Clinical medicine, like all the natural sciences of modern times, developed in the context of the complex interaction of various philosophical trends. On the one hand, mechanistic, metaphysical materialism was asserted. On the other hand, the mechanistic materialism of that time itself promoted the assertion of idealistic ideas in a number of fields of natural science, including medicine. Based on the laws of mechanics, mechanistic materialism was unable to explain all the diversity and integrity of nature and the entire world around it. Thus, the ground arose for vitalistic (Latin - vitalis - life) concepts, that is, explanations of life processes by supernatural, unknowable factors, such as "life force", impulse, etc.

The largest representatives of vitalism of that time were famous physicians : Georg-Ernst von Stahl (Stal GE, von, 1659–1734), who formulated the theory of phlogiston, and Samuel Hahnemann (Hahnemann S., 1755–1834), the founder of homeopathy. Discoveries in the field of natural science, and in particular the biomedical sciences (pathological anatomy, histology, embryology, microbiology, physiology), significantly weakened metaphysical concepts in medicine and strengthened the position of materialism. At the same time, representatives of the materialistic direction of the XVIII century. (J. Lametri, F. G. Politkovsky, and others.) For objective reasons, they themselves continued to remain in the positions of mechanistic materialism, since the time of the dialectical approach had not yet come.

As a result, clinical medicine with great inertia mastered the achievements of the medical and biological sciences, as a result of which there was a significant gap between the advanced thinking of natural scientists armed with an experimental method and the thinking of doctors, who until the beginning of the 19th century. practically did not use any instrumental methods of examination of the patient in their work. All this led to a serious lag of the clinical medicine of that time from the developing natural science.

INNER MEDICINE (therapy)

Clinical Approval

Learning the art of healing at the bedside was characteristic of ancient Greek medicine and the medicine of the peoples of the ancient and medieval East. However, in Europe, during the period of medieval scholastic domination, the teaching of medicine was conducted only from books, "reviewed" by church ministers. The revival of clinical (at the bedside) teaching in Western Europe in the XVI century. associated with the name of Giovanni Battista Montano (Montano, Giovanni Battista, 1489–1552) —the professor at the University of Padua, who argued that “you can only teach in visiting patients”. Nevertheless, the inertia of scholasticism was too great, the training of students in Western Europe remained for a long time bookish.

. At the end of the XVII - beginning of the XVIII century. The leading role in the development and implementation of clinical teaching in Western Europe belonged to the University of Leiden (Holland). The university organized a clinic, which was led by a physician, chemist and teacher Hermann Burhaave (Boerha-ave Hermann, 1668–1738, fig. 129), who headed the departments of medicine and botany, chemistry, practical medicine, and the university rector. (In Russian, his name is sometimes pronounced as Burgav.)

According to him, "clinical medicine is called, which observes patients at their bed." A thorough examination of the patient G. Burhaave combined with a physiological substantiation of the diagnosis and anatomical studies. Burhaave was a pioneer of instrumental methods of examination: he was the first to use an improved thermometer of G. Fahrenheit in clinical practice and used a magnifying glass for anatomical studies.

The clinical school created by G. Burhawa played a crucial role in the development of European and world medicine. Students and doctors from many countries came to him, calling him “totius Europae praeceptor” (“Europe-wide teacher”). Lectures of Burhaave were attended by prominent figures of that time, including Peter I. A. Galler, G. Lametri, G. van Sveten and de Gaener of the Vienna Clinical School were followers of G. Burhaave. Bidloo is the founder of the first Moscow hospital and medical school in Russia.

Medical business and medical education in the XVIII century.

At the turn of the XVII — XVIII centuries. in the economic, political and cultural life of Russia there have been major changes. In the depths of the feudal society, which had not yet exhausted the possibilities of development, new commodity-money relations developed. the formation of the all-Russian market. The reforms of Peter I (1682 — I725), which were carried out in the interests of the nobility, were aimed at resolving the contradictions that arose in this connection. A. S. Pushkin wrote about this period in the history of Russia in the poem "Poltava":

It was a vague time, When Russia is young, In straining forces, Muzhal with the genius of Peter. Severe was in the science of fame She was given a teacher: not one Lesson unexpected and bloody I asked her the Swedish paladin. But in the temptations of a long punishment, Enduring the blows of fate, Has strengthened Russia. So heavy Mlat, Dropping the glass, forges damask.

As a result of the reforms of the first quarter of the XVIII century. In the Russian economy, there have been major positive developments, its international prestige has strengthened. Russia has become a great European power.

The transformation of Peter I significantly contributed to the development of the medical business. Peter has always shown an interest in medicine. During his trips to the countries of Western Europe, he met famous natural scientists and doctors of the time: G. Burhaave, F. Ruysch, A. van Leeuwenhoek, I. Newton, and their scientific achievements.

Before Netra I, there was not a single higher medical school in Russia. The training of healers (mainly for the army) began in the second half of the 17th century, when the first medical school was opened under the Pharmaceutical Order (1654). It existed briefly and released only a few dozen healers. The need for doctors was felt, and some Russian people were sent to get higher medical education in advanced universities in Western Europe (mainly Padua and Leiden). So, in 1692 Peter I sent Peter Vasilyevich Posnikov to Padua (Postnikov, 1676–1716), who graduated from Moscow Slavic-Greek-Latin Academy in 1691. Two years later, P.V. Posnikov brilliantly defended his doctoral thesis “Signs indicating the occurrence of putrefactive fevers” (“Significant febres putridinus adventus causarum”) and received a “Dokhtur degree” in philosophy and medicine “with high praise”. Then during the year he improved his medical knowledge in Venice, Paris, Brussels and Leiden; has mastered several foreign languages. In 1698, he accompanied Peter I as part of the Great Embassy in Holland and England, after which he was left in France "for familiarization with the local behavior" and then in England for acquaintance with the activities of Oxford University.

P. V. Posnikov was the first Russian physician enrolled in the Pharmaceutical Order (1701). He is known as the first Russian physiologist. However, he did not manage to fully engage in this science (“living dogs die and the dead live”) - most of his life was given to the diplomatic service for the benefit of the Russian state.

At the beginning of the XVIII century. Foreign physicians who were invited to Russia served in the Russian army and navy. The economic and political development of the Russian state required the training of national medical personnel in the country.

The formation of higher medical education in Russia is associated with the name of Nikolai Lambertovich. Bidloo (Bidloo NL, 1670-1735, fig. 130). A native of Amsterdam, he graduated from the University of Leiden, where he studied medicine from G. Burhaave. In 1702, N. Bidloo was invited to Russia and became the “closest doctor” of Peter I. In 1707, he headed the first hospital school in Russia opened in Moscow on the initiative of Peter I at the first military land hospital across the Yauza River (now the Main military hospital named after N. N. Burdenko). The school was accepted "from all ranks of the people", graduates of seminaries and the Slavic-Greek-Latin Academy.

The curriculum included anatomy, surgery, desmurgy, internal diseases with anatomical dissections, pharmacy science, Latin, and drawing. Teaching anatomy was conducted on corpses. Pharmaceutical science studied in the pharmacy garden. There were no textbooks, and N. L. Bidloo taught students in his handwritten books, “Instructions for Learners of Surgery in the Anatomical Theater” (“Instructio de chirurgia in theatro anatomico studiosis proposi-ta”), which was later published in Latin and Russian (rice 130) languages, “The Mirror of Anatomy” (“Seculum anatomiae”), “The Treasure of Medical and Practical Lectures” (“PhD-lectoris thesaurus medico-practicus”). Teaching internal medicine was also practical and was conducted at the bedside (in Latin).

Subsequently, hospitals were opened in St. Petersburg (1718, 1719), Kronstadt (1720) and other cities. When they created hospital schools (in St. Petersburg and Kronstadt in 1733, in Barnaul - in 1758, etc.).

After the reform of medical education, which P. 3 produced. Kondoidi, an arhirat and president of the Medical Chancellery (1753), the teaching of physiology, obstetrics, and women’s and children’s diseases was introduced into the program of medical schools, a seven-year study period and an examination system were established. The name of P. 3. Kondoidi is also connected with the creation of the first Russian medical library (1756). In 1786, hospital schools were separated from hospitals and transformed into independent medical-surgical schools.

The opening of the Academy of Sciences and the activities of MV Lomonosov had a great influence on the development of medical education in Russia.

The Academy of Sciences in St. Petersburg was established by decree of Peter I in 1724 and opened in 1725. Its first president (1725–1733) was Life Lab Peter I, Laurenty Blumentrost. The Academy was not only a scientific, but also an educational institution, whose task was to "produce science to distribute it." A grammar school, an academic university (which developed three areas: mathematical, physical, humanitarian), a library, were established at the Academy. Kunstkamera (1728), astronomical observatory, anatomical theater and bo-taniichesky garden. At first, invited foreign scholars prevailed among the academy, among whom were prominent figures of their time: D. Bernoulli, L. Euler, and others.

The first Russian by nationality member of the Petersburg Academy of Sciences was Mikhailo Vasilyevich Lomonosov (1711–1765) —the ingenious domestic scientist, encyclopaedist, and educator.

MV Lomonosov was born in the village of Denisovka of the Kholmogorsky district (now the village of Lomonosov of the Arkhangelsk region) in the family of a fisherman. Having independently learned to read, he mastered Smotritsky's verbal grammar and Magnitsky's arithmetic and in 1731 left with Moscow for a wagon train, where he entered the Slavic-Greek-Latin Academy. At the end of 1735, among the 12 best students of her, M. V. Lomonosov was sent to the Petersburg Academy of Sciences for continuing education. Then he improved his knowledge in universities and laboratories in Germany (1736-1741).

In 1745, M. V. Lomonosov was elected Professor of Chemistry and a member of the St. Petersburg Academy of Sciences. His fruitful activity was aimed at the approval of the experimental method and contributed to the development of many natural sciences: physics, chemistry (see Table 10), geology, geography, astronomy, glass technology, mining and metallurgy, Russian history and grammar. An important place in his writings is devoted to the organization of a medical business in Russia (p. 312). A. S. Pushkin wrote about Lomonosov in his Journey from Moscow to St. Petersburg: “Lomonosov was a great man. Between Peter I and Catherine II, he alone is the original companion to education. He created the first university. It would be better to say that he himself was our first university. ”

The project of the first Russian university Lomonosov was composed in 1754. And in 1755 Moscow University (Fig. 131) was opened in three faculties: philosophical, legal and medical. Classes at the medical faculty began in 1765 in three departments: anatomy (with practical medicine), physical and pharmacy chemistry, and natural history. The first professor of the Medical Faculty was the famous Moscow obstetrician Johann Friedrich Erasmus (he came to Russia in 1750, died in 1777). He first began to lecture on anatomy, surgery, and the art of babies. In 1771, I. F. Erasmus took an active part in the fight against the plague epidemic in Moscow.

The first Russian professor at the Medical Faculty of Moscow I University was Semyon Gerasimovich I Zybelin (1735-1802). In 1758, he graduated from the Faculty of Philosophy of Moscow University, for several months he studied at the Academic University under the Academy of Sciences, which was headed by MV Lomonosov, and in 1759 he was sent to Leiden to receive the degree of doctor of medicine.

In 1764, S. G. Zybelin successfully defended his doctoral dissertation and, returning to Russia in 1765, he began! teaching theoretical medicine! (physiology and pathology with general therapy and diet). He was the first; Professor of Moscow University, the one who began to lecture on! Russian (1768), and not in Latin), as it was then accepted.

With G. Zybelin developed issues of hygiene and public medicine (combating child mortality, epidemics, etc.), which at that time was at the stage of its formation (late XVIII-early XIX century) "Many causes of this premature death of humanity are, of which two I suppose that the source is physical and political, ”S.G. Zybelin stated in one of his talk speeches,“ The Word, ”pronounced on solemn days at Moscow University. In 1784 he was elected to the St. Petersburg Academy of Sciences.

Some time at the medical school. there were no laboratories or clinics. The first clinical ward for 10 patients was opened in 1797 at the Moscow Military Hospital. It was headed by E. O. Mukhin - an outstanding Russian physiologist and surgeon (see p. 289).

In 1791, Moscow University received the right to assign the degree of doctor of medicine. Prior to that, from 1754 only the Medical Board (established in 1763 instead of the previously existing Medical Office) had such a right. The first doctoral thesis at the University of Moscow was defended in 1794 by Thomas I. Barsuk-Moiseyev (1768-1811). His work “Dis-sertatio medico-practica de respiratio-ne” was devoted to the physiology of respiration. In 1795, F.I. Barsuk-Moiseev became a professor at Moscow University.

XViti century It was a period of struggle of advanced Russian doctors for the independent development of Russian medicine. It was expressed in the struggle for the development of higher medical education, for the right to teach in higher medical schools and conduct this teaching in their native Russian language, for the approval of national personnel / in scientific, educational and administrative institutions. The number of Russian scientists (from the "born Russians") has steadily increased. The prophecy of M. V. Lomonosov came true:

Oh you, whom the Fatherland expects from its depths And wants those to be, What calls from other countries, O your days blessed! Dare now encouraged by your Arrogance to show what your own Platons and the quick minds of Newtons give birth to Russian land.

The first methods and instruments of physical examination

At the beginning of the XVIII century. in the clinics of Europe, not a single diagnostic device was used, there were no instrumental or laboratory methods for examining the patient. When making a diagnosis, the doctor proceeded from the results of the anamnesis (survey), probing the pulse and examining the patient and his discharge. Body heat was determined empirically (by hand application) until the second half of the 19th century. (while the first thermometric device was already invented by G. Galileo at the end of the XVI century).

The first reliable alcohol (1709), and then a mercury (1714) thermometer with a scale from 0 to 600 °, was suggested by one of the eminent scientists of his time Daniel Gabriel * Fahrenheit (Fahrenheit, DG, 1686 - 1736), who worked in Holland. As a reference, he used three points of reference. The first - 0 ° was determined in a vessel with a mixture of ice, water, ammonium salts and sea salt. The second — 32 ° F corresponded to the melting point of ice. The third, 96 ° F, was the normal temperature of the oral cavity. The boiling point of water in Fahrenheit corresponded to 212 ° F — 180 ° above the melting point of ice.

In the Military Medical Academy in St. Petersburg, 13 Fahrenheit letters are kept to G. Burhawa, who was the first doctor to apply his own modification of the Fahrenheit thermometer to determine the patient's body temperature. The Fahrenheit thermometer was the first to enter the clinic, but its large size made it very difficult to practice.

In 1730, the French naturalist Rene Antoine-Fersho Reomur (N. A. Reaumur, 1683-1757). invented an alcohol thermometer with a scale from 0 to 80 ° (0 ° corresponded to the freezing temperature of water). Having taken a volume of alcohol at 0 ° for 1000 conventional units, Reaumur  heated it to a boil which corresponded to 1080 units. That is why the boiling point of water according to Reaumuru was taken as 80 °.

Reaumur's thermometer turned out to be very convenient, but the last word on the scale graduation issue belongs to the Swedish astronomer and physicist Nersu Celsius (A. Celsius, 1701— 1744). In 1742, he proposed a centigrade scale in which 0 ° corresponded to the boiling point of water, - the melting point of the ice. Subsequently, M. Strömer (Sweden) turned the Celsius scale, making 0 ° the melting point of the ice and the starting point. In this form, the thermometer became the most widely known all over the world.

Thermometry entered the clinical practice with difficulty. As early as 1861, the famous German physician Karl Geohard (Gerhardt, Karl, 1833-1902) considered it "too complicated." In Russia, the successful introduction of thermometry into the clinic (1860) is closely connected with the name S-p-Botkin (see

An important role in the development of physical examination belongs to the Viennese doctor Leopold Azen-Ut *% * x \ <Auenbrugger, 'Leopold, 1 / ^ z — ieuyj — the author of the percussion method (Latin percussio — hit) those percussions, so good known today and with such difficulty entering into medical practice.

Being the son of an innkeeper, L Au-enbrugger often watched his father determine the amount of wine in barrels by knocking their walls. Perhaps these observations led him to the idea of ​​using percussion to determine the presence of fluid in the chest cavity.

For seven years, Auenbrugger has carefully studied the sounds made by tapping the chest in a healthy and sick body. He systematically compared his clinical observations with the data of pathologic-anatomical autopsies and, in the AMP, presented the results of his research in 95 pages of his essay "Inventum novum ..." ("A new way, like by tapping a person's chest, "Fig. 132).

“Based on my experience,” wrote Auenbrugger, “I affirm that the sign in question is extremely important not only for recognition, but also for the treatment of diseases; moreover, it deserves first place after examining pulse and breathing. In fact, whatever the disease, the unnatural sound produced by tapping the chest is detected, it will always indicate a great danger. ”

Despite the obvious importance of the new method today, percussion shared the lot of many great inventions: it was greeted with amusement, even hostility. The Viennese doctors and their patients, accustomed only to probing the pulse, came out with a sharp criticism of "this long and painful newfangled procedure." Moreover, Auenbrugger’s teacher for the University of Vienna and its rector, founder of the renowned Vienna clinical school G. van Swieten (Gerard, 1700-1772), also did not accept the new method. Auenbrugger was forced to leave work at the hospital. His further fate was tragic: he spent the last years of his life in a psychiatric clinic, where he died in 1809, without having learned about the revival and wide acceptance of his proposed method in France in 1808.

Auenbrugger’s forgotten name and his method were revived by Jean-Nicolas Corvizar de Mare (Corvisart, Jean Nicolas de Mare, 1755–-1821) —the founder of clinical medicine in France, Napoleon I.

With the Auenbrugger method, Korvizar first became acquainted with the enthusiasm after reading a small work of the Vienna physician Maximilian Stoll (M. Stoll, 1742-1787), who practiced this method in the clinic for the poor on the outskirts of Vienna .. - during the whole time when I studied medicine so that the name of Auenbrugger was mentioned ... I did not know percussion when I started teaching clinical medicine. ”

For 20 years, Korvizar and his _ numerous students thoroughly studied percussion sound as a new diagnostic tool. Unlike the author of the method, who percussed the ends of his fingers, folded into a pyramid, Korvizar began to tap with his hand. This method allowed him with great skill to recognize diseases of the lungs, the presence of fluid in the pleural cavity and pericardial bag, as well as cardiac aneurysm, the study. which brought Corvizar great fame. In 1808, a year before L. Auenbrugger’s death, he published the full translation of “Inventum novum ...” in French, supplementing it with his very solid (over 400 pages) comments. Here it is appropriate to quote the words of Anatol France: "The gift to resurrect the past is as amazing and precious as the gift to foresee the future."

Reading the lectures in the amphitheater of the Sharite hospital (on the walls of which his name is now carved), Corvizar widely promoted the method of percussion, along with which he often used the ancient method of direct auscultation (Latin auscul-tatio - listening). Putting his ear to the patient's chest, he tried to determine the intensity and rhythm of the heartbeat. Among other students, Corvizar's lectures were listened to by Rene Theophil Hyacinth Laennec (Laen-nec, Rene Theophile Hyacinthe, 1782— 1826) —a disciple who surpassed his teacher (Fig. 133).

R. Laennec was brought up in the family of his uncle, a famous doctor of the time of the French bourgeois revolution, which had a great influence on his development and his passion for medicine. Having studied Greek and Latin, Laennek already in his youth read in the original the works of ancient Greek and Roman authors. In his student years, the views of Laenne-ka were influenced by Kor-vizar and Bish.

As a student at the University of Paris, Laennec began work on the disease, which at that time was called phthisis, and from which a huge number of patients died. Pathologic autopsies revealed specific organs in various organs, which Laennec called tubercles. They arose and developed without external signs, and when the symptoms of the disease manifested, it was already impossible to save the patient. How to recognize the disease in its initial stage, when there were still chances to stop it and cure the patient? Listening to the ear, attached to the chest, did not give tangible results. There were no means of in vivo diagnosis, he was not yet born and made his discovery (1895). V.K. Roentgen.

The solution that Laannek had been looking for so long came unexpectedly. Returning from the clinic through the Louvre Park, he drew attention to the noisy gang of children playing around the logs of the building forest. Some children put ear. towards the end of the log, while others enthusiastically beat on the opposite end of the log: the sound, amplifying, went inside the tree. Laennec saw a solution to the problem.

The reason for the first application of the method of mediocre auuskulis with the help of a paper stethoscope was the fullness of a 19-year-old girl. “The age and sex of the patient,” wrote Laennec, “did not allow me to apply ... direct auscultation with the ear attached to the heart area ... I asked for several sheets of paper, rolled them into a tight cylinder, put one end of it to the heart area and put ear to another. I was equally and surprised and satisfied when I heard heart beats so clear and distinct that I had never heard them in the immediate course. application of the ear to the heart area. "

The next day, Laennec applied this method in his clinic at Necker Hospital. A thorough examination revealed that one third of the patients suffered from an active phase of consumption (i.e. tuberculosis, the term suggested by Laennec).

The first stethoscopes (from the Greek. Stet-hos - chest, scopeo - look, explore). Laennek glued thick paper, then, in search of optimal acoustic effects, began to grind them from various sorts of wood on a special machine. His own stethoscope was wooden (Fig. 134) and consisted of two cylinders, which, depending on the purpose of the study, could be used assembled or disassembled.

The invention of the first in the history of medicine device physical diagnosis - the stethoscope glorified the name of Laenneck, but his contribution to medicine is determined primarily by the development of pathological anatomy, the study of the clinical picture and diagnosis of lung diseases, which the invention of the stethoscope contributed to a large extent. R. Laennek described the auscultatory symptoms of heart diseases, studied the clinic and the pathomorphology of portal cirrhosis of the liver (Laennek's cirrhosis), established

the tuberculosis process is long before the discovery of the causative agent of this disease. Laennec considered tuberculosis a contagious disease. As a preventive measure, he proposed physical rest, enhanced nutrition, and sea air.

In 1819, his famous work “On Mediocre Auscultation or Recognition of Lung and Heart Diseases, based mainly on this new method of research (“ De l'auscultation mediate, ou traite du diagnostic des maladies des poumons et du coeur ”) .

Six years later, Rene Laennec died of tuberculosis, a disease that he did more than anyone else to defeat.

A great contribution to the development of methods of physical research was made by the Vienna professor Josef Skoda (Skoda, Josef, 1805-1881), a Czech by nationality. Working together with the outstanding pathologist of that time, K-Rokitansky, he carefully checked his clinical observations in the sectional hall. Proceeding from the laws of acoustics, Skoda explained the origin of percussion sound and gave a scientific rationale for the percussion method.

In 1826, a student of R. Laennec, Pierre Adolf Pjorry (Piorry, Pierre Adolp-he, 1794–1879), proposed a method of mediocre percussion using an ivory pleimeter.

In Russia, the first description of percussion was made by Professor of the Medical-Surgical Academy F. Ude-n (1754-1823). The merit of introducing percussion and auscultation into clinical practice belongs to P. A. Charukovsky (1790–1842) in St. Petersburg and G. I. Sokolsky (1807–1886) in Moscow.

The development of internal medicine and medical education in Russia in the XIX century.

In the first half of the XIX century. the maturing of capitalist relations in Russia proceeded against the background of the further decomposition of the feudal-serf system. The revolutionary ideology and movement of the Decembrists formed in these conditions had a significant impact on the development of Russian culture, science and education. By the beginning of the XIX century. in Russia there were two higher medical schools: the medical faculty of Moscow University and the St. Petersburg Medical-Surgical Academy — two centers of medical science and the formation of scientific medical schools. The Moscow University developed mainly issues of general pathology, therapy, and physiology: the Medical-Surgical Academy, took a leading place in the development of national anatomy, topographic anatomy and surgery.

The development of capitalist relations in the country in the first half of the nineteenth century. led to a significant increase in the network of higher education institutions. By the 60th years of the XIX century. there were already eight universities in Russia, which also included medical faculties: Dorpat (now Yuriev — Tartu, 1802), Vilna (1803); Kazan (1804), Kharkov (1805), Kiev (1841). According to the University Charter of 1804, universities enjoyed the right of autonomy (election of the rector, deans, professors, etc.). Some universities were promoters of advanced democratic ideas, and the government actively fought against freedom-loving sentiments in the country's higher education institutions.

In 1820, a government audit of universities was appointed.

In the Kazan Educational District, it was carried out by the district trustee M. L. Magnitsky, who arranged for a genuine defeat of Kazan University. As a result, the autopsy was forbidden, the anatomical theater and the museum were closed, all preparations of which were swept up and buried according to church rites.

Released under Nicholas I, the new University Charter of 1835 banned the autonomy of universities and placed them under the authority of trustees appointed by the tsarist government. After the abolition of serfdom in Russia, the autonomy of universities was restored (1863). However, in 1884, under conditions of increasing political reaction, the tsarist government again abolished it. Despite this, the universities of Russia remained the centers of free thought and advanced science.

A great contribution to the development of materialistic natural science was made by professor, pathology and therapy of Moscow University, materialist philosopher Justin Yevdokimovich Dyadkovsky (1784-1854). At a time when idealistic natural-philosophical concepts (FWJ Schel-ling) flourished in some countries of Western Europe, I. Ye. Dyakovsky proceeded from the reality and knowability of the surrounding world. He was a staunch supporter of the dialectical views of nature. Developing the doctrine of the disease, he proceeded from the idea of ​​the unity and integrity of the organism and the surrounding nature, recognized the leading role of the central nervous system and thus was a representative of the early nervism in Russian science. His pupil and follower is a physiologist I. T. Glebov was a teacher of I. M. Sechenov.

The largest representative of therapy in Russia in the first half of the nineteenth century. was a graduate of Moscow University (1800), and later his professor (1809) and the dean of the medical faculty Matvei Yakovlevich Mudroe (1776-1831). His system of clinical examination and individual approach to patients (“to treat not the disease, but the patient”) brought him fame as an outstanding therapist of the first quarter of the 19th century. Its main provisions are formulated in his "Word about the way to learn and learn practical medicine, or active medical art in the beds of patients" (1820). The case histories that M. I-Mudrov carefully wrote down “on the beds of the sick,” were “more precious than the richest library” for him. In examining patients, he was one of the first in Russia to apply methods of palpation, percussion and auscultation. During the Patriotic War of 1812, together with the professors of the medical faculty of Moscow University, M. Ya. Mudrov traveled to Nizhny Novgorod, where he assisted the wounded and sick.

M. Ya-Mudrov also made a significant contribution to the development of military hygiene (“A word about the benefits and items of military hygiene ...”, 1809), deontology (“A word about piety and moral qualities of a hippocratic doctor”, 1814), unity and integrity of the organism (M. Ya-Mudrov, I. E. Dyadkovo, I. M. Sechenov, G. A. Zakhar'in, S. P. Botkin, and I. P. Pavlov).

The second half of the XIX century. became the heyday of the Russian medical tshol. In the field of therapy, a special place was occupied by two scientific clinical schools: the school of S. P. Botkin, which marked the beginning of an experimental direction in domestic clinical medicine (at the Military Medical Academy), and the school of G. A. Zakharyin, personified the art of clinical practice (at Moscow University ).

The formation of his worldview I was influenced by advanced; Russian cultural figures of the time. In the house of Botkin in Moscow! there were V. G. Belinsky, A. I. Herzen, N. P. Ogarev, N. A. Nekrasov, I. S. Turgenev, A. V. Koltsov, T. N. Granovsky, I. M. Sechenov - friend student years.

In 1855, after graduating from the medical faculty of Moscow University, S. P. Botkin went to the theater of military operations of the Crimean War of 1853-1856, and worked for several months in a military hospital under the direction of N. I. Pirogov.

Then, for three years, S. P. Botkin was abroad, where he improved his medical knowledge and prepared for a professorship in major clinics and laboratories in Germany (R. Virchow and L. Traube), Austria (C. Ludwig), France (from C. Bernard and A. Trusso), England and Switzerland. On his return to St. Petersburg, S. P. Botkin defended his doctoral thesis "On the absorption of fat in the intestines" (1860) and at the age of 28 became a professor at the Medical-Surgical Academy.

The diverse scientific and practical activities of S. P. Botkin enriched Russian clinical medicine. He first described the clinical picture of a number of diseases; isolated infectious hepatitis (Botkin's disease); showed the possibility of studying in the experiment of renal hypertension; introduced a lot in the study of rheumatism, heart disease, blood vessels, kidneys.

For the first time in Russia, S. P. Botkin organized several laboratories at his clinic: general clinical, chemical, bacteriological and physiological, which for 10 years (from 1878) was headed by I. P. Pavlov. By combining experimental physiology with clinical medicine, S. P. Botkin created a fundamentally new direction in Russian clinical medicine — experimental therapy and laid the foundations for clinical pharmacology. Developing this direction, S. P. Botkin made a significant contribution to the development of the theory of nervism, which was subsequently formulated by I. P. Pavlov.

“His deep mind, not being enticed by the immediate success, sought the keys to. great riddle: what is a sick person and how to help him - in the laboratory, in an animal experiment - wrote about this side of the activity of the joint venture. Botkin I. P. Pavlov, - ... this high estimate of the experiment by a clinician is, in my opinion, no less a glory to Sergei Petrovich than his clinical, known to all of Russia activity. ”

S. P. Botkin's role is great in the development of social medicine: in organizing the fight against infectious diseases and high mortality rates in the construction of hospitals, the development of school hygiene, etc.

Of his 106 students, 40 became doctors of medicine, 45 headed the leading clinical departments in various cities of the country.

Vasily Parmenovich Obraztsov (1851–1920) —the professor at Kiev University, the founder of the Kiev Therapeutic School — was a student of S. P. Botkin. V. P. Obraztsov made a significant contribution to the development of clinical research methods and the study of diseases of the cardiovascular and digestive systems.

In 1886, he developed a deep methodical sliding palpation of the abdominal organs (Fig. 136). In terms of its value for the lifetime diagnosis of diseases of the abdominal cavity, it is comparable to the method of chest percussion, proposed by L. Auenbrugger. Its high accuracy was confirmed after the introduction of the method of x-ray with the use of contrast agents (1905).

V. Obraztsov also proposed the original method of direct percussion of the organs of the thoracic and abdominal cavities with one finger (1910), which made it possible to more accurately determine the boundaries of the organs. In 1909, V.P. Obraztsov (together with his student ND Strazhesko) gave a classic description of the clinical picture of coronary artery thrombosis, initiating the in vivo diagnosis of myocardial infarction.

The work of V. P. Obraztsov is inextricably linked with the development of social medicine in Russia: in 1875–77. He worked as a country doctor in the Vologda province.

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

The Provision on Zemstvos Institutions (1864) did not include “the care of public health” among the obligatory duties of the zemstvos. Nevertheless, the risk of epidemics and the high mortality of the working-age population forced the noblemen-landowners to take minimal care of the health services of the rural population; county zemstvos began to invite doctors. Zemstvo doctors and statisticians were filled with the desire to serve their people, many of them carried out revolutionary work. The type of a Zemstvo doctor that emerged in the first years of Zemstvo medicine combined the best traditions of Russian social medicine (see p. 316).

Initially, the system of .. medical aid in zemstvos was traveling: a local doctor lived in a district town and traveled around villages on certain days. Then the traveling system was replaced by a more progressive - stationary: the counties were divided into several medical areas, in the central of them was a hospital for 15-20 beds with a department for women in labor and an outpatient clinic. The doctor every day at a certain time took in the district site, and went to the sick in. if necessary or on call. The Zemsky doctor became the “main figure” of medicine in Russia (as N. V. Sklifosovsky noted in 1885 — chairman of the First Pirogov Congress).

Advanced zemstvo doctors waged a relentless struggle for free (at the expense of the zemstvos) health care. However, this was fully achieved only in a certain part of the provinces. Basically zemstvo medicine was paid in one form or another. A great contribution to the development of rural medicine was made by I. I. Molleson, E. A. Osipov, P.: I. Kudrin, N. I. Tezyakov, P. F. Kudryavtsev, F. F. Erisman, A. P. Voskresensky and many others.

Along with zemstvo medicine, the medical care of the urban centers of Czarist Russia also developed. However, in the vast majority of cities it was at a very low level (see p. 316).

Much attention was paid to the issues of social medicine by the Society of Russian Doctors in the memory of N. I. Pirogov.

An important milestone in the history of Russian medicine was the formation and development of women's medical education. Under the influence of the revolutionary situation of 1859-1861. and the abolition of serfdom in Russia (1861), the struggle for women's higher medical education became an integral part of the struggle for women's social equality. Professor A. A. Gruber, I. M. Sechenov, S. P. Botkin, and other ardent supporters of female education not only allowed women to listen to their lectures as volunteers, but also attracted them to practical classes and scientific work, although later this did not give them the legal right to treat the sick.

In the early 1960s, the issue of higher female education was widely “discussed at six universities in Russia. Four of them were in favor of admitting women to higher education. Despite this, a new university charter, approved in 1863, prohibited women from even crossing the threshold of higher education institutions. However, the desire of Russian women for higher education was so great that the most decisive of them began to leave for education abroad and, first of all, to Zurich (Switzerland), who was then, according to Vera Figner, “mental revolutionary center, which did not want to pass, no Russian intellectual, got abroad. "

The first Russian woman admitted to a foreign university was Nadezhda Prokofievna Suslova (1843-1918). In 1864 she entered the medical faculty of the University of Zurich, three years later she brilliantly graduated and in the same 1867 successfully defended her thesis for the degree of doctor of medicine, surgery and obstetrics. "This is the first Russian woman with a doctoral diploma, but received, unfortunately, in a foreign university," noted the journal Medical Herald.

The first woman who, despite all the obstacles, graduated from a higher medical institution in Russia (1868) and defended a dissertation for the degree of doctor of medicine (1876) in her homeland, was Varvara Alexandrovna Kashevarova-Rudneva (1842— 1899). After graduating from midwifery courses in 1862, and then special one-year post-graduate courses, V. A. Kja-shevarov-Rudnev was left in St. Petersburg to order lectures at the Medical-Surgical Academy for a full five-year course, followed by six-year service in Bashkir (Orenburg) Cossack army. That was in 1863, before the approval of the new University Charter, which banned the admission of women to Russian universities even as volunteers, and she is the only female student in Russia who studied under I. M. Sechenov and V. A. Gruber, N. M. Yakubovich and M. M. Rudnev, with Academician N. N. Zimin and AP Borodin, who replaced him. She became the first woman in the history of Russia who received the title of "doctor with honors" and a gold medal and was recognized by the doctor on a par with men.

In 1872, the tsarist government, worried about the revolutionary mood of female students abroad, decided to open a “Special female course for the education of midwifery scientists” at the Medical-Surgical Academy. It was the first higher women's medical school not only in Russia, but throughout Europe.

At the beginning of the 20th century, medical personnel training in Russia was conducted at the medical faculties of Moscow, Kiev, Kharkov, Yuryevsk (Derpt), Vilnius, Kazan, Saratov, Novorossiysk (in Odessa) and Warsaw University, at the Military Medical Academy, Psychoneurological Institute in St. Petersburg, at the Higher Women's Courses in Moscow, Kiev, and Odessa and at women's medical institutes in St. Petersburg and Kharkov. The total number of students was about 8,600, about 1,000 doctors graduated annually (rice, 137). However, for a country with a population of 160 million this was not enough.

At the turn of the 19th and 20th centuries, the rapid development of the natural sciences began (see Table 10). The discovery of the electron (1897) and the creation of quantum theory superseded the previous ideas about the atom as the simplest indivisible particle of matter. New data on the structure of matter and its properties had a revolutionizing effect on philosophy and natural science, including medicine, which was enriched by new methods of research and treatment. The discovery of x-rays (x-rays, 1895) expanded the possibilities of examining healthy and sick organisms and marked the beginning of a new medical discipline - radiology. The discovery (A. Becquerel, 1896) and the study of the phenomenon of radioactivity (M. Sklodowska-Curie and P. Curie, 1898, 1903) contributed to the development of medical radiology and radiobiology. All this led to further differentiation of medical disciplines. New branches emerged as separate branches of medicine and independent subjects of teaching: neuropathology, psychiatry, dermatology with venereology, infectious diseases and epidemiology, pediatrics, and others.