for the formation of corresponding medical-surgical academies.

Question 53

In the 18th century in Russia, the need for a larger number of doctors became particularly apparent, primarily to meet the needs of the military, the serving nobility and the emerging merchant class, as well as for medical care of factories and factories located in remote administrative and cultural centers of the country. In the 18th century, Russian science in the field of medicine and medical education united not with the overwhelming backward majority that dominated the medical faculties of many universities in Western Europe, but with the advanced, progressive for that time Leiden University. In contrast to the scholastic, purely bookish training of future doctors of medicine at the medical faculties of Western European universities that remained throughout the 17th century, hospital schools in Russia from the first years of their existence built the training of future doctors practically. In organizing medical education, Russia borrowed this advanced and not yet generally recognized method of teaching students at the patient’s bedside. It is no coincidence that schools for training doctors in Russia were created at hospitals. The task of training doctors in the 18th century was solved in Russia in an original, original way: a new type of higher educational institution for training doctors was created - schools based on large hospitals. In the training of medical personnel and the development of medicine in Russia in the 18th century. Hospital schools opened on the basis of hospitals and the medical faculty of Moscow University (1764) played a major role. The first hospital school was opened at a permanent military hospital in Moscow (1707). Later, such schools were opened in St. Petersburg, Kronstadt, Revel, Kyiv and other cities of Russia. These were higher educational institutions. To obtain the title of doctor after completing general educational training (Slavic-Greek-Latin Academy or theological school), study at a hospital school lasted 5-7 years, and sometimes 11 years. 3 years after passing the exams, the student was awarded the title of under-medicine (the average between a doctor and a paramedic), and at the end of the seventh year, the under-medicine was promoted to healer. Hospital school students studied anatomy, physiology, operative surgery, pharmacology, forensic medicine, neurology, dentistry with maxillofacial surgery, maxillofacial traumatology and orthopedics. Each hospital school had an anatomical theater with a museum.

Question 54

Development of feudal society in Russia in the 18th century. entered a new stage, which was characterized by the dominance of serfdom, the development of capitalist production, the formation of the army and navy, in connection with the military-political situation and the creation of a new technical organizational basis for solving the urgent tasks facing the state. There is an urgent need to train scientists, a significant number of engineers, and teachers who can provide solutions to the problems facing industry, the army, and trade. The importance of reforms aimed at further improving the management of medical care and creating a material base for medical institutions is great. Instead of the Pharmacy Order, in 1721 the Medical Office was created, which in 1763 was transformed into the Medical College. In 1718, an “instrument hut” was organized to produce surgical instruments.

In 1775, “Orders of Public Charity”, provincial medical boards were formed, new pharmacies were opened, the positions of county doctors were introduced, birth and death rates were recorded, autopsies of the dead were performed, and measures were taken for sanitary supervision of food products. In 1801, the beginning of the organization of smallpox vaccination was made using the vaccination method, which replaced variolation.

Peter I, being a member of the Paris Academy of Sciences, had extensive knowledge in the field of technology, was well acquainted with the natural sciences and understood the enormous national importance of medicine. He himself studied anatomy, dressed wounds, skillfully performed some surgical operations: abdominal puncture, bloodletting, etc. He often attended operations performed in hospitals and was present at autopsies.

Peter I mastered the technique of tooth extraction and often used it in practice. He always carried with him two sets of instruments: mathematical and surgical (the latter contained a pelican and forceps for removing teeth). The Leningrad Museum of Anthropology and Ethnography houses the “Register of Teeth Twitched by Emperor Peter I.” The collection contains 73 teeth removed personally by Peter I, and most of the teeth are molars, i.e. to the group of difficult to remove. However, despite the curvature of the roots, there are no fractures, which indicates a good command of the removal technique. The beginning of a new period in the development of science and social thought in Russia is associated with the opening of the Academy of Sciences in 1725. The emergence of the scientific system of materialist philosophy is associated with the name of the brilliant Russian scientist M.V. Lomonosov (1711-1765). The scientist’s philosophical, natural science and socio-political democratic views had a great influence on the development of natural science in Russia. Particularly important for the history of medicine is the letter written by M.V. Lomonosov in 1761 to Count I.I. Shuvalov “On the reproduction and preservation of the Russian people,” in which the scientist expresses concern for the health of the people and the development of medicine.

Question 55

P. A. Zagorsky - approved Russian anatomical terminalology instead of Latin. Created the first original domestic anatomy manual in Russia “abbreviated anatomy” in 2 books

I. F. Bush - he was essentially the first teacher of surgery at the academy. Bush's activities as a scientist were expressed in 44 scientific works, many of which had serious scientific significance. In addition, Bush took a very prominent part in the publication of one of the greatest scientific works on operative surgery - “Anatomical and surgical tables, printed by the highest permission and generosity of E.V. Emperor Nicholas I.” The author of the first Russian manual for the teaching of surgery with 3 parts (1807) founder of the first Russian surgical school and the first surgical clinic in Russia.

I. V. Buyalsky is a professor at the Department of Anatomy at the St. Petersburg Medical-Surgical Academy. In 1828 he published “anatomical and surgical tables”, which had illustrations. Buyalsky developed methods for embalming corpses and proposed new methods for producing thin corrosive preparations. He was the initiator of the ice anatomy method. He developed a number of new surgical operations (on the upper jaw, blood vessels), and created new surgical instruments. He made a significant contribution to the development of vascular surgery, for the first time in Russia he performed ligation of the innominate artery, and was among the first to use chloroform anesthesia and a starch dressing for fractures

Question 56

N.I. Pirogov is a great anatomist and surgeon, the creator of topographic anatomy as an independent science and experimental method in surgery, an innovator of ice anatomy methods and cuts of frozen corpses, one of the founders of military field surgery. Pirogov wrote several major works on surgery - the main one is “surgical anatomy of arterial trunks and fascia” as well as “a complete course of applied anatomy of the human body with drawings and illustrated topographic anatomy of cuts made in 3 directions through a frozen body. In 1847, he was the first in the world to use ether anesthesia en masse in the theater of military operations in Dagestan. Postoperative diseases were first divided by Pirogov into 2 groups: pure and purulent. He made a significant contribution to the development of asepsis and antisepsis (he used hand washing with disinfecting solutions of alcohol, lapis, iodine tincture. He performed a huge number of dental operations, developed methods of plastic surgery on the face, manufactured sets of surgical instruments that included dental ones.

Question 57

The development of military field surgery and its emergence as a scientific branch of medicine are associated with the name of the brilliant Russian surgeon Nikolai Ivanovich Pirogov (1810–1881), anatomist and public figure, professor of the Military Medical Academy (since January 1841). To evaluate the contribution of N. I. Pirogov to military field surgery, one must know its state before him. Help for the wounded was chaotic. The mortality rate reached 80% or higher. Pirogov considered it necessary to provide assistance during the battle, insisted on providing personnel with individual dressing packages, teaching them how to apply a primary dressing and stop bleeding. In 1847, Pirogov for the first time in the war used general ether and then chloroform anesthesia, thereby proving the possibility of general

There were doctors in all departments.

In the navy, there was one doctor on each warship.

Each warrior was supposed to have the necessary dressing material to provide first aid to himself and his comrade.

After the battle, the wounded were taken to the nearest cities or military camps, where they began to set up military institutions for the wounded and sick - valetudinary. The staff serving them consisted of doctors, housekeepers, instrument workers and junior staff.

Slaves were generally not treated.

Along with military medicine, during the Empire, medical science developed in cities and provinces, where the authorities began to establish paid positions for archiarchal doctors. Archiatrists united in collegiums.

No. 18. Asklepiades, his system for preventing and treating diseases.

Asclepiades of Prusa in Bithynia was a prominent Greek physician in Rome.

His system: treat safely, quickly and pleasantly. He considered disease as stagnation of solid particles in the pores and channels of the body. His treatment was aimed at restoring impaired functions and consisted of simple and natural measures: a reasonable diet, keeping the skin clean, hydrotherapy, massage, baths, walking, running, sweating. He advised paralyzed people to be carried on carpets and rocked. The main goal of this treatment is to expand the pores and move stagnant particles. Medicines were rarely prescribed. Asclepiades said: “A person who has sufficient knowledge of medicine will never get sick.”

No. 19. Galen. Development of an experimental research method. The doctrine of blood circulation. New in the method of preparing medicines.

Galen of Pergamum- an outstanding doctor of the Ancient world (Greek by origin. He worked in the public service - as an archiate, as well as in a gladiator school.

In 168 Galen - court archiatr Roman emperors Marcus Aurelius and his son Commodus.

Pneuma theory: it lives in the ventricles of the brain, liver and heart: in the ventricles - “spiritual” pneuma, in the liver - “natural” pneuma, in the liver - “vital” pneuma.

Galen's philosophy formed the basis of his natural scientific and medical ideas, stipulating the dualism of his teaching (we see correctly - we describe not).

Naturally, Galen’s scientific positions appeared in his extensive medical practice and research in the field of anatomy and physiology. Galen dissected animals: sheep, pigs, dogs, ungulates, monkeys, as well as abandoned babies. His mistakes were that he automatically transferred the data obtained from autopsies of animals to humans.

In his treatise “On the Purpose of Parts of the Human Body,” he described in detail the structure of all body systems - bones, muscles, ligaments, internal organs. His achievements were especially great in the study of the nervous system. Galen described all parts of the brain and spinal cord, 7 pairs of cranial nerves, and nerves of internal organs.

Galen described in detail the anatomical structure of the heart.

The pinnacle of Galen's philosophical concept was his doctrine of the pulse. It is presented in a 16-volume treatise in 4 parts, each of which consisted of 4 books.

The first part of the treatise “On the Differences of Pulses” defines the terminology of the subject and gives a classification of different pulses.

The second part of the treatise “On diagnosis by the pulse” Galen explains how to feel the pulse, etc.

The four books of the third part, “On Cases of Pulsations,” reveal Galen’s ideas about the nature of the pulse. Galen was convinced that the arteries contained blood.

According to Galen, the heart and arteries contract simultaneously; contraction and relaxation of arteries are 2 independent processes.

Galen had no idea about the unidirectional forward movement of blood. According to Galen, the blood moves forward in jerks, making pendulum-like movements; it is formed in the liver. Galen traced the path of blood from the right ventricle through the pulmonary artery to the lungs, and thus was close to discovering the circulation.

Galen had mistakes, but all his interpretations were aimed at finding a relationship between the pulse manifestation of the activity of the heart and blood vessels and human disease.

Twenty years later, Galen found his 16-books difficult and incomprehensible to understand, and he condensed this work into one short volume, understandable to a wide circle of colleagues.

Galen was widely involved in medical practice. In clinical works, Galen often refers to four conditions: dryness, moisture, cold, warmth. The recovery of a patient, according to Galen, is not a miracle, but the result of understanding the disease, deep knowledge and experience.

Let's experience Galen's contribution to the development of pharmacology. A number of medicines obtained by mechanical and physico-chemical processing of natural raw materials are still called “galenic preparations” (the ratio of medicine and liquid).

Galenism is a distorted, one-sided understanding of the teachings of Galen.

Galen belongs to the galaxy of the greatest scientists in the world.

No. 20. The era of feudalism, periods of the era and their characteristics.

No. 21. Medicine in Byzantium. The significance of the works of scientists for the subsequent development of medical science. Oribasy.

In the history of world culture, Byzantine civilization was the direct successor of the Greco-Roman heritage and the Christian worldview. During 10 centuries of its existence, it was the center of a unique and truly brilliant culture.

The main source and basis of medical knowledge in the Byzantine Empire were the “Hippocratic Collection” and the works of Galen, extracts from which served as the basis for compilations consistent with the spirit of Christianity.

Medicines have become the subject of special study. The interest in them was so great that botany gradually turned into a practical field of medicine, dealing almost exclusively with the healing properties of plants.

The main sources of knowledge about the plant world were the works of the “father of botany”, the Greek Theophrastus, and the Roman military doctor Dioscorides, a Greek by origin. His essay “On Medicinal Matter” was an unsurpassed textbook on medicinal healing for almost sixteen centuries.

One of the outstanding doctors was a Greek Oribasy from Pergamum. His teacher was the then famous physician Zeno with Fr. Cyprus. Oribasius was the friend and physician of Julian the Apostate. At his suggestion, Oribasius compiled his main encyclopedic work, “The Medical Collection,” in 72 books, 27 of which have come down to us. In it, he summarized and systematized the medical heritage from Hippocrates to Galen, including the works of Herodotus, Dioscorides, Dioclides and other ancient authors. About many works of ancient authors we know only what Oribasius managed to report.

At the request of his son, Oribasius compiled an abbreviated version of his extensive code, the so-called “Synopsis” in 9 books, which became a manual for students of medical sciences. An even more brief extract from the Synopsis is the work “Public Medicines.” It was intended for people who did not have a medical education and were preparing medicines at home.

For his scientific views and adherence to ancient traditions, Oribasius was persecuted by the church.

Aetius from Amida, the first outstanding surgeon. His main work, a manual on medicine “The Four Books” in 16 volumes, is a compilation of the works of Oribasius, Galen, Soranus and others.

Alexander from Thrall. His work on internal diseases and their treatment was popular throughout the Middle Ages.

Paul from the island of Aegina. compiled two large works: a work on women’s diseases (which has not reached us) and a medical-surgical collection in seven books. During the Renaissance, many medical faculties prescribed that surgery should be taught only according to the work of Paul. He was considered one of the bravest surgeons of his time.

No. 22. The emergence of higher schools. Civil hospitals and pharmacies. Monastic medicine.

Healing in Ancient Greece is a family tradition. By the beginning of the classical period, the scope of family schools expanded: they began to accept students who were not members of this type. This is how advanced medical schools developed, cat. in classic period were located outside the Balkan Peninsula, outside of Hellas proper - in its overseas settlements. Among the early schools, the most famous are the Rhodian and the Cyrenian. Both disappeared early, there is almost no information about them. The Crotonian, Cnidus, Sicilian and Kosian schools that appeared later constituted the glory of ancient Greek medicine.

The Crotonian school developed in ancient Greece earlier than other medical schools. It is named after the city of Croton, or Carton, in Southern Italy, which was at that time a Greek colony. The doctors of the Crotonian school focused their attention on the teaching of Anaximenes about air as the fundamental principle and primary source of everything that exists. Air, as is known, played a major role in the medical system of Egypt, China and Media. Among the philosophers and doctors of Greece, he acts as the “first mother”

The Knidos school developed in the city of Knidos, in Ionia. By flourishing refers to the first half of the 5th paragraph before i. e. Its head is Zvrifon, about whom, apart from his name, we know nothing.

The Knidos school is characterized primarily by brilliant (for that time, of course) achievements in practical medicine. The document confirming this position is the treatise “On Internal Suffering” (“Hippocratic Defender”). The Cnidians introduced a number of new remedies into medicine that still retain their significance: lime (cauterizing), clay (applications to the chest and head), garlic, onion, horseradish, mint.

Sicilian school Formed in the 1st half. 13th century, at the time of the cultural heyday of the South. Italy. The basis of their creativity is the development of the traditions of love lyrics of the troubadours. Prod. S. sh. differ stylistically. sophistication, sophistication of the figurative structure; in some of them the influence of people is visible. poetry.

Kos School of Medicine is the main medical school of Ancient Greece. The first information about it dates back to 584 BC. e., when the priests of the Delphic Oracle asked Nebros with Fr. Kos and his son Chrysos to stop the pestilence that was raging in the army that was besieging the city of Kirros. Both doctors immediately responded to this request and, as legend says, fulfilled it in the best possible way: the epidemic was stopped. The flourishing of the Kos school is inextricably linked with the name of Hippocrates II the Great, who went down in history as Hippocrates. The Kos Medical School considered the body in close connection with the surrounding nature and developed the principle of observation and treatment at the patient’s bedside.

The Kos school was characterized by a refusal to systematize diseases into groups and types and, in essence, a rejection of diagnosis: after careful observation of the doctors of the Kos school they moved directly to a prognosis based on established signs and to symptomatic treatment. Prognosis occupied an important place in the medical system of this school. Neighboring the Kos school, but opposite in method, the Knido school, on the contrary, devotes significant space to subsuming this disease under one of the established numerous headings.

No. 23. Achievements of doctors-scientists of the Arab caliphates.

Translations:

Translations were carried out from Greek and Persian into Arabic. The main work on translations took place in the “House of Wisdom” in Baghdad, which was created in 832.

Hunayn ibn Ishaq translated Hippocrates, Dioscorides, Galen, Plato, Aristotle, Oribasius and many others. As a result, Hunayn ibn Ishaq acquired deep knowledge in the field of medicine. He introduced medical terminology into Arabic and laid the precious lexical foundation of medical texts in Arabic.

The translation activity of the Arabs played an invaluable role in preserving the heritage of the civilizations that preceded them; many works reached medieval Europe only in Arabic translations.

Treatment of internal diseases:

al-Razi is an outstanding philosopher, physician, and chemist of the Early Middle Ages.

His works on philosophy and logic, alchemy and medicine, theology and astronomy testify to the versatility of his talent.

He studied the effect of mercury salts on the monkey's body. His name is associated with the use of cotton wool in medicine, maintaining clear documentation about each patient (a kind of “medical history”), and the invention of a number of instruments, for example, for removing foreign bodies from the larynx.

Among the 236 known works, no more than 30 have survived; the treatise “On Smallpox and Measles,” cat. It is recognized as one of the best works of medieval Arabic-language medical literature. In it, he formulated the idea of ​​infection, described their differential diagnosis, treatment, and nutrition of the patient. Even today, this treatise has not lost its scientific value. The essay “Medical Book” in 10 volumes, it summarized the knowledge of that time in the field of the theory of medicine, medicinal healing, hygiene, cosmetics, surgery and infectious diseases. Al-Razi compiled the book “For those who do not have a doctor” - a book for poor patients.

Persian Ibn Ilyas- author of the anatomical treatise “Anatomy of Mansur” - a descriptive anatomy of the skeleton, muscles, nerves, veins and arteries corresponding to that time is given with the addition of 5 large illustrations. (autopsies on animals, more often on anthropoids. According to faith)

Ibn al-Nafis from Damascus described the pulmonary circulation (the most outstanding achievement of Arab anatomy). This discovery of the pulmonary circulation is given in the work of Ibn al-Nafis “Comments on the section of anatomy in the “Canon” (Ibn Sina)”

Surgery made progress in the medieval Arabic-speaking world. First of all, this concerns eye surgeries and successful abdominal and obstetric interventions (considered lethal in the Ancient World), treatment of traumatic injuries and dislocations. Painkillers have been described, but their nature remains unclear.

Al-Zahrawi performed the operation brilliantly. I thought that knowledge was necessary for a surgeon, Galena advised. He used catgut in abdominal surgery and for subcutaneous sutures, shock with a thread with two needles, and the first use of the supine position during pelvic operations. He described what is today called tuberculous bone damage and introduced cataract removal into eye surgery and developed a method of local cauterization during surgical operations - cauterization.

Ophthalmology:

Ibn al-Haytham explained the refraction of rays in the media of the eye and gave them names, and proposed the use of biconvex lenses. Work “Treatise on Optics”

Ali ibn Isa developed a cataract removal operation - “Ammara operation”. Book “Memorandum for ophthalmologists”

No. 24. The significance of Avicenna’s works for medical science and practice.

Avicenna (or Ibn Sina) is a great scientist and encyclopedist of the medieval East, who excelled in 12 sciences.

Ibn Sina composed more than 450 works, of which only 238 have survived to this day.

The first works: “Result and Result” in 20 volumes and a book on ethics “Benefit and Sin” - an extensive commentary on books from the palace library. Ibn Sna also wrote the books “Exit and Return”, “Book of Healing”, the main work “Canon of Medicine” (or “Canon of Medicine”) in 5 books. Each book, in turn, is divided into parts (fan), departments (jumla), articles (makala) and paragraphs (fasl). For several centuries, the “Canon” served as the main teaching aid in European universities, having a huge impact on the level of specialized knowledge of doctors in medieval Europe. Advanced Central Asian scientists - philosophers, doctors, natural scientists - were the heralds of a number of new ideas that received recognition and development only a few centuries later. These include attempts to introduce the experimental method into pathology and medicine, the affirmation of the natural scientific essence of medicine as a field of scientific and practical activity, the idea of ​​​​connecting medicine with chemistry, the relationship of the body with the environment and the role of this environment in pathology, the inextricable connection between the mental and the physical, the assumption of Ibn Sina about invisible creatures that can cause febrile diseases and spread through air, water and soil, etc.

The “Canon of Medical Science” brought Avicenna worldwide fame and immortality.

Ibn Sina also dealt a lot with issues of botany, because as a doctor, he could not help but pay due attention to the study of plants that have healing properties.

The work of Ibn Sina occupies a special place in the history of culture. The greatest physician and thinker of his time, he was already recognized by his contemporaries, and the honorary title “Sheikh-ar-rais” (mentor of scientists), assigned to him during his lifetime, accompanied his name for many centuries. The “Canon of Medicine,” which immortalized his name, was translated many times into many European languages, published about 30 times in Latin, and served as a mandatory guide to medicine for European universities and hospitals for more than 500 years. Schools of the Arab East.

No. 25. Questions of dentistry in Avicenna’s “Canon of Medical Science”.

The main medical work of Ibn Sina, which brought him centuries-long fame throughout the cultural world, is the “Canon of Medical Science.” This is a truly medical encyclopedia, in which everything related to the prevention and treatment of diseases is presented with logical order.

No. 26. Al-Razi (Razes), his contribution to medicine and healthcare.

Abu Bakr Muhammad ibn Zakariya al-Razi (850-923) - an outstanding philosopher, physician and chemist of the Early Middle Ages. He was born in Ray, near Tehran. He began to study medicine relatively late - when he was about 30 years old. Al-Razi traveled a lot, toured the entire Islamic world of that time, but spent most of his life in Baghdad, where he founded and headed a hospital that was filled with his students. The works of al-Razi that have reached us testify to the versatility of his talent. Being an excellent chemist, he studied the effect of mercury salts on the monkey's body. The name of al-Razi is associated with the use of cotton wool in medicine and the invention of a number of instruments, for example, for removing foreign bodies from the larynx. Among the 236 works of al-Razi (of which no more than 30 have survived), the small treatise “On Smallpox and Measles”, which is recognized as one of the most remarkable works of medieval Arabic-language medical literature, is of particular value. In this treatise, al-Razi clearly formulated the idea of ​​​​the contagiousness of smallpox and measles, described their differential diagnosis (considering smallpox and measles to be different forms of the same disease), treatment, nutrition of the patient, measures to protect against infection, and skin care for the sick. Another work by al-Razi, “The Medical Book,” in 10 volumes, is an encyclopedic work that summarized the knowledge of that time in the field of medical theory, medicinal healing, dietetics, hygiene and cosmetics, surgery, toxicology and infectious diseases. Al-Razi often visited poor patients and even compiled a special book for them, “For Those Who Don’t Have a Doctor.” Throughout his life, he kept records of his observations, in which he analyzed each disease and drew conclusions. His name is associated with the first introduction in the Arabic-speaking world of clear documentation about each patient. By the end of his life, he became blind, but al-Razi’s students preserved the legacy of their teacher even after his death, summarizing it in the fundamental work “A Comprehensive Book of Medicine” in 25 volumes, which became the first encyclopedic compendium on medicine in Arabic literature.

No. 27. The emergence of medical schools and universities in Western Europe. Methods of teaching in them.

In medieval Western Europe, medical education was preceded by training in a ecclesiastical or secular (from the 13th century) school, where the “seven liberal arts” were taught. The first higher schools appeared in Italy, the oldest of them being the medical school in Salerno. The Salerno medical school was secular, continued the best traditions of ancient medicine and adhered to a practical direction in teaching. Its deans were not ordained, and it was financed by city funds and tuition fees. The school united ancient traditions and Arab heritage. By order of Frederick II, the Salerno School was given the exclusive right to confer the title of doctor and issue licenses for the right to practice medicine. Without a license from this school, it was prohibited to practice medicine on the territory of the Empire. The school had its own training program: 3 years - preparatory course, then 5 years - study of medicine + 1 year - compulsory medical practice. The teaching system included anatomical demonstrations on animals; from 1238, dissection of human corpses was allowed once every five years. The Salerno School made a significant contribution to the development of anatomy and surgery.

The formation of universities in medieval Western Europe is closely connected with the growth of cities, the development of crafts and trade, and the needs of the economic life of culture. The European concept of “university” initially had nothing to do with school and education. In the Middle Ages, this was the name given to a group of people bound by a common oath or oath of mutual assistance and joint action. But after they received a papal charter (in the 12th century), universities became full-fledged. It was from this time (1158) that the history of universities as higher schools began. Medieval universities were distinguished by significant independence from secular and ecclesiastical authorities (their own governing bodies, their own courts, their own privileges, etc.). The language of medieval learning was Latin, and books were a rarity. Universities had three higher faculties - theology, medicine and law. There was also a preparatory faculty of liberal arts (grammar, dialectics, rhetoric, mathematics, geometry, astronomy and music were studied). At the Faculty of Medicine, training lasted 5-7 years and ended with the award of a Bachelor of Medicine degree. The number of medical students was small (up to 10 people in the faculty); for leadership, the head of the dozen was elected - the dean, who headed the faculty and was re-elected every 3 months. The university was headed by a rector, who was also elected. The teachers had various degrees (bachelors, masters, doctors).

No. 28. Main medical institutions of the Middle Ages: hospitals, infirmaries, quarantines.

The formation and development of the hospital business during the Early Middle Ages was associated with Christian charity and consisted not so much in healing the sick, but in caring for the weak, infirm and homeless. Already in the 5th century, the church allocated a quarter of its income to charity for the poor. Moreover, the poor were considered not so much the financially poor as the helpless and defenseless people, orphans, widows, and pilgrims. Among them there were always disabled people, helpless sick people and frail old people. The first Christian hospitals appeared in Western Europe at the turn of the 5th-6th centuries at cathedrals and monasteries; later they were established with donations from private individuals. At the dawn of the Middle Ages, a private hospital was more of an almshouse and an asylum than a hospital in the modern sense. It was noticeably different from the Roman valetudinarius, which was originally intended to treat the wounded on the battlefield, i.e. to provide medical care. Monastic hospitals remained charitable institutions even in their heyday (10-11 centuries). Their medical fame was determined by the popularity of individual monks who excelled in the art of healing. The growth of cities and the number of citizens led to the emergence of city hospitals, which also carried out the functions of a shelter and a hospital; concern for spiritual health remained in the first place. Patients were placed in a general ward; there were no separate rooms for women and men; the beds were separated by screens or curtains. Upon entering the hospital, everyone took a vow of abstinence and obedience to their superiors. Also, long before the development of scientifically based measures to combat infectious diseases, medieval Europe began to use the closure of harbors, the detention of people and goods on arriving ships for 40 days, which is where the term quarantine (from Italian 40 days) came from. By 1485, a whole system of sea quarantines and infirmaries was developed, in which the sick were treated and people arriving from contaminated areas and countries were isolated. Thus the first foundations of the future quarantine service were laid. By the period of the Late Middle Ages, hospitalization had become primarily a secular occupation, and hospitals were increasingly approaching the appearance of modern ones and became medical institutions where doctors worked and there were attendants.

No. 29. The spread of infectious diseases in the Middle Ages: plague, leprosy, syphilis and methods of combating them.

The saddest pages in the history of infectious diseases are associated with the Middle Ages in Western Europe, where the peculiarities of the socio-economic, political and cultural development of feudal states significantly contributed to the spread of massive infectious diseases. During the Crusades, leprosy became widespread. In the Middle Ages, it was considered an incurable and particularly sticky disease. A person who was recognized as a leper was expelled from society. He was publicly buried in a church and then placed in a leper colony, after which he was presumed dead. But he was given the freedom to beg. Lepers were given a special dress made of black material, a special hat with a white ribbon and a rattle, the sounds of which were supposed to warn others of his approach. When meeting a passerby, he had to step aside, and entry into the city was allowed only on certain days. When making purchases, they had to point at them with a special cane. Another terrible epidemic disease was the plague. "Black Death" 1346-1348 was introduced to Europe through Genoa, Venice and Naples. Starting in Asia, it devastated many states. The death of the sick occurred a few hours after infection. The living did not have time to bury the dead. Long before the development of scientifically based measures to combat infectious diseases, medieval Europe began to use the closure of harbors and the detention of people and goods on arriving ships for 40 days, which is where the term quarantine (from Italian 40 days) came from. By 1485, a whole system of sea quarantines and infirmaries was developed, in which the sick were treated and people arriving from contaminated areas and countries were isolated. Thus the first foundations of the future quarantine service were laid.

No. 30. T. Paracelsus, his criticism of scholasticism in medicine and teaching, the origin of iatrochemistry.

Philip Aureolus Theophrastus Bombastus von Hohenheim (1493-1541) - the founder of iatrochemistry, an outstanding naturalist, physician and chemist of the Early Renaissance, known in history under the Latinized name Paracelsus (similar to Celsus). Paracelsus was one of the founders of the experimental method in science. He taught students not only in lectures, but also at the bedside of patients or during walks for minerals and medicinal plants. He was both a theorist and practitioner. With Paracelsus, a radical restructuring of chemistry (i.e., alchemy of that time) in its application to medicine began: from the search for ways to obtain gold to the preparation of medicines. His healing system was based on three invisible elements: sulfur, mercury, salt and their compounds. In his opinion, in each organ of the body these substances are combined in certain proportions. Disease was understood as a violation of their correct relationships. This is why Renaissance doctors placed such importance on medicines containing salt, sulfur and mercury. The widespread use of minerals in the treatment of diseases was innovative for Renaissance medicine, because in Antiquity and during the classical Middle Ages in Europe, almost exclusively remedies prepared from plants and animal parts were used to treat patients. Paracelsus successfully used rubbing mercury in the treatment of syphilis and recommended preparations containing antimony as effective medicines. Paracelsus was convinced that nature both causes disease and cures it. Consequently, the doctor must understand the visible and invisible natural processes occurring in a person. He criticized the teaching of the ancient Greeks about the four juices of the body, condemned the abuse of bloodletting and laxatives, so popular in medieval Western Europe, and developed his own classification of diseases and factors affecting human health (1-diseases associated with disruption of natural functions under the influence of bad habits, 2 -diseases caused by poisonous substances, 3-diseases caused by psychological factors, 4-diseases caused by astral influences, 5-diseases based on spiritual causes). Paracelsus also insisted on combining surgery and medicine into one science and created the book “Grand Surgery”.

No. 31. The Renaissance, its characteristics.

The Renaissance began in the second half of the 14th century in Italy and by the end of the 15th century it had already spread throughout Europe.

During the Renaissance, the experimental method began to become more established. Preference was given to observation and accurate counting. Mathematics became the queen of sciences. During this period, measuring instruments and instruments were invented and improved. Galileo Galilei designed the first telescope and created the first thermoscope. Nicolaus Copernicus developed the heliocentric theory. Poets and artists sought to reflect in their work the world and people around them as they saw them in reality. They sought support in the realistic art of ancient authors, especially the Greeks. That is why this cultural phenomenon of the Late Middle Ages in Western Europe was called “Renaissance” (spiritual revival of antiquity).

The main philosophy was humanism- man and the real earthly world were placed at the center of the worldview. Humanists did not oppose religion and did not challenge the basic tenets of Christianity. Thus, culture and science gradually acquired a secular character and became more independent and independent from the church.

Basic features of natural science Renaissance:

1. humanistic worldview

2. approval of the experimental method in science

3. development of mathematics and mechanics

4. metaphysical thinking (which was a step forward compared to the scholastic method of the Middle Ages)

Along with the dynamically developing culture of the Renaissance, there were also old, rooted trends - scholasticism remained the official philosophy that dominated Catholic universities, and the people preserved the traditions of rural and urban culture.

No. 32. A. Vesalius, his work “On the structure of the human body”

Andreas Vesalius (1514-1564) studied at three universities - in Louvain, Montpellier and Paris, where he studied medicine. Vesalius lived in an era when Galen was the most important authority on anatomy. Vesalius knew his works well and treated him with great respect, but while dissecting human corpses, Vesalius became convinced that Galen’s views on the structure of the human body were largely erroneous, since they were based on the study of the anatomy of monkeys and other animals. Vesalius corrected more than 200 errors in the works of Galen, described the heart valves and thus created the prerequisites for justifying the circular movement of blood.

Vesalius outlined his observations in anatomical tables, and also published a short anatomy textbook, “Extraction” (Epitome, 1543).

In 1543, he published the fundamental work “On the Structure of the Human Body” in seven books, in which he not only summarized the achievements in the field of anatomy over the previous centuries, but also enriched science with his own reliable data obtained as a result of numerous dissections of the human body, corrected a large number mistakes of his predecessors and, most importantly, brought all this knowledge into the system for the first time, i.e. made a science out of anatomy.

The first volume of his work describes bones and joints, the second - muscles, the third - blood vessels, the fourth - the peripheral nervous system, the fifth - the abdominal organs, the sixth - the structure of the heart and lungs, the seventh - the brain and organs feelings. The text is accompanied by 250 drawings made by Kalkar.

Vesalius' experimentally proven conclusions dealt a powerful blow to medieval scholasticism. Vesalius's teacher was more willing to admit that human anatomy had changed than to admit that Galen might be wrong. Vesalius was expelled from the University of Padua

The works of Vesalius open the “Golden Age” in the history of anatomy.

No. 33. V. Harvey, his work “On the movement of the heart and blood in animals” and its influence on the state and development of medicine.

Harvey, William (1578–1657), English naturalist and physician, founder of physiology and embryology.

Graduated from Cambridge University, then studied in Padua and returned to London

Based on the achievements of his predecessors, Harvey mathematically calculated and experimentally substantiated the theory of blood circulation, according to which blood moves in one direction, in a circular pattern in small and large circles, certainly returning to the heart. According to Harvey, in the periphery, blood passes from arteries to veins through anastomoses and through tissue pores; during Harvey’s lifetime, microscopes were not used in physiology, so he could not see the capillaries. They were discovered by Malpighi 4 years after Harvey's death.

In 1628, Harvey's famous book Anatomical Study on the Movement of the Heart and Blood in Animals was published in Frankfurt. In it, he first formulated his theory of blood circulation and provided experimental evidence in its favor. By measuring the systolic volume, heart rate and total amount of blood in the body of a sheep, Harvey proved that in 2 minutes all the blood must pass through the heart, and within 30 minutes an amount of blood equal to the weight of the animal must pass through it. It followed that, contrary to Galen’s statements about the flow of more and more new portions of blood to the heart from the organs that produce it, the blood returns to the heart in a closed cycle. The closure of the cycle is ensured by the smallest tubes - capillaries connecting arteries and veins. Harvey's theory was so revolutionary that it was regarded as an attack on the authority of great scientists. And yet, even before the scientist’s death in 1657, its truth was fully proven. Harvey was attacked by the church and many scientists. But some scientists (Descartes, Galileo) immediately recognized his theory.

No. 34. Development of the experimental method in science and medicine (F. Bacon)

Traditionally, the idea of ​​a new method of studying nature, of the beginning of modern science, is associated with the name of F. Bacon (1561-1626), the author of the famous work “New Organon”. In his works, a program for the development of experimental natural science was developed. He did not ignore medicine either.

Discussing the classification of human knowledge, he includes medicine in the section of human philosophy: “Medicine that is not based on philosophy cannot be reliable.” Noting the merits of Paracelsus in the development of medicine, Bacon writes about his persistent desire to base alchemy and medicine on experience, observation of nature and experiment. At the same time, he repeatedly emphasized the need for a thorough study of the medications that iatrochemists offered.

Not being a doctor, Bacon largely determined the path for the further development of medicine. His main philosophical treatise, “The Great Restoration of the Sciences,” devoted to the formation of science and scientific knowledge, was not completed. However, its second part - the “new Organon” - was published in 1620. In this work, Bacon formulated three main goals of medicine: the first is the preservation of health, the second is the cure of diseases, the third is prolongation of life.

Bacon considered the main tools of knowledge to be feelings, experience, experiment and what follows from them.

Predicting the development of science, Bacon looked ahead for many centuries. In medicine, he put forward a number of ideas, the implementation of which was carried out by many subsequent generations of scientists. These include: studying the anatomy of not only a healthy, but also a sick organism; invention of pain relief methods; widespread use of primarily natural factors in the treatment of disease and the development of balneology.

No. 35. A. Pare, an outstanding surgeon of the feudal era.

Ambroise Pare (1510-1590) - French surgeon and obstetrician, did not have a medical education, he studied surgery in a Paris hospital, where he was an apprentice barber.

A. Pare began serving in the army as a barber-surgeon and participated in many military campaigns. During one of them, he did not have enough hot resinous substances with which to fill the wounds. Having nothing else at hand, he applied a digestive of egg yolk, rose oil and turpentine oil to the wounds and covered them with clean bandages. In the morning, he was surprised to discover that the wound treated with digestive did not become inflamed or swollen, unlike wounds traditionally filled with boiling oil. Then he decided never to cauterize the unfortunate wounded again.

Pare's first work on military surgery, “A method for treating gunshot wounds, as well as wounds inflicted by arrows, spears, etc.” was published in 1545 in French, since Paré did not know Latin, but it was soon republished.

Pare significantly improved the technique of many surgical operations, re-described the rotation of the fetus on its leg, used vascular ligation instead of twisting and cauterization, improved the technique of craniotomy, and designed a number of new surgical instruments and orthopedic devices, including artificial limbs and joints. Many of them were created after Pare’s death according to his drawings.

Paré also wrote an essay “On Freaks and Monsters,” in which he cited many medieval legends about various animal people, bird people, etc.

No. 36. B. Ramazzini, his doctrine of occupational diseases.

B. Ramazzini is considered in world literature the founder of pathology and occupational hygiene, his name has become a household name. “Ramazzinist” societies have been founded in many European countries

Their congresses are timed to coincide with the international congress on occupational health.

Ramazzini's work "Discourse on the Diseases of Craftsmen" was published in 1700. He studied atmospheric phenomena affecting health, in particular atmospheric electricity, oxygen content in the air, ozone. The content of the book "Discourse on the Diseases of Craftsmen" was a complete description of diseases associated with lifestyle patients, and primarily with working conditions. He described more than 60 professions of that time. Ramazzini not only described occupational diseases but also proposed measures to prevent them. The significance of the book goes into the area of ​​occupational pathology and hygiene.

No. 37. The founder of experimental hygiene is I. Pettenkofer.

Max von Pettenkofer - founder of experimental hygiene, founded. In 1879, he headed the first hygienic institute in Europe. Initially, Max Petenkoffer was engaged in precision medicine and only accidental circumstances forced him to take up hygiene. One day he was tasked with finding out why the air in the royal castle was so dry that the king constantly felt a sore throat. After this They began to work on hygiene issues and in this field earned themselves the reputation of a first-class hygienist. In 1879, he founded the first Institute of Hygiene in Europe and headed it. As the chief hygienist of Munich, he raised hygiene to the level of modern science. He studied the influence of external factors: air, water , clothing, housing, on the health of society and individuals. together with the professor. Bülem developed hygienic food standards. Professor Petenkoffer could not ignore infectious diseases since one of the tasks of a hygienist is to prevent the population from diseases. Of all infectious diseases, the scientist was primarily interested in halera, epidemics of which occurred especially often during that period; for the scientist, the study of halera and the fight against it. They were not only a research stage but also a personal matter. He explained the reason as follows: I fell ill with chalera in 1852 after the epidemic of 1836 - 1837, when I attended the senior classes of the gymnasium, did not affect me. After me, my cook fell ill and died in the hospital, then one of my twin daughters, Anna, recovered with difficulty. These experiences left an indelible mark on my soul and prompted me to explore the paths taken by the halera." Petenkoffer argued with Kochch, he believed that the halera causes not only the microbe, but also the water conditions in which it is located. Of course, he was wrong.

No. 38. The founder of clinical medicine is G. Boerhaave.

At the end of the 17th century and the beginning of the 18th century, the University of Leiden played a decisive role in the development and implementation of clinical teaching in Western Europe. A clinic was established at the university, which was headed by the chemist and teacher Fgerman Boerhaave, who headed the departments of medicine and botany, chemistry of practical medicine, and the rector of the university. In Russian, his name is sometimes pronounced Burgav. According to him, “clinical medicine is that which observes patients at their bedside.” G. Boerhaave combined a thorough examination of the patient with a physiological substantiation of the diagnosis and anatomical studies. He was a pioneer of instrumental examination methods: he was the first to use the improved G. D. Fahrenheit thermometer in clinical practice and used a magnifying glass for anatomical studies. The clinical school created by G. Boerhaave played an exceptional role in the development of European and world medicine. Students and doctors from many countries came to see him, calling him a teacher throughout Europe. Boerhaave's lectures were attended by prominent figures of the time, including Peter I.

No. 39. D. Morgagni, his work “On the location and causes of diseases discovered by the anatomist” and its significance for making a scientifically based diagnosis.

Morgagni Giovanni Battista is an Italian doctor who, while conducting autopsies, described numerous pathologies, anomalies, and tumors of various organs. He sought not only to outline the basics of pathological processes, but also to provide information about the pathogenesis, symptoms, and diagnosis of relevant diseases. The fruit of his many years of research was the work “on the location. And causes of diseases identified by the anatomist.” It outlines the fundamentals of pathological anatomy as a science. Morgagni was the first to describe many anatomical structures that were later named after him."

No. 40. The significance of the works of R. Laennec and L. Auenbrugger for the development of pathology and therapy.

The Viennese physician Leopold Auenbrugger played an important role in the development of physical examination methods. He is the author of the percussion method. That is, tapping, so well known today, and with such difficulty was included in medical practice. For seven years, the doctor carefully studied the sounds made when tapping the chest in a healthy and sick body. In 1761, Aurenbrugger presented the results of his research on 95 pages of the essay “inventum” novum". Unfortunately, his work was not received properly; it was appreciated only years later.

René Théophile Hyacinthe Lennec.

While a student at the University of Paris, Laennec began work on studying the disease, which at that time was called consumption and from which a lot of people died at that time. Pathoanatomical autopsies revealed specific formations in various organs, which Laennec called tubercles. They arose and developed without external signs, and when the symptoms of the disease appeared, it was no longer possible to save the patient. Laennec became famous for inventing the stathoscope, a device for listening to the chest sounds of a patient. R. Laennec described auscultatory symptoms of heart defects, studied the clinic and pathomorphology. Portal cirrhosis of the liver established the specificity of the tuberculosis process long before the discovery of the causative agent of the disease. He considered tuberculosis to be a contagious disease, and the quality of preventive measures suggested physical rest, increased nutrition and sea air.

In 1819, his work “on mediocre auscultation or recognition of diseases of the lungs and heart, based mainly on this new method of research,” was published.

No. 41. K. Rokitansky, development of humoral pathology

In the middle of the 19th century, the greatest influence on the development of pathological anatomy was exerted by the works K. Rokitansky, in which he not only presented changes in organs at various stages of disease development, but also clarified the description of pathological changes in many diseases. Rokitansky considered the main cause of painful changes to be a violation of the composition of body fluids (juices) - dyscrasia. At the same time, he considered the local pathological process as a manifestation of a general disease. Understanding disease as a general reaction of the body was the positive side of his concept

K. Rokitansky was the last representative of the dominant for centuries theories of human humoral pathology, which had no scientific basis. . In the middle of the 19th century. Rokitansky's humoral pathology came into conflict with new factual data. The use of the microscope brought natural science to the level of the cellular structure of organisms and dramatically expanded the possibilities of morological analysis in health and disease.

In 1844, K. Rokitansky founded the Department of Pathological Anatomy at the University of Vienna and created the world's largest pathological anatomical museum. The name of K. Rokitansky is associated with the final separation of pathological anatomy into an independent scientific discipline and medical specialty.

No. 42. Cellular pathology of R. Virchow

The principles of the morphological method in pathology were laid down by Rudolf Virchow. Guided by the theory of cellular structure, Virchow first applied it to the study of a sick organism and created the theory of cellular pathology, which is set out in his article “Cellular pathology as a doctrine based on physiological and pathological histology. According to Virchow, the life of a whole organism is the sum of the lives of autonomous cellular territories; a material substrate disease is the cell (i.e. the dense part of the body, hence the term “solidary” pathology); all pathology is the pathology of the cell. The theory of cellular pathology was a step forward compared to the theory of tissue pathology of Bisha and humoral pathology of Rokitansky. It quickly gained universal recognition. had a positive influence on the subsequent development of medicine. Some provisions of the cellular theory of pathology in its original form contradicted the doctrine of the integrity of the body and were criticized by contemporaries during the author’s lifetime. The cellular theory of pathology, which at one time played a progressive role in the development of science, was replaced by a functional direction. based on the doctrine of nervous and humoral regulation.

No. 43. The discoveries of L. Pasteur and R. Koch and their role in the development of medicine

Pasteur's main discoveries: the enzymatic nature of lactic acid, alcoholic and butyric acid fermentation, the study of the "diseases" of wine and beer, refuting the hypothesis of the spontaneous generation of microorganisms, the study of diseases of silkworms, the basis of ideas about artificial immunity, the creation of a vaccine against anthrax (1881) by artificially changing virulence microorganisms, creation of an anti-rabies vaccine (1885). Pasteur's discoveries laid the scientific foundations for the fight against infectious diseases by vaccination. He discovered a method of destroying microbes by exposing them to high temperatures, which is called pasteurization. He also discovered a method of sterilization, which had a great influence on the development of medicine.
Robert Koch is the founder of bacteriology. Koch created laboratory bacteriology and determined the research strategy. He developed solid nutrient media for growing pure bacterial cultures and formulated criteria for the relationship between a pathogen and an infectious disease - the “Koch's truad”. Koch was the first to finally establish the etiology of anthrax and discover the causative agent of tuberculosis and cholera. While studying tuberculosis, he obtained a tuberculin-glycerol extract of a pure culture of Mycobacterium tuberculosis, which turned out to be a valuable diagnostic tool. Advances in the field of microbiology have opened up great prospects for the development of industry and agriculture, and have made possible the scientifically based fight against infectious diseases and their successful specific prevention.

No. 44. The most important achievements and directions for the development of hygiene in Russia in the 19th century

Dobroslavin is the first domestic professor of hygiene. In 1871, he began teaching a course in hygiene at the St. Petersburg Medical-Surgical Academy and founded the first department of hygiene in our country. On his initiative, an experimental hygienic laboratory was created for scientific research and practical training with academy students. He is the author of the first textbooks on hygiene in Russia. His scientific works are devoted to the study of metabolism, food hygiene and military hygiene. He made a great contribution to the development of public medicine in Russia.
The second department of hygiene in Russia was created in 1882 at Moscow University. It was headed by Erisman, an outstanding Russian hygienist, one of the founders of scientific hygiene in Russia, and an active figure in public medicine. He paid great attention to school hygiene and home hygiene, for the first time published materials on the blatantly unsanitary condition of basement dwellings and rooming houses in St. Petersburg, fought for the improvement of sewerage and “the proper arrangement of the sanitary unit in Russia.” His lectures and scientific works were distinguished by a broad public approach to solving medical problems. The work of F. F. Erisman, carried out jointly with other hygienists to study the working conditions of workers in factories and factories in the Moscow province, was of great social and hygienic significance. They revealed the direct dependence of the health of workers on sanitary working conditions and the degree of exploitation, and showed the class essence of the harmful influence of “the unfavorable conditions in which modern civilization has placed this labor, completely leaving it to unlimited exploitation by greedy and self-interested entrepreneurs.” F. F. Erisman developed hygienic standards for assessing water quality, created the first sanitary station, which was subsequently reorganized into the Moscow Research Institute of Hygiene named after F. F. Erisman. He wrote a fundamental manual and several monographs on hygiene.

No. 45. Medicine in the Old Russian state (9-13 centuries)

In Ancient Rus', healing existed in different forms: 1) folk healing was preserved among the people; 2) after the adoption of Christianity, monastic medicine actively developed under the shadow of monasteries; Since the reign of Yaroslav the Wise, secular medicine has appeared in Rus'.
Traditional healers were called lechtsy. The doctors passed on their medical knowledge and secrets from generation to generation, from father to son in family schools. In medical practice, they widely used various remedies of plant, animal and mineral origin. The following plants were used: wormwood, nettle, plantain, wild rosemary, linden blossom, birch leaves, ash bark, juniper berries, onions, garlic, horseradish, birch sap. Medicines of animal origin include honey, raw cod liver, mare's milk and deer antlers. The Russian people have long known about the healing properties of “sour water” - narzan. The experience of folk healing has been summarized in numerous herbalists and medical books.
Monastic medicine. The first hospitals at monasteries were established in Kyiv and Pereyaslavl. The most famous monastery hospital in Rus' was located in the Kiev Pechersk Lavra. Old Russian monastic hospitals were centers of education: Greek and Byzantine manuscripts were collected in them and medicine was taught. "Izbornik" is the most popular book about medicine.
Secular medicine has been known since the reign of Yaroslav the Wise. In cities, at the courts of princes and boyars, secular doctors, both Russian and foreign, served. It was based on the experience of centuries-old Russian folk healing.

No. 46. Written medical monuments of Kievan Rus. The meaning of Christianity.

Written medical monuments of Kievan Rus. The meaning of Christianity.

1) Written medical monuments in Kievan Rus are contained in various sources: chronicles, legal acts of that time, charters, other written monuments and monuments of material culture. One of the outstanding achievements of Slavic culture of that time was the creation in the 9th century. Slav. Alphabet - Cyrillic (beginning of Slavic writing)

"Izbornik Svyatoslav" - The oldest monument of Russian medical literature is an article in Svyatoslav’s Collection, which contains medical and hygienic information. The Izbornik was translated in the 10th century. from the Greek original for the Bulgarian Tsar Simeon, and in 1703 it was rewritten in Rus' for the Chernigov prince Svyatoslav Yaroslavich. In this unique encyclopedia, in addition to other information, a number of medical and hygienic tips are given, the most common remedies from plants are described, but in 1076. Another “Izbornik” was recorded. Compiled by John. He collected extracts from the works of Byzantine writers, fragments from biblical books and lives. The “Izbornik” talks about healers-razalniks (surgeons) who knew how to “cut tissue,” amputate limbs and other diseased or dead parts of the body, do therapeutic burns, and treat with herbs and ointments.

2) The meaning of Christianity. The Eastern Slavs founded their state at the beginning of the 9th century. Thanks to the chronicles, information about this event has reached us, and the state became known as Kievan Rus. Christianity was adopted in the 10th century. 988

Reasons for accepting Christianity:

Social inequality of people required justification and explanation

A single state required a single religion

Isolation of Rus' from Christian European countries

The adoption of Christianity had important political consequences:

It contributed to the centralization and strengthening of the state, its rapprochement with European Christian countries (Byzantium, the Bulgarian state, England, Germany), the close ties of Kievan Rus with Byzantium and Bulgaria, established in the 9th century, contributed to the mutual enrichment of cultures. As a result, the phenomenon of Russian medieval culture was formed.

No. 47. Main types of medical care in Kievan Rus.

The level of development of sanitation in the Old Russian state was ahead of the countries of Western Europe. This is evidenced by excavations of ancient Novgorod: hygienic items were found. Pottery and wooden water pipes and water collectors were opened, hospitals for the civilian population and alchemist specialists who prepared medicines were found.

An integral part of the medical and sanitary life of ancient Rus' was the Russian steam bath. This is also mentioned in the chronicles of Christian times. The chronicle of Nestor (11th century) contains the first written mention of a Russian steam bath, the healing power of which has been known in Rus' since ancient times. For a long time, colds, joint diseases and skin diseases were treated here, dislocations were set, bloodletting was performed and “pots” were applied, prototypes of modern medicinal cups. Various diseases and epidemics were called “pestilence”, “pestilence”.

No. 48. Formation of the Moscow State. Pharmacy order and its functions. The first medical school.

After the expulsion of the Golden Horde, the Grand Duchy of Moscow became a large multinational state in Europe (under Ivan III). By the end of the 16th century. The territory of the principality almost doubled. There were 220 cities in the country. The population reached 7 million people. In 1550, John IV approved the new Code of Laws, a system of ancient laws.

The Apothecary Prikaz, the first state medical institution in Russia, was founded around 1620. In the first years of its existence, it was located on the territory of the Moscow Kremlin, in a stone building opposite the Chudov Monastery. At first it was a court medical institution, attempts to create which date back to the times of Ivan the Terrible (1547-1584), when in 1581 the first Sovereign (or “Tsarev”) pharmacy in Rus' was established at the Tsar’s court, since it served only the tsar and members of the royal family. The pharmacy was located in the Kremlin and for a long time (almost a century) was the only pharmacy in the Moscow state. In the same 1581, at the invitation of Ivan the Terrible, the court physician of the English Queen Elizabeth arrived in Moscow for royal service. the retinue included doctors and pharmacists (one of them named Yakov), who served in the Sovereign’s pharmacy. Thus, initially, only foreigners (English, Dutch, Germans) worked in the court pharmacy; professional pharmacists from natural-born Russians appeared later. The pharmaceutical order was to provide medical assistance to the king, his family and associates. Prescribing medicine and its preparation were associated with great rigor. The medicine intended for the palace was tasted by the doctors who prescribed it, the pharmacists who prepared it, and, finally, by the person to whom it was handed over for transfer “upstream.” The “selected medical products” intended for the tsar were kept in the pharmacy in a special room - the “breech” under the seal of the clerk of the Pharmacy Prikaz. Being a court institution, the “tsar’s pharmacy” served service people only as an exception. Functions: management of pharmaceutical gardens and collection of medicines; (inviting foreign doctors, checking their educational documents, assigning positions, forensic information, monitoring their salaries, collecting and storing herbal medicine); This also included the preparation and sale of honey and vodka.

The first state medical school in Russia was opened in 1654 under the Pharmacy Order with funds from the state treasury. Children of archers, clergy and service people were accepted into it. The training included collecting herbs, working in a pharmacy and practicing in a regiment. In addition, students studied anatomy, pharmacy, Latin, diagnosis of diseases and methods of treating them. Folk herbalists and medical books, as well as “doctor's tales” (histories of illnesses), served as textbooks. During the war, chiropractic schools operated. Anatomy in the medical school was taught visually: there were no teaching aids for bone preparations and anatomical drawings. Doctors who provided medical care to the civilian population most often treated them at home or in a Russian bathhouse. Inpatient medical care was practically non-existent at that time.

No. 49. Activities in the Moscow State to combat epidemics.

The country's trade gates often opened the way to terrible epidemics, which in the Middle Ages devastated and ruined the states of Europe. Particular epidemics of “endemic” diseases, the idea of ​​“the stickiness of the infection” led to the introduction of protective measures in Rus'. Communication with plague-ridden houses ceased; their residents were fed from the street through the gate. To destroy infection in homes, ancient folk remedies were used: freezing, burning and fumigation, ventilation, washing. Royal decrees were also sent to isolate contaminated areas, especially to the capital city (the task was to save the sovereign and the troops). During the period 1654-1665, more than 10 royal decrees were signed “on precautions against pestilence.” During the plague, it was necessary to establish outposts and abatis, through which no one was allowed to pass under pain of death.

No. 50. Medicine in the Muscovite state (15-17 centuries), training of doctors, opening of schools and hospitals.

The training of Russian doctors at that time was of a craft nature: the student studied for a number of years with one or several doctors, then served in the regiment for several years as a doctor's assistant. Sometimes the Pharmacy Order prescribed a verification test (exam), after which those promoted to the rank of Russian doctor were given a set of surgical instruments. The Pharmacy Order made high demands on the students of the Medicine School. Those accepted for study promised: “...not to harm anyone, not to drink, not to drink, and not to steal by any means...” The training lasted 5-7 years. Medical assistants assigned to foreign specialists studied from 3 to 12 years. The first graduation of the Medical School, due to the large shortage of regimental doctors, took place ahead of schedule in 1658. The school functioned irregularly. Over the course of 50 years, she trained about 100 Russian doctors. Most of them served in the regiments. Systematic training of medical personnel in Russia began in the 18th century. Doctors who provided medical care to the civilian population most often treated them at home or in a Russian bathhouse. Inpatient medical care was practically non-existent at that time. Doctors who provided medical care to the civilian population most often treated them at home or in a Russian bathhouse. Inpatient medical care was practically non-existent at that time.

Monastic hospitals were built at the monasteries. In 1635, two-story hospital wards were built at the Trinity-Sergius Lavra, which have survived to this day, just like the hospital rooms. In the Moscow state, monasteries had important defensive significance. Therefore, during enemy invasions, temporary hospitals were created on the basis of their hospital wards to treat the wounded. And despite the fact that the Pharmacy Order did not deal with monastic medicine, during wartime the care of the sick and medical care in temporary military hospitals on the territory of the monasteries was carried out at the expense of the state. This was an important distinctive feature of Russian medicine in the 17th century. The first Russian doctors of medicine appeared in the 15th century.

Related information.