What is wrong with Russian medicine?! Evidence-based medicine and domestic medical science.
Domestic science and medicine in the 19th – early 20th centuries.
Russian medicine has developed in close connection with the achievements of world science and medical practice. Without dwelling on all its achievements, let us consider the schools that were important not only for domestic but also for world science and medicine.
At the beginning of the 19th century. In Russia there were two centers for training specialists: the Faculty of Medicine of Moscow University and the St. Petersburg Medical-Surgical Academy. They were also centers for the development of medical sciences and clinical disciplines. In the first, questions were developed general pathology, therapy and physiology, in the second – anatomy, topographic anatomy and surgery. The development of capitalism led to an expansion in the number of universities: at the end of the 19th century. there were already 10 of them.
Russia's first scientific anatomical school developed by the beginning of the 19th century. at the St. Petersburg Medical-Surgical Academy under the guidance of academician P.A. Zagorsky(1764 – 1846). Russian anatomical terminology is being approved to replace Latin, and a national manual on anatomy is being created. Academician became his successor and successor I.V. Buyalsky(1798 – 1866). His “Anatomical and Surgical Tables” (1828) immediately gained worldwide fame. Among the first Russian surgeons, he used anesthesia, starch dressing, antiseptics, developed methods for embalming corpses, and much more. The highest flowering of the Russian anatomical school is associated with the activities of the great anatomist and surgeon N.I. Pirogov.
By the end of the 19th – beginning of the 20th centuries. in Russia there were already three leading anatomical schools: in Moscow - a school D.N. Zernova(1834 – 1917), in Kyiv – school V.A. Betsa(1834 – 1894), in St. Petersburg – P.F. Lesgafta(1838 – 1909) – the founder of theoretical anatomy and the creator of the national science of physical education.
The Russian school has gained worldwide fame embryology. Worked in Russia Caspar Friedrich Wolf(1733 – 1794), Karl Bare(1792 – 1876) laid the foundations for comparative vertebrate embryology. The honor of founding this direction as a science belongs to our compatriots - Alexander Onufrievich Kovalevsky(1840 – 1901) and Ilya Ilyich Mechnikov(1845 – 1916), who became a Nobel laureate in 1908. Embryology has become one of the most important disciplines. Its use in medicine was not limited to the field of anatomy and histology. And today it has important practical significance for preventive medicine and the fight against hereditary diseases.
Russian medicine occupied an outstanding place in medical science. school of physiologists, which is associated with the names of Ivan Mikhailovich Sechenov(1829 – 1905) and Ivan Petrovich Pavlova(1849 – 1936). Sechenov's work was of particular importance for the physiology of the nervous system and neuromuscular physiology. He was the first to put forward the idea of reflex basis mental activity and proved that “all acts of conscious and unconscious life, according to their mode of origin, are reflexes.” Sechenov discovered central (Sechenov) inhibition (1863). His classic work “Reflexes of the Brain” (1863) by I.P. Pavlov called it “a brilliant stroke of Russian scientific thought.”
I.P. Pavlov is the creator of the doctrine of higher nervous activity, the founder of the largest physiological school of our time, an innovator in research methods in physiology. Nobel laureate (1904). He became a pioneer in substantiating the principle of nervism - the idea of the decisive role of the nervous system in regulating the functional state and activity of all organs and systems of the body. The result of these studies was his the doctrine of higher nervous activity– one of the greatest achievements of natural science of the 20th century.
In the area clinical medicine XIX century The activities of the surgeon, teacher Nikolai Ivanovich are of great importance Pirogov(1810 – 1881), creator of topographic anatomy and experimental trends in surgery, one of the founders of military field surgery. In the creation of topographic anatomy, the “ice anatomy” method occupies an important place. Russia was one of the first countries where ether anesthesia became widespread. It was scientifically substantiated by Pirogov. In 1847, he was the first in the world to use anesthesia en masse in a theater of war. He applied the first plaster cast in field conditions(1854), expressed the idea of bone grafting (1854). In the area military field surgery Pirogov was the first to justify and put into practice the sorting of the wounded into four groups: hopeless, seriously wounded, moderately injured, lightly wounded. For the first time, postoperative patients were divided into two groups: clean and purulent. Pirogov took the initiative to attract women to care for the wounded in the military theater - the creation of a nursing institute. He stood at the origins of the creation of zemstvo medicine, putting forward the basic organizational principles of its activities.
Along with N.I. Pirogov made a significant contribution to the development of clinical medicine: the founder of the largest school of Russian clinicians, the organizer of a clinical experimental laboratory, Sergei Petrovich Botkin(1832 – 1889); one of the leading therapists who developed a clinical examination scheme and introduced the compilation of medical histories into practice M.Ya. Mudrov(1776 – 1831); founder of the Kyiv scientific therapeutic school, one of the founders of domestic cardiology and hematology V.P. Samples(1851 – 1920), etc.
In the 19th century, the domestic pediatrics. Specialized assistance children in Russia dates back to 1834, when a special children's hospital with 60 beds was opened in St. Petersburg. In 1842, the world's first hospital with 100 beds for children opened in Moscow. early age. Both hospitals were supported by charitable funds.
The founder of scientific pediatrics in Russia was Stepan Fomich Khotovitsky(1796 - 1885), professor of the department of obstetrics, women's and children's diseases of the St. Petersburg Medical-Surgical Academy, where from 1836 he read a course of lectures, published in 1847 under the title “Pediatrics”. In 1861, a special course on pediatrics was taught at the academy, and in the early 70s. XIX century The first department of childhood diseases in the country is opened under the leadership of a professor N.I. Bystrova. In 1888, a similar department was opened at Moscow University, which from 1891 to 1902 was headed by the creator of a large scientific school of clinical and physiological direction - N.F. Filatov(1847 – 1902). He was the first to isolate and describe chicken pox and scarlet fever, revealed early sign measles on the oral mucosa. His lectures, recorded and published by his students, were republished many times. In 1885, the first scientific society of children's doctors in Russia was created in St. Petersburg under the leadership of N.I. Bystrov, in 1892 - a similar society in Moscow under the leadership of N.F. Filatova.
Along with other specializations in the 19th century. received further development dentistry. In the first half of the 19th century. Dentistry was carried out mainly by doctors without higher education who had the right to treat diseases and perform all operations without exception. In 1809, there were 18 dentists in Russia. Since 1838, dentists began to be called dentists (they passed the exam at the Medical-Surgical Academy). During the first half of the 19th century. in St. Petersburg, 54 people passed the medical exam, one of them was a woman, Maria Nazon. By 1902, there were already 221 dentists in the country.
The Industrial Revolution and Urban Growth Drive Development hygiene. In Russia, the formation of scientific hygiene took place in the second half of the 19th century. One of its founders, Professor A.P. Dobroslavin(1842 – 1889) in 1871 initiated the opening of the first department of hygiene and experimental laboratory in Russia (at the St. Petersburg Medical-Surgical Academy). He is the author of the first domestic textbooks on hygiene. In 1878 A.P. Dobroslavin founded the Russian Society for the Protection of Public Health and published the magazine “Health”. The second department of hygiene in Russia was created in 1882 at Moscow University, it was headed by professor F.F. Erisman(1842 – 1915). It should be noted the activities of F.F. Erisman in the field of public sanitation, practical participation in the development of water supply and sewerage systems in Moscow, inspection of factories and factories in the Moscow province.
Medical care organization system in Russia by the beginning of the 20th century. included the following elements:
1) military medicine, which originated in the 16th century. as a result of the reforms of Ivan the Terrible;
2) factory medicine (since 1719);
3) urban medicine (since 1775);
4) zemstvo medicine (since 1864).
Until the second half of the 19th century. the rural population (more than 90% of the country's population) did not have organized medical care. The zemstvo reform of 1864 led to the emergence zemstvo medicine in 34 of 97 provinces and regions of Russia. It was organized as an “optional” duty of the zemstvo. At the same time, zemstvos allocated up to half of the funds for medicine (for “optional expenses”). The attention of the Zemstvo people was drawn to the rural population (i.e., the absolute majority of the country's population), which for the first time received the opportunity for systematic medical care. Zemstvo medicine represented a huge step forward in the process of rationalizing health care and in creating a system of medical care for the population. The first sanitary doctor of Russia I.I. Molleson wrote: “For the first time, we Russians have to take a major step forward and show the way to others, since, as far as we know, there has not even been an attempt at such an organization of traditional medicine anywhere abroad.”
In the provinces, zemstvo medicine was under the jurisdiction of local government. Provincial and zemstvo councils determined the form of medical care for peasants, hired doctors, and established their job responsibilities. At the congresses of doctors practicing zemstvo medicine, representatives of zemstvo administrations were present - to determine the possibility of implementing the doctors' proposals, as well as to convey to the doctors the points of view of the population on various problems.
For the first time in Russia, a large professional stratum became associated with a social movement. At the first stage of the existence of zemstvo medicine, the cadre of doctors was strongly influenced by the ideology of the various intelligentsia in the form of various ideas of populism - from educational to revolutionary. In the 1860s. A.V. Petrov, V.O. Portugalov and others were active members of Land and Freedom. Health issues were reflected in the program documents of revolutionary populism. Created in 1868 by a student of S.P., it was under populist influence. Botkin by Professor N.A. Vinogradov "Society of Doctors of Kazan". Doctors from all regions joined the society. In the Perm province, the branch of the Society was represented by the senior doctor of the provincial hospital V.I. Dunaev and the first sanitary doctor of Russia I.I. Molleson. The “Society of Doctors of Kazan” actively developed ideas for sanitary and hygienic areas, as well as sanitary descriptions of areas to combat epidemic and local diseases.
To avoid the spread of democratic ideas, the government prohibited the creation of a common zemstvo center, fearing that zemstvos would go over to political activity. Zemstvo organizations were initially disunited, but the task of consolidating zemstvo doctors was carried out by Pirogov Congresses of Doctors. Chairman of the First Pirogov Congress N.V. Sklifosovsky identified the zemstvo doctor “as the main figure among Russian doctors.” At the II Congress of F.F. Erisman, E.A. Osipov and others compiled a program for collecting information on zemstvo medicine. The result of this work was the publication of the Zemstvo Medical Bulletin, which contained information on all 369 districts of 34 zemstvo provinces of Russia. The compiler of the collection was D.N. Zhbankov, main editors – F.F. Erisman and E.A. Osipov.
The zemstvo doctor represented a special type of physician who experienced strong influence democratic ideas, had deep social ties with the peasantry and considered themselves defenders of their interests. The specificity of zemstvo doctors was their younger age than those in public service(75% are under 40 years old). At first, service in zemstvos was considered private and did not have any established framework. Unlike others medical services zemstvo doctors did not have any special medical superiors and considered themselves to be in a contractual relationship with the zemstvo that invited them. These agreements were developed in Russia experimentally.
A special feature of the country was the social nature of zemstvo medicine. The doctor did not depend on the position of private practice and was equally interested in the cure of both rich and poor patients; unnecessary “healing” operations were excluded. There were no market relations between the doctor and the patient, because The doctor received his salary from the zemstvo. Zemstvo doctors were content with a relatively small salary and refused private practice. For this, a number of zemstvos provided them with additional benefits– pensions and benefits, assignments on scientific trips to university cities to improve their skills while maintaining their salary.
In the initial period of the existence of zemstvo medicine, zemstvo doctors fought for the most effective forms working with the population. So, in the 60-70s. gg. XIX century zemstvos, to save money, invited paramedics to work instead of doctors, who were given the right self-treatment. Zemstvo doctors believed that such independence of illiterate paramedics was unacceptable and stubbornly fought against “paramedicism.”
In the second half of the nineteenth century. The struggle between two public service systems was also widely discussed: traveling And stationary. The traveling system was typical for more early period– first half of the 19th century. Its essence was that the doctor visited settlements according to a predetermined schedule, made appointments and examined patients. In his absence, paramedics were busy carrying out medical recommendations. Traveling took the doctor’s time away from serving patients and did not allow him to improve his knowledge; Only young people and few people took up this type of activity. experienced doctors. By the beginning of the twentieth century. in 34 provinces, the traveling system was preserved in only 2 districts, while the stationary system existed in 138 districts, and in 219 it was “mixed”.
Zemstvo doctors considered the most progressive form of service to the population to be inpatient, when the patient was constantly monitored by doctors and received medications in a timely manner and in the proper proportion. Therapeutic effect provided and enhanced nutrition in hospitals, as well as rest from hard peasant labor. In addition, in the hospital it was possible to differentiate patients by type of disease and perform operations; the introduction of physiotherapy and hydrotherapy began.
Zemstvo medicine gained worldwide fame thanks to local form of public service. The site was supposed to serve 6-6.5 thousand people. It included a local hospital, a pharmacy, an apartment for a doctor who saw patients at any time of the day, and a house for staff. By the beginning of the twentieth century. a structure has developed medical care of three links: medical district - district hospital - provincial hospital. In 1934, the League of Nations recommended that the district system be used by other countries to organize assistance to rural populations.
From the very beginning of the introduction of zemstvo medicine, the issue of paying for patients was discussed. Zemstvo doctors were able to defend the need to maintain free admission to patients. This made it possible to treat chronic diseases, take urgent measures during epidemics, when the population did not hide their illnesses, but sought medical help. The main provisions for serving peasants were developed:
1) treatment should be free;
2) placement in the hospital and leaving it must be voluntary;
3) the economic part of the hospital should be under the control of a doctor, so as not to save on expenses.
As a result, by the end of the nineteenth century. peasants no longer saw the doctor as a “stranger” and increasingly sought medical help. The situation was similar with free medicines. The urban population received medicines from privileged pharmacies; the rural population was far from pharmacies, and medicines were too expensive for peasants. In addition, if medicines were paid for, 2/3 of sick women, old people and children, for whom the peasant family would not be able to allocate funds, would fall out of the sight of doctors. A number of provincial zemstvos began to purchase medicines from manufacturers abroad and create pharmacy warehouses within the province, which significantly reduced treatment costs.
At first, zemstvo councils invited doctors to serve, implying only medical activities. But the difficult sanitary conditions in the country and the high mortality rate almost immediately forced attention to sanitation.
Superiority in the making sanitary work belongs to the Perm province, where the rate of a sanitary doctor was introduced. In 1871 he became I.I. Molleson. True, the conflict between the branch of the Kazan Doctors’ Society and the Perm provincial government led to the dismissal of doctors and the suspension of sanitary work. Later, zemstvo sanitation appeared in the Moscow province, where its development turned out to be more sustainable. Its leader E.A. Osipov believed that sanitary work should be in close connection with medical care and be based on the district system.
In its most complete form, the zemstvo sanitary organization consisted of the following units:
1) provincial sanitary council - a collegial body of zemstvo councilors and doctors;
2) provincial sanitary bureau - the executive body of the council (headed by a doctor), which is the sanitary department of the provincial zemstvo government;
3) sanitary doctors - one per county;
4) doctor-statistician at the provincial sanitary bureau; doctor in charge of smallpox vaccination, epidemiologist;
5) local sanitary councils at medical districts;
6) sanitary guardianship.
In this form, sanitary organizations existed in the Kherson and St. Petersburg zemstvos, as well as in the Perm, Yekaterinoslav and Nizhny Novgorod provinces. Sanitary activities in Russian zemstvos differed significantly from foreign practice. In Europe, sanitary authorities were associated with government control; in Russia, zemstvo sanitary authorities were public structures opposing the bureaucracy of the state. Sanitary doctors, often associated with the revolutionary movement, were considered “unreliable.”
Sanitary activities were associated with constant contacts between doctors and the population, which made it possible to involve residents in sanitary work. In cases of outbreaks of epidemics, zemstvo doctors received good helpers from the ranks of the local population, which allows us to speak about the public nature of zemstvo medicine.
Thus, by the beginning of the twentieth century. all segments of the Russian population were provided with medical care. Through the efforts of doctors, zemstvos and the public, a unique system of zemstvo medicine was created, built on the following principles:
· free,
· availability,
· connection between practice and science,
· involvement in sanitary and preventive activities public and population.
The country has come close to creating a healthcare system.
Topic 4. MODERN MEDICINE
(XX - early XXΙ centuries)
1. The influence of outstanding discoveries in natural science
and medical technology
Fundamental discoveries in the leading fields of natural science of the twentieth century. radically changed medicine and influenced previously established ideas about the essence of processes in nature and the human body. In the area physicists The most important research was carried out, revolutionary discoveries were made.
With the discovery of X-rays, the era of obtaining images of internal organs, the era of visualization, began. For the first time, the doctor had the opportunity to see what was happening in the body of a living person. The science of radiology is being formed (the theory and practice of using x-rays to study human and animal organisms). Another major discovery - the phenomenon of radioactivity - influenced the formation of radiobiology (the science of the effects of all types of ionizing radiation on living organisms) and medical radiology (the science that studies the possibility of using ionizing radiation for the diagnosis and treatment of a number of diseases).
A huge achievement of physics was the discovery of the structure of atoms and the radiation they emit, the emergence and development of electronics, quantum mechanics, the theory of relativity, nuclear physics, cybernetics (the science of control, communications and information processing). The creation of new precise methods of nuclear magnetic measurements and related discoveries opened up the prospect of nuclear magnetic tomography (“line-by-line” examination of the whole body or part of it). The biggest achievement was the development of a computer method for image reconstruction in tomography. Fundamental work in the field of quantum electronics and high-speed electronics has created the possibility of introducing lasers into medicine.
Significant impact on development theoretical foundations medicine provided chemistry. Thanks to the successes of physics and physical chemistry, it became possible to study the physicochemical basis biological phenomena at the molecular level. At the intersection of physics, chemistry and biology, scientific disciplines such as biochemistry, biophysics, radiation biology, space biology and medicine, molecular biology, etc. arose. In biological and medical research, in laboratory and functional diagnostics, methods of physics, chemistry, and applied mathematics are increasingly used. Special areas of biophysics and biochemistry include medical biophysics and medicinal chemistry. The further development of anesthesia is based on the achievements of chemistry. Fundamental work in biochemistry has been completed nucleic acids. Radical discoveries were made that made it possible to build general scheme metabolism, obtain data on chemical composition and the metabolism of a number of important substances in organs and tissues, to establish that most pathological processes are associated with impaired energy metabolism at the molecular and submolecular levels, etc.
Advances in biology and genetics have had a significant impact on the development of medicine. In 1906, a science studying heredity and variability was formed - genetics. The most important milestone in its development was the creation in 1911. chromosome theory heredity: American scientist T. Morgan and the staff of his scientific school experimentally proved that the main carriers of genes are chromosomes. In the 1920-30s. The world's largest genetic scientific schools developed in the USSR N.I. Vavilova,N.K. Koltsova, Yu.A. Filipchenko, A.S. Serebrovsky, in the 1960s. – N.V. Timofeev-Resovsky, N.P. Dubinina and others. At the beginning of the 20th century. Scientists in Japan and the United States managed to obtain stem cells from ordinary skin cells of patients by transforming only four genes. This discovery eliminates the problems of cloning a human embryo and the rejection of an artificially created organ during cloning. Scientists assure that now science and medicine will take a less expensive path and without violating moral standards in order to rejuvenate the body or cure heart or brain diseases.
To the outstanding achievements of biology of the second half of the 20th century. refers to the occurrence molecular biology; the formal date of its origin is considered to be 1953, when J. Watson And F. Crick deciphered the structure of the DNA molecule - the keeper and transmitter of hereditary information. This discovery was a breakthrough in the doctrine of heredity. Hereditary pathology is represented in all areas of clinical medicine, where it makes up a significant part of the overall morbidity and mortality of the population. Today, in pediatric clinics of any profile, every 3rd bed is occupied by patients with hereditary pathologies. In the structure of overall mortality of children under 5 years of age, every 2nd child dies from a hereditary pathology. Modern medicine is based on molecular biological and genetic knowledge, hence the role of this knowledge in clinical medicine among doctors of various specialties. It was possible to discover the nature of many previously unexplained pathological processes and outline the path to their treatment and prevention. It became possible to create genetic engineering, i.e. technologies for targeted targeted changes in the hereditary properties of organisms, production of genetically engineered therapeutic and prophylactic drugs. It has become possible to create a data bank about all the genes of an organism - the so-called genome. Methods for express diagnosis, prevention and treatment of a number of hereditary diseases have been developed, and medical and genetic consultations have been organized.
In the middle of the twentieth century. revolution in natural science connected with revolution in technology, which made it possible to develop fundamentally new samples medical equipment, expanded the possibilities of diagnosis, treatment and rehabilitation, carrying out preventive, sanitary and hygienic and anti-epidemic measures. Advances in optics, nuclear physics, robotics, electronics, and microtechnology played a decisive role in improving medical technology.
Thanks to the achievements optics operating microscopes with manual, foot, sound (perceiving speech commands) controls were created, which expanded the capabilities of surgical ophthalmology and otorhinolaryngology, reconstructive surgery(survival of limbs amputated as a result of injuries), cardiac surgery and neurosurgery. The use of fiber optics has ensured the creation of fundamentally new diagnostic endoscopic devices for medical examination, visual examination of internal organs, cavities and canals of the body by introducing into them instruments equipped with optical and lighting systems (for example, bronchoscopy). The integration of medicine and technology has made it possible to create endoscopic surgery, based largely on the use of more advanced flexible fiber optic endoscopes under video control. First made in France endoscopic(laparoscopic) operation (1986) was figuratively called the second Great French Revolution. Surgeons were now able to perform minimally traumatic, highly effective interventions for diseases of the abdominal cavity, operations on the stomach, esophagus, intestines, and organs chest cavity and small pelvis.
Devices that use magnets are widely used in medical practice. Since the 1920s Magnets were used in ophthalmology in the 1950s. have been introduced into surgery (for example, reconstructive operations on bones) and are used in therapy.
The advent of the cardiopulmonary bypass machine (ACB) marked the onset of a true revolution in cardiovascular surgery. Soviet scientist S.S. Bryukhonenko (1890 - 1960) developed an artificial blood circulation apparatus - “autojector” (1924) and was the first in the world to show the possibilities of its use in surgery.
The progress of medicine was facilitated by the created devices artificial ventilation lungs, artificial kidney, various automatic systems for regulating anesthesia, blood pressure during surgery, automatic cardiac stimulators, artificial organs.
Achievements electronics significantly changed medicine. The creation of an electron microscope makes it possible to obtain tens and hundreds of thousands of times magnification of images of the smallest objects. Electronic medical equipment accelerates diagnosis and implementation of treatment and preventive measures, provides fundamental and applied scientific research. Modern technology- this is, first of all, computer equipment. Its appearance is the most outstanding achievement in the last 50 years. Achievements of the scientific and technological revolution of the second half of the twentieth century. opened a new era in medicine - the era of medical information technologies. New diagnostic technologies have appeared: ultrasound, computed tomography, magnetic resonance imaging, angiocardiography, radio-pharmacological methods, etc. Surgical and other technologies for the treatment of diseases are being developed: endoscopic (laparoscopic), cardiac surgery, microsurgical, neurosurgical, electroencephalographic, laser, electromagnetic, robotic, organ and tissue transplantation and etc. Information technologies make it possible to collect and process almost 80% of all information in medicine.
Thus, the natural sciences armed medicine with experimental and theoretical data on the patterns of development of processes occurring in the human body, and the mutual influence of the natural and technical sciences provided medicine with objective methods of research, diagnosis, treatment, prevention, early detection, differentiation, detailing of pathology; choose a rational sequence of treatment measures with a step-by-step assessment of the effectiveness of the procedures performed; changed the possibilities of medicine, made previously curable fatal diseases; provided high-tech, effective medical care; created the necessary conditions for wide application all information known in medicine.
2. Deepening the differentiation of medicine
and strengthening of integration processes in it
Revolutions in natural science and technology led to significant changes in the traditional structure of sciences, the process of differentiation of science deepened and, at the same time, integration processes in it intensified.
Theoretical medicine, medical and biological disciplines. For outstanding discoveries in the field of biomedical sciences and related fields of knowledge was awarded the most large number the most prestigious prizes, including the Nobel Prizes (almost 300 prizes). Human morphology - anatomy, embryology, histology (the science of tissues), cytology (the science of cells) - has transformed from a descriptive science into a general biological and experimental science, studying the morphological basis of the interaction of the structure of the body, organs and tissues. X-ray anatomy has become a special field of scientific knowledge and makes it possible to study the shape and structure of the living human body.
At the turn of the XIX-XX centuries. the transition has begun physiology from an analytical understanding of life processes to a synthetic one. The scientific teachings of I.M. played a fundamental role in this transition. Sechenov and I.P. Pavlova (1849 – 1936) about the unity of the organism and the environment. In the twentieth century it is created the study of the control system of body functions, the origins of which are in the works I.P. Pavlova and research by other prominent scientists. I.P. Pavlov introduces the term "nervism"- this is a direction in physiology, based on the idea of the dominant role of the central nervous system in the regulation of all functions and physiological processes in the body of animals and humans. For work in the field of digestion (description of the mechanisms of nervous regulation of digestion) in 1904 I.P. Pavlov was awarded the Nobel Prize. In 1935, the XV Congress of Physiologists proclaimed him the oldest physiologist in the world and confirmed the enormous contribution of original Russian physiology to the treasury of medicine. N.E. contributed to the development of the physiology of excitable tissues and the nervous system as a whole. Vvedensky (1852 – 1922); A.A. Ukhtomsky (1875 – 1942); L.A. Orbeli (1882 – 1958); B.F. Verigo(1860 - 1925) - the first physiologist of the Urals, the first dean of the medical faculty of Perm University, student of I.M. Sechenov; V.V. Parin (1903 – 1971), graduated from the Faculty of Medicine of Perm University, outstanding figure medicine, an innovative scientist, his works on the physiology of blood circulation, heart, and medical cybernetics are widely known. He created the foundations of space physiology and medicine.
In the study of control and coordination of functions, coordination of adaptation, not only the nervous system plays a role, but also the endocrine system, acting in conjunction with the centers of the nervous system. This was also recognized by the Canadian pathologist G. Selye(1907 – 1982), who nominated stress theory and general adaptation syndrome. His works contributed to the development endocrinology And hormone therapy. The discovery of the hormone insulin in 1921 by physiologists F. Banting (1891 – 1941) (Canada) and D. McLeod (1876-1935) (England) revolutionized treatment diabetes mellitus. Later, the hormones cortisone, prednisolone, etc. were isolated. Hormone therapy for endocrine and non-endocrine diseases became widespread.
In the second half of the 20th century. an independent theoretical and clinical field of medicine has formed - allergology. She studies the causes of occurrence, mechanisms of development, manifestations, methods of diagnosis, prevention and treatment allergic reactions and diseases.
Basics of the new branch of pharmacology - chemotherapy laid at the beginning of the twentieth century. German scientist P. Ehrlich. He proved the ability, according to a given plan, to synthesize drugs that can act on pathogens, in particular the pathogens of syphilis. In the 1930s The creation of such highly effective agents as sulfonamide drugs (sulfidine, streptocide) began. G. Domagk (1895-1964, Germany) substantiated their antibacterial effect and used it in medical practice. In the 1940s started era of antibiotics. Industrial production of penicillin began (in 1929 in England A. Fleming discovered penicillin; in 1942 in the USSR Z.V. Ermolyeva discovered domestic penicillin. Z. Waksman (USA) discovered streptomycin in 1943, the first antibiotic effective against tuberculosis.
The borderline section of pharmacology, biochemistry, food hygiene and some other areas of science is vitaminology. In the 20th century the doctrine of vitamins arose, first discovered by the Russian scientist N.I. Lunin (1853 - 1937) back at the end of the 19th century. K. Funk (1884 – 1967) coined the term vitamin deficiency . The mechanisms of development of many vitamin deficiencies have been deciphered. Ways to prevent them have been found, and methods for synthetically producing some vitamins have been developed.
In clinical medicine, based on the progress of natural sciences and technology, on effective medical technology, and the achievements of theoretical medicine, radical transformations took place and its character changed. Changes have affected the understanding of the nature of diseases and the possibilities of their early recognition, treatment, rehabilitation and prevention. Of particular importance are the methods of structural, laboratory and functional diagnostics: electrocardiography, sound method of measuring blood pressure, cardiac catheterization, methods for studying function external respiration, nuclear
Just as it is often difficult for doctors to make a correct diagnosis of a patient, it is also not easy to determine what is wrong with domestic medicine itself. Inefficiency? Lack of professionalism? Bribery? There are a lot of problems in this area, so it is not possible to make an unambiguous diagnosis, and therefore it is not known which side is better to start “treatment”.
Very often from our friends, acquaintances, and work colleagues we hear phrases like: « I won't go to the hospital, it will go away on its own.» . Foreigners who have never been to our clinics wonder why Russian people are so negligent about their health. In fact, everything is very simple, although very sad. Someone is not confident in the qualifications of doctors, so they see no point in visiting medical institutions. Someone doesn’t want to waste their time and nerves sitting in queues and watching how doctors with absolute indifference can arrange a tea party at any time and also be rude to you at the same time. Unfortunately, the situation in domestic medicine is such that people seek help either when they need sick leave or when things are getting really bad. In other cases, people try to self-medicate, which often does not lead to positive results. Why is it that such a situation has arisen that people trust the advice of strangers more than qualified specialists?
Small salaries
Naturally, the problem of lack of money is typical not only for medicine. We face this problem in almost all areas of our lives. Of course, we want that for 10,000 rubles a doctor, having studied for 7 years, will immediately give us accurate diagnoses, prescribed inexpensive effective treatment and at the same time he smiled and was polite. Perhaps we want too much. Because doctors are people too, they can make mistakes, they can get tired, and in the end, the hospital is their place of work, where they go to earn money and feed their family. However, if you think about it, what motivates a person when he decides to become a doctor? Obviously, not multi-thousand-dollar salaries. Most likely, he is driven by the desire to be useful, to help people, to save lives. What then? I don't think this desire disappears during the work process. Youthful naivety simply disappears. The doctor understands that thousands of these sick people come, it is very difficult to help everyone, but at home they have their own family and children. Treating people becomes just a job for him, for which he receives money. But he simply doesn’t have the strength to be smiling, polite and sympathetic with everyone, and in the end, it’s not his responsibility. But if the patient wants to “appease” him in all known ways, then an amazingly sensitive and caring doctor awakens in him, who is capable of much for the sake of his patient. It already appears here constant worry for the patient, and a smile, and efficient treatment. That is, this is what free Russian medicine is like. And not only does the concept of “free” only include an examination, but all procedures and examinations must be completed at your own expense, and in the end it will cost you a “tidy sum.” And in order for this examination to be at the proper level, you will have to “unfasten” the doctor separately.
Of course, the state, aware of these problems, is trying to fight bribery in hospitals. Health workers' salaries were raised and working conditions improved. However, either the patients themselves have retained the habit of “financially motivating” doctors, or the doctors have retained the habit of not really worrying about patients who do not pay anything. In any case, people are not becoming more willing to visit clinics.
Of course, for people who value their time and are accustomed to good service, an alternative has appeared - paid private clinics. On the one hand, this is a big step forward - you can visit such a clinic at any convenient time, including on holidays and weekends, without queues and wasted nerves. You will receive the necessary attention and professional service using modern diagnostic and treatment methods. It would seem – beauty, and that’s all. However, only those who visited them know how much treatment in such a clinic will cost. The average worker, teacher, salesperson with a salary of 10,000-15,000 thousand rubles is better off never getting sick. And it would be good if doctors there had a conscience and a sense of proportion. However, they consider it their duty to send patients who do not understand and are ready to give everything for the sake of their health to various procedures that cost one more than the other and send them to certain pharmacies for expensive drugs, because contracts have been concluded with pharmacies, and doctors also receive a certain percentage from this.
That is why the expression “money can’t buy health” is, unfortunately, gradually losing its relevance.
Unsuitability health workers
To become a doctor, an applicant needs to try to pass the exams as best as possible, go through a difficult selection process for a medical university, be prepared to pay about 100,000-200,000 thousand per year of study (prices vary depending on the region of residence), be patient, be ready to study, study and more study once in order to make as few mistakes as possible in practice, and not for 5 years, like everyone else, but 7, including internship and residency.
And now, having gone through all these circles of hell, a person can call himself a doctor. And everything would be fine if students studying in medical specialties were more conscious and studied not for the sake of tests and diplomas, but for the sake of obtaining real knowledge. After all, who else but them will benefit from this knowledge in practice, because the life and health of the population of our country directly depends on the quality of education and training of young specialists.
After the release of popular TV series about doctors, such as House and Interns, competition for medical specialties increased several times. Young people began to think that being a doctor was a fun and interesting profession, and that this was exactly what they wanted to do in the future. Despite the mistakes of novice doctors, there is always a super-doctor, House-Bykov, who will undoubtedly save everyone and make a diagnosis with amazing accuracy. And voila! In the end everyone is healthy and happy.
Unfortunately, even if there are doctors in the hospital who can be called truly masters of their craft, there are simply not enough of them for all the patients. Looking at the incompetent behavior of the interns in the series, everyone laughs. Yes, it would be funny if it weren't so sad. There are such “specialists” who “hit the mark” and cannot distinguish a stomach ulcer from kidney stones in many Russian hospitals. Naturally, knowing this, people are often simply afraid to go to the hospital so as not to worsen the situation. However, incompetence does not only apply to young and inexperienced doctors. Because there have always been lazy and not entirely conscientious students.
Often, doctors who have worked half their lives in a hospital are only capable of writing referrals to their colleagues. Such doctors are usually unable to even make a diagnosis. Some might say I'm exaggerating. Maybe. However, I witnessed how experienced doctors treated a person with a heart attack first for an ulcer, then for osteochondrosis with various massages, then simply advised him to drink half a bottle of sedative and wait to sleep. And how can you trust doctors after this?
The state of Russian hospitals.
I think many have heard phrases like “D and just the sight of hospital walls will make me feel even worse" Indeed, not only that if you need inpatient treatment, it’s not a fact that they will provide it to you right away, but also the condition of the hospitals and the level of service in them leaves much to be desired. Hospitals are constantly overcrowded, there are not enough places, people are lying in the corridors. Many hospital walls have not “heard” the word repair since Soviet times. Often there is no talk of any modern equipment.
And in such conditions people should recover. But scientists have proven that the physical recovery of the body occurs much faster against the backdrop of emotional recovery. That is, droppers and pills are, of course, good, but if you create at least “human conditions” for patients, the recovery process will be faster and more enjoyable.
Knowing about this condition hospital institutions, people in need of inpatient treatment are often left to be treated at home, without receiving the appropriate examination, necessary procedures and peace.
Not good ambulance
Most often, people call an ambulance when they have no other choice, when they realize that they cannot cope on their own. It is at such moments that they dial the famous number 03...But do they always get the help they need? And most importantly, is it timely? Some time ago, when the ambulance launched its website, it was read as “skorpom.ru”. Jokes immediately started pouring in on this topic, saying that the name could not have been more accurate. Indeed, many cases of people passing away are due to the slowness of those who must rush to help at the first call.
Of course, again, it’s not just the ambulance workers who are to blame. There are a lot of calls, but there are not enough staff and machines. These are questions again for the state. But there are also cases when ambulance workers, often having given a sedative injection to the patient, left with peace of mind.
I think everyone remembers their own cases when the ambulance “surprised” in the bad sense of the word. But there is one that left a negative mark on my memory more than others. This happened in a village 20 km from the city. The 18-year-old guy who was driving healthy image life, went in for sports, did not smoke, did not drink alcohol, had a stroke. The parents, having not previously encountered such symptoms, immediately called an ambulance, whose workers, seeing the semi-paralyzed young man, said that he was “pumped up” on drugs. The parents waited until morning; the boy’s condition did not change. The ambulance workers, who were brought in by the young man’s friends in the morning, began to understand that we were not talking about any drugs. They said that he needed to be hospitalized while lying down, but there was no car right now. Friends ran around the village looking for a car. As a result, an ambulance arrived a couple of hours later and took the guy to the city.
As you understand, the man’s condition worsened every minute. But the registries of our hospitals rarely pay attention to the condition of those admitted. After about half an hour of fussing with the registration and paperwork, the guy was finally taken to the intensive care unit. He remained paralyzed for almost a month. But he survived. I came to my senses. I learned to speak and write again, and eventually returned to sports. But neither he nor his parents and friends will ever forgive doctors for such negligent attitude. Because this is not forgiven.
Of course, reading this article, one gets the feeling that everything is too bad in our medicine and there is no light at the end of the tunnel. But we would all really like it to be there. And no modern equipment, no funding, no high salaries can help our medicine, unless the doctors themselves want it . After all, the main thing is concentrated in their hands. After all, before there were no ultrasound machines and tomographs, there was simply the knowledge of doctors and the desire to help people. May real doctors forgive me, who truly save other people’s lives, who truly treat people, who truly care, care and help people. There are some, of course. Such doctors need to be erected monuments, such doctors need to be respected and idolized.
And let there be as many of them as possible!..
As stated in the Great medical encyclopedia(vol. 2.1, p. 250, 1983): “Prevention arose in connection with attempts to empirically search for means of protection from diseases and accidents in the form of elements of individual and personal hygiene. The emergence of public prevention is associated with the development of the state and the responsibilities of its bodies and institutions to implement preventive measures, primarily against mass diseases of the population.”
Already in the primitive community, certain sanitary rules and prohibitions were formed regarding the construction of dwellings, caring for the cleanliness of the body, etc. Traditional medicine at that time had a number of preventive hygienic techniques ( physical methods, preventive medication, etc.). Hygienic recommendations, including daily routine, gymnastics, cleanliness of the body, regulation of sleep and meals, etc., have become part of the everyday life of many peoples and are reflected even in religious institutions (for example, the Mosaic commandments, etc.).
In the writings of doctors Ancient Egypt, Mesopotamia, India, China, Ancient Greece and other countries contain discussions about prevention, which is given preference over the treatment of diseases. The great Hippocrates said: “...not only the doctor himself must use everything that is necessary, but also the patient, those around him, and all external circumstances must contribute to the doctor in his activities.”
The way of life of the ancient Egyptians was expediently regulated; there was a lot of rationality in it. Thus, it was recommended to get up early, do gymnastics daily and wipe the whole body cool water, sports were encouraged, gymnastics and some sports were included in the number of activities in all ancient Egyptian schools.
During the slave era, elements of public sanitation appeared. Thus, in Sparta there was a whole system of rules for hygienic and physical education, and laws Ancient Rome sanitary measures were provided (rules for water use, food control, etc.).
In the Middle Ages, due to the widespread spread of infectious diseases, various anti-epidemic measures were developed and legislated. The hygienic advice of Arab and European doctors prescribed moderation in food consumption, maintaining body cleanliness, abstaining from drinking wine, rational image life. The preventive measures set out in the “Salerno Code of Health” (XIV century), one of the commandments of which reads: “If there are not enough doctors, let three be your doctors: cheerful character, peace and moderation in food."
The importance of preventive measures was highly valued by medieval doctors in Armenia, Georgia, and Central Asia. A special place in the development of prevention is occupied by the great physician, poet and philosopher Ibn Sina (Avicenna), who in his works, and especially in the “Canon of Medical Science”, gave primary importance to dietetics, diet and sleep, and physical exercise. In fact, he laid out in poetic form the basic principles of preventive medicine.
Preserving health is the task of medicine.
The key to illness is to understand and eliminate the causes...
Don't forget about
What is the best protection against illness?
Treat the disease while it is hidden.
And I repeat again: treat the causes,
In that main principle our medicine.
Until the XVIII-XIX centuries. Preventive medicine was essentially empirical, i.e. its recommendations were not scientifically based. Many years of medical experience indicate that people have learned to prevent diseases before the causes and mechanisms of their development became clear. Thus, E. Jenker vaccinated against smallpox in 1796 - more than 100 years before the discovery of the causative agent of this disease. Or another example: people knew how to prevent the development of scurvy (for example, by eating sauerkraut in the diet of sea expeditions) long before the discovery of vitamin C, the deficiency of which is the cause of the development of this disease.
During the Renaissance, the preventive focus of medicine intensified. The accumulated experience gave rise to the creation of preventive medicine based on the achievements of fundamental science. In particular, F. Bacon considered promoting health, eradicating disease, and prolonging human life as the main tasks of medicine.
There is no doubt that domestic medicine was under a certain influence of the medical views of the West and Ancient East(manuscripts, books, foreign doctors, domestic doctors improving their knowledge in Western clinics). This trend became especially noticeable as medical science developed. In this regard, we can talk about the internationalization of medical science. And this is not surprising, since discoveries in science in one country become the property of other countries. “A man must grow with his feet into the soil of his homeland, but let his eyes survey the whole world” (Santayana).
At the same time, foreign authors often write that the foundations of preventive medicine were laid in the West, and not in “dense” Rus'. Unfortunately, due to ignorance or other reasons, some of our authors talk about this, which is not true. Isn’t this the kind of authors M.E. was talking about? Saltykov-Shchedrin: “There is no more dangerous person than a person who is alien to humanity, who is indifferent to the fate of his native country, to the fate of his neighbor, to everything except the fate of the altyn he has put into circulation.”
We will try to show that preventive focus has always been the essence, the basic principle of our domestic medicine.
Lisovsky V.A., Evseev S.P., Golofeevsky V.Yu., Mironenko A.N.
On this day we decided to remember outstanding domestic doctors.
Fyodor Petrovich Gaaz (1780 - 1853)
Russian doctor of German origin, known as the "holy doctor". From 1806 he served as a doctor in the Russian service. In 1809 and 1810 he traveled around the Caucasus, where he studied mineral springs (now Caucasian Mineralnye Vody), explored the springs in Kislovodsk, discovered the springs of Zheleznovodsk, and was the first to report the springs in Essentuki. During the War of 1812 with Napoleon, he worked as a surgeon in the Russian Army.
Haaz was a member of the Moscow Prison Committee and the chief physician of Moscow prisons. He dedicated his life to easing the lot of prisoners and exiles. He ensured that the old and sick were freed from shackles, and abolished the iron rod in Moscow to which 12 exiles heading to Siberia were chained. He also achieved the abolition of shaving half of the head of women. On his initiative, a prison hospital and a school for the children of prisoners were opened.
In addition, Haaz fought for the abolition of the right of landowners to exile serfs, and received and supplied medicines to poor patients.
Dr. Haas's motto is: "Hasten to do good." The Federal State Treatment and Prevention Institution was named in honor of the famous physician. Regional hospital named after Dr. F. P. Haas."
Grigory Antonovich Zakharyin (1829 - 1897)
Russian general practitioner, founder of the Moscow clinical school. He graduated from the Faculty of Medicine of Moscow University, was a professor in the Department of Diagnostics at Moscow University, and later - director of the faculty therapeutic clinic. In 1894, Zakharyin treated Emperor Alexander III.
Zakharyin became one of the most outstanding clinical practitioners of his time and made a huge contribution to the creation of an anamnestic method for studying patients. He outlined his diagnostic techniques and views on treatment in “Clinical Lectures”.
The research methodology according to Zakharyin consisted of a multi-stage questioning of the patient by the doctor, which made it possible to get an idea of the course of the disease and risk factors. At the same time, Zakharyin paid little attention to objective research and did not recognize laboratory data.
Doctor Zakharyin was known for his difficult character and lack of restraint in dealing with patients.
Nikolai Ivanovich Pirogov (1810 - 1881)
Surgeon and anatomist, naturalist and teacher, creator of the first atlas of topographic anatomy, founder of military field surgery, founder of anesthesia. One of the founders of surgery as a scientific medical discipline. He developed a number of important operations and surgical techniques, was the first to propose rectal anesthesia and began to use ether anesthesia. For the first time in the world, he used anesthesia in military field surgery.
Pirogov was the first to widely use a plaster cast. Before this, gypsum was almost never used in medicine. The starch dressing had limited use; it dried slowly, became soaked with pus and blood, and was inconvenient in field conditions.
During the defense of Sevastopol, he involved women in caring for the wounded at the front. It was also he who first introduced mandatory primary sorting of the wounded into four groups. The mortally wounded were assisted by priests and nurses; the seriously wounded, requiring immediate assistance, were attended to by the doctor first. Those who did not require urgent surgery were sent to the rear. The slightly wounded, who could be quickly returned to duty, were treated by paramedics.
Even before the advent of antiseptics, Pirogov separated the wounded with purulent and gangrenous complications from those whose wounds were clean, which helped avoid the spread of infection.
As a teacher, Pirogov strove for the implementation of universal primary education and was the organizer of Sunday public schools. He also fought for the abolition of corporal punishment in the gymnasium.
Nikolai Vasilievich Sklifosovsky (1836 - 1904)
Honored Russian professor, surgeon, one of the founders of abdominal surgery ( surgical treatment women's diseases, diseases of the stomach, liver and biliary tract, bladder), contributed to the introduction of the principles of antisepsis and asepsis, developed an original operation for connecting bones in false joints (“Russian castle”). He made a significant contribution to the development of military field surgery, advocated bringing medical care closer to the battlefield, and the principle of “saving treatment” gunshot wounds, the use of plaster casts as a means of immobilization for wounds of the extremities.
Sklifosovsky owns more than seventy scientific works on surgery, the development of asepsis and surgery in general.
The Moscow Research Institute of Emergency Medicine was named after Sklifosovsky.
The black spot in Sklifosovsky’s biography was the fate of his family. The only son of the legendary doctor committed suicide. Vladimir shot himself shortly before the October Revolution. He was a member of a terrorist organization and was supposed to kill the Poltava governor, however, he could not shoot the man with whom his family was friends.
In 1919, Cossacks of a pro-Bolshevik detachment brutally killed the wife of Nikolai Vasilyevich and his eldest daughter. Moreover, the document signed by Lenin, which stated that repressions would not apply to the family of the famous surgeon, could not save them from reprisals.
Sergei Petrovich Botkin
(1832 — 1889)
Russian general practitioner, founder of the doctrine of the integrity of the human body, public figure. He graduated from the Faculty of Medicine of Moscow University, was a participant in the Crimean War, and worked in the Simferopol hospital. He also worked in clinics in Konigsberg, Berlin, Vienna, England, and Paris.
In 1860, Sergei Botkin moved to St. Petersburg, where he defended his doctoral dissertation and received the title of professor of medicine.
Botkin became one of the founders of women's medical education, organized a school for female paramedics, as well as women's medical courses. For the first time in Russia, he created an experimental laboratory, where he studied physiological and pharmacological action medicinal substances. He created a new direction in medicine called nervism. It was he who established the infectious nature of such a disease as viral hepatitis, developed the diagnosis and clinic of the wandering kidney.
In 1861 he opened the first in history clinical treatment patients a free outpatient clinic, achieved the construction of a free hospital, opened in 1880 (Alexandrovskaya Barracks Hospital, now the S.P. Botkin Hospital). Among Botkin’s students there are 85 doctors of science, including A. A. Nechaev, M. V. Yanovsky, N. Ya. Chistovich, I. P. Pavlov, A. G. Polotebnov, T. P. Pavlov, N. P. Simanovsky.
Ivan Petrovich Pavlov
(1849 — 1936)
Ivan Petrovich Pavlov is one of the most authoritative scientists in Russia, a physiologist, the creator of the science of higher nervous activity and ideas about the processes of regulation of digestion. He is the founder of the largest Russian physiological school and winner of the Nobel Prize in Medicine and Physiology in 1904 “for his work on the physiology of digestion.”
The main directions of Pavlov's scientific activity are the study of the physiology of blood circulation, digestion and higher nervous activity. The scientist developed methods surgical operations to create an “isolated ventricle”, he used a “chronic experiment”, new for his time, which made it possible to carry out observations on healthy animals under conditions as close as possible to natural ones.
As a result of his work, a new scientific discipline- the science of higher nervous activity, which was based on the idea of dividing reflexes into conditioned and unconditioned. Pavlov and his collaborators discovered the laws of formation and extinction conditioned reflexes, have been researched different types and types of inhibition, the laws of basic nervous processes were discovered, sleep problems were studied and its phases were established, and much more.
Pavlov became widely known for his doctrine of the types of the nervous system, which is based on ideas about the relationship between the processes of excitation and inhibition, and the doctrine of signaling systems.
Pavlov's scientific work influenced the development of related fields of medicine and biology, including psychiatry. Under the influence of his ideas, large scientific schools in therapy, surgery, psychiatry, and neuropathology were formed.
Sergei Sergeevich Yudin (1891 - 1954)
Large Soviet surgeon and scientist, chief surgeon Research Institute of SP named after. N.V. Sklifosovsky, Director of the Research Institute of Surgery named after. A. V. Vishnevsky.
Yudin developed techniques for gastric resection for peptic ulcer, perforated ulcer stomach and stomach bleeding, operations to create an artificial esophagus.
Sergei Sergeevich Yuin wrote 15 monographs and published 181 scientific papers.
In 1948, he was arrested by the NKVD on false charges as “an enemy of the Soviet state who supplied British intelligence with spy information about our country.” While in prison, he wrote the book “Reflections of a Surgeon.” From 1952 until his release in September 1953, he was in exile, during which he worked as a surgeon in Berdsk. The doctor was released only after Stalin's death, in 1953.