Учебное пособие (Методичка) по Истории Медицины. И.Ю.Худоногов

contribution to the development of the basic theoretical concepts of physiology and medicine. In 1856 he graduated from the Medical Faculty of Moscow University and was sent abroad, where he worked in the laboratories of I. Müller, E. DuboisReymond, K. Ludwig, G. Helmholtz. Returning to Russia, I.M. Sechenov defended his doctoral dissertation “Materials for the future physiology of alcoholic intoxication” (1860). His classic studies on the physiology of respiration and blood, gas exchange in liquids and energy exchange formed the basis for the subsequent development of aviation and space physiology and medicine. Research by I.M. Sechenov on the physiology of labor (“Three Eights”) were the basis for the development of occupational health. His work in the field of the higher divisions of the central nervous system physiology and neuromuscular physiology is of particular importance.

I.M. Sechenov believed that all acts of the conscious and unconscious life are reflexive. Considering the reflex as the instrument of the nervous system activity, he came to the conclusion that physiological processes underlie complex mental phenomena that can studied by physiological methods. In neurophysiology I.M. Sechenov laid the foundations for the doctrine of inhibition, proving that it is as important a process of nervous activity as excitation. Applying his original research methodology, I.M. Sechenov discovered mechanisms for suppressing reflexes in the frog's brain. These centers, located in the visual hillocks of the brain, causing inhibition of the speed of the onset of reflex acts, were called “Sechenov's”, and the inhibitory effect caused by them began to be called “central or Sechenov's inhibition”. The results of these studies, summarized in the work “Reflexes of the Brain” (1863), were published in the “Medical Bulletin”, and then came out as a separate edition and received a huge scientific resonance. I.M. Sechenov, being a man of the most democratic convictions, maintained friendly relations with N.G. Chernyshevsky, S.P. Botkin, D.I. Mendeleev, I.I. Mechnikov, N.E. Vvedensky, and the great predecessor of N.I. Pirogov was his ideal. I.M. Sechenov created a large physiological school in Russia represented by his students, professors N.E. Vvedensky (1852-1922) – the author of the classic study

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on excitation and inhibition as phases of a single process and the doctrine of parabiosis; A.A. Ukhtomsky (1875-1942), B.F. Verigo (1860-1924), who further developed questions of the physiology of excitable tissues; M.N. Shaternikov (1870-1939), who studied gas exchange, physiology of nutrition; V.V. Pashutin (1845-1901) – the founder of a new discipline – pathological physiology. Viktor Vasilievich Pashutin opened the department of general pathology at Kazan University in 1874 and founded the first national school of pathophysiologists (professors V.V. Podvysotsky, P.M. Albitsky, N.I. Lunin, V.K. Vysokovich, A.B. Foht, I.I. Mechnikov and others). The works of Ivan Petrovich Pavlov (1849-1936) on the study of the activity patterns of the digestive system and higher nervous activity had an impact on the further development of the ideas of nervism, which constituted the main direction of the development of Russian physiology. I.P. Pavlov after graduating from the Medical-Surgical Academy was invited by S.P. Botkin to work in the physiological laboratory at his clinic. Here he completed his doctoral dissertation "Centrifugal nerves of the heart" (1883) and began work on digestion. After working for two in the laboratories of R. Heidenhain and K. Ludwig in Germany, I.P. Pa returned to S.P. Botkin. In 1890 he was elected professor of pharmacology (later physiology) at the Military Medical Academy, where he worked until 1925, and at the same time headed the physiological department at the Institute of Experimental Medicine. The principle of neuro-reflex regulation of digestion and metabolism was established by the research of I.P. Pavlov and his staff. In particular, in experiments on animals, it has been proven that the vagus nerve can increase the secretory activity of the stomach. I.P. Pavlov also proved that, depending on the nature of food or gustatory stimulation, the secretory reaction has qualitative differences. In 1904 for outstanding achievements in the field of physiology of digestion I.P. Pavlov was awarded the Nobel Prize. I.P. Pavlov introduced the method of chronic experiment into the practice of physiological research, which made it possible to study the body of a practically healthy animal and experimentally substantiate the principles of nervism. Digestion research led I.P. Pavlov to the creation of the doctrine of

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conditioned reflexes, this marked a new era in the study of the processes of higher nervous activity – one before the greatest achievements of natural science of the 20th century. The method of conditioned reflexes opened up the opportunity to learn empirically the complex connections of the organism with the external environment, to reveal the laws governing the activity of the organism as a whole. The humoral and cellular theories were important directions in the development of pathology in the 19th century. The Viennese pathologist K. Rokitansky (18041874) considered the main cause of diseases to be a violation of the body fluids (juices) composition. He considered the local pathological process as a manifestation of a general disease, which was the positive side of his concept. In the middle of the 19th century, the humoral theory came into conflict with new factual data. The use of a microscope has expanded the possibilities of morphological analysis in health and disease.

R. Virkhov (1821-1902), the founder of cellular pathology, saw a self-sufficient organism in the cell and considered be the essence of the disease through various anatomical and histological changes. The introduction of the microscopy

method allowed R. Virkhov study the phenomena of leukocytosis, embolism,

thrombosis, leukemia, inflammation, fatty degeneration and other pathological processes at the cellular level. However, R. Virkhov's theory made the cell absolutized, transforming the body into a sum of cells, and pathology into pathology of isolated cells, which contradicted the doctrine of the integrity of the body. Some provisions of the theory of cellular pathology have been subjected to critical analysis by Russian scientists. Professor Alexei Ivanovich Polunin (18201888), who headed the first department of pathological anatomy at the Faculty of Medicine of Moscow University in 1849, was one of them. He was the first to introduce Russian scientists to the works of R. Virkhov, translating them into Russian, and believed that juices and solid particles are equally important for the body, that changes occurring in some entail changes in others. A.I. Polunin gave a pathological description of cholera, the first to establish, on the basis of autopsies, the curability of pulmonary tuberculosis. In 1859, the Department of Pathological

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Anatomy was opened at the Medical-Surgical Academy in St. Petersburg, M.M. Rudnev (1837-1878) headed it. M.M. Rudnev was the first to introduce practical classes for students in pathological histology, emphasized the importance of pathological anatomy for the clinic, and recognized the role of the nervous system in pathological processes. A new fruitful period in biology and medicine is associated with advances in microbiology (bacteriology). The beginning of scientific experimental microbiology is associated with the discoveries of the French chemist Louis Pasteur (1822-1895) and the German physician Robert Koch (1843-1910). L. Pasteur refuted the hypothesis of the spontaneous origin of life, established the cause of diseases of wine and beer, silkworms, laid the foundations for the concept of artificial immunity (for example, chicken cholera), for the first time created vaccines against anthrax and rabies. R. Koch was the first to propose a method of growing pure bacterial cultures on nutrient media, discovered the causative agents of tuberculosis (Koch's bacillus), cholera, rinderpest, sleeping sickness, received the bacterial preparation tuberculin (used for diagnostic purposes), and finally established etiology of anthrax. L. Pasteur's discoveries served as the basis for the development of medical microbiology and the fight against infectious diseases 1885 he opened the world's first anti-rabies station in Paris, and in 1886 such a station was created in Odessa on the basis of a bacteriological laboratory – the first in Russia and the second in the world. L.C. Tsenkovsky (1822-1887) – known for his work in the field of botany, bacteriology (developed methods for obtaining and preserving vaccines against anthrax), described more than 40 new microorganisms, was the founder of the scientific school of domestic microbiologists. Research by scientists G.N. Minh (1836-1886) and O.O. Mochutkovsky (1845-1903) were of great importance. The priority in establishing ways of transmission of typhus and relapsing fever (through bloodsucking insects) belongs to them. G.N. Minh also studied plague, anthrax, leprosy, and established the infectious nature of the latter.

For the first time in Russia, teaching bacteriology was introduced by Professor G.N. Gabrichevsky (1860-1907) at Moscow University in 1892. The main works

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of G.H. Gabrichevsky devoted to the etiology and treatment of diphtheria, scarlet fever, relapsing fever, plague, and malaria. In 1895 he founded the Bacteriological Institute in Moscow, and in 1897 he organized the Russian Bacteriological Society. In 1890, the Institute of Experimental Medicine, the first major research institution in pre-revolutionary Russia, was opened on the basis of the antirabies station in St. Petersburg. The main activity of the institute was the study of infectious diseases of humans and animals. A large school of domestic microbiologists and epidemiologists (professors S.N. Vinogradskiy, D.K. Zabolotny, V.I. Isaev, L.A. Tarasevich, V.L. Omelyanskiy) was formed at the institute. D.K. Zabolotny founded the first department of microbiology in Russia at the St. Petersburg Women's Medical Institute (1898). On the basis of the advances in microbiology, new disciplines stand out: there are virology and immunology. The foundations of virology were laid by Dmitry Iosifovich Ivanovsky (1864-1920), who proved in his work “Mosaic disease of tobacco” (1892) the existence of pathogens of plant diseases, invisible in ordinary optical microscopes. Nikolai Fedorovich Gamaleya (1859-1949) continued researchthe field of virology. The largest Russian biologist, pathologist, bacteriologist Ilya Ilyich Mechnikov (1845-1916) – one of the founders of evolutionary embryology, the creator of the phagocytic theory of immunity, was the founder of immunology. In 1908 I.I. Mechnikov, together with P. Ehrlich, the creator of the humoral theory of immunity, was awarded the Nobel Prize. Russian natural science and medical science in the 19th – early 20th centuries in the field of morphology, physiology, pathology, microbiology and immunology took a leading place in world science, gave great scientists and created scientific schools, enriched world science with new progressive and valuable ideas and discoveries.

Questions for self-control:

1. What socio-economic changes took place in Russia in the second half of the XIX – early XX century?

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2.What role did the Sovremennik magazine play in the promotion of natural science and medical views in Russia?

3.What contribution did I... Sechenov in the development of Russian physiology on a natural-scientific materialistic basis?

4.What role did the Russian materialist scientists A.I. Polunin, M.M. Rudnev, P.F. Lesgaft, V.V. Pashutin, D.N. Zernov and others in the formation of domestic medical science?

5.What views did the leading scientists and doctors of Russia adhere to on the relationship between the body and the environment, on the role of the nervous system in the body?

6.What scientific and social traditions contributed to the formation of physiology in Russia?

7.How did the development of domestic microbiology (bacteriology) take place?

8.What achievements of domestic scientists in the development of world

microbiology can be distinguished?

9. What contribution did I.I. Mechnikov in the development of biology and

medicine?

10. What role did I.P. Pavlov in the development of the physiological direction in

domestic and world medicine?

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Theme 11. Clinical medicine in Russia and its relationship with prevention

(second half of the 19th century – the beginning of the 20th century)

Progressive philosophical views and advances in natural science in the second half of the 19th century made it possible for the fruitful development of clinical disciplines and, above all, therapy. Clinical medicine began to acquire a natural science character. Diagnostic methods have changed significantly. Autopsies, then physical methods (percussion, auscultation, etc.), instrumental methods (thermometry, endoscopy, etc.) and laboratory researches began to be introduced gradually.

The development of therapy in Russia in the second half of the 19th century was determined by two major clinical schools: S.P. Botkin at the Medical-Surgical Academy in St. Petersburg and G.A. Zakharyin at Moscow University.

The founder of the St. Petersburg scientific school, an outstanding Russian clinician Sergei Petrovich Botkin (1832-1887) was the founder of the scientific clinical and experimental direction in domestic medicine. The formation of his worldview took place under the influence of leading figures of Russian culture, such as V.G. Belinsky, A.I. Herzen, N.P. Ogarev, N.A. Nekrasov, I.S. Turgenev, A.V. Koltsov, T.I. Granovskiy and others. His friendship from his student years with I.M. Sechenov was fruitful.

After graduating from the medical faculty of Moscow University in 1855, S.P. Botkin worked for several months in a military hospital under the leadership of N.I. Pirogov in Simferopol. Then he improved his knowledge abroad in the largest clinics and laboratories in Germany (R. Virchow, L. Traube), Austria (K. Ludwig), France (K. Bernard, A. Trousseau), England and Switzerland. Returning to Russia, S.P. Botkin defended his doctoral dissertation “On the absorption of fat in the intestines” (1860) and at the age of 28, becoming a professor at the St. Petersburg Medical-Surgical Academy, headed the department and clinic of internal diseases.

A characteristic feature of S.P. Botkina was a combination of the widespread introduction into clinical medicine of the achievements and methods of natural sciences (including experiment) with keen observation, virtuoso mastery of the

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methods of clinical examination of a patient and a rare ability to analyze and compare clinical data.

S.P. Botkin made many discoveries of both practical and theoretical significance. He first described the clinical picture of a number of diseases, established the infectious nature of hemorrhagic jaundice (Botkin's disease), developed the diagnosis and clinic of a prolapsed kidney, isolated relapsing fever from typhus of other forms, introduced new things into the study of rheumatism, heart disease, blood vessels, and kidneys.

S.P. Botkin created a new physiological direction in Russian clinical medicine, named by I.P. Pavlov's “nervism”, the origins of which were laid in the works of the leading figures of Russian medicine: S.G. Zybelina, I.E. Dyadkovsky, M. Ya. Mudrova, N.I. Pirogov. According to this doctrine, the body is a unity whole, and the nervous system plays a leading role in its life and communication with the external environment. The neurogenic theory of pathogenesis, which was developed by S.P. Botkin, was a step forward in the development of theoretical medicine. It opened the for further improvement in all branches of clinical medicine. From the standpoint of the neurogenic theory of S.P. Botkin and his students were able correctly explain the mechanism of a number of pathological phenomena and functional disorders in the work of organs and systems of the body, to determine approaches to the treatment of diseases and the mechanism of action of many drugs.

S.P. Botkin strove to put the methods of treating patients on a scientific basis. He was the first in Russia to organize general clinical, physiological, chemical and bacteriological laboratories. S.P. Botkin influenced the formation of the scientific worldview of I.P. Pavlov, who was having been gratefully acknowledged this. I.P. Pavlov for 10 years (since 1878) headed the physiological laboratory at the clinic of S.P. Botkin. The work carried out in the laboratories of S.P. Botkin, laid the foundations for experimental pathology, clinical pharmacology and therapy; clinical analyzes were carried out and questions of physiology and pathology of the

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body were studied; the physiological and pharmacological effects of the drugs have been studied in animal experiments.

Outstanding clinical, scientific and pedagogical activity of the great Russian clinician S.P. Botkin was closely associated with practical work in the field of public health. S.P. Botkin took part in solving every important issue in the field of public health. He initiated the creation of a government commission to develop a project for the rehabilitation of populated areas of Russia, to study the causes of high morbidity and mortality of the population and to develop measures to combat them.

The organization of sanitary affairs in St. Petersburg was also initiated by S.P. Botkin.

He proposed to introduce (and this was done) the posts of sanitary doctors, in particular school sanitary doctors, to organize care by doctors who were paid by the City Duma (Duma’s doctors). At the clinic, he opened the first free outpatient department in the history clinical treatment of patients. At the suggestion of S.P. Botkin, two hospitals were built in Petersburg: one of them (Aleksandrovskaya) was a free barrack hospital for laborers. For many years S.P. Botkin was the chairman the Society of Russian Doctors in St. Petersburg. The society played a noticeable role not only in organizing and educating St. Petersburg doctors, but also served as an example for many scientific societies in Russia, attracting the attention of doctors and the public to acute health issues, to the sanitary needs of the country's population. S.P. Botkin edited publications such as the “Archives of the Internal Medicine Clinic” and the “Weekly Clinical Newspaper”, which served the same purpose and played an important role in the formation of many generations of doctors and scientists. S.P. Botkin's activities during the Crimean and Russian-Turkish wars made it possible to lay the foundations for military field therapy.

S.P. Botkin is the creator of the largest scientific clinical school in the 19th century. Out of 108 of his students, 85 became doctors of medicine, headed

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departments in various cities of the country. Among them V.A. Manassein, V.P. Obraztsov, A.A. Ostroumov, N.P. Gundobin and others.

Grigory Antonovich Zakharyin (1829-1897) professor at Moscow University was a prominent representative of another major school of clinicians. After graduating from Moscow University in 1852, he worked in the clinic of Professor A.I. Overa. Then for three years he worked in the laboratories and clinics of K. Bernard, A. Trousseau, L. Traube, R. Virchow.

In his clinical activities, G.A. Zakharyin developed the traditions of the founders of the Moscow clinical school S.G. Zybelina and M. Ya. Mudrova. The scientific school of G.A. Zakharyin was created simultaneously with Petersburg one. The predominance of practical activity over “purely scientific” interests was characteristic of her. The most important directions that were developed by G.A. Zakharyin and his school were: the method of questioning and direct observation of the patient, balneotherapy and climatotherapy, widespread hygiene promotion in the treatment of the patient, disease prevention.

G.A. Zakharyin continued the physiological direction in medicine. He proceeded from the understanding of unity of all organism parts and connected the development of the disease with the effect of the external environment on the organism. He especially carefully studied the conditions of life, work of the patient, his habits and hereditary factors.

He believed that a drug only treatment cannot always lead to a full recovery and that the hygienic regimen is often decisive, which the doctor recommends to the patient on the basis of a careful study of his living and working conditions. In his statements about the importance of hygiene, G.A. Zakharyin had in mind primarily personal hygiene, while issues of public hygiene did not find any clear expression in his practice.

G.A. Zakharyin was the first scientist in our country to widely promote the use of mineral waters, to study their composition, action, methods of application for various diseases. He substantiated the therapeutic effect of balneotherapy procedures on the body from the standpoint of nervism.

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