Medicine capitalism era
History Of Medicine / / May 01, 2016
outstanding Russian physician, professor at Moscow University A. OSTROUMOV was raised domestic medical school.In the context of that time - the end of XIX century AA OSTROUMOV has made remarkable achievements in the field of major departments of internal pathology.
AA OSTROUMOV was born in Moscow on December 27, 1844 Childhood future clinician passed - in heavy material and moral conditions.Secondary education he got at the Moscow Theological Seminary, and a special - at the medical faculty of Moscow University, from which he graduated in 1870. Among the professors who have studied the future clinician, it should be noted, first of all, GA Zakharyin and histologist AIBabukhin.After graduation OSTROUMOV AA for a year working hospital doctor, and then with the assistance of GA Zakharyin he was invited to intern Faculty therapeutic clinic.Within 2 years of stay in the clinic he produced and in 1873 he defended his doctoral thesis on "On the Origin of the first heart sound."Shortly after defending his th
On his return to Moscow in 1879 AA OSTROUMOV as a privat-docent began lecturing at the clinic of hospital treatment."By the end of the first lecture - he recalled one of his students prof.AP Langovoy - students were absolutely fascinated by the young professor;the patient was pulled so completely that complex and intricate case was for them understandable.Language lecturer was a simple, but at the same time clear and shaped. "In 1880, AA OSTROUMOV was appointed Professor of Hospital therapeutic clinic.Since that time his energetic work on the equipment and organization of the clinic that was made soon known throughout the country and was named Ostroumovskaya.
young professor called attention not only to the hospital equipment to better service patients on the organization of teaching, but also on the development of the scientific activity of the clinic.
This creative hard work continued until 1900 in this year due to poor health AA OSTROUMOV decided to leave Moscow and moved to Sukhumi.There he spent the last 8 years of his life.He returned to Moscow terminally ill with sarcoma in the chest cavity, and a few months later, July 11, 1908, he died.
We shall, first of all, on the analysis of understanding AA Ostroumov organism and its relationships with the environment, on his theory of disease and other problems associated with this.
AA Ostroumov as its wonderful predecessors - IE Dyadkovsky, SP Botkin and GA Zakharyin, it was clear position that clinical medicine can successfully develop only in connection with the development of natural science.Shortly after graduating from medical faculty of the young doctor began to study these physiological problems, the solution of which would help in its practical medical activity.The first scientific work AA Ostroumova were: "On the Origin of the first cardiac sound", "On timpanichesky sound light," "On the innervation of blood vessels."
Young scientist indicated in these studies on a gross error of those researchers who, seeking to understand the essence of percussion and auscultation, based on the study not of the body, and physical bodies.Solving the problem of the origin of the tympanic sound in the lungs, AA OSTROUMOV wrote that "the most significant data we found in clinical observations."At the same time he opened the insolvency of the teachings of French physiologists and Nuazelya Magendie, who considered the arteries and veins simple tubes.And here, extending into the area of physiology, AA OSTROUMOV reasoned and acted as a clinician.He proved the existence delaying vascular nerves that are easily excited by reflex.
«We now see - said the scientist - as far from the truth, attempts by some physiologists to present as dead vessels elastic tube.On the contrary, their role in the circulation is just as important as the role of the pump - the heart. "These works AA Ostroumova along with similar statements Botkin became the starting point for the development of the doctrine of the peripheral heart and a proper understanding of diseases associated with impaired circulation.
At a time when hospitals (especially in the West) had great influence morfologizma AA OSTROUMOV gave priority to the study of changes in functions.For him, as well as for its local predecessors and teachers organism is a single whole and the upset in any one part of it was considered, taking into account the reaction of the whole organism.However, since the latter can exist only under certain favorable conditions, therefore, the aim of the clinical trial is to study these conditions.
Patriotic medical science since the end of the XVIII century, came to the conclusion that knowledge of stimuli of the outside world for understanding pathological processes.AA OSTROUMOV fully shared this materialist standpoint.But studying the problem of heredity and the individual characteristics of the body, he also stated: "It is impossible to think that the cause of the disease is only outside of us."Often it is here, in the hereditary qualities of the body, is the main reason abnormalities.Thus, combining these two basic principles, AA OSTROUMOV came to the need to trace the development of his birth with the patient, taking into account both the influence of the outside world.Thus it is necessary to know not only what the individual is ill, but he carries the disease.If MJ wiser and other doctors of the first half of the XIX century, developed the original scheme of the patient history associated with his life and life, and GA Zakhar'in it deepened and expanded, the AA OSTROUMOV in accordance with the new developments in the field ofbiology and heredity doctrine went further in this regard.He made a point to be aware of the health of the parents and ancestors of the patient, and in respect of the proposed scheme the patient study of functionality of individual organs and whole organism.To do this, he thought it necessary to observe the patient, not only at rest but also during operation.The procedure for collecting information on AA Ostroumov, does not matter.Wherever to begin, it is necessary to examine the entire body.Such a functional approach to the patient makes it possible to correctly judge the development of the disease and outline remedial measures.In these methods, the examination the doctor can judge the extent to which large compensatory force of the body.
objecting to only one anatomical understanding of the disease process, AA OSTROUMOV pointed out that the disease and its course often depends not so much on the morphological changes, but on the biological properties of the organism and its environment conditions.He asserted that "the best you can compensate for the enormous destruction and live with them for more than a little."AA wit no doctor thought the problem solved, if it is in a hospital setting will put the patient on his feet.It must be treated so that the patient was able to feel healthy and out of hospitals, in terms of its labor regime.
effort to figure out the meaning of this or that disease symptom, AA OSTROUMOV conducted this assessment always in the aspect of the body as a whole.Once explained at a lecture to students the causes of dyspnea in heart patients suffering from stenosis and aortic insufficiency, he pointed out: "To solve this problem, first of all, do not be amiss to note that the heart of the general is heavily dependent on the nervous system, for example, thatIt proved by the fact that the renal or hepatic colic reflex is caused not only strong heart, but even the expansion of the right ventricle, with the noise, determined at listening, and at the long existence of colic even been cases of valve failure.If the healthy heart is so highly dependent on the nervous system, ie. E. In other words, the state of various other human body organs (stomach, intestine, kidney, liver, uterus, etc. F.), Of course, again through the nervoussystem, it is clear that for heart diseases such dependence appears even more sharply.That's why people suffering from heart disease, the most slightest movement is already a strong shortness of breath due to the fact that there is developing rapidly stagnation or even improper blood supply to the central nervous system, which, in turn, depends on the improper operation suddenly clogged heart underthe influence of one or the other reasons on the part of the nervous system.Such stagnation or even improper blood supply of the brain under the influence of heart irritates the respiratory centers, and hence there is a strong and shortness of breath.That's our patient severe shortness of breath has the same origin, ie. E. In this case it is not a phenomenon of fatty degeneration of the heart muscle, and is only one of the phenomena of disorders of the nervous system. "We have given these statements AA Ostroumova as an example of its clinical thinking, taking them from unpublished lectures delivered them into the training season 1881-1882, the
In connection with this understanding of the disease as a process that changes the reaction of the organism, AAOSTROUMOV drew attention to the fact that the diagnostic terms taken from the arsenal of pathological anatomy and general pathology, can not serve as a verbal designation of the complex processes that occur in a sick body.Indeed, the diagnosis of "heart disease", pointing to an anatomical defect, does not give any idea about the state of the individual.Reviewing the lecture one patient, AA OSTROUMOV said: "We have diagnosed him with typhus, and now put the diagnosis of his own body."The concept of diagnosis AA OSTROUMOV put a broad view of the patient's condition, its functionality, on the conditions that can help to compensate for violation of health.
AA OSTROUMOV criticized mechanical, primitive idea of the febrile process that prevailed among doctors - Virchow's followers."It is impossible, - pointed out that clinician - to pay particular attention to the degrees apart from the condition of the body."Fever, according Ostroumova, it is not only upset teploreguliruyuschih centers, but a complex process associated with many disorders of nutrition and metabolism.Doctors are prone to digital definitions are on the wrong track.
Realizing the importance of the nervous system to live a healthy and sick organism, A. Wit and are warned against the unilateral interests.Analyzing one patient at a lecture, he said: "Depressed state of the nervous system in the area of the cerebral cortex is not so important for us, as a disorder of the medulla oblongata activity, in the sense of nervous disorders subject to its management organs - heart, lungs, vasomotors".Where the general condition of the patient could be put at the mercy of nervous system disorder, a major cause of them, in his opinion, were the characteristics of the organism, arising from the adverse effects of the environment.
With deep knowledge in the fields of biology, physiology and other sciences, wit no theoretical thought it possible to fill the gaps in the clinic hypothetical ill-founded assumptions.Speaking one day of action in the body of some drugs, and reading all the theoretical assumptions about this, AA OSTROUMOV noted that perhaps the best left side of the dark yet satisfied with the theoretical speculation and one empirical fact beneficial effects of medicines, which were discussed.Prof.DD Pletnev in connection with the treatment of Graves' disease at the XII Congress of the therapeutic said: "I recall in this regard the words of a great clinician, my teacher, Ostroumova, which is one consultation saw the doctor, who did not know how to put the diagnosis to the patient: II do not know, but will be treated well, and the patient will recover. "
Activity great clinician coincided with the era of microbiology, often turns out to be a very significant impact on the understanding of the doctors questions of etiology and pathogenesis.
AA OSTROUMOV pointed to the inability in many cases to attach so much importance to the beginning of infection."Those who, in addition to microbes, do not see anything, did not give the individual data rates.In the description of TB, you will find many pages devoted to the study of microbial life, its forms, characteristics;on the same body in which he lives this microbe, two, three lines in passing, as a subject, not a long standing focus.You understand how wrong and harmful is a point of view ", - he wrote.
treatment methods used AA Ostroumov, flowed from his understanding of the disease."If we are sufficiently determined body of the functional activity of force, if we know the condition of the environment and conditions for cooperation of other organs necessary for normal function of organs, here we find indications for diet and lifestyle that are required in this case."Radical treatment OSTROUMOV is called when removed the external causes of the disorder compensation.For specific vehicles, he said that they do not exclude the individual aid measures.They can not be fully in effect if the body is weakened.AA OSTROUMOV pointed to the importance of climatic treatment, on the harmful effects of overcrowded cities, but did not consider it possible to re-evaluate the purity of the air of the village due to soil contamination near the dwellings.
In some diseases as a good therapeutic agent he recommended that milk is based on the fact that milk is easy to digest, stops the processes of putrefaction and fermentation in the gut, has a diuretic effect, tempers irritable condition of the nervous system and is very useful when the weakness of the heart muscle, vascular lesionssystem, venous stasis.Any medical event, told AA OSTROUMOV, it is necessary to appoint, given the state of the whole organism.That is why, considering that empiricism better good than bad theory, he emphasized: "the illusion is difficult to think properly."On bad specialists, he said: "You often hear that the patients treated by specialists, did not get any relief.This is understandable.The specialist treats only the body of their specialty, but the sense is not, and can not be, because the evil lies deeper in the body. "It is not appropriate to pay attention and to some bouts of illness.Resorting to symptomatic treatment, forget about the soil in which the disease developed."We want - told AA OSTROUMOV - that things went differently, smarter."
AA wit no opinion that medical science is the sole clinic affiliation.He believed that a physician working alone in the clinic may not be highly educated."The clinic - argued AA OSTROUMOV - we do not see any moral or material situation of the patient in the home, and seeing it in the artificial, alien environment for him."This scientific experience any health care worker will grow only when he will be able to observe the development of the pathological process since its inception.That is why it is rightly believed that the best opportunity for medical observation is life in small towns and villages.
basis of clinical medicine AA OSTROUMOV considered prevention, and he distinguished between general and private prevention.The study of the environmental conditions in the broadest sense of the word makes it possible to judge the norms of human existence in general.The study of the effects of the environment, taking into account individual characteristics of the organism allows you to schedule private preventive measures.
All medical activities should be purely scientific, he told AA wit.However, under the medical science, he did not mean a one-sided infatuation with laboratory and instrumental methods, and the ability to explore the patient, to understand the surrounding environment.
Despite some erroneous views AA Ostroumova, especially in the understanding of heredity, it was one of the great figures of Russian and world clinics, the study of which works still gives a lot of valuable doctor of any specialty and any skill level.