What does it mean in medicine. The concept of medicine. Traditional and alternative medicine
Medicine is a science that studies a person in a healthy and diseased state with the aim of strengthening his health, protecting him from diseases and curing him. Thus, the tasks of medical science include not only the treatment of the sick, but also the strengthening of the health of the healthy.
It is quite obvious that these tasks cannot be solved without knowing how the human body is arranged (ie, anatomy) and how it functions (ie, physiology). Therefore, medical science is based primarily on these two sciences - anatomy and physiology.
Sometimes physiology and medicine erroneously equate meyau1y. These sciences have different tasks and different ways to solve them. The difference between physiology and medicine lies primarily in the fact that the physiologist studies the general patterns of the function of an abstract healthy person, while the doctor studies these functions in the specific person he is examining. In addition, a doctor, unlike a physiologist, must know not only how a healthy organism functions, but also what morphological changes and dysfunctions occur in various diseases and pathological conditions. In other words, he must know deviations from the norm, that is, pathology. Otherwise, he will not be able to resolve the issue of the athlete’s state of health and make a diagnosis of “healthy”. But it is this question that is the main one in physical culture and sports, since it is on its solution that the admission to physical exercises and their dosage depend primarily. In addition, the doctor must be able to treat diseases, injuries and injuries that occur in athletes, which is not part of the functions of a physiologist.
Medicine consists of two large sections: theoretical and clinical.
In addition to anatomy and physiology, the theoretical section includes microbiology, pharmacology and a number of other disciplines.
In the clinical section, i.e. in the so-called clinical medicine, both a healthy and a sick person are studied - the diagnosis, prevention and treatment of diseases, as well as the reactions of a healthy person to various external influences, factors affecting health, ways to strengthen it and maintenance.
The study of various diseases has shown that, despite external differences, they have common causes, common symptoms and common patterns of development. It turned out that, although outwardly the diseases differ significantly from each other, they obey general laws. Without knowledge of these laws, it is impossible to study either a healthy, let alone a sick person, since, without having mastered the general patterns of the emergence and development of pathological processes, it is impossible to prevent, diagnose, or treat diseases.
The science that studies these general patterns is called general pathology. Therefore, before studying clinical medicine, and sports medicine belongs to this section of medicine, it is necessary to learn the basics of general pathology.
It would seem that medicine, designed to heal and treat a person, should be international and the tasks of health care should be the same both in a socialist and in a capitalist state. However, it is not.
Health care in a socialist state and health care in a capitalist state differ significantly.
The tasks of Soviet medicine are determined by the Program of the CPSU, which has a special section "Caring for health and increasing life expectancy." Thus, in our country, care for the health of Soviet people is, as noted above, a state task. V. I. Lenin spoke about this. He considered the health of the worker in our country not only as his personal benefit, personal happiness, but also as public wealth, which the state is called upon to protect and the plundering of which is criminal.
V. I. Lenin considered public health in a complex with the conditions of the material and cultural life of the country and considered it necessary to resolutely strive to improve health, prevent diseases, improve physical condition, increase the working capacity and increase the life expectancy of Soviet people.
All these fundamental instructions of V. I. Lenin underlie Soviet medicine, one of the components of which is sports medicine.
Free medical care of the population with polyclinic and hospital care, careful monitoring of the state of health in order to prevent the occurrence of various diseases, starting from the first day of the birth of a Soviet citizen, and even before his birth - in antenatal clinics for pregnant women, is a huge socialist achievement .
Our country has a wide network of state medical institutions (hospitals, polyclinics, consultations, etc.), all preventive measures are provided by the state. In the Soviet Union (according to 1971 data) there are 618,000 doctors, which is more than 25% of the number of doctors in the world.
The situation is completely different in capitalist countries, where qualified medical care is paid for by the patients themselves, and it is quite expensive, and therefore not accessible to everyone. There, caring for a person's health is a purely personal matter, and the state does not provide medical care to the population to the extent that it is necessary.
All of the above applies to sports medicine, which does not exist in isolation from medical science as a whole.
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Books
- Life-threatening conditions in the practice of a first contact doctor, A. L. Kostyuchenko. The reference book provides fairly complete information about life-threatening conditions based on the specifics of the first contact doctor's activities. At the present level, the directions,…
The term used earlier by the old oncologists is very broad. Usually denoted stomach cancer (although in principle it could denote any malignant tumor). It has not been widely used for a long time. In general, the surname "Petrov" was often used in oncology in various slang terms, meaning the surname of an oncologist - Academician N.N. Petrov.
cancer, c-r, Blastoma, Bl., NEO, neoplasma (neoplasm), Disease ...., Tumor (tumor)
All of the above terms refer to a malignant tumor, usually cancer. They are all used in order not to write the word "cancer" in plain text. To refer to sarcoma, another abbreviation is more often used - SA (Sa).
Trial laparotomy, Laparotomia explorativa, Petrov's operation, Exploratory resection (of something)
All terms denote a situation when, after the "opening" of the abdomen, inoperability, neglect of the tumor, stage 4 of cancer are revealed, in which it is pointless to perform any intervention. After that, the abdomen is sutured without any operation. Among physicians, such slang expressions as "test", "drive through" are often used.
Palliative surgery, palliative resection (of something)
Palliative surgery (not radical) - an operation in which neglect, inoperability of the tumor is also established, but some kind of intervention is performed - either to eliminate some complication (bleeding, stenosis, etc.), or in the hope of achieving a temporary remission , especially under the condition of subsequent chemotherapy or radiation treatment (also palliative, that is, not radical).
Symptomatic treatment at the place of residence
A phrase in which it is encrypted that the patient has an inoperable, advanced tumor, usually stage 4, and that such a patient, therefore, is not subject to special types of radical treatment by a specialist - an oncologist. It implies the prescription of drugs that only alleviate the condition of an incurable patient, and, first of all, narcotic analgesics as needed. Among doctors, slang expressions "symptoms", "symptomatic patient" are often used. It can be considered a synonym for the 4th clinical group of dispensary registration.
Generalization (dissemination)
A term for an advanced tumor in which there are many regional and/or distant metastases. As a rule, we are talking about the 4th stage of the tumor process and the 4th clinical group of dispensary registration.
Progression
The term denotes the continuation of tumor aggression, the continued growth of cancer. The usual development of untreated cancer. However, progression can also occur after special treatment according to a radical program. In such a situation - the antonym of the word "remission". Moreover, the timing of progression can be very variable - the continuation of the growth of cancer cells after treatment can occur after 1 - 2 months, and after 10 - 20 - 30 years. (The most remote period of progression from the end of treatment, found by me in the literature, is 27 years).
Secondary hepatitis (pulmonitis, lymphadenitis, etc.), secondary hepatitis (pulmonitis, lymphadenitis, etc.)
All terms refer to the presence of distant metastases (in the liver, lungs, lymph nodes, etc.). Indicates advanced tumor, stage 4 cancer.
Virchow's lymphadenitis
Virchow's metastasis (cancer metastasis in the supraclavicular lymph node on the left - by the name of the author who first described it) Indicates the neglect of the tumor, 4 stages of cancer.
mts
Metastasis (short for Latin - metastasis). It can denote both regional metastases and distant ones.
prima, secunda, tercia, qarta (prima, second, third, fourth)
Latin words are numerals. They indicate the stage of development of cancer, the tumor process - the first, second, third and fourth. Among physicians, incurable patients are often referred to by the slang term "quart".
T.... N.... M....
Abbreviation of Latin words used in the international classification of malignant tumors by stages. T-Tumor - primary tumor, values can be from 1 to 4 depending on the size; N - Nodulus - nodes (lymphatic), values can be from 1 to 2-3 depending on the level of damage to regional lymph nodes; M - Metastasis - metastases, meaning distant metastases, values can be 0 or 1 (+), that is, distant metastases are present or not. For all categories (TNM), the value may be x (x) - there is not enough data available to evaluate.
Difference of stage and clinical group
Often, patients, even in long-term remission, panic when they hear the term "clinical group 3", considering this to be the 3rd stage of the development of the tumor process. This is not true. "Clinical groups" are dispensary observation groups, and in their numerical designation there is no correlation with the stage of tumor development.
1 clinical group - patients with background precancerous diseases subject to dispensary observation;
2 clinical group - patients with oncological diseases of any stage, subject to special types of treatment (surgical, radiation, chemohormonal);
3 clinical group - radically cured cancer patients;
4th clinical group - incurable patients, patients with advanced malignant tumors, not subject to special types of treatment.
As you can see, the 3rd clinical group means a very good option.
Adequate pain relief
Under this phrase, the recommendation to prescribe narcotic analgesics to relieve pain is usually "hidden". However, the problem of pain relief in incurable patients is much more complex and broader than the simple prescription of drugs.
Palliative radiation (chemotherapy)
Palliative chemotherapy, palliative radiation - non-radical application of these methods. That is, a situation where a specific treatment is given to a obviously incurable patient with a deliberately non-radical goal, either to stop any complications and improve the quality of the remaining life, or in the hope of at least temporarily stabilizing the tumor process. The concept of palliation corresponds to that of surgical treatment.
When formulating a diagnosis of a malignant tumor of any localization (with rare exceptions), after the type and localization of the tumor, three Latin letters "T", "N" and "M" and the numbers after each of them must be indicated. This is the classification of malignant tumors adopted by the International Cancer Union. "T" is the first letter of the Latin word "Tumor" (tumor), "N" - "Nodulis" (lymph nodes) and "M" - "Metastases" (metastases).
Category "T" is determined by the size and spread of the primary tumor (the depth of tumor invasion into the organ wall layer);
Category "N" - the presence, number of affected and localization of the affected regional lymph nodes. "Regional" means their location in the same "region" as the tumor itself;
Category "M" reflects the presence or absence of distant metastases.
The numbers added to these three main components indicate the prevalence of the process and are different for each tumor:
TO, Tl, Т2, ТЗ, Т4 N0, N1, N2, N3 MO, M1
Numerous combinations of these categories define a process step (see below). Periodically, the International Cancer Union makes changes to the classification after the coordination of these changes with all the national committees of the countries that are members of the Union. Since January 1, 2010, version 7 of the TNM classification has been in force.
T - primary tumor:
Tx - it is not possible to estimate the size and local spread of the primary tumor;
TO - the primary tumor is not determined;
Tis - preinvasive carcinoma (carcinoma in situ);
T1, T2, TK, T4 - reflects the increase in the size and / or local spread of the primary tumor.
N - regional lymph nodes:
Nx - insufficient data to evaluate regional lymph nodes;
N0 - no signs of metastatic lesions of regional lymph nodes;
N1, N2, N3 - reflects the varying degree of metastatic damage to regional lymph nodes.
Note. Direct spread of the primary tumor to the lymph nodes is regarded as their metastatic lesion. Metastases in any lymph nodes that are not regional for this localization are classified as distant,
M - distant metastases:
Mx - insufficient data to evaluate distant metastases ( in the 7th version of the classification, the category "Mx" was abolished); MO - no signs of distant metastases; Ml - there are distant metastases. Category Ml can be supplemented with letters a and b for some tumor locations and symbols depending on the location of distant metastases:
Lungs - PUL
Bone marrow - MAR
Bones - OSS
Pleura - PLE
Liver - HEP
Peritoneum - PER
Brain - BRA
Adrenals - ADR
Lymph nodes - LYM
Leather - SKI
Others - OTN
The main categories can be subdivided if more detail is needed in the prevalence of the process (eg T1a, T1b and N2a, N2bl).
The pathohistological classification of pTNM in all cases uses the following general principles:
pT - primary tumor:
pTX - the primary tumor cannot be assessed histologically;
pTO - histological examination did not reveal any signs of a primary tumor;
pTis - preinvasive carcinoma (carcinoma in situ);
pT1, pT2, pT3, pT4 - histologically confirmed increase in the degree of spread of the primary tumor.
pN - regional lymph nodes:
pNx - the state of regional lymph nodes cannot be assessed;
pNO - metastatic lesions of regional lymph nodes were not detected;
pN1, pN2, pN3 - histologically confirmed increase in the degree of damage to regional lymph nodes.
Note. Direct spread of the primary tumor to the lymph nodes is regarded as a metastatic lesion.
A tumor nodule larger than 3 mm found in connective tissue or in lymphatic vessels outside the lymph node tissue is considered a regional metastatic lymph node. A tumor nodule up to 3 mm is classified in the pT category as tumor extension.
When the size of the metastasized lymph node is the criterion for determining pN, as in breast cancer, then only the affected lymph nodes are evaluated, not the entire group.
RM - distant metastases:
pMx - the presence of distant metastases cannot be determined microscopically;
rMO - microscopic examination did not reveal distant metastases;
pM1 - microscopic examination confirmed distant metastases.
Category pM1 can have the same divisions as category M1.
Also, if more detail is needed, a subdivision of the main categories (for example, pT1a and / or pN2a) is possible.
Histological differentiation - G
Additional information regarding the primary tumor can be noted as follows:
Gx - the degree of differentiation cannot be established;
G1 - high degree of differentiation;
G2 - average degree of differentiation;
G3 - low degree of differentiation;
G4 - undifferentiated tumors.
Note. Grade 3 and 4 may be combined in some cases as "G3-4, poorly differentiated or undifferentiated tumor".
When encoding according to the TNM classification, additional characters may be used.
Thus, in cases where the classification is determined during or after the use of various treatments, the TNM or pTNM categories are marked with the symbol "y" (for example, yT2NlM0 or pyTlaN2bM0).
Tumor recurrences are shown with a g symbol (eg, rT1N1aMO or rpT1aN0M0).
The symbol a indicates the establishment of TNM after autopsy.
The symbol m denotes the presence of multiple primary tumors of the same localization.
The symbol L defines the invasion of the lymphatic vessels:
Lx - invasion of the lymphatic vessels cannot be detected;
L0 - there is no invasion of the lymphatic vessels;
L1 - invasion of the lymphatic vessels detected.
Symbol V describes invasion of venous vessels:
Vx - invasion of venous vessels cannot be detected;
V0 - no invasion of venous vessels;
V1 - microscopically revealed invasion of venous vessels;
V2 - macroscopically determined invasion of venous vessels.
Note. Macroscopic lesion of the venous wall without the presence of a tumor in the lumen of the vessel is classified as V2.
It is also informative to use the C-factor, or the level of reliability, which reflects the reliability of the classification, taking into account the diagnostic methods used. The C factor is divided into:
C1 - data obtained using standard diagnostic methods (clinical, radiological, endoscopic studies);
C2 - data obtained using special diagnostic techniques (X-ray examination in special projections, tomography, computed tomography, angiography, ultrasound, scintigraphy, magnetic resonance, endoscopy, biopsy, cytological studies);
SZ - data obtained as a result of a trial surgical intervention, including biopsy and cytological examination;
C4 - data obtained after radical surgery and morphological examination of the surgical material; C5 - data obtained after autopsy.
For example, a specific case can be described as follows: T2C2 N1C1 M0C2. Thus, the clinical classification of TNM before treatment corresponds to CI, C2, C3 with varying degrees of reliability, pTNM is equivalent to C4.
The presence or absence of a residual (residual) tumor after treatment is indicated by the R symbol. The R symbol is also a prognostic factor:
Rx - not enough data to determine the residual tumor;
R0 - no residual tumor;
R1 - residual tumor is determined microscopically;
R2 - residual tumor is determined macroscopically.
The use of all the additional characters listed is optional.
Thus, the classification according to the TNM system gives a fairly accurate description of the anatomical distribution of the disease. Four grades for T, three grades for N, and two grades for M make up the 24 TNM categories. For comparison and analysis, especially of large material, it becomes necessary to combine these categories into groups by stages. Depending on the size, degree of germination in the surrounding organs and tissues, metastasis to the lymph nodes and distant organs, the following stages are distinguished:
stage 0 - carcinoma in situ;
Stage 1 - a tumor of small size, usually up to 2 cm, not extending beyond the affected organ, without metastases to the lymph nodes and other organs;
Stage II - a tumor of somewhat large size (2-5 cm), without single metastases or with single metastases to regional lymph nodes;
Stage III - a tumor of considerable size that has sprouted all layers of the organ, and sometimes the surrounding tissues, or a tumor with multiple metastases to regional lymph nodes;
Stage IV - a significant tumor that has sprouted all layers of the organ, and sometimes the surrounding tissues, or a tumor of any size with metastases to distant organs.
The classification of TNM is quite difficult to understand for non-specialists, so if you have any questions, please contact your doctor.
Only in recent years has a satisfactory definition of the concept of medicine been given: “Medicine is a system of scientific knowledge and practical measures united by the goal of recognizing, treating and preventing diseases, maintaining and strengthening the health and working capacity of people, and prolonging life 1 . In this phrase, for accuracy, it seems to us that after the word "measures" the word "societies" should be added, since in essence medicine is one of the forms of society's activity in the fight against diseases.
It can be repeated that medical experience, medical science and practice (or art) have a social origin; they cover not only biological knowledge, but also social problems. In human existence, it is easy to see that biological laws give way to social ones.
The discussion of this question is not empty scholasticism. It can be argued that medicine as a whole is not only a science, but also a practice (moreover, the oldest), which existed long before the development of sciences, medicine as a theory is not only a biological, but also a social science; the goals of medicine are practical. B.D. is right. Petrov (1954), arguing that medical practice and medical science, which emerged as a result of critical critical generalization, are inextricably linked.
G.V. Plekhanov emphasized that the influence of society on a person, his character and habits is infinitely stronger than the direct influence of nature. The fact that medicine and the incidence of people are of a social nature, it would seem, is beyond doubt. So, N.N. Sirotinin (1957) points to the close connection of human diseases with social conditions; A.I. Strukov (1971) writes that human disease is a very complex socio-biological phenomenon; and A.I. Germanov (1974) considers it a "socio-biological category".
In a word, the social aspect of human diseases is beyond doubt, although each pathological process taken separately is a biological phenomenon. Here is another statement by S.S. Khalatova (1933): “Animals react to nature as purely biological beings. The influence of nature on man is mediated by social laws. Nevertheless, attempts to biologize human disease still find defenders: for example, T.E. Vekua (1968) sees the difference between medicine and veterinary medicine in the "qualitative difference between the human body and the animal body."
The references given to the opinions of many scientists are appropriate, because the relationship between patient and doctor can sometimes create the illusion that healing is, as it were, a completely private matter; such an involuntary delusion could have been encountered with us before the Great October Socialist Revolution and exists now in bourgeois states, while the knowledge and skill of a doctor are entirely of social origin, and a person’s illness is usually due to the way of life and the influence of various factors of a particular social environment; the physical environment is also largely socially conditioned.
It is impossible not to recall the significance of the socialist worldview for medical practice and understanding of illness and understanding of human illness. ON THE. Semashko (1928) wrote that the view of disease as a social phenomenon is important not only as a correct theoretical setting, but also as a fruitful working doctrine. The theory and practice of prevention have their scientific roots from this view. This teaching makes a doctor not a craftsman from a hammer and a tube, but a social worker: since the disease is a social phenomenon, then it is necessary to fight it not only with medical, but also with social and preventive measures. The social nature of the disease obliges the doctor to be a public figure.
Socio-hygienic research proves the social conditionality of the state of people's health. Suffice it to recall the famous work of F. Engels "The Condition of the Working Class in England" (1845) 2 . With the help of biomedical analysis, the mechanism of action of environmental factors (climate, nutrition, etc.) on biological processes in the body is established. However, we must not forget about the connection and unity of the social and biological conditions of human life. Housing, food, working environment are social factors in origin, but biological in terms of the mechanism of influence on the anatomical and physiological characteristics of a person, i.e. we are talking about mediation by the body of social conditions. The higher the socio-economic level of modern society, the more effective is the organization of the environment for the conditions of human life (even in space). Therefore, both biologism and abstract sociologism are metaphysical and unscientific in solving the problems of medicine. In these facts, one can notice a decisive importance in understanding the theory of medicine and health care, a general worldview, taking into account socio-economic foundations, and a class approach.
Description of diseases in ancient times and modern terminology. Practical experience of doctors accumulated over several millennia. It can be recalled that the activities of ancient doctors were already carried out on the basis of the great experience of their predecessors. In the 60 books of Hippocrates, which, apparently, reflected the works of his students, a significant number of names of internal diseases, which were supposed to be fairly familiar to the reader. Hippocrates did not describe their symptomatology; he only had case histories of specific patients and many practical and theoretical remarks. In particular, the following, conditionally speaking, nosological units are noted: peripneumonia (pneumonia), pleurisy, purulent pleurisy (empyema), asthma, exhaustion (phthisis), sore throats, aphthae, runny nose, scrofulosis, abscesses of various types (apostemes), erysipelas, cephalgia, frenitis, lethargy (fever with drowsiness), apoplexy, epilepsy, tetanus, convulsions, mania, melancholia, sciatica, cardialgia (heart or cardia?), jaundice, dysentery, cholera, intestinal obstruction, suppuration of the abdomen, hemorrhoids, arthritis, gout , stones, stranguria, puffiness (ascites, edema), leukophlegmasia (anasarca), ulcers, crayfish, "large spleen", pallor, fatty disease, fevers - continuous, daily, tertsiana, quartana, burning fever, typhus, ephemeral fever.
Before the activities of Hippocrates and his school, doctors distinguished at least 50 manifestations of internal pathology. A rather lengthy enumeration of various disease states and correspondingly different designations is given in order to present more concretely the great successes of observation, albeit primitive, by doctors of ancient civilizations - more than 2500 years ago. It is useful to realize this and thus be attentive to the hard work of our predecessors.
The position of medicine in society. People's concern for the treatment of injuries and diseases has always existed and achieved some success in varying degrees in connection with the development of society and culture. In the most ancient civilizations - for 2-3 thousand years BC. - there were already some laws governing medical practice, such as the code of Hammurabi, etc.
Quite detailed information about ancient medicine was found in the papyri of Ancient Egypt. The Eberts and Edwin Smith Papyri were summaries of medical knowledge. A narrow specialization was characteristic of the medicine of Ancient Egypt, there were separate healers for the treatment of lesions of the eyes, teeth, head, stomach, as well as the treatment of invisible diseases (!) (maybe they belong to internal pathology?). This extreme specialization is considered one of the reasons that delayed the progress of medicine in Egypt.
In ancient India, along with many empirical achievements of medicine, surgery reached a particularly high level (removal of cataracts, removal of stones from the bladder, facial plastic surgery, etc.); the position of healers, apparently, has always been honorable. In ancient Babylon (according to the code of Hammurabi) there was a high specialization, and there were also public schools of healers. In ancient China, there was an extensive experience of healing; the Chinese were the first pharmacologists in the world, they paid great attention to the prevention of diseases, believing that a real doctor is not the one who treats the sick, but the one who prevents the disease; their healers distinguished about 200 types of pulses, 26 of them to determine the prognosis.
Repeated devastating epidemics, such as the plague, at times paralyzed the population with fear of "divine punishment." “In ancient times, medicine, apparently, was so high and its benefits were so obvious that medical art was part of a religious cult, was the property of a deity” (Botkin S.P., ed. 1912). At the beginning of European civilization, since the ancient period of Ancient Greece, along with the exclusion of religious views on diseases, medicine received the highest appreciation. Evidence of this was the statement of the playwright Aeschylus (525-456) in the tragedy "Prometheus", in which the main feat of Prometheus was to teach people to provide medical assistance.
In parallel with temple medicine, there were medical schools of sufficiently high qualification (Kosskaya, Knidas schools), whose help was especially obvious in the treatment of injured or wounded people.
The position of medicine and medical care, in particular in the era of Roman rule, was very low. Rome was inundated with many self-proclaimed healers, often swindlers, and prominent scholars of the time, such as Pliny the Elder, called doctors the poisoners of the Roman people. We should pay tribute to the state organization of Rome in attempts to improve hygienic conditions (the famous water pipes of Rome, the cesspool of Maximus, etc.).
The Middle Ages in Europe essentially produced nothing for the theory and practice of medicine. It should also be noted that the preaching of asceticism, contempt for the body, concern mainly for the spirit could not contribute to the development of medical techniques, with the exception of the opening of separate houses of charity for the sick and the publication of rare books on medicinal plants, for example, the book of the 11th century by M. Floridus " On the properties of herbs» 3 .
The development of medical knowledge, like any education, corresponded to the generally accepted scholastic method. Medical students were required to study logic for the first 3 years, then books by canonized authors; medical practice was not in the curriculum. Such a situation, for example, was even officially established in the 13th century and beyond.
At the beginning of the Renaissance, there were few changes in studies compared to the Middle Ages, classes were almost exclusively bookish; scholasticism, endless abstract verbal intricacies overwhelmed the heads of the students.
It should be noted, however, that along with a very heightened interest in ancient manuscripts, intensified scientific research began in general and the study of the structure of the human body in particular. The first researcher in the field of anatomy was Leonardo da Vinci (his research remained hidden for several centuries). The name of Francois Rabelais, the great satirist and physician, can be noted. He publicly performed an autopsy and preached the need to study the anatomy of the dead 150 years before the birth of the "father of pathological anatomy" G. Morgagni.
Little is known about the state organization of education and healthcare in this era, the transition from the dark Middle Ages to the new medicine was slow.
The state of medical care in the 17th-18th centuries was rather miserable, the poverty of knowledge was masked by abstruse reasoning, wigs and solemn robes. This position of healing is quite truthfully depicted in the comedies of Molière. The existing hospitals provided meager care to the sick.
Only during the Great French Revolution of 1789 does the state regulation of medical education and help; so, for example, from 1795, by decree, a mandatory teaching students at the bedside.
With the emergence and development of capitalist society, medical education and the position of the practitioner took certain forms. Education in the medical arts is paid, and in some states it is even very expensive. The patient personally pays the doctor, i.e. buys his skill and knowledge to restore his health. It should be noted that most physicians are guided by humane convictions, but in the conditions of bourgeois ideology and everyday life, they must sell their work to patients (the so-called fee). This practice sometimes acquires the disgusting traits of "chistogan" among doctors as a result of the desire for more and more profit.
The position of the healer in primitive communities, among the tribe, was honorable.
In semi-wild conditions, not so long ago, unsuccessful treatment led to the death of the doctor. For example, in the reign of Tsar Ivan IV, two foreign doctors were executed in connection with the death of the princes they treated, they were slaughtered "like sheep."
Later, during the period of serfdom, the remnants of feudalism, the attitude towards the doctor was often dismissive. As early as the end of the 19th century, V. Snegirev wrote: “Who does not remember how doctors stood at the lintel, not daring to sit down ...” G.A. Zakharyin has the honor of fighting against the humiliation of doctors.
The position of "purchase and sale" in medical practice was in pre-revolutionary Russia. The deviation of the doctor's activity from the rules of humanity (sometimes from elementary honesty) is noted in the writings of D.I. Pisareva, A.P. Chekhov and others. However, doctors and the general public know the life and ideal behavior of most doctors (for example, F.P. Gaaz and others), as well as the actions of medical scientists who subjected themselves to life-threatening experiments for the development of science, the names of numerous Russian doctors are familiar who conscientiously worked in the countryside. However, the practice of bourgeois relations prevailed everywhere, especially in the cities.
The Great October Socialist Revolution created new, most humane rules for medical practice. All relations between the doctor and the patient, distorted by bourgeois ideology and practice, have changed dramatically. Creation of a public health system providing free medical care, established new doctor-patient relationship.
Caring for the health of the population in our country is one of the most important tasks of the state, and the doctor has become the executor of this serious task. In the USSR, doctors are not people of the so-called free profession, and public figures working in a particular social area. The relationship between doctor and patient has also changed accordingly.
In conclusion, mentioning the high value of the medical profession, it should be reminded to novice doctors or students that this activity is difficult both in terms of the chances of success and the environment in which the doctor will have to live. Hippocrates (ed. 1936) eloquently wrote about some of the difficulties of our work: “There are some of the arts that are difficult for those who possess them, but beneficial for those who use them, and for ordinary people - a blessing that brings help, but for those who practice them - sadness. Of these arts there is also that which the Hellenes call medicine. For the doctor sees the terrible, touches that which is disgusting, and from the misfortunes of others he reaps sorrow for himself; the sick, thanks to art, are freed from the greatest evils, illnesses, sufferings, from sorrow, from death, because medicine is a healer against all this. But the weaknesses of this art are difficult to recognize, and the strengths are easy, and these weaknesses are known only to doctors ... "
Almost everything expressed by Hippocrates is worthy of attention, careful thought, although this speech, apparently, is more addressed to fellow citizens than to doctors. Nevertheless, the future doctor must weigh his possibilities - the natural movement of helping the suffering, the inevitable environment of difficult spectacles and experiences.
The difficulties of the medical profession were vividly described by A.P. Chekhov, V.V. Veresaev, M.A. Bulgakov; it is useful for every doctor to think over their experiences - they complement the dry presentation of textbooks. Familiarity with artistic descriptions of medical topics is absolutely necessary to improve the culture of the doctor; E.I. Lichtenstein (1978) has given a good summary of what writers have said about this side of our lives.
Fortunately, in the Soviet Union, a doctor is not a "lone handicraftsman", dependent on the police or Russian tyrants, but is a worker, quite respected, a member of the state health care system.
1 TSB, 3rd ed. - T. 15.- 1974.- C. 562.
2 Engels F. The situation of the working class in England// Marx K., Engels F. Soch.- 2nd ed.- T. 2.- C. 231–517.
3 Odo from Mena / Ed. V.N. Ternovsky.- M.: Medicine, 1976.
Source of information: Aleksandrovsky Yu.A. Borderline psychiatry. M.: RLS-2006. — 1280 p.
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