Irkutsk State Medical University” of the Ministry of Healthcare of the Russian Federation

Federal State Budgetary Educational Institution of Higher Education “Irkutsk State Medical University” of the Ministry of Healthcare of the Russian Federation

Department of Public Health and Healthcare

I.V. Orlova

Irkutsk, 2020

УДК 61(091)(075.8)=111 ББК5гя73

О-75 Recommended by the CCMС of FSBEI HE ISMU MOH Russia as a study guide for foreign students, mastering educational program of higher education by the educational program of the specialty of General Medicine, Dentistry for mastering the discipline “History of Medicine” (Protocol № 1 of 28.10.2020)

Author: I.V. Orlova – Candidate of Historical Sciences, Associate Professor, Department of public health and healthcare, FSBEI HE ISMU MOH Russia

Reviewers: A.V. Zavialov – Candidate of Sociological Sciences, Senior teacher, Department of Clinical, Social Psychology and Humanities, FSBEI HE ISMU MOH Russia

M.I. Vinokurova – Candidate of Pedagogical Sciences, Associate Professor, Department of Foreign Languages with Latin and "Russian for Foreigners" Programs, FSBEI HE ISMU MOH Russia

Orlova I.V. О-75 History of Medicine: study-guide / I. V. Orlova; FSBEI HE ISMU MOH Russia, Department of Public Health and Healthcare. – Irkutsk : ISMU, 2020. – 83 p.

This textbook covers key concepts and events in the history of medicine, dating back to ancient times. The training material is presented in the form of texts. In order to assimilate the material under study and self-control, test tasks are included in it. There are drawings in the textbook. These pictures are taken from Wikipedia. The manual is intended for foreign students mastering educational programs of higher education in the educational program of the specialty General Medicine, Dentistry for mastering the discipline "History of Medicine". УДК 61(091)(075.8)=111 ББК5гя73

LIST OF ABBREVIATIONS

BCE / BC – Before Christ (Before Common Era) CE / AD – Anno Domini (from Latin – Common Era) UN – United Nations WHO – World Health Organization

INTRODUCTION

The task of teaching the History of Medicine to foreign students is to give them the opportunity to master theoretical knowledge about the events and processes of the development of medicine. This study-guide covers the period of the formation of medical science from ancient times till nowadays. The study-guide describes the development of individual areas of medical science, as well as the role of famous scientists. The study-guide consists of 9 topics, the topics are accompanied by exercises and tests. At the end of the study guide, there is a list of recommended literature, as well as the appendix "Recommendations for presentation preparation" which provides practical tips for students who want to make meaningful and effective presentations. Before a student starts making reports and presentations for the "Reading Skills Development" block, he / she is advised to study the material in this section and follow the suggested tips. The study-guide meets the requirements of the Federal State Educational Standards of Higher Education, the work program of the discipline "History of Medicine" and is intended for foreign students who master educational programs for specialists.

CONTENTS

№ Topics p.

1. History of medicine as a science. Medicine in early civilizations: Babylonia and Ancient Egypt 6

2. Medicine in early civilizations: Ancient India and Ancient China 14

3. Medicine of Ancient Greece and Ancient Rome 29

4. Medieval medicine: the East and Europe 25

5. Medieval medicine: famous European scientists 37

6. European medicine from the second half of the 18th century to the 19th century. 44 Development of Biomedical sciences 7. European medicine from the second half of the 18th century to the 19th century. 52 Development of Medical and Clinical sciences 8. Development of the regional medicine in the middle of the 19th – 20th centuries 63

9. Medical organizations in the 20th century 70

Final test 74

Correct answers 79

Recommended literature 80

Supplement 81

TOPIC 1. HISTORY OF MEDICINE AS A SCIENCE. MEDICINE IN EARLY CIVILIZATIONS: BABYLONIA AND ANCIENT EGYPT PLAN 1. History of medicine as a science 2. Prehistoric medicine 3. Medicine in early civilizations

1. History of medicine as a science The subject of history of medicine includes history and medicine studies. This combination makes the discipline more interesting. It is impossible to imagine а world without medicine. The word "medicine" is derived from Latin and means the art of healing. Since the ancient times, medicine has always helped to cure people of dangerous diseases. The main purpose of modern medicine is not only to treat an illness, but give a well- timed diagnosis and try to prevent it. Modern medicine has advanced greatly, so that doctors can foresee health problems of a baby already in the womb. It has become possible due to modern technologies. The development of medicine started in ancient times, when people used to treat themselves with different things, such as animal organs and secretions, minerals and herbs. It was the time of herbal medicine. Today some things seem strange and funny to us. However, some people still follow this way of treatment and find it effective. There are also many kinds of medicines consisting of vegetal components. Whenever we ask how this or that was, we must turn to history. History is a science about the past. Studying the past helps us understand what life was like at a certain period of time. We can also understand different events of the past and special features of previous civilizations by thinking them up. Studying the past we can see what problems existed many years ago, and what the methods of solutions were. We can evaluate situations which happened in the past to make conclusions for the present. History is a conversation between the present and the past. History can be compared with an intricate puzzle. Some pieces of the puzzle have been lost forever. But every generation of historians tries to find the lost. When we talk about history of medicine we should consider medicine as a historical phenomenon, as a part of culture at a certain age or in a certain country. I suggest that we divided history of medicine into the following periods: - Prehistoric medicine; - Medicine in early civilizations; - Medicine in Ancient Greece and Ancient Rome;

- Medieval medicine: the East and Europe; - European medicine from the second half of the 18th century to the 20th century; - Regional medicine in the middle of the 19th – 20th centuries/

2. Prehistoric medicine Talking about prehistoric medicine, we should remember and understand the following. 1. At first medicine was not a science. It was only healing. 2. Healing was a collective activity. Women did it because they wanted to take care of children. Men did it because they wanted to help tribesmen in the hunt or battle. What was it like? What methods did prehistoric people use? Australian aborigines used means of flora and fauna for healing. For example, for food poisoning they used urine and clay. Aborigines of America used different methods, such as compresses, massage and intestinal lavage. They were able to make operations, using herbs for anesthesia as well. A healing magic was popular in the prehistoric period, which caused the emergence of rituals. For example, trepanation1. In modern medicine trepanation is a skull perforation operation with the aim to get to the center of a brain malady. Judging about the prehistoric period, historians concluded that prehistoric people were absolutely sure that this manipulation led to the exorcism of the evil spirit. Picture 1. Trepanation on Scientists believe these were unique situations because some trepanation facts were the skull of a primitive man 1 successful. The main evidence of successful operations is calluses on skulls found by archeologists.

Trepanation of the skull of the Ancient Incas (modern Peru)

Trepanation is the removal of certain parts of the human skull, practiced 12 000 years ago. The Incas had a wide knowledge of human anatomy and were able to apply them in practice. Healers of Inca treated wounds and fractures successfully, using "tire" of the large feathers of birds; performed operations of amputation of the upper and lower extremities, made trepanation of skulls. The Incas used four different techniques of surgery: 1) drilled a hole in the cranial bone, 2) scraped a hole, 3) cut a rectangular bone fragment, 4) cut out a round piece of bone, which, after the operation was completed, could be reinserted into place. The latter method, according to researchers, was used in cases of urgent surgical intervention, if the wound was severe with obvious consequences. Anesthesia, according to historians, was common and was achieved by the use of herbs that have a narcotic effect, juices of cacti and other plants; their juices and infusions operated for several days.

1 Trepanation on the skull of a primitive man [Resource]: ru.wikipedia.org/wiki/Trepanation (date: 16.02.2020). 7

3. Medicine in early civilizations Prehistoric times changed with a period of early civilizations. These civilizations appeared in places with warm and mild climate. These were the first states. Usually historians call them states of the ancient East. The territory which we know as the ancient East was stretching from the modern Tunisia to the modern China and from the modern Ethiopia to the Caucasus Mountains. There are many specific features, contributing to the development of medicine in the ancient East: 1) invention of writing and creating of the first texts on medicine; 2) formation of two ways of medical practice: accumulation of experience and preservation of religious beliefs and traditions; 3) training of physicians; 4) creation of the first sanitation and development of hygienic principles; 5) formation of bases of the medical ethics (deontology). Babylonia One of the most famous states of the ancient East was the Babylonian kingdom. Babylonia was stretching between the rivers of Tigris and Euphrates. The political and cultural heyday of Babylonia falls to the 18th century BC. This was in the reign of the famous Babylonian king Hammurabi. In 1901 French archaeologists found a stone pillar. It was a tall pillar with King Hammurabi’s laws. There were notes of the first inscribed laws on it. Some articles of the laws say about medical activities, formation of deontological fundamentals and professional relationship. Also in Babylonia there were strict hygienic rules and prohibitions. For example, it was forbidden to drink water from ponds and rivers. There were different drinks instead, including 16 types of beer. There was no sewerage in the early period in Babylonia. There was a practice to take out all sewage onto the street. However, by the 8th century BC Babylonians created different constructions similar to sewers. Also by this time in homes of wealthy people bathrooms appeared. Speaking about the status of healers we should note that attitude to them in society was different. It depended on many reasons. But the healer’s status in the royal house was very high. As a result, on the one hand healing became legal. On the other hand, there were no medical schools; medical knowledge was given over only inside a certain social group. Ancient Egypt The center of the Egyptian civilization was the valley of the river Nile. The main sources on history of medicine in Ancient Egypt are medical texts, descriptions of historians (for example, Herodotus), archaeological research, including the study of mummies, pyramids and medical instruments. The art of healing in Ancient Egypt was a unique phenomenon and part of the culture. Egyptian healing was strongly connected with mythology. Egyptian mythology prescribed to keep the dead body. So, the earliest knowledge about the structure of the human body was obtained due to embalming. 8

By the 2nd millennium BC Egyptians made descriptions of some parts of the body, such as the brain, heart, blood vessels, kidneys, intestines, muscles. It should be said that there were no researches, only descriptions. For example, Egyptians compared the brain with boiling copper and also noted that a brain injury leads to paralysis of limbs. They considered the heart and the vessels to be the major organs. That's why diagnostics by pulse was very popular. As a result of these descriptions the fundamentals of anatomy were laid. The famous Greek historian Herodotus noticed an interesting fact. In the 5th century BC Egyptians considered that the cause of all diseases was bad food. Therefore, stomach lavage was a very popular and regular practice in Egypt. The first enema was invented. Herodotus also described in detail the process of mummification2. Earlier we talked about Egyptian mythology which prescribed to keep the dead body. So, Egyptians believed in life after death and considered it a continuation of real earthly life. That's why they wanted to preserve the dead body from decay. It 2 was the main reason of embalming. Picture 2. Process of mummification

In the 5th century BC Herodotus described what it was like in practice: - first, it was an expensive procedure, - secondly, it was a very long and complicated procedure. The chief embalmer was a priest wearing a mask of Anubis. Anubis was the jackal headed god of the dead. He was closely associated with mummification and embalming, hence why priests wore a mask of Anubis. In the beginning they removed the brain through the nostrils with a special instrument. Then they removed the abdominal cavity through a cut in the groin. Liberated cavities were washed, rubbed, filled with incense and sewed up. After this the body was placed for 70 days in the alkaline solution. Then the body was wrapped up with long ribbons very tightly and smeared with gum (frozen sticky sap of the bark of certain trees). The face was made up with copper, lead and vegetal dyes. A mummy, embalmed thousands years ago, stays preserved up to now. Mummification was mainly done to wealthy people as poorer people could not afford the process. If the person had been a Pharaoh, he would be placed inside his special burial chamber with lots of treasure! Poor people were buried in the sand. Sand dries the body out strongly and it doesn’t decay. There were many infectious and parasitical diseases in Ancient Egypt. The most popular parasitical disease was the schistosomiasis (helminthes disease). The heart of this disease was the valley of the river Nile. The main features of this disease were the presence of worms in the body, blood in urine and diarrhea.

2 Process of mummification. [Resource]: ru.wikipedia.org/wiki/ Mummification (date: 16.02.2020). 9

For the first time schistosomiasis was discovered in 1851 by Dr. Theodore Bilharz, a German surgeon was working in Cairo (Egypt). Schistosomes infect freshwater snails. Infected snails secret cercaria 4-6 weeks after infection. Cercariae are floating tailed larvae about 1 mm. The larvae may be in the fresh water to 72 hours. During this time, they stick to the skin of a person or die. Cercariae attach themselves to man. Then these parasites migrate through the skin into the dermal (superficial) veins, and within the next few days they penetrate into small vessels. After this, the worms migrate through the capillaries to a large circle of blood circulation and finally mature. Adult worms have a small size: about 12-26 mm in length and in width of 0.3-0.6 mm. They migrate to the veins, where they start producing eggs. At the present time, around 20 million people worldwide have a severe clinical form of the disease. To the south of the Sahara from schistosomiasis annually die 200 thousand people. Women and children are the most vulnerable category of the population. Because women in the water wash clothes, and children play near rivers and in the water.

Schistosomiasis (Endemic Disease)

Schistosomiasis is one of the most important parasitic diseases of humans and is a global public health problem in the developing world. The disease is caused by trematodes of the genus Schistosoma, which cause periportal fibrosis and liver cirrhosis owing to deposition of eggs in the small portal venules. Schistosoma lead to liver disease. Many individuals do not exhibit symptoms. If symptoms do appear, they usually take from four to six weeks from the time of infection. The first symptom of the disease may be a general feeling of illness. Within twelve hours of infection, an individual may complain of a tingling sensation or light rash, commonly referred to as swimmer's itch, due to irritation at the point of entrance. The rash that may develop can mimic scabies and other types of rashes. Other symptoms can occur two to ten weeks later and can include fever, aching, a cough, diarrhea, chills or gland enlargement. These symptoms can also be related to avian schistosomiasis, which does not cause any further symptoms in humans. The manifestations of schistosomal infection vary over time as the cercariae, and later adult worms and their eggs migrate through the body. If eggs migrate to the brain or spinal cord, seizures, paralysis, or spinal cord inflammation are possible. Schistosomiasis occurs mainly in agricultural areas. Infection with Schistosoma mansoni is found in parts of South America, Africa, and the Middle East. Infection with Schistosoma japonicum is found in the Far East, mostly China and the Philippines.

Ancient Egypt had a great influence on the development of medicine among different nations. Medical knowledge was given over at special institutions and schools. That is how healers became physicians. There was a medical specialty in Ancient Egypt. Herodotus wrote that a physician had a right to treat only one disease. Egyptian physicians were popular in the countries of the ancient world.

EXERCISES FOR INDEPENDENT WORK

Test 1. WHAT COUNTRY PRACTICED MUMMIFICATION A) Babylonia B) Ancient Egypt C) Ancient India D) Ancient China 2. THE MAIN FEATURES OF PREHISTORIC MEDICINE A) healing and collective activity B) broad knowledge of the human body structure C) creation of the first sanitary laws and prohibitions D) yoga appearance 3. WHAT ORGAN EGYPTIANS COMPARED WITH THE BOILING COPPER A) vessels B) stomach C) brain D) kidneys 4. IT IS A HELMINTHES DISEASE A) smallpox B) schistosomiasis С) cough

Exercise 1 Fill in: mythology; blood; mummification; worms; human skull; features; Herodotus; Nile; urine; schistosomiasis. 1) Trepanation is the removal of certain parts of the ………………., practiced 12 000 years ago. 2) Egyptian …………………. prescribed to keep the dead body. 3) The famous Greek historian ………….. noticed the process of .………...... 4) The heart of schistosomiasis was the valley of the river …………. 5) The main ……………..… were of ……………… the presence of ………… in the body, ………… in …………… and diarrhea.

Exercise 2 Put the action in the correct order Step-by-step process of mummification Order Insert a hook through a hole near the nose and pull out part of the brain 1 Cover the corpse with natron (salt) for 70 days Make a cut on the left side of the body near the tummy Rinse inside of body with wine and spices After 40 days stuff the body with linen or sand to give it a more human shape After the 70 days wrap the body from head to toe in bandages Remove all internal organs Let the internal organs dry Place the lungs, intestines, stomach and liver inside canopic jars Place the heart back inside the body Place in a sarcophagus (a type of box like a coffin) 11

Exercise 3 Use the scheme and information from the text; make a story according to the plan: 1) What is schistosomiasis 2) How human infection occurs 3) What is the danger of this disease

Scheme 1. Circulation

Glossary History of medicine – is the science or practice of the diagnosis, treatment, and prevention of disease in the past. Schistosomes – is a chronic disease, endemic in parts of Africa and South America, caused by infestation with blood flukes. Stomach (gastric) lavage – is a medical procedure to cleanse the stomach. Trepanation – is a surgical operation of boring the bone in order to penetrate the focus of the disease.

Topics of reports 1. Prehistoric medicine 2. Mummification in Ancient Egypt 3. Schistosomiasis – is an endemic disease

TOPIC 2.

MEDICINE IN EARLY CIVILIZATIONS: ANCIENT INDIA AND ANCIENT CHINA PLAN 1. Medicine in Ancient India 2. Medicine in Ancient China

1. Medicine in Ancient India The political and cultural heyday of the Indian civilization falls to the 2nd millennium BC. The main features were the architecture of cities, a high level of sanitation, the development of crafts and trade. Indian culture was more developed than in Egypt. In the 6th century BC Buddhism spread in India. It became the basis of the philosophical doctrine of Ayurveda (the study of a long life). The main principle of Ayurveda is making a good use of natural resources. Even today Ayurveda is successful and highly evaluated all over the world. Ayurveda medicine and yoga are closely associated. They both find their roots in the Vedas. Ayurveda aims to keep the body and mind balanced so that the individual remains healthy, and yoga is an art of body-mind coordination that ensures physical and mental fitness as well as enhances one's spirituality.

What does Ayurveda mean?

Ayurveda is an ancient medical tradition from India. The term is derived from the Sanskrit ayur, meaning "life" and veda, meaning "knowledge" or "science." The concept of ayurveda is based on two major principles. The first principle is that the body and mind are interconnected, and the second principle is that the mind is powerful enough to heal the body. The body is cured of illnesses only when one's awareness of the self-expands. Practice. Ayurvedic doctors regard physical existence, mental existence, and personality as a unit, with each element being able to influence the others This is a holisticapproach used during diagnosis and therapy, and is a fundamental aspect of Ayurveda. Diagnosis. Ayurveda has eight ways to diagnose illness, called Nadi (pulse), Mootra (urine), Mala (stool), Jihva (tongue), Shabda (speech), Sparsha (touch), Druk (vision), and Aakruti (appearance). Ayurvedic practitioners approach diagnosis by using the five senses. For example, hearing is used to observe the condition of breathing and speech. The study of the lethal points is of special importance.

In Ancient India knowledge about the structure of the human body was the most complete. The study of corpses was not forbidden. Indian physicians concluded that there are many components in the human body. They told that the body consisted of 6 major parts (a head, a torso and 4 limbs), 500 muscles, 900 chords, 90 sinuses, 300 bones, 107 joints, 24 nerves, 9 sensory organs and 3 substances: mucus, bile, air. Health was understood as the harmony of these three substances, a proper use of the body and clarity of mind. A malady was understood as decay of the harmony and a negative influence of the climate, rough food, bad water, untidiness. Knowledge about the structure of the human body contributed to the formation of a unique surgery. The sources of that time describe more than 300 operations, more than 120 surgical instruments, about 750 vegetal medicines. Physicians of Ancient India also performed amputations, plastic surgery and a cesarean section. A considerable role in the development of medicine belonged to monasteries and monks. All monks had medical knowledge. Medicine in Ancient India was strongly connected with religion and philosophy. It contributed to the emergence of yoga. There were centers of medical education in Ancient India. A student stayed there for several years. There was medical ethics which required that a physician should be healthy, neat, modest and patient. Besides, he should have a short beard and trimmed nails, and wear white clothes. In contrast to Babylonia and Ancient Egypt Indian civilization hasn’t disappeared altogether. It influenced later periods in history of medicine.

2. Medicine in Ancient China In the 2nd millennium BC in the valley of the Yellow River emerged the state of Ancient China. By that time writing, paper, silk, gunpowder, and the compass had been invented. The main sources of medical studies of Ancient China are texts and archeological data. The oldest medical text that reached us up to now is "The Canon of Medicine" dated with the 2nd century BC. It teaches about the relationship between man and nature, the harmony of the Yin and Yang energies, causes of diseases and methods of their treatment. The basis of Chinese medicine was Chinese philosophy. Its main outlines are as follows. - There are two types of energy: the Yin and Yang energies. Yin is negative, dark, cool and feminine. Yang is positive, light, warm and male. - There are 5 components: water, fire, wood, metal, earth. They appear as a result of struggle of the Yin and Yang energies. These ideas formed the basis of Chinese medicine. So, every organ belonged to a particular type of energy. For example, the liver, heart, spleen, kidneys and lungs belonged to the Yin energy, because they kept the substance. The gall bladder, stomach, large intestine, small intestine, urinary bladder 15 belonged to the Yang energy, because they delivered the substance and emptied. Health was understood as the harmony of the Yin and Yang energies and the 5 components. A malady was understood as decay of the harmony.

Basic Understanding of Yin and Yang

1. Neither Yin nor Yang are absolute. Neither Yin or Yang exist without the other. Without the existence of the other, completeness would not be and it wouldn’t follow Yin-Yang. 2. Yin Yang is not static. If Yin changes then Yang changes with it to accommodate. Example: As the earth spins, the length of day and night varies. If the days grow longer, the nights grow shorter. The summation of Yin and Yang form a whole. As one aspect increases, the other decreases. 3. The balance of Yin Yang can be skewed due to outside influences. Excesses of one causes deficiencies in the other. This becomes particularly important in Chinese healing practices. An excess of Yang results in a fever. An excess of Yin results in fluids in the body. 4. All physiological processes, signs and symptoms can be reduced to Yin-Yang. In general, every treatment modality aims to: - Tonify (increase the availability of energy) Yang or Yin. - Disperse (distribute over the body excess) Yang or Yin.

Anatomical representation began to take shape in the ancient times. But in the 2nd century BC Confucianism (a new accepted religion) forbade dissection (autopsy) of corpses. However, diagnostics and prevention of diseases proved to be successful. For example, there were 4 main diagnostic research methods: 1) inspection of the patient's skin, eye and tongue; 2) listening to the sounds in the human body and determination of smells; 3) patient survey; 4) study of pulse and active points. It should be noted that the doctrine of the pulse3 was at the highest level of diagnostic art in Ancient China. Chinese physicians knew about 28 kinds of pulse. By the way, in Europe this theory was put into practice only in the 17th century. Chinese physicians also proved the existence of the active points which contribute to the regulation of life processes. Picture 3. Diagnostic of the pulse3 What it was like? What is the method? It was the beginning of acupuncture practice. 295 active points were described and studied in detail in the 3rd century BC. By the way, now the method includes more than a thousand points. Chinese physicians believed that through punctures at the active points the

3 Diagnostic of the pulse. [Resource]: //ru.wikipedia.org/wiki/ Diagnostic of the pulse (date: 16.02.2020). 16 harmony between the Yin and Yang energies can be achieved. Such punctures were made with special needles. They were stone acupuncture needles.

Public health in Ancient China

In Ancient China, measures were taken to protect public and personal health. For example, the city's territory was sanitized; the squares and streets in the cities were paved with stone. Quarters were located on dry, sunny southern slopes next to clean water bodies. The houses of rich people were built on a foundation, they were light and spacious. The rich houses were heated with pipes laid inside the walls and under the floor. The pipes were warm air from the furnace. The houses were periodically smoked with smoke, insects, covered the cracks from the mice. The Chinese believed that cleanliness in the house is useful not only for health, but also is a source of pleasant emotions. Practice washing clothes and washing the body with hot water. Widespread tradition of washing feet at the entrance to the house. The Chinese had the rules to brush their teeth, wash their hands 5 times a day, wash their heads every 3 days and bathe once every 5 days. As soap, alkali was used. Food was prepared and eaten on the tables. The number and variety of dishes depended on a person's social origin. The dishes were cleaned with sand, washed with rainwater.

At that period prevention of diseases reached a high level. There were main preventive methods: massage, gymnastics, breathing exercises. But the most interesting method was variolation (the method of vaccination people with the smallpox virus). Chinese variolation appeared in the 12th century BC, 2 millennia before the European practices. For a long time, Chinese medicine developed in isolation. Only in the 13th century the first pieces of information about it reached Europe. This means that many positions of Chinese medicine were ahead of the European ones. Variolation or inoculation was the method first used to immunize an individual against smallpox (Variola) with material taken from a patient or a recently variolated individual in the hope that a mild, but protective infection would result. The procedure was most commonly carried out by inserting/rubbing powdered smallpox scabs or fluid from pustules into superficial scratches made in the skin. The patient would develop pustules identical to those caused by naturally occurring smallpox, usually producing a less severe disease than naturally acquired smallpox. Eventually, after about two to four weeks, these symptoms would subside, indicating successful recovery and immunity. The method was first used in China and the Middle East before it was introduced into England and North America in the 1720 in the face of some opposition. The method is no longer used today. It was replaced by smallpox vaccine, a safer alternative. This in turn led to the development of the many vaccines now available against other diseases. Origins of variolation. The Chinese practiced the oldest documented use of variolation. They implemented a method of "nasal insufflation" administered by blowing powdered smallpox material, usually scabs, up the nostrils. Various insufflation techniques have been recorded throughout the sixteenth and seventeenth centuries within China. Similar methods were seen through the Middle East 17 and Africa. Two similar methods were described in Sudan. Both had been long established and stemmed from Arabic practices – "buying the smallpox".

EXERCISES FOR INDEPENDENT WORK

Test 1. WHAT COUNTRY CONSIDERED HEALTH AS THE HARMONY OF THE YIN AND YANG ENERGIES? A) Babylonia B) Ancient Egypt C) Ancient India D) Ancient China 2. WHAT ORGANS DID THE CHINESE ASSOCIATE WITH THE YIN ENERGY? A) brain, heart, blood vessels, urinary bladder B) gall bladder, stomach, large intestine, small intestine C) liver, heart, spleen, kidneys, lungs D) liver, kidneys, intestines, muscles 3. WHAT WERE THE MAIN PREVENTIVE METHODS IN ANCIENT CHINA? A) massage, variolation, gymnastics, breathing exercises B) gymnastics, variolation, medical ethics C) breathing exercises, massage, mummification 4. WHEN THE METHOD OF VARIOLATION WAS DISCOVERED IN ANCIENT CHINA? A) in the 17th century B) in the 12th century BC C) in the 5th century BC

Exercise 1 Complete the table "The features of the development of medicine", using the texts Prehistoric medicine Babylonia Ancient Egypt Ancient India Ancient China 1) Healing; … … … … 2) Collective activity Using: herbs, minerals, animal organs

Exercise 2 Fill in: 107; 6; 500; 4; 900; 90; 300; 3; 24; 9; operations; monks; surgical instruments; physician; vegetal medicines; 1) There was medical ethics which required that a … should be healthy, neat, modest and patient. 2) Indian physicians told that the body consisted of … major parts (a head, a torso and … limbs), … muscles, … chords, … sinuses, … bones, … joints, … nerves, … sensory organs and … substances: mucus, bile, air. 3) All Indian … had medical knowledge. 4) The sources of that time describe more than 300 …, more than 120 …, about 750 …

Glossary Acupuncture – a system of complementary medicine that involves pricking the skin or tissues with needles, used to alleviate pain and to treat various physical, mental, and emotional conditions. Anatomy – a study of the structure or internal workings of something. Cesarean section – a surgical operation for delivering a child by cutting through the wall of the mother's abdomen. Variolation – a method of artificial infection of human smallpox virus. Yoga – a Hindu spiritual and ascetic discipline, a part of which, including breath control, simple meditation, and the adoption of specific bodily postures, is widely practiced for health and relaxation.

Topics of reports 1. The philosophical doctrine of Ayurveda 2. Variolation in Ancient China 3. Yin and Yang energies in medicine

TOPIC 3. MEDICINE OF ANCIENT GREECE AND ANCIENT ROME PLAN 1. Medicine of Ancient Greece 2. Medicine of Ancient Rome

1. Medicine of Ancient Greece The civilization of Ancient Greece existed for 3 thousand years. At the beginning, the territory of Ancient Greece was on the Balkan Peninsula and some islands of the Mediterranean Sea. But the lack of land for agricultural development contributed to the colonization of the coasts of the Mediterranean and Black Seas. The development of medicine in Ancient Greece depended not only on the political and historical processes, but also on the influence of the culture of the colonized lands. However, an independent and unique phenomenon of Greek culture was based on religious ideas and Greek mythology. The Greeks believed that there were many gods and they lived on the Mount Olympus. Also Greeks attributed their gods with human actions and desires. Each god protected various fields of life, science or crafts. So, god of medicine and healing was Asclepius4. He was the son of the sun god Apollo. Asclepius was born mortal, but for the highest achievements in the medical art was rewarded with immortality. He could cure the sick and resurrect the dead. In mythology there are 4 most respected Asclepius’s children: Machaon, who was a military surgeon, Podalirius – a doctor of internal (physical) medicine, Hygieia Picture 4. Asclepius4 – the goddess of health, Panacea – the patroness of drug healing. So, in the name of one of Asclepius’s daughters we have a derived word "hygiene", in the name of another daughter – a derived word "panacea", as means for all diseases. In the ancient arts the main Asclepius’s attribute was a walking stick, entwined with a snake. The snake was a symbol of wisdom and updates. Today, one of the symbols of modern medicine is the Stick of Asclepius. The main source of history of medicine in Ancient Greece was the poems by Homer. In Homer's poems 141 injuries of the body and limbs are described. Treatment of wounds included removing arrows, applying bandages, stopping blood by using herbs. During the battle soldiers treated wounds themselves. For a long time medicine in Greece was family business. In the 5th century BC Ancient Greece reached the highest political and cultural heyday. Education, philosophy, specialized schools were very popular. There were medical schools located in the cities of Cyrene, Croton, Knidos, and on the islands

4 Asclepius. [Resource]: //ru.wikipedia.org/wiki/ Asclepius (date: 16.02.2020). 20 of Rhodes, Sicily, Kos. The bright representative of the medical school on the island of Kos was Hippocrates5. His name has become a symbol of the medical art. However, modern historians and archaeologists can’t exactly determine the writings which belong to Hippocrates, because all Greek texts are anonymous. The first collection of medical texts was made many years after Hippocrates’s death. But in honor of the legendary physician it was called the Hippocratic Collection. This collection contains 5 works on medical ethics. A special place belongs to the "Physician’s Oath". Physicians had to take this oath after graduation. This tradition has moved to different countries of the world. Today, graduates of all Russian medical universities give the "Russian Physician’s Oath".

Father of Medicine

Hippocrates (about 460 BC – about 370 BC) is a famous Ancient Greek healer, doctor and philosopher. He went down in history as the "father of medicine". Hippocrates medicine is obliged to the emergence of the theory of human temperament.

According to his teaching, the general behavior of a person depends on the ratio of four juices (liquids) circulating in the body – blood, bile, black bile and mucus (phlegm, lymph). The predominance of bile makes a person impulsive, "hot" – choleric.

The predominance of mucus makes a person calm and slow – phlegmatic. The predominance of blood makes a person agile and cheerful – sanguine. The predominance of black bile makes a person sad and fearful – melancholic.

Hippocrates described the methods of examining patients – auscultation and palpation. He seriously studied the nature of the discharge (sputum, excrement, urine) in various diseases. When examining a patient, he used techniques such as percussion, auscultation, and palpation,

of course, in the most primitive form. Hippocrates is also known as an eminent surgeon of antiquity. His writings describe various methods of applying dressings, treating fractures and dislocations with the help of

stretching and special apparatus (the Hippocratic Bench) and treating wounds. In addition, Hippocrates described the rules of the position of the surgeon and his hands during surgery, placement of tools, lighting during surgery.

In the 4th century BC the Greek state was conquered by Macedonia. The young king of Macedonia Alexander the Great had an idea to conquer all the nations of Europe and Asia. As a result of military campaigns of Alexander the Great, his state grew into an empire. This territory was stretching from Sicily (Italy) to the Himalayas in India and included large areas of Picture 5. Hippocratic Bench5 Europe, Asia and Africa. However, after the death of Alexander the Great in 323 BC this state fell apart.

5 Hippocratic Bench. [Resource]: //ru.wikipedia.org/wiki/ Hippocratic Bench (date: 16.02.2020). 21

This ambitious colonization on the one hand promoted to the spread of Greek culture to the East. On the other hand, it did not reject national traditions of the conquered lands. Medicine of that period developed significantly, because it was a mix of traditions, experiences, cultural features, studies in different countries. This became the basis for the development of anatomy and surgery. Egyptian embalming experience and new laws of Egypt governing in the reign of Alexander. These laws allowed giving offenders who had been sentenced to death to scientists for vivisection. There was a practice of performing operations on live people for experimental purposes or scientific research. What methods did Greek anatomists use? First, offenders had the abdominal cavity opened. Then the aperture was ripped up and the death came immediately. Then the chest was opened and the location and structure of organs were studied. In this way descriptive anatomy began to form, the most ancient and primitive kind of anatomy when at the result of autopsy the structure of the human or animal organism were chaotically described. There are three types of anatomy: - descriptive anatomy; - systematic anatomy which studies the structure of the organs and systems with common features; - topographic anatomy which is a branch of applied anatomy, the basis for surgery.

Father of Anatomy

Herophilus (about 335 BC – about 280 BC) was Alexandrian physician who was an early performer of public dissections on human cadavers; and often called the father of anatomy. Erasistratus and Herophilus were together the founder of the Alexandrian Medical School. When the ban on human dissection was lifted, Herophilus began to study the of the brain, the organ he regarded the center of the nervous system. He rendered careful accounts of the eye, liver, salivary glands, pancreas, and genital organs of both sexes. He described and named the duodenum, at the lower end of the stomach, and the prostate gland. A student of Hippocrates’ doctrine of medicine, Herophilus emphasized the curative powers of drugs, dietetics, and gymnastics. He was first to measure the pulse, for which he used a water clock. In addition, Herophilus sought to correct certain misconceptions of medicine that were widely prevalent at the time, such as that arteries carried blood instead of spirit and that the heart had 2 atria and 2 ventricles instead of 3 ventricles. In the midst of an era where dissections were considered taboo, Herophilus conducted systematic dissections, often done in public, predating Andrea Vesalius for more than a thousand years. Unfortunately, Herophilus was accused of conducting dissections on living people and was named a "butcher". All the works which he left behind were burnt during Anatomythe destruction became of anthe independent Library of Alexandria. branch of medicine. It is attributed to the development of the Accusations of vivisections is the main reason why Herophilus has not received as much recognition for his scientific investigations of the human body as Hippocrates, Galen or Vesalius.

Herophilus is considered to be the founder of descriptive anatomy. In his work "Anatomy" he described the hard and soft meninges, parts of the brain. In the essay "On the eyes" Herophilus described the vitreous body and the retina. In the tractate "On the pulse" Herophilus described anatomy of the vessels, believing that the arteries are filled with a mixture of blood and air. Surgery in the time of Alexander the Great was formed under the influence of Indian surgery. The most important achievements were bandaging of blood vessels, the invention of the catheter, operations on the liver, kidneys, and spleen, limb amputations, laparotomy at ileus and ascites. As it was told, after Alexander the Great's death in 323 BC his empire fell into several independent states. But in the 1st century BC the Roman Empire conquered them.

2. Medicine of Ancient Rome The concept of Ancient Rome refers to a huge historical period. Its meaning was changing over several centuries, from "the city of Rome" to "the Great Roman Empire". The city of Rome was founded in 753 BC on the territory of Ancient Italy. The Roman Empire, whose territory included the entire Mediterranean coast, fell in 476 BC from raids of barbarians. Historical sources on history of medicine in Ancient Rome are the works of physicians, philosophers, archaeological and ethnographic data. It should be noted that in the field of medicine the early period of Ancient Rome is characterized with: 1) development of sanitary laws, 2) building of sanitary constructions (aqueducts and thermae), 3) uprising of medical specialties. At first, physicians in Ancient Rome were slaves – prisoners of war from Greece, Asia Minor, Egypt. Than physicians from Greece and Egypt started to be given the Roman citizenship. A great contribution to the development of Roman culture was made by Greeks. For example, the Romans accepted Greek mythology. The Roman patron of medicine and physicians was Aesculapius (identical to the Greek god Asclepius). The development of Roman medicine also became possible due to regular military campaigns. This is the main reason for development of military medicine. There were physicians in all military units. At that time the medical job developed in cities and provinces as well. A practitioner was called a doctor, and he began to be paid. Doctors in Rome had a high social status. They had a lot of rights and privileges. It became the reason for foreign doctors’ arrival in Rome. That led to their excess, competition, and afterwards to the separation of specialties. So by the 1st century BC there were dentists, oculists, surgeons. Sets of surgical instruments found by archeologists evidence on the development of surgery. Those sets included tweezers, forceps, clamps, bone saws, surgical blades and needles, catheters. 23

The famous Roman physician Galen lived in the 1st century AD. He was Greek by origin. Galen traveled a lot and studied writings of physicians from different countries. For 5 years he worked as a doctor with gladiators. He often made vivisection. Galen regarded anatomy as the foundation of medical knowledge, and he frequently dissected and experimented on such lower animals as the monkeys, pigs, sheep, and goats. He distinguished seven pairs of cranial nerves, described the valves of the heart, and observed the structural differences between arteries and veins. One of his most important demonstrations was that the arteries carry blood, not air, as had been taught for 400 years. Notable also were his vivisection experiments, such as tying off the recurrent laryngeal nerve to show that the brain controls the voice, performing a series of transections of the spinal cord to establish the functions of the spinal nerves, and tying off the ureters to demonstrate kidney and bladder functions. Galen was seriously hampered by the prevailing social taboo against dissecting human corpses, however, and the inferences he made about human anatomy based on his dissections of animals often led him into errors. His anatomy of the uterus, for example, is largely that of the dog’s. Galen’s ideas on the pulse and blood movement existed in European medicine for 14 centuries were not criticized. What were those ideas about? Today we know that blood has a forward, unidirectional motion. But Galen believed that blood moves in spurts, and is formed in the liver. In the 16th century a Spanish scientist Servetus was the first to describe the pulmonary circulation. Servetus showed the mechanism of blood returning from the lungs to the heart. This knowledge was absent in Galen’s system.

Father of Anatomical physiology

Galen (about 131 — about 217) made great achievements in the study of the nervous

system. Galen described all sections of the brain and spinal cord. Using cross-section of the

spinal cord at the level of each vertebra, he studied the sensory and motor disorders of the

section placed below. The top of his scientific activity was the doctrine of the pulse. Galen explained how to feel out the pulse, and how to do it between hits. Galen believed that the arteries contain blood. He repeated Erasistratus’s experiments many times and rejected his

idea of the air in the arteries. Galen made a great contribution to the development of pharmacology. Today he is considered the founder of experimental anatomical physiology and pharmacology. Galen is

one of the greatest scientists of the world. Galen was a practicing surgeon. He considered the basis of anatomical surgery. Earlier we talked about his working as a doctor with gladiators for 5 years. He successfully cured

complex wounds, received in melee, with weapons, or after battle with wild animals. Galen was a skilled traumatologist.

According to Galen, blood is formed in the liver and is then carried by the veins to all parts of the body, where it is used up as nutriment or is transformed into flesh and other substances. A small amount

24 of blood seeps through the lungs between the pulmonary artery and pulmonary veins, thereby becoming mixed with air, and then seeps from the right to the left ventricle of the heart through minute pores in the wall separating the two chambers. Building on earlier Hippocratic conceptions, Galen6 believed that human health requires an equilibrium between the four main bodily fluids, or humours-blood, yellow bile, black bile, and phlegm. Galen’s writings achieved wide circulation during his lifetime, and copies of some of his works survive that were written within a generation of his death. By 500 AD his works were being taught and summarized at Alexandria. Learned medicine in the Arabic world thus became heavily based upon the commentary, exposition, Picture 6. Galen6 and understanding of Galen. In 1543 the Flemish physician Andreas Vesalius showed that Galen’s anatomy of the body was more animal than human in some of its aspects, and it became clear that Galen and his medieval followers had made many errors. Galen’s notions of physiology, by contrast, lasted for a further century, until the English physician William Harvey correctly explained the circulation of the blood. At the beginning of our era Christianity was spreading in Europe. For a long time a new religion was persecuted. Only in 380 Christianity became an official religion. The history of Christianity is connected with the emergence and development of monastic hospitals and hospital business. Monasteries gave a shelter to the elderly, children, wounded and sick people. The first great Christian hospital was built in 370. It was like a small city, every building corresponded to a certain type of disease. The ancient period of the Roman Empire ended in the 5th century AD, when barbarians invaded Europe and began to destroy the Roman civilization.

EXERCISES FOR INDEPENDENT WORK

Exercise 1 Fill in: modern medicine; walking stick; Hygieia; military healing; surgeon; panacea snake; doctor; children; Asclepius. In mythology … was god of medicine and healing. There are 4 most respected Asclepius’s …: Machaon, who was a …., Podalirius – a … of internal (physical) medicine, … – the goddess of health, Panacea – the patroness of drug …. So, in the name of one of Asclepius’s daughters we have a derived word "hygiene", in the name of another daughter – a derived word " … ", as means for all diseases. In

6 Galen. [Resource]: //ru.wikipedia.org/wiki/ Galen (date: 16.02.2020). 25 the ancient arts the main Asclepius’s attribute was a …, entwined with a snake. The … was a symbol of wisdom and updates. Today, one of the symbols of … is the Stick of Asclepius.

Exercise 2 Complete the table "Main characteristic", using the texts Asclepius Hippocrates Herophilus Galen 1) 2) 3) 4)

Exercise 3 Translate and learn Russian words существительное noun существительное noun врач обследование Древняя Греция аускультация Древний Рим пальпация отец хирургия медицина анатомия клятва глагол verb принцип есть (быть) медицинская этика получать традиция говорить диплом описать метод изучать пациент

Text (текст) Гиппократ – это врач из Древней Греции. Гиппократ – это "отец медицины". "Клятва Гиппократа" – это принцип медицинской этики. Есть традиция: получать диплом и говорить клятву. Гиппократ описал методы обследования пациента: аускультация и пальпация. Гиппократ изучал хирургию и анатомию. В Древней Греции было много врачей: Гиппократ, Герофил и др.

Test (тест) 1. WHERE WAS THERE THE GOD OF MEDICINE AND HEALING ASCLEPIUS BY NAME? A) Древняя Греция B) Древний Рим 2. WHAT OATH DO GRADUATES FROM RUSSIAN MEDICAL UNIVERSITIES TAKE? A) The Physician’s Oath B) The Hippocratic Collection 26

C) The Canon of Medicine 3. WHAT METHODS OF EXAMINATION OF THE PATIENT DID HIPPOCRATES DESCRIBE? (More than one correct answer is possible) A) аускультация B) медицинская этика C) пальпация 4. WHAT DID HEROPHILUS DESCRIBE IN THE ESSAY "ON THE EYES"? A) stomach and kidneys B) vitreous body and retina C) vessels and arteries 5. WHAT MEDICAL ACHIEVEMENTS WERE MADE IN THE TIME OF ALEXANDER THE GREAT? A) filling the ventricles of the heart and blood vessels with wax B) establishment of medical universities C) limb amputations, laparotomy at ileus and ascites 6. WHAT SANITARY CONSTRUCTIONS WERE CREATED IN ANCIENT ROME? A) libraries at hospitals B) aqueducts and thermae 7. WHEN WAS THE FIRST CHRISTIAN HOSPITAL BUILT? A) in 323 B) in 380 C) in 370 8. MATCH THE COLUMNS: A) autopsy 1. A physical method of medical diagnostics which consists of listening to the sounds produced during the internal organs’ functioning.

B) аускультация 2. A physical method of medical diagnostics conducted by feeling the patient's body. C) пальпация 3. А dissection and examination body, including internal organs. 9. MATCH THE COLUMNS: A) melancholic 1. The predominance of bile makes a person impulsive, «hot» B) choleric 2. The predominance of mucus makes a person calm and slow C) phlegmatic 3. The predominance of blood makes a person agile and cheerful D) sanguine 4. The predominance of black bile makes a person sad and fearful

Glossary Auscultation – is a physical method of medical diagnostics which consists of listening to the sounds produced during the internal organs’ functioning. 27

Autopsy – a dissection and examination body, including internal organs. Laparotomy – a surgical incision into the abdominal cavity for diagnosis or in preparation for a surgery. Ophthalmology – a branch of medicine concerned with the study and treatment of disorders and diseases of the eye. Palpation – is a physical method of medical diagnostics conducted by feeling the patient's body. Pharmacology – a branch of medicine concerned with the drug action modes uses. Thermae – ancient public baths.

Topics of reports 1. Hippocrates contribution to the development of Medicine 2. Herophilus contribution to the development of Medicine 3. Galen contribution to the development of Medicine

TOPIC 4. MEDIEVAL MEDICINE: THE EAST AND EUROPE PLAN 1. Medieval medicine of East 2. Medieval medicine in Europe

1. Medieval medicine of East The medieval period lasted from about the 5th to the 17th century. It was a long and controversial period. As regards the medicine of that time, it developed more progressively in the Medieval East. On the one hand, it was connected with the Arab conquest, and on the other hand, with the spread of the Muslim religion. An outstanding Persian philosopher, physician, and alchemist Abu Bakr Muhammad Ibn Zachariah al-Razi (shortly, Al-Razi) lived in the 9th – 10th centuries. He began to practice medicine late, when he was 30. He traveled across the Islamic world. Being a skilled chemist, Al-Razi studied the effects of mercury on the organism of a monkey. He was the first to use cotton wool in medicine, invented instruments for getting out things from the larynx. Al-Razi is the author of more than 200 works. The most famous is the tractate "On smallpox and measles". The structure of the human body was not the subject of scientific study. Muslims, as well as the Christian religion, did not allow autopsies. Therefore, following Galen's example, anatomy was studied on animals. However, surgery made great progress. The basis was the works of Galen and surgical practice. Another outstanding surgeon Al-Sahrawi (the 10th – 11th centuries) introduced catgut in abdominal surgery. He described the phenomenon which is called tuberculous lesions of bones in modern medicine. Al-Sahrawi introduced the cataract operation in surgical practice. It should be noted that ophthalmology has a special place in medicine and surgery of the medieval East. Influence of Arabic medicine on treatment of eye diseases in Europe was fundamental up to the 17th century. Another strong point of Arabic medicine was preventive medicine. There were a lot of hygienic rules and traditions. They appeared due to hot climate, features of everyday life and religious beliefs. Many of these rules are set out in the Koran. For example, the fivefold ablution, cleanliness, the prohibitions to drink wine and eat pork. The first Islamic general hospital was founded in Baghdad in 805. Gradually, the number of hospitals increased. In 1160 there were more than 60 hospitals and shelters in Baghdad. By the 12th century, nearly every city had a general hospital. There was a pharmacy, a mosque, a library, and a kitchen in such hospitals. From the 13th century medical schools began to be established there as well.

The great scientist, physician, and philosopher was Abu Ali al Hussein ibn Abdallah ibn Sina (shortly, Ibn Sina; Europeans call him Avicenna). He was born near Bukhara, a city of the modern Uzbekistan, in 980. By 18 years, Ibn Sina assimilated 12 sciences including chemistry and medicine. Ibn Sina created more than 450 writings. The main work is called "The Canon of Medicine"7, which Picture 7. "The Canon of Medicine"7 he wrote for 20 years. "The Canon" is an encyclopedia of medical knowledge of the medieval period. It consists of 5 books. Each book is divided into parts: sections, articles and paragraphs. The first book is dedicated to the theory of medicine, anatomy and physiology, causes of diseases, symptoms of diseases, diet, general principles of prevention and treatment. The second book is dedicated to simple medications of vegetal and animal origins. In the third book, which is the biggest, Ibn Sina describes diseases of certain organs: the head, ears, nose, eyes, larynx, etc., and gives advice and instructions on their diagnosis and treatment. The fourth book is dedicated to methods of treatment. For example, for surgery he describes ways of treatment of dislocations, fractures, tumors, purulent inflammations. In the fourth book he also describes common diseases (infectious diseases, fever) and suggests the doctrine of poisons. Describing surgical practice, Ibn Sina gave prominence to three things: knowledge of anatomy, cleanliness of surgical instruments, nursing of the patient after the surgery. In the fifth book he describes complex drugs, poisons and antidotes. In general, "The Canon" includes recipes of 811 drugs. Medieval medicine in the East developed medical knowledge in the countries of Asia, Africa and Europe. It became a source of European medicine.

2. Medieval medicine in Europe Medieval medicine in Europe was influenced by different facts. The Barbarians who came to Europe and began to destroy the Roman civilization. For hundreds years the achievements of science and culture of ancient Greece and Rome were lost for Europe. That’s why historians call that time which lasted from the 5th to the 14th centuries the dark ages. The first universities appeared in Europe in the 12th century. Usually, there were 3 faculties in medieval universities, such as medical, theological, law. Medicine course was theoretical and lasted for 5 to 7 years. The amount of medical students was few, about 10 people. Another feature of medieval science was development of religious philosophy (theology) and a great influence of religion on all fields of activity. For many years, this influence revealed itself in the form of strict prohibitions and activities of the Inquisition Court.

7 The Canon of Medicine. [Resource]: //ru.wikipedia.org/wiki/ The Canon of Medicine (date: 16.02.2020). 30

As an example, let us consider the fate of the English scientist Roger Bacon8 (1214 – 1292). He lived in the 13th century. People called him "an amazing doctor". He studied the nature of the soil, plants, animals and medical means. The main scientific method he used was the experience. As a result, the Inquisition court accused him of "communicating with the evil spirit". About 1257 Bacon underwent confinement. During period of confinement Bacon wrote his greatest works: "Opus majus" (major work), "Opus minor" (minor Picture 8. Roger Bacon8 work) and "Opus tertium" (third work). In "Opus majus", Bacon discussed physiology of eyesight and the anatomy of the eyes and the brain, considering light, distance, position and size, direct and reflected visions, refraction, mirrors and lenses. In "Opus majus" he made use of scientific materials already written, added new material, and included a section on moral theory. Bacon stayed in prison for 24 years and came out being a very old man. Another example of an unrecognized scientist in those times was Paracelsus9 (1493 – 1541). He was a Swiss alchemist, physician, astrologer, and philosopher. During his travels in Egypt, Arabia, and the Holy Land, he observed the methods of physicians, chemists, and spiritual healers there, and applied this experience to his own research. Rejecting the theories of Galen, which had been the foundation for European medicine during the Middle Ages, Paracelsus Picture 9. Paracelsus9 taught instead that health depended on the harmony between man and nature, and on the balances of certain chemicals within the body. He regarded Nature as the One, a living organism, and believed in the natural healing power present in Nature and the human body. A physician, he said, must have wisdom and certain spiritual qualities in order to be able to cure his patients, being "endowed with no less compassion and love than God extends toward man". All knowledge could be discovered by intuition, searching within the human mind, because man was a microcosm of the Universe, and the principles operating within the Universe operated in a corresponding way within man. Paracelsus’ aggressive manner of teaching and his outspoken criticism of traditional medical theory made him unwelcome in medieval universities, and only recently have his contributions to medicine been recognized. He pioneered the use of chemistry in medicine, developed the use of mercury to cure syphilis, recognized the role of minerals in certain illnesses, coined the word "alcohol" and named the element zinc. Paracelsus believed that a physician should proceed from the cause to the effect, instead of beginning a diagnosis with the body itself, saying. "The physician should proceed from external things, not from man". He believed in treating the cause of the disease rather than just the symptoms. Paracelsus believed the practice of medicine should be based on experience, observation, and

8 Roger Bacon. [Resource]: //ru.wikipedia.org/wiki/ Roger Bacon (date: 16.02.2020). 9 Paracelsus. [Resource]: //ru.wikipedia.org/wiki/ Paracelsus (date: 16.02.2020). 31 experiment. He was the first to record that inhaled dust, rather than subterranean spirits, was the cause of lung disease in miners. He associated the occurrence of goiter with a lack of vital elements in drinking water, and found a connection between goiter in adults and cretinism (a condition caused by a malfunction of the thyroid gland) in their children. Paracelsus identified certain diseases as being caused by toxic elements ingested or inhaled into the patient’s body, a concept that later led to the discovery of bacteria and viruses as the cause of disease. In medieval Europe, the insane were thought to be possessed by demonic spirits; Paracelsus regarded insanity as an illness and urged that insane persons be treated with kindness. He also taught that a person’s state of mind had a powerful effect on their physical body, and that many symptoms and diseases had psychological causes. For ten centuries, anatomy has hardly been studied. Anatomy of human corpses was forbidden. For many years European physicians studied anatomy and surgery by the researches of Hippocrates, Galen, Ibn Sina. In the Middle Ages, the Church declared the opening of corpses and "bloodshed" to be a great sin, it prohibited operations, and people who were engaged in various scientific studies were subjected to cruel persecution. There is an interesting fact. In most medieval European universities, surgery was not taught because it wasn’t considered to be a medical specialty. Bath attendants (bathhouse worker serving visitors) and barbers (hairdressers) practiced surgery. Only in 1238, were allowed the professors of the Salerno medical school to open one corpse for 5 years to demonstrate. In 1241, autopsies were allowed for forensic purposes. The first forensic autopsy was performed by the famous Italian surgeon Salicheto (1201 – 1277). He introduced a knife into the surgical practice for the treatment of wounds, and cauterization was used in Arabic medicine. He offered to sew guts and nerves when they were wounded. Salicheto made an autopsy for the first time for forensic purposes. In 1302, a forensic autopsy was performed in Poland. In 1316 a professor at the University of Bologna Mondino Luzzi (1275 – 1326) published a textbook on anatomy. However, Mondino himself had the opportunity to reveal only two corpses, and his textbook consisted mainly of texts derived from a poor translation of Galen. Nevertheless, the book Mondino more than two centuries was a university manual on anatomy, it was studied by Andrea Vesalius. Only in the 14th and 15th centuries some universities began to receive permits for anatomical demonstrations: it was usually allowed to open no more than one corpse in a year. The situation changed after the spread of Arab scientists’ translations and with the invention of firearms and in the course of gunshot wounds treatment. People suffered from the serious diseases such as dysentery, typhoid fever, cholera and diarrhea mainly due to dirty water and foods infected by bacteria. People thought these diseases were caused by eating raw fruits and vegetables, whereas it wasn’t the case. Рeople were used to vomiting because they had intestinal infections and food poisoning. Influenza (flu) is an acute, extremely viral infection of the upper respiratory tract, spread by inhalation. Flu was 32 not a major worry in the 14th century but became a serious issue in the 15th. Because flu is very infectious it often forms epidemics, generally occurring in the winter or early spring. There were many epidemics and pandemics in the Middle Ages. They broke out due to cultural, sanitary, and historical conditions (for example, crusades to the countries of the East). Most European cities were founded in the 12th century. However, sewer constructions appeared only in the 15th century. In cities all garbage, wastes and food scraps were taken out into the street. It caused the conditions for infectious diseases, which quickly moved into epidemics. Migration during the crusades caused a spread of different illnesses. For example, leprosy. It was considered to be incurable. People with leprosy were expelled from the society. The idea to isolate sick people appeared in the East in the 3rd century. In Europe the first leper colony was opened in 570.

What is leprosy?

Leprosy is a chronic infectious disease caused by mycobacteria Mycobacterium leprae and Mycobacterium lepromatosis, which mainly affect the skin, the peripheral nervous system,

sometimes the anterior chamber of the eye, the upper respiratory tract over the larynx, testicles, hands and feet. In the Middle Ages, the disease became widespread, and numerous leprosariums appeared. At the beginning of the XIII century, the number of leprosariums in

Europe was 19 thousand. The first known leprosarium was the St. Nicholas Hospital in Harbletown in England, founded in 1084. These institutions were located within the monasteries. Leperosoria contributed to the prevention of the spread of the disease, acting as

a quarantine. The causative agent of leprosy (Mycobacterium leprae) was discovered in 1873 in Norway by Gerhard Hansen, who worked at the St. Jorges hospital in Norway. Now it is a museum, and the bacterium discovered by Hansen has become the first causative agent of the

disease to mankind. In the modern world, leprosy is common in tropical countries. In terms of incidence, India is in first place, Brazil is second and Burma is third. In 2000, World Health Organization

listed 91 countries with endemic leprosy foci. India, Burma and Nepal together accounted for 70% of the incidence of diseases.

Another terrible disease was plague. There were three pandemics in the history of plague. The first plague came out of Egypt, and continued for about 60 years. The second and most terrible pandemic of plague was brought from Asia by merchant ships. There was a rule to close a harbor for 40 days. Thus the term quarantine was introduced. The 3rd pandemic of plague broke out in India at the end of the 19th century. In the Middle Ages, the doctor always wore a hat. It was believed that a mask in the form of a bird's beak drives away the plague. Plague doctor10 wore leather gloves. A box of aromatic herbs was worn around the neck, which should Picture 10. repel the plague. To prevent disease, the doctor always ate garlic. Plague doctor10

10 Plague doctor. [Resource]: //ru.wikipedia.org/wiki/ Plague doctor (date: 16.02.2020). 33

What is the plague?

Plague is an infectious disease caused by the bacterium Yersinia pestis. Symptoms include fever, weakness and headache. The first known pandemic is the so-called "Justinian Plague" (551 – 580), which began in Egypt and covered the territory of the entire civilized world of that time. More than 100 million people died. In the 14th century, a terrible epidemic of “black death”, brought from Eastern China, passed through Europe. Around 1320 and 1330, a plague epidemic began to spread throughout China and Central Asia, then to the Middle East and Egypt. Muslim historical sources write about the enormous mortality, the speed of spread of the disease and unheard of infectiousness. By 1346, the plague was brought to the Crimea, and from there to Europe. In 1348, almost 15 million people died from it, which accounted for a quarter of the entire population of Europe. In 1351, the plague struck Poland. By 1352, 25 million people died in Europe, a third of the population. In the years 1350 – 1352, the "black death" came from the Baltic to the Russian lands. Up to 34 million people died in Europe from the plague over the period 1347–1351. The great London epidemic of 1664–1665 killed nearly a quarter of the city’s population. In 2017 the countries with the most cases include the Democratic Republic of the Congo, Madagascar and Peru. In the United States infections usually occur in rural areas.

EXERCISES FOR INDEPENDENT WORK

Test (тест) 1. WHO INTRODUCED CATGUT TO ABDOMINAL SURGERY? А) Al-Razi В) Galen С) Al-Sahrawi D) Ibn Sina 2. WHAT MUSLIM TRADITIONS APPEARED ON THE BASIS OF SANITARY RULES? (More than one correct answer is possible) А) fivefold ablution В) cleanliness С) building a general hospital nearly every city D) prohibitions to drink wine and eat pork 3. WHEN WAS THE FIRST ISLAMIC GENERAL HOSPITAL IN BAGHDAD BUILT? A) in 805 B) in 1160 C) in 380 4. WHO IS THE AUTHOR OF THE "CANON OF MEDICINE"?

А) Al-Razi В) Galen С) Al-Sahrawi D) Ibn Sina 5. MATCH THE COLUMNS: A) The first book of the 1. Description of complex drugs, poisons and antidotes "Canon of Medicine" B) The second book of the 2. Simple medications of vegetal and animal origins "Canon of Medicine" C) The third book of the 3. Description of methods of treatment. For example, for surgery he "Canon of Medicine" describes ways of treatment of dislocations, fractures, tumors, purulent inflammations. In the fourth book he also describes common diseases (infectious diseases, fever) and suggests the doctrine of poisons D) The fourth book of the 4. Description of diseases of certain organs: the head, ears, nose, "Canon of Medicine" eyes, larynx, etc., and gives advice and instructions on their diagnosis and treatment Е) The fifth book of the 5. Description of the theory of medicine, anatomy and physiology, "Canon of Medicine" causes of description of symptoms of diseases, diet, general principles of prevention and treatment 6. WHAT WAS THE MAIN PREVENTIVE METHOD AGAINST EPIDEMICS IN EUROPE? А) medical ethics В) quarantine С) breathing exercises 7. WHY THE EUROPEAN MIDDLE AGES IS CALLED THE "DARK AGES"? A) because the amount of medical students was few, about 10 people B) because the achievements of science and culture were lost for Europe C) because there were a lot of infectious diseases 8. WHAT SCIENTIST WAS CALLED AN "AMAZING DOCTOR"? А) Al-Razi В) Galen С) Roger Bacon D) Ibn Sina 9. WHO PRACTICED SURGERY IN THE MIDDLE AGES? А) scientists 35

В) bath attendants С) graduates of medical school D) barbers (hairdressers) 10. WHO WAS THE FIRST TO CONDUCT A FORENSIC AUTOPSY IN EUROPE? А) Salicheto В) Mondino Luzzi С) Andrea Vesalius D) Galen 11. WHAT CHANGES IN ANATOMY OCCURRED IN THE 14th – 15th CENTURIES? А) ban on autopsy B) some universities began to receive permits for anatomical demonstrations C) published new textbooks on anatomy Exercise 1 Complete the table "Main scientific activity", using the texts Roger Bacon Ibn Sina Paracelsus 1) 2)

Exercise 2 Complete the table "Main symptoms of disease", using the texts Smallpox Plague Leprosy 1) 2)

Glossary Cataract – a medical condition under which the lens of the eye becomes progressively opaque, resulting in blurred vision. Catgut – a surgical sutures made of the dried intestines of sheep or horses. Epidemic – a widespread occurrence of an infectious disease in a community at a particular time. Pandemic – an epidemic, characterized with the spread of infectious diseases throughout the country, and territories of the neighboring states. Quarantine – a state, period, or place of isolation where people or animals that have arrived from anywhere or have been exposed to an infectious or contagious disease are placed.

Topics of reports 1. Main activities of Ibn Sina 2. Main activities of Roger Bacon 36

TOPIC 5. MEDIEVAL MEDICINE: FAMOUS EUROPEAN SCIENTISTS PLAN 1. Medieval medicine: theoretical research 2. Medieval medicine: practical research

1. Medieval medicine: theoretical research The 14th – 15th centuries are called the later Middle Ages. It was a period of great progress in culture and science. In contrast to religious philosophy, the experiment as a scientific method was approved. That was the reason for the development of anatomy as a science. One of the founders of anatomy was Leonardo da Vinci. Claiming the method of experiment, he was the first in the medieval Europe who performed autopsy on human corpses and systematically studied them. He introduced new methods of anatomical studies: washing bodies with running water, filling the ventricles of the heart and blood vessels with wax, sawing the bones and organs. There were many muscles, bones, nerves and internal organs Leonardo described and sketched. Another outstanding Italian scientist Andreas Vesalius made a great contribution to the development of anatomy. He lived in the times when Galen’s works were the main authority in medicine. Vesalius respected Galen’s studies, but denied some of the ideas. You already know that autopsies were forbidden in the Middle Ages and Galen studied anatomy on corpses of monkeys. Vesalius corrected more than 200 Galen’s errors and described correctly the human skeleton, muscles, internal organs. Vesalius created a fundamental work "The structure of the human body", consisting of 7 books. He filled the work with the data obtained as a result of numerous dissections of the human body and for the first time systematized them. Therefore he created scientific anatomic bases. The first volume of his work was dedicated to the study of bones and joints, the second to the anatomy of muscles, the third to the blood vessels, the fourth to the peripheral nervous system, the fifth to the abdominal organs, the sixth to the structure of the heart and lungs, the seventh to the brain and sensory organs. Since Vesalius’s conclusions were experimentally valid, they struck a powerful blow to the accepted scientific concepts. He was declared insane. A Spanish philosopher and physician Michael Servetus11 also denied Galen’s views and described the pulmonary circulation. Servetus discovers that, contrary Galen’s approach towards blood circulation, the transmission of the blood from the right ventricle of the heart to the left ventricle does not take place through pores of the middle wall of the heart, but rather by means of a great contrivance which pumps blood forward from the right ventricle towards Picture 11. Michael Servetus

11 Michael Servetus [Resource]: //ru.wikipedia.org/wiki/ Michael Servetus (date: 16.02.2020). 37 the lungs for its oxygenation, and transfuses it afterwards to the left ventricle of the heart. Only in 1616, William Harvey performed an autopsy, and doctors received widespread recognition of the pulmonary circulation function.

Michael Servetus

Michael Servetus (1511 – 1553) was born in Spain. He was a Spanish theologian, doctor and humanist. His interests included many sciences, astronomy, meteorology, geography, law, the study of mathematics, anatomy and medicine. He is known in several areas of medicine. Servetus was the first European to describe the function of the pulmonary circulation, although it was not widely recognized at the time for several reasons. One of the reasons was the description, which appeared in the theological treatise Christianismi Restitutio (“Christianization of restitution”), and not in the book on medicine. In addition, most copies of the book were burned shortly after its publication in 1553. Three copies remained, but they remained hidden for decades. On October 27, 1553 Servetus was burned at the stake just outside Geneva with what was believed to be the last copy of his book (Christianismi Restitutio) chained to his leg.

There were many scientists who studied different systems of the human body, such as Bartolomeo Eustace, Gabriel Fallopian, William Gabriel. At the junction of physics and medicine are inventions of Galileo and Suntory. After Servetus the study of the blood movement was continued. Hieronymus Fabricius (1533 – 1619) proved the unilateral movement of blood through the veins towards the heart. He studied medicine in Padua under the leadership of Fallopian. Thanks to his efforts, a new, improved anatomical theater was built in Padua. During the autopsy of animals, Fabricius studied the formation of the fetus, the structure of the esophagus, stomach, intestines, especially the eyes, ears and larynx. He was the first to describe webbed warehouses called their "valves". For what they exist, Fabricius did not understand. He believed that the folds regulate the movement of blood from the heart; in fact, they allow blood to flow through the veins only towards the heart. In his work "Tabulae Pictae", first published in 1600, Fabricius described the cerebral fissure separating the temporal bone from the frontal bone. The later Middle Ages are characterized with the emergence of new infections, such as syphilis, typhus, measles. An Italian physician Girolamo Frokastoro described three ways of transmission: via touch contact, with contaminated objects, by air at a distance. He believed that not all infectious diseases are transmitted at a distance, but all of them can be transmitted by touch. Fracastoro introduced the terms "infection" and "disinfection".

Girolamo Fracastoro

Girolamo Fracastoro (1478 – 1553) was born in Verona and educated at Padua where at 19 he was appointed professor at the University. After receiving his degree in 1502, Fracastoro was appointed instructor of logic at the University of Pauda and later in the same year he was appointed the conciliarus anatomicus at the same university. In 1505 he was elected as to the college of Physicians in Verona, a position he held concurrently with his position at Pauda. Immediately his fame spread near and far. Patients from all over Italy started coming to Verona to consult him. Fracastoro is best remembered for his epic poem “Syphilis sive morbus Gallicus” (Syphilis or The French Disease) published in three books. “De Contagione et Contagiosis Morbis” (On Contagion & contagious Diseases) published in 1546 is another of his major work. In 1553 Fracastoro had a massive stroke and died. He was buried at the Church of Santa Eufemia in Verona where he lay until 1740. Thereafter, his remains were exhumed and lost.

Girolamo Fracastoro’s work of "Syphilis sive morbus Gallicus" ("Syphilis or The French Disease") was published in three books. The first book goes on describing the horrors of disease. The second book he talked about cure and prevention. Third book he talked about Columbus voyage and the discovery of guiacim, a specific remedy against syphilis – a disease endemic among natives of the land Columbus travelled to. Another of his major work is "De Contagione et Contagiosis Morbis" ("On Contagion & contagious Diseases") was published in 1546. Here he proposed that epidemics are caused by tiny particles or spores capable of transmitting diseases both through direct or indirect contacts as well as without contact over long distance. He believed that not all infectious diseases are transmitted at a distance but all of them can be transmitted by touch. He introduced the terms "infection" and "disinfection".

2. Medieval medicine: practical research In the late Middle Ages there was a change in views of surgery. Earlier it was told that surgery wasn’t considered a medical specialty. The first Surgical Academy was opened in 1731 in Paris. It is worth mentioning that European surgery had no anesthetic techniques until the middle of the 19th century. Therefore, all operations caused great sufferings to patients and in 90% of cases they ended in death. The development of surgery is associated with the name of a French 12 surgeon and obstetrician Amboise Pare12. He published his first book "The Picture 12. A. Pare . Portrait from the book method of curing wounds caused by arquebus and firearms" in 1545. The

12 Amboise Pare. [Resource]: //ru.wikipedia.org/wiki/ Amboise Pare (date: 16.02.2020). 39 usual method of sealing wounds by searing with a red-hot iron often failed to arrest the bleeding and caused patients to die of shock. For the ligature technique he designed the "Bec de Corbeau" ("crow's beak"), a predecessor to modern haemostats13. A hemostat is tweezers with a lock. It is used to control and stop Picture 13. Нaemostat13 bleeding from arteries and veins. A hemostat is also used to capture and store objects during surgery. The name comes from the Greek words hemo – blood and stat – stop. Hemostat is a 19th century French surgery statement by Jules-Emile Pean. He invented it in 1862. Although ligatures often spread infection, it was still an important breakthrough in surgical practice. Pare detailed the technique of using ligatures to prevent hemorrhaging during amputation in his 1564 book "Treatise on Surgery". During his work with injured soldiers, Pare documented the pain experienced by amputees which they perceive as sensation in the 'phantom' amputated limb. He also performed many neurosurgical procedures.

Father of Modern medicine

Ambroise Pare (1510 – 1590) was born in France in the family of a poor master. When Pare was 17, he went to Paris, where he entered medical school (1529), after two years of study at the school of surgeons, he received the title of surgeon (1536). He was a barber and surgeon in the French army. In the army, he independently treated the wounded. Ambroise received his first experience of medical practice in the field during the war, which was led by King Francis I of France. At that time, under the military conditions, little could be done for the wounded and injured, few recovered. In 1539, Pare returned from the army and passed the exam for the title of "master of the barber-surgeon". In 1545, using the experience of his observations, he published the book "A Method to Heal Gunshot Wounds, as well as Wounds Caused by Arrows, Spears, etc.". The book was written in French, as the author did not know Latin. Pare was a court surgeon under the kings Henry II, Francis II, Charles IX and Henry III. Since 1562, Pare officially received the status of the first surgeon. It is for this reason that his books have survived. In 1564, he published "A Treatise on Surgery", in which he described the use of ligatures* in surgical operations (for the first time this method of stopping bleeding was used by Hippocrates in the 5th century BC, followed by Galen in the 2nd century BC). * Ligature is a thread (or method) used in the ligation of blood vessels. Introduced to surgery before BC. e., however, in the Middle Ages this practice was lost. To stop vascular bleeding, moxibustion and twisting of blood vessels were used. It was reintroduced into practice in 1557 by Ambroise Pare.

13 Modern haemostat [Resource]: //ru.wikipedia.org/wiki/ Haemostat (date: 16.02.2020). 40

EXERCISES FOR INDEPENDENT WORK

Test (тест) 1. SELECT REPRESENTATIVES OF THE EUROPEAN MIDDLE AGES (More than one correct answer is possible) A) Amboise Pare B) Ibn Sina C) Girolamo Fracastoro D) Michael Servetus 2. WHAT NEW METHODS DID DA VINCI INTRODUCED? (More than one correct answer is possible) A) washing bodies with running water B) auscultation C) filling the ventricles of the heart and blood vessels with wax, sawing the bones and organs D) vaccination 3. WHY WERE THERE MISTAKES IN GALEN'S TEACHING? A) he criticized religion B) he studied anatomy on corpses of animals C) he did not know the autopsy methods 4. WHAT WORK WAS WRITTEN BY VESALIUS? A) "Syphilis or The French Disease" B) "A Method to Heal Gunshot Wounds, as well as Wounds Caused by Arrows, Spears, etc." C) "The structure of the human body" 5. MATCH THE COLUMNS: A) The first book of the 1. Talking about the discovery a specific remedy "Syphilis or The Fr. Disease" against syphilis (disease endemic among natives)

B) The second book of the 2. Describing the horrors of disease "Syphilis or The Fr. Disease"

C) The third book of the 3. Talking about cure and prevention "Syphilis or The Fr. Disease"

6. WHO DESIGNED "THE CROW'S BEAK", THE FORERUNNER OF MODERN HEMOSTATS? A) Amboise Pare B) Ibn Sina C) Andreas Vesalius

7. MATCH THE COLUMNS:

Exercise 1 Complete the table "Main scientific activity", using the texts Michael Servetus Amboise Pare Girolamo Fracastoro Andreas Vesalius 1) 2) 3)

Exercise 2 Translate and learn Russian words Keywords by text

существительное noun существительное noun анатом брюшная полость кость легкие мышца органы чувств нервная система тело структура сердце сустав мозг

Text (текст) Везалий (Vesalius) – итальянский анатом. Он создал большой труд «Структура человеческого тела», который состоит из семи книг: - первая книга – об изучении костей и суставов, - вторая книга – об анатомии мышц, - третья книга – о кровеносных сосудах, - четвертая книга – о нервной системе, - пятая книга – об органах брюшной полости, - шестая книга – о строении сердца и легких, - седьмая книга – о мозге и органах чувств. 42

Glossary Infection – the invasion of an organism's body tissues by disease-causing agents, their multiplication, and the reaction of host tissues to the infectious agents and the toxins they produce. Pulmonary circulation – the portion of the circulatory system which carries deoxygenated blood away from the right ventricle of the heart, to the lungs, and returns oxygenated blood to the left atrium and ventricle of the heart. Syphilis – a sexually transmitted infection caused by the bacterium Treponema pallidum subspecies pallidum.

Topics of reports 1. Main activities of Girolamo Frokastoro 2. Main activities of Michael Servetus 3. Main activities of Andreas Vesalius

TOPIC 6. EUROPEAN MEDICINE FROM THE SECOND HALF OF THE 18TH CENTURY TO THE 19TH CENTURY. DEVELOPMENT OF BIOMEDICAL SCIENCES PLAN

1. Development of Biomedical Sciences 2. Development of Genetics 3. Development of Histology and Embryology 4. Development of Microbiology and Experimental Immunology 5. Development of Physiology

1. Development of Biomedical Sciences

Today we will talk about the development of the European and Russian medicine in the 18th –19th centuries. The fact is that medicine of that time developed in parallel in Europe and Russia. Innovative ideas quickly spread over the European continent. The basis for the development of medicine of that period was the ideas of such scientists as Leonardo da Vinci, Andreas Vesalius, Michael Servetus, Hieronymus Fabricius, Bartolomeo Eustace, Gabriel Fallopian, William Gabriel, Girolamo Frokastoro. The term biology was proposed by Lamarck. But biology is a very broad science, so it is divided into branches: genetics, anatomy, embryology, microbiology, physiology, etc. Today these sciences are called biomedical. We know that the founder of modern anatomy is Andreas Vesalius (Italy). But in the 18th century the Netherlands became the center of anatomical studies. Frederick Reusch was a follower of Vesalius. Reusch mastered the technique of anatomical preparations. He also invented a unique method of embalming corpses and created the first anatomical museum. One of the most famous visitors of the museum was the Russian Tsar Peter the Great. In Russia, the beginning of anatomical studies is dated to the reign of Peter the Great. Peter the Great met Reusch twice. The results of those meetings were: - Opening of the hospital school in 1707; it was the first institution of medical education in Russia. - Teaching anatomy on corpses with demonstration; an introduction to the practice of autopsies. - Establishment of the first anatomical museum in Russia in 1718 in Saint Petersburg. - Invitation to Russia a Dutch doctor Nicolaas Bidloo. He founded the first surgical school in Russia.

The heyday of European surgical anatomy is associated with activities of a Russian scientist Nikolai Pirogov. He is the founder of topographical anatomy. For the first time he applied dissection of frozen corpses, the so-called "ice anatomy".

2. Development of Genetics

An important step in science was the discovery of the heredity law done by a Czech scientist Gregor Mendel. He was the founder of Genetics. Mendel made experiments on plants for 10 years. He concluded that plants contain genetic factors, which are inherited in crosses. He first spoke of hereditary units which will later be called genes. All of these ideas he outlined in a scientific work. However, society was not ready to accept those ideas. The recognition of Mendel's ideas took place in 1900, after his death. So, genetics in its development has passed a series of stages. The first stage is connected with the discovery of G. Mendel (1865) about the discreteness (divisibility) of hereditary factors. Discreteness of heredity is that the individual properties and characteristics of the body develop under the control of hereditary factors (genes) that, when merging gametes and forming zygotes, do not mix, do not dissolve, and when new gametes are formed, they are inherited independently of each other. The value of the discoveries of G. Mendel was evaluated after his laws were rediscovered again in 1900 by other biologists. Mendel's laws of heredity laid the foundation for the theory of the gene – the greatest discovery of natural science of the 20th century, and genetics turned into a rapidly developing branch of biology. The second stage is characterized by a transition to the study of the phenomena of heredity at the cellular level. The development of the cell theory led to a refinement of the structure, shape and number of chromosomes and helped to establish that the genes controlling these or other signs are parts of chromosomes. This was an important prerequisite for the approval of the chromosomal theory of heredity. The third stage in the development of genetics occurred in the middle of the 20th century, it reflects the achievements of molecular biology and is connected with the use of the methods and principles of the exact sciences - physics, chemistry, mathematics, biophysics, etc. – in studying the phenomena of life at the molecular level. The objects of genetic research have become fungi, bacteria, viruses. At this stage, the relationship between genes and enzymes was studied and the "one gene - one enzyme" theory was formulated.

3. Development of Histology and Embryology

Histology is a science on the structure and development of tissues of living organisms. The emergence of this science was possible due to the invention of the microscope. The emergence of historical histology as a science is closely related to the invention of the microscope. The first microscope was designed by the Dutchman Z. Jansen in 1590. In 1612 a microscope was made by G. Galileo. However, these microscopes were not used for histological studies, because they could not enlarge the object. In 1659, the English physicist H. Huygens designed a microscope, which was used by his compatriot Robert Hooke. In 1665, R. Hooke used this microscope to study the fine structure of the cork. In the cork, he found cells separated from each other similar to honeycomb, which he called cells (from the Greek kutos, the cavity). But Hooke did not see the contents of the cell, because he was examining dead plant tissue. However, this term is used to the present. Hooke's research marked the beginning of a microscopic study of plants. The discovery of cells in plants prompted an interest in studying the microscopic structure of animal organs. However, the researchers had significant difficulties. Firstly, animal cells are small compared to plant cells, secondly, they lack dense shells and they are poorly delimited from each other and thirdly, they are soft and difficult to make thin sections out of them. In the first half of the XIX century, the study of the inner contents of the cell (mucous juice) began. In 1831, a nucleus was discovered in a cell (R. Brown). In 1840, the term protoplasm (Jan. Purkin) was introduced to designate the inner contents of the cell. In 1838, the work of the German botanist M. Schleiden appeared, in which he suggested that the plant organism is an aggregate of cells. In 1839, the German zoologist T. Schwann distributed the views of Schleiden on animals. In his work "Microscopic research on the similarity in the structure and growth of animals and plants", he formulated a cell theory about the universality of the cellular structure of animals and plants. However, the Schleiden-Schwann cell theory had a number of flaws: the cell of multicellular organisms seemed to be an independent living unit and was considered out of touch with the organism. Together with histology developed embryology, which reached success in the middle of the 19th century. Embryology is a branch of both biology and medicine concerned with the study of embryos and their development.

4. Development of Microbiology and Experimental immunology As we know in the medieval period there were various epidemics and pandemics. Assumptions about the living organisms that could be pathogens were made by Galen, Ibn Sina and others. Girolamo Fracastoro described 3 ways of infection. But development of microbiology as a science took place in the 19th century and was connected with invention of optical devices. Microbiology is the study of microorganisms, their structure, development and effects on humans, animals and plants. 46

The fight against smallpox is an example of combating microorganisms. We remember that in ancient China variolation was used. In the 17th century it appeared in Europe. It is smallpox vaccination of a sick person. In Europe, vaccination started to be used in London with the support of King George the First. In Russia it was initiated by Empress Catherine the Great. Shocked at a smallpox epidemic in Austria, Catherine the Great asked the London medical community to make urgent vaccination of her and her son. The result was very successful. Therefore, special institutions for smallpox vaccination began to be established in Russia. However, vaccination did not always give the desired effect: the immune system quickly destroyed, or people died soon after the vaccination. The solution was found by Edward Jenner in 1796, when he discovered the method of vaccination with cowpox. This discovery was preceded by a long experimental work and the following interesting fact. In a conversation with an elderly milkmaid Jenner noticed that her hands were covered with smallpox rash. He asked her whether she was ill with smallpox. The milkmaid answered that she couldn’t fall ill with smallpox because she had already been ill with cowpox. For 30 years, Jenner collected information about people who had been ill with cowpox. He wanted to make sure of the protective properties of cowpox against smallpox. Jenner made an experiment on an 8-year-old boy who had been vaccinated with cowpox14. He watched the child for several years and tried to infect him with smallpox. But the boy became immune to infection. This was evidence of the success Picture 14. E. Jenner vaccinated of the experiment. an 8-year-old boy14 In 1798, vaccination was introduced in the British army and navy. In 1803 the Royal Jennerian Society was opened. Its purpose was introduction of vaccination in England. In 1808, vaccination became a government program. The vaccine of that period was very different from what we have now. Only in 1906, Enrique Paschen (Germany) discovered the smallpox virus. Fundamental microbiology formation took place in the second half of the 19th century. Jenner could not imagine the mechanism of processes in the organism after vaccination. This mystery came out to light with the help of experimental immunology. Its founder was a French scientist Louis Pasteur. Louis Pasteur was struck with Jenner’s studies. Pasteur realized that the vaccination method could be applied to other infectious diseases. Thus, Pasteur created vaccines against cholera, anthrax, rabies. He introduced the concept of immunity. In 1881 in Paris the Institute of anti-rabies and other infectious diseases was established. It was supervised by the Institute of Pasteur.

14 Jenner [Resource]: //ru.wikipedia.org/wiki/ Jenner vaccinated an 8-year-old boy (date: 16.02.2020). 47

An outstanding Russian scientist Ilya Mechnikov answered the question about mechanisms of immunity. Studying intracellular processes, Mechnikov discovered the leukocytes which are able to gather around foreign particles (including bacteria) and eat them up. Thus the body becomes protected against pathogens.

5. Development of Physiology The foundations of physiology were laid in ancient times, when people tried to understand the work of the body as a whole, its separate parts and systems. We know that in the Middle Ages there were religious prohibitions of autopsies. That was the main reason for stagnation in the development of physiology. However, studies of Andreas Vesalius, Michael Servetus, Hieronymus Fabricius, Galileo, etc. created the basis for physiology as a science. Outstanding achievements in the development of physiology belong to Russian scientists Ivan Sechenov and Ivan Pavlov. Sechenov was the founder of the doctrine of brain reflexes. In 1866 Sechenov introduced the idea that all acts of conscious and unconscious life are reflexes. Later the idea was developed by Pavlov in the theory of the higher nervous activity. Pavlov is not only an outstanding scientist and the author of the doctrine of the higher nervous activity; he is an innovator of experiments on animal behavior. The meaning of reflexes in the theory is as follows. The brain of higher animals and the human organism adapt to the environment. So innate reflexes were called unconditioned, and reflexes acquired during the life – conditioned reflexes. The conditioned reflex is the key concept in the study of the higher nervous activity. For example, of the real experiments on Pavlov's dogs15. As a basis the digestion process is taken because it implies no intellectual activity. Reflexes occur in response to signals received from the sensing regions located on the tongue and mouth. Whenever the dog saw the food, the unconditioned reflex revealed itself in salivation. Then Pavlov changed the conditions of the Picture 15. Experimental design15 experiment and added a stimulus. In the room with the dog a light bulb was put. After the lamp lighted up, the food appeared. First, the dog did not see the connection. Then the link "light – eating" became regular and saliva began to appear in respons e to the lamp light. Thus the unconditioned reflex (salivation when the dog saw food) turned into a conditioned one (when the dog saw the light bulb up). In order to see the dog salivating Pavlov made a small operation – he spent the salivary gland duct under

15 Experimental design [Resource]: //ru.wikipedia.org/wiki/ Experimental design (date: 16.02.2020). 48 the cheek out. Thus, the scientist was able to observe how saliva ran down and was collected in a test tube. Pavlov also contributed to the study of the mechanism of the main digestive glands activity16. For the purpose of study of the digestive system of the dog a complex operation was made. The esophagus was cut and a tube closed with a plug was inserted into the stomach. It made it possible Picture 16. Digestive experiment16 to start experiments with fake feeding animals. As the dog ate, all the food fell out of the upper end of the esophagus. In a few minutes of fake feeding the gastric juice began to secrete. Thus the chemical composition of the gastric juice varied depending on the kind of food. In 1904 Pavlov was given the Nobel Prize for his outstanding achievements in the study of physiology of digestion.

EXERCISES FOR INDEPENDENT WORK

Test (тест) 1. MATCH THE COLUMNS: A) Gregor Mendel 1. Swedish physicist B) Andreas Vesalius 2. Russian physiologist C) Ivan Pavlov 3. Czech geneticist D) Anders Celsius 4. Italian anatomist 2. WHAT SCIENCES EMERGED FROM BIOLOGY? (More than one correct answer is possible). A) генетика B) хирургия C) анатомия D) микробиология E) стоматология F) эмбриология 3. WHAT RUSSIAN MONARCH INITIATED VACCINATION? A) Peter the Great B) Ecatherine the Great 4. MATCH THE COLUMNS: A) 1796 1. The Royal Jennerian Society was opened

16 Digestive experiment [Resource]: //ru.wikipedia.org/wiki/ Digestive experiment (date: 16.02.2020). 49

B) 1798 2. The method of vaccination with cowpox was discovered C) 1808 3. Vaccination became a government program D) 1803 4. Vaccination was introduced in the British army and navy 5. MATCH THE COLUMNS: A) Edward Jenner 1. Discovered leukocytes B) Enrique Paschen 2. Discovered the method of vaccination with cowpox C) Ilya Mechnikov 3. Discovered the smallpox virus D) Louis Pasteur 4. Сreated vaccines against cholera, anthrax, rabies. 6. WHO IS THE AUTHOR OF THE DOCTRINE OF UNCONDITIONED AND CONDITIONED REFLEXES? A) Ilya Mechnikov B) Nikolai Pirogov C) Ivan Pavlov 7. WHAT ACHIEVEMENT BY IVAN PAVLOV WAS GIVEN THE NOBEL PRIZE? A) the study of physiology of digestion B) the doctrine of the higher nervous activity C) the discovery of the smallpox virus 8. MATCH THE COLUMNS: A) рефлекс 1. The ability of an organism to resist a certain infection or toxin B) иммунитет 2. A bacterium, virus, or other microorganism that can cause a disease C) патоген 3. An action that is performed as a response to a stimulus without a conscious thought

Exercise 1 Complete the table "Main scientific activity", using the texts Gregor Mendel Robert Hooke Edward Jenner Louis Pasteur 1) 2) 3)

Exercise 2 Translate and learn Russian words Keywords by text

существительное noun существительное noun животные физиолог медицина физиология

Нобелевская премия физиология пищеварения область эксперимент открытие глагол verb последователь изучать рефлекс получать система пищеварения проводить

Text (текст) Иван Павлов17 – русский физиолог. Он был последователем другого русского физиолога Ивана Сеченова. Павлов провёл много экспериментов на животных, изучал рефлексы и систему пищеварения. В 1904 году Павлов получил Нобелевскую премию в области медицины и физиологии за открытие

физиологии пищеварения. Picture 17. 17 Ivan Pavlov Glossary Immunity – an ability of an organism to resist a certain infection or toxin. Leukocyte – a colorless cell that circulates in the blood and body fluids and is involved in fighting foreign substances and diseases; a white blood cell. Nobel Prize – a set of annual international awards in recognition of academic, cultural, or scientific advances. Pathogen – a bacterium, virus, or other microorganism that can cause a disease. Reflex – an action that is performed as a response to a stimulus without a conscious thought.

Topics of reports 1. History of vaccination 2. Contribution of Russian scientists to the development of physiology

17 Ivan Pavlov [Resource]: //ru.wikipedia.org/wiki/ Ivan Pavlov (date: 16.02.2020). 51

TOPIC 7. EUROPEAN MEDICINE FROM THE SECOND HALF OF THE 18TH CENTURY TO THE 19TH CENTURY. DEVELOPMENT OF MEDICAL AND CLINICAL SCIENCES

PLAN

1. Appearance of Asepsis and Antiseptics 2. Development of Surgery 3. Development of Dentistry 4. Development of Pediatrics 5. Development of Psychiatry 6. Development of Obstetrics (Midwifery) and Gynecology

A branch of medicine which is directly involved in diagnostics and treatment of diseases is called clinical medicine. Medical training at the bedside followed the traditions of ancient Greece and the East. As we said, in medieval Europe, medical training was in the form of theoretical lectures. Also European clinics did not use diagnostic devices. The diagnosis was based on the results of the patient’s survey, probing the pulse, examination of the patient and his excretion. Despite the fact that Galileo invented the thermometer in the 16th century, European physicians in the 18th century determined the body temperature by hand application. Scientists have proposed different models of thermometers. In 1742 a Swedish physicist Anders Celsius proposed the centigrade thermometer, where 0 (null) corresponds to the boiling point of water, and 100 corresponds to the melting point of ice. Later they turned the scale and 0 became the point of melting ice. This variant of the thermometer has gained the world-wide popularity. Modern medicine is based on physical methods of diagnostics, such as inspection, palpation, percussion, auscultation. These methods require minimum equipment. Applying them, a doctor uses only his sensory organs. They can be used in different conditions. Percussion in Europe had not been applied till the middle of the 18th century. Many doctors did not treat it seriously. Introduction of auscultation to practice contributed to the emergence of stethoscopes.

1. Appearance of Asepsis and Antiseptics Until the middle of 19th century 80% of patients died after surgery. The situation changed with antiseptic and aseptic methods coming into use. Asepsis is a way to prevent wounds from festering. At the heart of the aseptic method is aseptic sterilization of tools, clothes, etc. Antiseptics are antimicrobial 52 substances that are applied to living tissue/skin to reduce the possibility of infection, sepsis. The antiseptic method is used for preventing infection, decay, etc. by inhibiting the action of microorganisms. There are mechanical, physical, chemical and biological antiseptic methods. Medieval surgeons Hugh of Lucca, Theoderic of Servia, and his pupil Henri de Mondeville were opponents of Galen's opinion that pus was important to healing, which had led ancient and medieval surgeons to let pus remain in wounds. They advocated draining and cleaning the wound edges with wine, dressing the wound after suturing, if necessary and leaving the dressing on for ten days, soaking it in warm wine all the while, before changing it. Their theories were bitterly opposed by Galenist Guy de Chauliac and others trained in the classical tradition. The widespread introduction of antiseptic surgical methods was initiated by the publishing of the paper Antiseptic Principle of the Practice of Surgery in 1867 by Joseph Lister, which was inspired by Louis Pasteur's germ theory of putrefaction. In this paper, Lister advocated the use of carbolic acid (phenol) as a method of ensuring that any germs present were killed. Practical application of aseptic and antiseptics methods became possible after the works of Louis Pasteur (1822 – 1895). He proved that decay is a process of microorganisms’ life activity. The antiseptic method is used for preventing infection, decay, etc. by inhibiting the action of microorganisms. There are mechanical, physical, chemical and biological antiseptic methods. The modern concept of asepsis evolved in the 19th century. Ignaz Semmelweis showed that hand washing prior to delivery reduced fever. After the suggestion by Louis Pasteur, Joseph Lister introduced the use of carbolic acid as an antiseptic, and in doing so, reduced surgical infection rates. Lawson Tait went from antisepsis to asepsis, introducing principles and the iconic statutes that have remained valid to this day. Ernst von Bergmann introduced the autoclave, a device used for the practice of the sterilization of surgical instruments. Asepsis refers to any procedure that is performed under sterile conditions. This includes medical and laboratory techniques (such as with bacterial cultures). This can incorporate techniques such as flame sterilization, and methods to protect wounds and other susceptible sites from organisms that could cause infection. This ensures that only sterile equipment and fluids are used during invasive medical and nursing procedures. The largest example of aseptic techniques is in hospital operating theatres where the aim is to keep patients free from hospital micro-organisms. The best advantage of aseptic technique is that harmful microbes are not introduced. For example, in the surgical field or determining what microbe has caused what disease. The advantage of antiseptics was that it allowed surgeons to sterilize equipment and operating rooms for the first time. The main disadvantage was that the carbolic acid made hands of surgeon and nurses cracked or sore. Thus, the era of anesthesia, aseptic and antiseptics opened up new prospects for the development of emergency surgery. 53

2. Development of Surgery We know that surgery was not considered a medical science for a long time. The first country in Europe where surgeons were recognized as doctors was France. In France and in England surgery developed very quickly. There were new operations, bandages and manipulations there. A real breakthrough in surgery is associated with analgesics coming into use and the invention of anesthesia (narcosis). The era of anesthesia began with ether. American dentists were the first to use it. In Russia ether Picture 18. Nikolai Pirogov18 anesthesia got a much wider application. Scientific backgrounds of ether anesthesia were laid by Nikolai Pirogov18. In that period there was a war of Russia and Turkey, and Pirogov applied anesthesia for wounded soldiers. He invented a special device for filling with ether. He was surprised at success of his experiment. For the first time an operation took place without moans and cries of the wounded.

Nikolai Pirogov (1810 – 1881) is the Russian surgeon and anatomist, naturalist and teacher, professor, creator of the first atlas of topographic anatomy, founder of the Russian military field surgery, founder of the Russian school of anesthesia. Nikolai Pirogov was born in 1810 in Moscow. In 1823 he entered the Medical Faculty of Moscow University. In 1833, after defending his thesis for the degree of doctor of medicine, he was sent to study at the University of Berlin. After returning to Russia (1836) at the age of twenty -six, he was appointed professor. In 1841, Pirogov was invited to St. Petersburg, where he headed the department of surgery at the Medical-Surgical Academy. In search of a new method of teaching, Pirogov began to apply anatomical studies on frozen corpses. Thus was born a new medical discipline – topographic anatomy. After Pirogov published the first anatomical atlas. In 1847, Pirogov went to the army in the Caucasus, because he wanted to test the operational methods developed by him in military conditions. In the Caucasus, he first applied bandaging with bandages soaked in starch. At the same time, Pirogov, the first in the history of medicine, began to operate on the wounded with ether anesthesia in the field, after conducting about ten thousand operations under ether anesthesia.

Nikolai Pirogov was not only the founder of topographical surgery by applying ice in dissection of corpses and the first who used ether anesthesia. He was the founder of military surgery. In the field, he used to sort the wounded into 4 groups: 1) mortally wounded. They needed priests; 2) seriously wounded. They needed an urgent operation; 3) moderately wounded. They could be operated the following day; 4) slightly wounded. There was no need in operation.

18 Nikolai Pirogov [Resource]: //ru.wikipedia.org/wiki/ Nikolai Pirogov (date: 16.02.2020). 54

Postoperative patients were divided into two groups: pure and purulent. Purulent patients were placed in isolation wards. Pure patients stayed in common wards. Pirogov’s name is also associated with the first in the world women's care organization for the wounded. It was the Sisters of Mercy.

3. Development of Dentistry Dentistry has come a long way to become an independent science in the 18th century. A French barber Pierre Foshar19 was a surgeon, but he gained a greater recognition as a dentist. He described more than 130 diseases of the teeth and oral cavity. On the basis of this knowledge he introduced the first classification of odontic diseases. He was engaged in correcting improper teeth Picture 19. Pierre Foshar is shown on development. the cover of his book 19

Pierre Foshar (1690 – 1762), French surgeon and dentist. At the beginning of his activity, Foshar worked as a barber, then, after training, became a surgeon (1723). Since 1731, he devoted himself to dentistry and became widely known as a private practitioner. Fochar is the author of one of the first classifications of dental diseases. He described not only the clinic (about 130 dental diseases), but also offered an explanation of the etiology and pathogenesis of some of them, for example, caries. Pierre Fochar made a significant contribution to dental prosthetics. He was inspired by the idea of using special springs to hold full dentures in his mouth, he used gold caps in dental prosthetics and a porcelain coating for artificial teeth. He is rightfully consider ed the founder of orthodontics, a section of prosthetic dentistry that deals with methods for correcting abnormally growing teeth and jaws. Pierre Foshar, one of the founders of scientific dentistry, the author of the first "Guide to surgery and dentistry" (1728).

Russian surgeons have contributed to development of surgical stomatology. A large number of dental procedures were made by Nikolai Pirogov. The first dental school in Russia was opened in 1881.

4. Development of Pediatrics Pediatrics as an independent medical science began to take shape in the middle of the 19th century. The first hospital for children was opened in 1802 in Paris, the second hospital – in 1834 in St. Petersburg. Those hospitals treated children and trained pediatricians. In the 19th century children's hospitals were supported by charity. A high infant mortality rate was the main cause for establishment of the International League to fight infant mortality in 1902.

19 Pierre Foshar is shown on the cover of his book [Resource]: //ru.wikipedia.org/wiki/ Pierre Foshar (date: 16.02.2020). 55

Pediatrics is the branch of medicine that involves the medical care of infants, children, and adolescents. A medical doctor who specializes in this area is known as a pediatrician. The Swedish physician Nils Rosen von Rosenstein (1706 – 1773) is considered to be the founder of modern pediatrics as a medical specialty, while his work "The diseases of children, and their remedies" (1764) is considered to be the first modern textbook on the subject "Pediatrics as a specialized field of medicine" continued to develop in the mid-19th century; German physician Abraham Jacobi (1830–1919) is known as the father of American pediatrics because of his many contributions to the field. He received his medical training in Germany and later practiced in New York City. The first generally accepted pediatric hospital is the Hospital for Sick Children, which opened in Paris in June 1802 on the site of a previous orphanage. In other European countries, the Charite (a hospital founded in 1710) in Berlin established a separate Pediatric Pavilion in 1830, followed by similar institutions at Sankt Petersburg in 1834, and at Vienna and Breslau (now Wrocław), both in 1837. In 1852 Britain's first pediatric hospital, the Hospital for Sick Children, Great Ormond Street was founded by Charles West. The first Children's hospital in Scotland opened in 1860 in Edinburgh. In the US, the first similar institutions were the Children's Hospital of Philadelphia, which opened in 1855, and then Boston Children's Hospital (1869). Subspecialties in pediatrics were created at the Harriet Lane Home at Johns Hopkins by Edwards A. Park.

Early History of Pediatrics

Traditional medical doctors cared for patients of any age, including both the young and the old, with little specialization. Some points throughout early history in relation to pediatrics are outlined in the timeline below. 1552 BC: The Ebers Papyrus discussed many topics including breastfeeding, cure for worms and treatment of ocular diseases. 400 BC: Hippocrates wrote about several issues relating to pediatric health including asthma, cephalhematoma, clubfoot, diarrhea, hydrocephalus, mumps, scrofula and worms. 100 AD: Soranus of Ephesus noted the fingernail test as a means to check the fat content and quality of breast milk. 200 AD: Galen described cases of children with ear discharge, pneumonia and intestinal prolapse. 990 AD: Avicenna wrote about health conditions such as convulsions, meningitis, tetanus, umbilical abscess and worms.

Until recently, physician–historians of pediatrics have generally assumed that "pediatrics as a specialized branch of medicine had no real existence before the middle of the nineteenth century". This may be true if we equate pediatrics with professional organizations and specialized children’s hospitals. But as a body of knowledge and practices addressing the sick child, pediatrics has a much longer history. 56

Reconstructing the history of what might be called "pediatrics before pediatricians" entails going beyond the rare books and treatises that were long the traditional sources for medical historians. In this article, we explore 18th century English hospital admission registers with respect to the medical care of neurodisability. In this 18th century data set, 67 cases of pediatric neurodisability made up 4.5% of the total number of admissions. Of these, 25 had a diagnosis consistent with epilepsy, and the other 42 had a diagnosis consistent with a neuromuscular disability. There is a wide range of descriptive terms in the data set. Epilepsy is described under the terms Spasmus clonica, Fits/Fitts, Epilepsy/Epileptic, and Convulsions (Most extraordinary). Neuromuscular disability is described under the terms Palsy, Sciatica, Lameness, Weakness, Distorted spine, Chorea, and Hemiplaegia.

Abraham Jacobi father of Pediatrics

Pediatrics as a specialized field of medicine continued to develop in mid-19th century. A German physician Abraham Jacobi (1830-1919) is known as the father of American pediatrics

because of his many contributions to the field. He received his training in Germany and later practiced in New York. He was born on the 6th of May, 1830 in Hartum, Westphalia. He was son of a poor Jewish shopkeeper and his wife who educated him at a great sacrifice. He attended the gymnasium in Minden. After graduating there, he studied medicine at university of Greifswald, Gottingen, and Bonn, and receiving an MD at Bonn in 1848. WORKS OF ABRAHAM JACOBI - Contribution to midwifery and diseases of women and children (with E. Neoggerath; New York, in 1859); - Dentition and its Disarrangements (in 1862); - The raising and education of abandoned children in Europe (in 1870); - Infant diet (in 1874); - Treatise on diphtheria (in 1880)

5. Development of Psychiatry The first shelters for mentally ill people appeared in the 4th – 5th centuries within Christian monasteries. However, the idea of mentally ill people as possessed by the evil spirit remained until the late 18th century. The founder of psychiatry as a science was a French physician Philippe Pinel. Pinel was the first who created normal conditions for the mentally ill, took off their chains, involved them in work, and turned the psychiatric clinic into the hospital with treatment. Psychiatry is the medical specialty devoted to the diagnosis, prevention, and treatment of mental disorders. These include various maladaptations related to mood, behavior, cognition, and perceptions. The beginning of psychiatry as a medical specialty is dated to the middle of the nineteenth century,

57 although its germination can be traced to the late eighteenth century. In the late 17th century, privately run asylums for the insane began to proliferate and expand in size. Dr. Benjamin Rush, the "father of American psychiatry", was the first to believe that mental illness is a disease of the mind and not a "possession of demons". His classic work "Observations and Inquiries upon the Diseases of the Mind", published in 1812, was the first psychiatric textbook printed in the United States. Rush served on the Pennsylvania Hospital medical staff from 1783 until the time of his death in 1813. In the 19th century and the beginning of the 20th century there was a large-scale increase in the number of psychiatric inpatients. Thousands upon thousands of people ended up in psychiatric hospitals. There was speculation at the time that the human race was "degenerating" as a result of some unknown natural selection process. Emil Kraepelin traveled to Java and noted that mental illness was rare there, and felt the "domestication" of the human race was to blame. Unfortunately, he ignored the effects of poverty, poor hygiene, poor nutrition, and lack of education as possible causes of mental illness. His ideas were very influential, and since there were no pharmacological treatment at the time, many countries began measures such as sterilizing anyone with mental illness to stop the "decline of the human race". Psychiatric authorities saw themselves as advocates of the mental health of the population (and some advocates of racial purity), rather than as medical doctors who treated individuals. It is toward the end of this time that Weston Price made his famous journeys, and thus the name of his book, Nutrition and Physical Degeneration, and his preoccupation with the decline of physical, moral, and mental fiber, as it were, in the 1930s.

Founder of modern scientific psychiatry

Emil Kraepelin (1856 – 1926) was a German psychiatrist, founder of modern scientific psychiatry, psychopharmacology and psychiatric genetics. All the psychiatry of the end of the 19 century and the first quarter of the 20 century was built on his ideas.

Emil Kraepelin was born in 1856. In 1873, he entered the Medical Faculty of the University of Wurzburg While still a student, he attends a psychiatric clinic in Wurzburg every day. After graduation, Kraepelin worked as an assistant at psychiatric clinics in Munich and Leipzig. The first work on psychiatry was done by him in 1882. It was a competitive essay on the theme "On the Impact of Acute Diseases on the Emergence of Mental Illness". He also published a number of works on the implementation of experimental techniques in a psychiatric clinic to combat alcoholism. In 1883, the scientific direction of clinical psychiatry. At the suggestion of Wundt, Kraepelin began to write the first version of the world-famous "Psychiatric Textbook". In 1886, Kraepelin received the title of professor. The merit is the development of the classification of mental diseases and their clinical picture. The system is based on the causes, symptoms, course and underlying diseases, data from these etiological and pathological anatomical data.

6. Development of Obstetrics (Midwifery) and Gynecology Obstetrics and gynecology had not been separated until the 19th century. Formation of obstetrics (midwifery) as an independent branch of medicine began in the early 18th century in France. Obstetric clinics were organized; the first obstetrician school was opened there. Before the 1680s mortality rates in lying-hospitals would reach unacceptably high levels and became an area of public concern. Much of these maternal deaths were due to puerperal fever, then known as childbed fever. In the 1800s the Hungarian Physician Dr. Ignaz Semmelweis (1818 – 1865) noticed that women giving birth at home had a much lower incidence of childbed fever than those giving birth by physicians in lying-hospitals. His investigation discovered that washing hands with an antiseptic solution before a delivery reduced childbed fever fatalities by 90%. So it was concluded that it was physicians who had been spreading disease from one laboring mother to the next. Despite the publication of this information, doctors still would not wash. It was not until the 20th century when advancements in aseptic technique and the understanding of disease would play a significant role in the decrease of maternal mortality rates among many populations. Prior to the 18th century, caring for pregnant women in Europe was confined exclusively to women, and rigorously excluded men. The expectant mother would invite close female friends and family members to her home to keep her company during childbirth. Skilled midwives managed all aspects of the labour and delivery. The presence of physicians and surgeons was very rare and only occurred if a serious complication had taken place and the midwife had exhausted all measures at her disposal. Calling a surgeon was very much a last resort and having men deliver women in this era was seen as offending female modesty. As said, prior to the 18th and 19th centuries, midwifery was not recognized as a specific medical specialty. Ephraim McDowell developed a surgical practice in 1795 and performed the first ovariotomy (the surgical operation for dissection of the ovary) in 1809 on a 47-year-old widow who then lived on for thirty-one more years. He had attempted to share this with John Bell whom he had practiced under who had retired to Italy. Bell was said to have died without seeing the document but it was published by an associate in Extractions of Diseased Ovaria in 1825. By the mid-century the surgery was both successfully Pennsylvanian surgeons the Attlee brothers made this procedure very routine for 465 surgeries. This procedure was successfully performed in Europe by English surgeons Sir Spence Wells and Charles Clay as well as French surgeons Eugene Coberle, Auguste Nelaton. The 18th century marked the beginning of many advances in European midwifery, based on better knowledge of the physiology of pregnancy and labour. By the end of the century, medical professionals began to understand the anatomy of the uterus and the physiological changes that take place during labour. The introduction of forceps in childbirth also took place at this time. All these medical advances

59 in obstetrics were a lever for the introduction of men into an arena previously managed and run by women – midwifery. The addition of the male-midwife (or man-midwife) is historically a significant change to the profession of obstetrics. In the 18th century medical men began to train in area of childbirth and believed with their advanced knowledge in anatomy that childbirth could be improved. In France these male- midwives were referred to as accoucheurs, a title later used all over Europe. Obstetrics entered a stage of stagnation in the 19th century, which lasted until about the 1880s. The central explanation for the lack of advancement during this time was the rejection of obstetrics by the medical community. The 19th century marked an era of medical reform in Europe and increased regulation over the profession. Major European institutions such as The College of Physicians and Surgeons considered delivering babies ungentlemanly work and refused to have anything to do with childbirth as a whole. Even when a Medical Act in 1858 was introduced, which stated that medical students could qualify as doctors, midwifery was entirely ignored. This made it nearly impossible to pursue an education in midwifery and also have the recognition of being a doctor or surgeon. Obstetrics was pushed to the side. By the late 19th century, the foundation of modern-day obstetrics and midwifery began developing. Delivery of babies by doctors became popular and readily accepted, but midwives continued to play a role in childbirth. Midwifery also changed during this era due to increased regulation and the eventual need for midwives to become certified. Many European countries by the late 19th century were monitoring the training of midwives and issued certification based on competency. Midwives were no longer uneducated in the formal sense. As midwifery began to develop, so did the profession of obstetrics near the end of the century. Childbirth was no longer unjustifiably despised by the medical community as it once had been at the beginning of the century. But obstetrics was underdeveloped compared to other medical specialties. Many male physicians would deliver children but very few would have referred to themselves as obstetricians. The end of the 19th century did mark a significant accomplishment in the profession with the advancements in asepsis and anesthesia, which paved the way for the mainstream introduction and later success of the caesarean section.

EXERCISES FOR INDEPENDENT WORK

Test (тест) 1. WHEN WAS THE FIRST HOSPITAL SCHOOL OPENED IN RUSSIA? A) in 1718 B) in 1707 C) in 1796 60

2. MATCH THE COLUMNS: A) перкуссия 1. A physical method of medical diagnostics which consists of listening to the sounds produced during the internal organs’ functioning.

B) аускультация 2. A physical method of medical diagnostics conducted by feeling the patient's body. C) пальпация 3. A physical method of medical diagnostics by striking or tapping of the individual parts of the body. 3. WHERE DID THE FIRST HOSPITAL FOR CHILDREN APPEAR? A) in France B) in Russia C) in Germany 4. WHERE DID THE FIRST PSYCHIATRIC CLINIC WITH TREATMENT APPEAR? A) in France B) in Russia C) in Germany 5. WHAT DID NIKOLAI PIROGOV DO? (More than one correct answer is possible). A) He founded topographical surgery B) He contributed to mass application of anesthesia C) He created the first anatomical museum in Russia D) He organized the Sisters of Mercy system E) He invented the microscope F) He invented the antiseptic method G) He divided the wounded into groups H) He applied dissection of frozen corpses ("ice anatomy") 6. MATCH THE COLUMNS: A) Joseph Lister 1. Worked "The diseases of children, and their remedies" B) Nils Rosen von 2. Advocated the use of carbolic acid (phenol) as a method of Rosenstein ensuring that any germs present were killed. C) Benjamin Rush 3. Published work "Observations and Inquiries upon the Diseases of the Mind" 7. MATCH THE COLUMNS: A) caesarean section 1. A method to prevent wounds from festering B) asepsis 2. The surgical operation for dissection of the ovary C) ovariotomy 3. The use of surgery to deliver babies

Exercise 1 Complete the table "Main scientific activity", using the texts Pierre Foshar Abraham Jacobi Emil Kraepelin Philippe Pinel 1) 2)

Exercise 2 Complete the table "Major changes in clinical sciences of the 18th century to the 19th century", using the texts Surgery Dentistry Psychiatry Obstetrics and Gynecology 1) 2)

Glossary Antiseptic (n) – is a substance which kills or retards the growth of microorganisms, especially when used for protection against infection; (adj) 1. preventing infection, decay, etc. by inhibiting the action of microorganisms; 2. using anticeptics; 3. free from infection or infectious agents; sterile; 4. very clean or tidy. There are mechanical, physical, chemical and biological antiseptic methods. Asepsis – is a way to prevent wounds from festering. At the heart of the aseptic method is aseptic sterilization of tools, clothes, etc. Auscultation – is a physical method of medical diagnostics which consists of listening to the sounds produced during the internal organs’ functioning. Gynecology – is a branch of medicine that studies diseases of the female reproductive system. Obstetrics – is a branch of medicine for pregnancy, childbirth and the postpartum period. Palpation – is a physical method of medical diagnostics conducted by feeling the patient's body. Pediatrics – is a branch of medicine dealing with children and their diseases. Percussion – is a physical method of medical diagnostics by striking or tapping of the individual parts of the body, like a chest or a back, and analysis of sounds that are produced at this time. Psychiatry – is a branch of medicine connected with the study and treatment of mental illnesses, emotional disturbance, and abnormal behavior. Stethoscope – is a medical instrument for listening to internal organs or breathing.

Topics of reports 1. Development of dentistry in 19th century 2. Development of aseptic and antiseptic in the 19th century

TOPIC 8. DEVELOPMENT OF THE REGIONAL MEDICINE IN THE MIDDLE OF THE 19TH – 20TH CENTURIES PLAN

1. Charity of Irkutsk merchants and industrialists 2. Society of Physicians of Eastern Siberia 3. Development of the regional medicine in the middle 19th – 20th centuries

1. Charity of Irkutsk merchants and industrialists At the beginning of the 19th century, there were very few medical institutions (hospital for inpatients, outpatient hospitals, pharmacies) in the Irkutsk region. Medical institutions were built, as a rule, with the money of Irkutsk merchants and industrialists. Charity in Irkutsk was the most effective throughout Siberia. In 1806 – 1807 Irkutsk merchant Nikolai Chupalov built a hospital with 100 beds. When the building became old, it was dismantled. At this place, another merchant Yefimiy Kuznetsov built a new hospital with 220 beds. For many years, this hospital received the name Kuznetsovskaya20. Years later, in the period from 1884 to 1888 near the Kuznetsovsky hospital were built: a house 20 for doctors, a pharmacy, a psychiatric ward, an infectious Picture 20. Kuznetsovsky Hospital isolation ward. It should be noted that the treatment in the hospital was paid and very expensive. So, at the end of the 19th century, staying in a hospital for one day cost the Irkutsk citizen 18–20 kopecks in silver. For comparison, a pound (16 kg) of bread cost 9–10 kopecks more. For visiting a doctor it was necessary to pay 30 kopecks. Today, the Irkutsk Regional Children's Clinical Hospital (4 Gagarina St.) is located in the building of the former Kuznetsovsky Hospital. In 1881 – 1883 in the center of Irkutsk (now the corner of Lenin and Sverdlov St.), an educational house was built with the money of the Irkutsk owner of gold mines Ivan Bazanov. It was a large complex of buildings: the main building, the building of the maternity ward and midwifery school, household services.

20 Irkutsk [Resource]: // Irkpedia.org Kuznetsovsky Hospital (date: 16.02.2020). 63

The foster home took children under one year of age, mostly foundlings, sometimes from poor parents. To our time, there are two buildings of the Bazanovsky educational house21. Today the main building of the educational house is the ophthalmology department of the Clinics of Irkutsk State Medical University. In 1895 the city children's Ivano-Matreninsky 21 hospital was opened in Irkutsk, named after its founders Picture 21. Bazanovsky Educational House marrieds Ivan and Matrena Bazanov. It had therapeutic and surgical buildings, a large outpatient building, a pharmacy, two infectious isolation wards and office. Today this building has retained its functions – a Children's hospital, it houses the clinical departments of the Irkutsk State Medical University.

2. Society of Physicians of Eastern Siberia In the second half of the 19th century, scientific medical societies began to be organized in various cities of Russia. The Society of Physicians of Eastern Siberia in Irkutsk was one of the first provincial medical societies and the fourth in Russia. Unofficially, the Society of Physicians of Eastern Siberia began to work in 1858 on the initiative of Irkutsk doctors. By the time the Society opened, it consisted of 17 physicians, 5 pharmacists and a veterinarian. The Society dealt with issues of science and practical health. The following issues were discussed at the meetings of the society: population statistics, morbidity and mortality, description of epidemics, information about the physical qualities of soldiers, research of mineral waters, meteorological observations. The great merit of the Society of Physicians was in organizing statistics on mortality, and later on the morbidity of the population. In 1888, at the initiative of the chairman of the Society of Physicians, a Statistical bureau was created: the introduction of card registration was supposed to help in studying the diseases of the population. But this did not work, because the patients did not go to the doctor. In 1898, the Society introduced the rule to bury the dead only upon presentation of a medical certificate. From this time began a systematic study of morbidity for causes of mortality. In March 1910 the Society organized Sanitary bureau. A bad medical situation was the cause of widespread diseases. The population of Eastern Siberia suffered from social and infectious diseases. Social disease caused by social and economic conditions.

21 Irkutsk [Resource]: // Irkpedia.org/ Bazanovsky educational house (date: 16.02.2020). 64

Among social diseases, tuberculosis and syphilis were widespread. Among infectious diseases, trachoma was widespread. These diseases became chronic. In the 19th century, the main causes of such diseases were: low standard of living; lack of basic sanitary knowledge in people; lack of preventive measures; few physicians.

What is trachoma? Trachoma is an infectious disease caused by bacterium Chlamydia trachomatis. The infection causes a roughening of the inner surface of the eyelids. This roughening can lead to pain in the eyes, breakdown of the outer surface or cornea of the eyes, and eventual blindness. Untreated, repeated trachoma infections can result in a form of permanent blindness when the eyelids turn inward. The disease quickly spread through hands, household items, clothes. With a low level of hygiene in East Siberia at the end of the 19th century, hundreds of thousands of people, mostly from the poor, were infected with trachoma. Trachoma officially included in the list of neglected diseases by the World Health Organization . According to statistics, trachoma is eliminated in Russia.

What is tuberculosis? Tuberculosis is a widespread infectious disease of humans and animals caused by various types of bacteria from the Mycobacterium tuberculosis complex group. Tuberculosis usually affects the lungs, less often affecting other organs and systems. The main source of tuberculosis infection is carriers with open forms of tuberculosis, that is, those who secrete bacilli into the external environment. Until the 20th century, tuberculosis was practically incurable. Today a comprehensive program has been developed to identify and treat the disease in the early stages of its development.

3. Development of the regional medicine in the middle 19th – 20th centuries Health in different regions of Russia developed in different ways. In the 17th, 18th, 19th centuries Eastern Siberia was considered to be the outskirts of Russia, whose aborigines were the Buryats and Evenkis. A mass migration of Russians to Eastern Siberia began in the 19th century. The sanitary condition of the region was bad: there were few qualified doctors, hospitals; and medical care was expensive. The situation began to change for the better at the turn of the 19th – 20th centuries: - the Society of Physicians of Eastern Siberia was established in Irkutsk in 1858; - the Sanitary Commission was created in Irkutsk in 1882; - more hospitals started to be built; - establishment of Irkutsk medical university in 1919. The Society of Eastern Siberian doctors dealt with various problems and laid the bases of Medical Statistics of the region, Medical Statistics and free healthcare. At their meetings the society members

65 discussed problems related to the study of infectious diseases and sanitary measures. Among the members of this society were doctors, who contributed not only to the development of regional medicine, but to the development of Russian healthcare as such. For example, Nikolai Kashin. He described two endemic diseases: Urov disease and endemic goiter. Urov disease got its name after the river Urov. Kashin was the first who observed it in the aborigines of the river Urov valley. What is this disease like? It is deforming osteoarthritis, progressing in a very slow manner. Its first symptoms usually appear at the age of 6-15 years. The external symptoms of the disease are: deformation of joints; development of the skeleton disorders, dwarfism; a gerontic appearance, monkey-like posture with evident lordosis, sometimes goiter. Kashin studied the etiology, pathogenesis, clinical symptoms of the disease as well as treatment and prevention measures. In 40 years the disease was described by another Russian doctor, Beck, and it got the name of Kashin-Beck disease. Endemic goiter in the 19th century was the most common in Eastern Siberia and especially in Irkutsk region. Kashin gave detailed descriptions of the river Lena and its tributaries, analyzed autopsy data and showed what areas are the most prone to this disease. He described its clinical symptoms. Kashin thought that resettlement of people who lived in deprived areas to be the best measure to combat endemic goiter. He organized resettlement of seven villages in the valley of the river Urov to a healthier place. The main reason for Urov disease is a lack of calcium in water and soil, with an excess of iron, manganese and zinc. A lack of iodine in soil and water leads to disruption of thyroid function and appearance of goiter. Kashin’s research on goiter in Eastern Siberia is the only source for the study of this endemic. It has not lost its relevance to the present.

3. Irkutsk State Medical University An important event for the region's development was the establishment of the university. Irkutsk State University (ISU)22 was opened in 1918, and in 1919 it established the Medical School with clinics. In 1922 the first graduation of doctors was 27 people took place. Picture 22. ISMU emblem22 From the first days of its existence the university Medical School of began to have a huge impact on development of healthcare in Eastern Siberia. Its main task was training of qualified physicians, and later – training of scientists’ medical research. In 1920, a year after the establishment of the Medical

22 ISMU emblem //https://mir.ismu.baikal.ru/ 66

Faculty of ISU the Department of Obstetrics and Gynecology was opened, and a clinic for 20 people was organized. In 1921 the Department of Ophthalmology was organized. The widespread eye diseases required numerous eye surgeries in towns and districts of the region, and training of ophthalmologists. In 1923, the T.B. prophylactic center was established in Irkutsk. Irkutsk Medical Institute began an independent establishment only in 1930, when it was separated from the university (ISU). In the mid-1930s separation of cancer patients was practiced at the clinics of Irkutsk Medical Institute. Later, in 1946 the Regional Cancer Center was established. Among the first founders of dental care in the region were also the members of the medical institute. During the Great Patriotic War (1941 – 1945) the country needed doctors, so the institute changed training of doctors to 4-5 years. Those doctors were sent to the front or to the military hospital of Irkutsk. In 1960, the medical institute started training foreign students. In 1995, the institute received the status of university. Today, there are about 5,000 students at 6 faculties of Irkutsk State Medical University (ISMU): - General Medicine; - Pediatrics; - Medical Prophylaxis; - Dentistry; - Pharmacy; - Medical Biochemistry. Also in 50 specialties of residency and 34 specialties of post-graduate studies. Today, the development of university research activities answer the needs of the region. The staff of the university is represented by the leading specialists in all branches of medicine. The development of university research activities answer the needs of the region. The staff of the university is represented by the leading specialists in all branches of medicine.

EXERCISES FOR INDEPENDENT WORK

Test (тест) 1. WHEN WAS THE SOCIETY OF EASTERN SIBERIAN DOCTORS WAS ESTABLISHED IN IRKUTSK? А) in 1858 B) in 1882 C) in 1919 2. WHEN WAS THE MEDICAL SCHOOL WITH CLINICS ESTABLISHED IN IRKUTSK? A) in 1858

B) in 1882 C) in 1919 3. WHAT ENDEMIC DISEASES HAVE BEEN STUDIED BY KASHIN? (More than one correct answer is possible). A) Urov disease B) endemic goiter C) schistosomiasis 4. WHEN IRKUTSK MEDICAL INSTITUTE RECEIVED UNIVERSITY STATUS? A) in 1930 B) in 1960 C) in 1995 5. WHAT EVENTS CHANGED THE HEALTHCARE SYSTEM OF THE IRKUTSK REGION IN THE MID-19TH AND EARLY 20TH CENTURIES? (More than one correct answer is possible) A) opening of the educational house in Irkutsk B) establishing Society of Physicians of Eastern Siberia in Irkutsk C) mass migration of Russians to Eastern Siberia D) financial participation of merchants in the construction of hospitals E) creating Sanitary Commission in Irkutsk 6. WHEN WAS THE KUZNETSOVSKY HOSPITAL BUILT? А) 1806 – 1807 B) 1884 – 1888 C) 1881 – 1883

Exercise 1 Translate and learn Russian Text Text (текст) Иркутский государственный медицинский университет – это первое учебное заведение в Восточной Сибири. Он был основан в 1919 году. Сегодня в университете учится около 5 000 студентов; шесть факультетов (лечебный, педиатрический, стоматологический, медико- профилактический, фармацевтический, медицинской биологической химии). С 1960 года в университете учатся иностранные студенты. Сегодня Иркутский государственный медицинский университет – это центр медицинской науки и образования.

Exercise 2 Complete the table "Main activity of famous Irkutsk", using the texts 68

Nikolai Kashin Ivan Bazanov Yefimiy Kuznetsov 1) 2) 3)

Exercise 3 Complete the table "Main symptoms of disease", using the texts Urov disease Tuberculosis Trachoma 1) 2) 3)

Glossary

Lordosis – excessive curvature of the spine. Goiter – a swelling of the neck resulting from enlargement of the thyroid gland. Etiology – the cause, or a set of causes of some disease or condition. Endemic – (of a disease) regularly found among particular people or in a certain area.

Topics of reports 1. History of Irkutsk State Medical University

2. Endemic diseases of Eastern Siberia

TOPIC 9. INTERNATIONAL MEDICAL ORGANIZATIONS IN THE 20TH CENTURY PLAN 1. Development of International health organizations 2. Symbols of medicine

1. Development of International healthcare organizations The 20th century is characterized with a number of events that have played a major role in the development of international healthcare and recognition of medical advances. The beginning of the 20th century was marked with a significant event. In 1901 the first Nobel Prize in Medicine was awarded. The Nobel Prize is the highest award for a scientist. On the testament of Alfred Nobel, the Nobel Foundation was established. It allows paying the percent of premiums annually. Alfred Nobel's idea was to help talented scientists. Thus, each year the Nobel Prize is awarded in different fields of science, including physiology and medicine. In the 20th and early 21st century the Nobel Prize in Physiology and Medicine was awarded to 200 scientists. The International Committee of the Red Cross. The idea of international union of for the helping sick and wounded soldiers emerged in the second half of the 19th century. The Red Cross emblem was used as a symbol of protection. Nowadays the Committee is an independent and neutral organization. The International Red Cross is against the use of nuclear energy for military purposes, racial discrimination. It calls for demilitarization and elimination of war from the life of nations. The main goal of the International Red Cross is to: 1) to help prevent and alleviate the suffering of people; 2) protection of human life, health and values, especially during natural disasters; 3) promoting the social well-being. To achieve this goal should be guided by certain principles: Humanity; Impartiality; Neutrality; Independence; Volunteerism; Unity; Versatility. These principles were adopted in 1965 at the XX International Conference of the Red Cross in Vienna. The Russian Red Cross Society provides a practical assistance to healthcare of different countries by building hospitals and arranging their work, sending medical brigades and humanitarian assistance to the population of the countries that have suffered from natural disasters, accidents and military actions. In 1907 the International Office of Public Hygiene was created in Paris. Its task was to collect and spread the data on infectious diseases (cholera, plague, fever, etc.), and methods to combat them. That organization checked on hygiene of ships, food hygiene, and water hygiene. The organization

70 existed until the middle of 20th century. Its experience was used later when creating the World Health Organization (WHO). The World Health Organization23 is a specialized agency of the United Nations Organization (UNO), consisting of 194 members from different countries, whose main function is the solution of international health problems. It was founded in 1948. A desire for international cooperation of different countries in the field of healthcare was due to the need for healthcare measures and prevention of epidemics and pandemics. st By the 21 century the World Health Organization united more than Picture 23. Emblem WHO23 190 countries. Each year it works on more than 1,500 health projects: - fight against infectious and noninfectious diseases; - training and advanced training of medical personnel; - environmental protection; - healthcare of mothers and children; - development of sanitary statistics; - international drug control. Russia is one of the countries which founded the World Health Organization. The country actively participates in the majority of its programs. For example, in 1958 at the suggestion of the former Soviet Union (the USSR) a program on eradication of smallpox was adopted all over the world. The program started with vaccination of the population. But a low financial status of many countries made it impossible to carry out mass vaccination. As a result of smallpox focus were reported in 30 countries of South America, and 12 countries of Asia and Africa. They were imported cases of smallpox. On the whole, smallpox was registered in 42 countries; the total number of cases reached 2.5 million people. The World Health Organization provided the countries with the vaccine and began training medical personnel. Soon, some countries with smallpox focus developed their own production of the vaccine. The Soviet Union made a donation to the World Health Organization of more than 1.5 billion doses of smallpox vaccine. Finally, by common efforts the endemic of smallpox was stopped. The last case of smallpox was reported in Brazil in 1971. The Physicians for Prevention of Nuclear War International Movement. In 1980 the United States held a large conference of American scientists and physicians, who discussed possible consequences of nuclear war. In the short term this trend became popular; it has become a movement and united a number of countries. The main activities of "The Physicians for Prevention of Nuclear War International Movement" in Russia at the present time are collection and systematization of data;

23 Emblem WHO [Resource]: //ru.wikipedia.org/wiki/ World Health Organization (date: 16.02.2020). 71 formation of the expert group on nuclear problems to ensure a high quality of publications on this subject; formation of public opinion for elimination of nuclear weapons.

2. The symbols of medicine

The modern symbol of medicine is the snake that winds around the bowl24 bowing its head over it. This symbol was adopted in Russia in 1924, and then became widespread outside the country. The image of snake has accompanied physicians since ancient times. The legendary Greek physician Asclepius, who was called not only a great doctor, but even a doctor-god, the Picture 24. Symbol of patron of medicine, was always depicted with a snake. There is a Greek myth medicine24 about it. Being already rather well-known, Asclepius was invited to resurrect the dead son of the king. Asclepius was leaning on a stick, when the stick was wrapped by a poisonous snake. In fear, Asclepius killed it with a stick. But then the second snake appeared. It brought some herb in the mouth. This herb resurrected the killed snake. Asclepius found the herb and resurrected the dead prince. As for the bowl, it symbolizes the vessel where the snake spews its venom. As you know, snake venom is used in medicine. However the bowl with the snake is not the only symbol of medicine, there are others which are quite popular. One of them is the image of Asclepius’s walking stick. Its origin stems from the 6th century BC and has Greek roots. The stick is entwined with a snake. This first international symbol of medicine refers to the legend told above. In 1948, at the First International Healthcare Assembly, the walking stick entwined with a snake was chosen the emlem of the organization. From that moment on it became the symbol of medicine as such. The Red Cross was originally used as an emblem of the Medical Service in the armed forces, which provided protection and assistance to the sick and wounded. This symbol entered the European practice in the second half of the 19th century. On the robe of military medics there was a red cross, which was clearly seen during the fight. The Red Crescent symbol was adopted during the period of the Turkish wars. In wartime, the image of the Red Cross against the white background is a distinctive sign and denotes the protection of military medical services, as well as hospitals, medical transport and assistance of the patients.

24 Symbol of medicine[Resource]: //ru.wikipedia.org/wiki/ Snake that winds around the bowl (date: 16.02.2020). 72

FINAL TEST

1. WHAT COUNTRY PRACTICED MUMMIFICATION A) Babylonia B) Ancient Egypt C) Ancient India D) Ancient China 2. THE MAIN FEATURES OF PREHISTORIC MEDICINE A) healing and collective activity B) broad knowledge of the human body structure C) creation of the first sanitary laws and prohibitions D) yoga appearance 3. IT IS A HELMINTHES DISEASE A) smallpox B) schistosomiasis С) cough 4. WHAT COUNTRY CONSIDERED HEALTH AS THE HARMONY OF THE YIN AND YANG ENERGIES? A) Babylonia B) Ancient Egypt C) Ancient India D) Ancient China 5. WHAT WERE THE MAIN PREVENTIVE METHODS IN ANCIENT CHINA? A) massage, variolation, gymnastics, breathing exercises B) gymnastics, variolation, medical ethics C) breathing exercises, massage, mummification 6. WHAT OATH DO GRADUATES FROM RUSSIAN MEDICAL UNIVERSITIES TAKE? A) The Physician’s Oath B) The Hippocratic Collection C) The Canon of Medicine

7. WHAT DID HEROPHILUS DESCRIBE IN THE ESSAY "ON THE EYES"? A) stomach and kidneys B) vitreous body and retina C) vessels and arteries

8. WHAT MEDICAL ACHIEVEMENTS WERE MADE IN THE TIME OF ALEXANDER THE GREAT? A) filling the ventricles of the heart and blood vessels with wax B) establishment of medical universities C) limb amputations, laparotomy at ileus and ascites 9. WHAT SANITARY CONSTRUCTIONS WERE CREATED IN ANCIENT ROME? A) libraries at hospitals B) aqueducts and thermae 10. WHEN WAS THE FIRST CHRISTIAN HOSPITAL BUILT? A) in 323 B) in 380 C) in 370 11. MATCH THE COLUMNS: A) melancholic 1. The predominance of bile makes a person impulsive, «hot» B) choleric 2. The predominance of mucus makes a person calm and slow C) phlegmatic 3. The predominance of blood makes a person agile and cheerful D) sanguine 4. The predominance of black bile makes a person sad and fearful 12. WHO INTRODUCED CATGUT TO ABDOMINAL SURGERY? А) Al-Razi В) Galen С) Al-Sahrawi D) Ibn Sina 13. WHAT MUSLIM TRADITIONS APPEARED ON THE BASIS OF SANITARY RULES? (More than one correct answer is possible) А) fivefold ablution В) cleanliness С) building a general hospital nearly every city D) prohibitions to drink wine and eat pork 14. WHEN WAS THE FIRST ISLAMIC GENERAL HOSPITAL IN BAGHDAD BUILT? A) in 805 B) in 1160 C) in 380 15. WHO IS THE AUTHOR OF THE "CANON OF MEDICINE"? А) Al-Razi В) Galen С) Al-Sahrawi D) Ibn Sina 74

16. WHAT WAS THE MAIN PREVENTIVE METHOD AGAINST EPIDEMICS IN EUROPE? А) medical ethics В) quarantine С) breathing exercises 17. WHY THE EUROPEAN MIDDLE AGES IS CALLED THE "DARK AGES"? A) because the amount of medical students was few, about 10 people B) because the achievements of science and culture were lost for Europe C) because there were a lot of infectious diseases 18. WHAT SCIENTIST WAS CALLED AN "AMAZING DOCTOR"? А) Al-Razi В) Galen С) Roger Bacon D) Ibn Sina 19. WHO PRACTICED SURGERY IN THE MIDDLE AGES? А) scientists В) bath attendants С) graduates of medical school D) barbers (hairdressers) 20. WHO WAS THE FIRST TO CONDUCT A FORENSIC AUTOPSY IN EUROPE? А) Salicheto В) Mondino Luzzi С) Andrea Vesalius D) Galen 21. WHAT CHANGES IN ANATOMY OCCURRED IN THE 14th – 15th CENTURIES? А) ban on autopsy B) some universities began to receive permits for anatomical demonstrations C) published new textbooks on anatomy 22. SELECT REPRESENTATIVES OF THE EUROPEAN MIDDLE AGES (More than one correct answer is possible) A) Amboise Pare B) Ibn Sina C) Girolamo Fracastoro D) Michael Servetus 23. WHAT NEW METHODS DID DA VINCI INTRODUCED? (More than one correct answer is possible) 75

A) washing bodies with running water B) auscultation C) filling the ventricles of the heart and blood vessels with wax, sawing the bones and organs D) vaccination 24. WHY WERE THERE MISTAKES IN GALEN'S TEACHING? A) he criticized religion B) he studied anatomy on corpses of animals C) he did not know the autopsy methods 25. MATCH THE COLUMNS:

A) Amboise Pare 1. An Italian scientist, the author a fundamental work "The structure of the human body" B) Girolamo Fracastoro 2. A French surgeon and published, the author a book "The method of curing wounds caused by arquebus and firearms" C) Andreas Vesalius 3. An Italian doctor who described the three modes of transmission, introduced the terms "infection" and "disinfection" 26. WHAT RUSSIAN MONARCH INITIATED VACCINATION? A) Peter the Great B) Ecatherine the Great 27. MATCH THE COLUMNS: A) Edward Jenner 1. Discovered leukocytes B) Enrique Paschen 2. Discovered the method of vaccination with cowpox C) Ilya Mechnikov 3. Discovered the smallpox virus D) Louis Pasteur 4. Сreated vaccines against cholera, anthrax, rabies. 28. WHO IS THE AUTHOR OF THE DOCTRINE OF UNCONDITIONED AND CONDITIONED REFLEXES? A) Ilya Mechnikov B) Nikolai Pirogov C) Ivan Pavlov 29. WHAT ACHIEVEMENT BY IVAN PAVLOV WAS GIVEN THE NOBEL PRIZE? A) the study of physiology of digestion B) the doctrine of the higher nervous activity C) the discovery of the smallpox virus 30. WHEN WAS THE FIRST HOSPITAL SCHOOL OPENED IN RUSSIA? 76

A) in 1718 B) in 1707 C) in 1796 31. WHERE DID THE FIRST HOSPITAL FOR CHILDREN APPEAR? A) in France B) in Russia C) in Germany 32. WHERE DID THE FIRST PSYCHIATRIC CLINIC WITH TREATMENT APPEAR? A) in France B) in Russia C) in Germany 33. WHAT DID NIKOLAI PIROGOV DO? (More than one correct answer is possible). A) He founded topographical surgery B) He contributed to mass application of anesthesia C) He created the first anatomical museum in Russia D) He organized the Sisters of Mercy system E) He invented the microscope F) He invented the antiseptic method G) He divided the wounded into groups H) He applied dissection of frozen corpses ("ice anatomy") 34. MATCH THE COLUMNS: A) caesarean section 1. A method to prevent wounds from festering B) asepsis 2. The surgical operation for dissection of the ovary C) ovariotomy 3. The use of surgery to deliver babies 35. WHEN WAS THE SOCIETY OF EASTERN SIBERIAN DOCTORS WAS ESTABLISHED IN IRKUTSK? А) in 1858 B) in 1882 C) in 1919 36. WHEN WAS THE MEDICAL SCHOOL WITH CLINICS ESTABLISHED IN IRKUTSK? A) in 1858 B) in 1882 C) in 1919 37. WHAT ENDEMIC DISEASES HAVE BEEN STUDIED BY KASHIN? (More than one correct answer is possible). 77

A) Urov disease B) endemic goiter C) schistosomiasis 38. WHEN IRKUTSK MEDICAL INSTITUTE RECEIVED UNIVERSITY STATUS? A) in 1930 B) in 1960 C) in 1995 39. WHAT EVENTS CHANGED THE HEALTHCARE SYSTEM OF THE IRKUTSK REGION IN THE MID-19TH AND EARLY 20TH CENTURIES? (More than one correct answer is possible) A) opening of the educational house in Irkutsk B) establishing Society of Physicians of Eastern Siberia in Irkutsk C) mass migration of Russians to Eastern Siberia D) financial participation of merchants in the construction of hospitals E) creating Sanitary Commission in Irkutsk 40. WHEN WAS THE KUZNETSOVSKY HOSPITAL BUILT? А) 1806 – 1807 B) 1884 – 1888 C) 1881 – 1883 41. MATCH THE COLUMNS: A) in 1907 1. The first Nobel Prize in Medicine was awarded B) in 1948 2. International Office of Public Hygiene was created C) in 1980 3. Physicians for Prevention of Nuclear War International Movement has begun work D) in 1901 4. The United Nations Organization was founded 42. WHAT IS THE SYMBOL OF MEDICINE? (More than one correct answer is possible). A) snake B) Asclepius C) Asclepius’s walking stick D) Red Cross and Red Crescent

CORRECT ANSWERS TO TOPICS TOPIC 1 1-B 2-A 3-C 4-B TOPIC 2 1-D 2-C 3-A 4-B TOPIC 3 1-A 2-A 3-A,C 4-B 5-C 6-B 7-C 8-A3, B1, C2 9-A4, B1, C2, D3 TOPIC 4 1-C 2-A, B, D 3-A 4-D 5-A5, B2, C4, D3, E1 6-B 7-B 8-C 9-D 10-A 11-B TOPIC 5 1-A,C,D 2-A,C 3-B 4-C 5-A2, B3, C1 6-A 7-A2, B3, C1 TOPIC 6 1-A3, B4, C2, D1 2-A,D 3-B 4-A2, B4, C3, D1 5-A2,B3,C1,D4 6-C 7-A 8-A3, B1, C2 TOPIC 7 1-B 2-A3, B1, C2 3-A 4-A 5-A, D, G, H 6-A2,B1,C3 7- A3,B1,C2 TOPIC 8 1-A 2-C 3-A,B 4-C 5-B,D,E 6-B

CORRECT ANSWERS TO THE FINAL TEST

1-B 2-A 3-B 4-D 5-A 6-A 7-B 8-C 9-B 10-C 11-A4,B1,C2, D3 12-C 13-A, B, D 14-A 15-D 16-B 17-B 18-C 19-D 20-A 21-B 22-A,C,D 23-A,C 24-B 25-A2, B3, C1 26-B 27-A2,B3,C1,D4 28-C 29-A 30-B 31-A 32-A 33-A,D,G,H 34-A3,B1,C2 35-A 36-C 37-A,B 38-C 39-B,D,E 40-B 41-A2,B4,C3,D1 42-A,C, D

RECOMMENDED LITERATURE

Main literature 1. История медицины [Электронный ресурс] : учебник / Ю. П. Лисицын. – 2-е изд., перераб. и доп. – Электрон. текстовые дан. – М. : ГЭОТАР-Медиа, 2015. – Режим доступа: Электронная библиотека медицинского вуза «Консультант студента» : http://www.studmedlib.ru/book/ISBN9785970431399.html. – Загл. с экрана. 2. Сорокина Т. С. История медицины. – Москва : Академия, Academia. – 2008. – 421 с.

Additional literature 1. Орлова И. В. История развития здравоохранения в Восточной Сибири в XIX – первой половине XX веков : учебное пособие для студентов / И. В. Орлова, Б. С. Соктуев ; ГБОУ ВПО ИГМУ, Кафедра общественного здоровья и здравоохранения. – Иркутск : ИГМУ, 2016. – 95 с.

Supplement 1

Recommendations on presentation preparation

Before you start making a presentation, please consider the following tips. They will help you prepare a substantial and effective presentation, regardless of an academic discipline. 1. The style remains the same during the whole presentation. Avoid styles that will distract the audience from the presentation itself. 2. Auxiliary information (control buttons) should not prevail over basic information (text, pictures, etc.). 3. It is recommended to use no more than three colors on one slide: one for the background, one for headings, one for the text. Use contrasting colors for the background and the text. Pay attention to the color of the hyperlinks. 4. You should not use animation effects too much. They should not distract the audience from the content of the information on the slide. 5. Conciseness and brevity of the presentation is achieved with short abstracts, dates, names, and terms. Do not overload the slide with textual information. Do not use solid text blocks. 6. Each slide should have a title. Headlines should attract the attention of the audience. 7. If there is a drawing on the slide, the inscription should be placed under it. 8. Fonts: for headers – 40 and more, for basic information – 24 and more. The text should be clearly visible. Use one of the following fonts: Arial, Verdana, Tahoma, Comic Sans MS. You cannot mix different types of fonts in the same presentation. 9. Bold, italicized or underlined words should be used to highlight the information on the slide. 10. The presentation volume should not be less than 8–10 slides. 11. The presentation structure is recommended to be the following: the 1st slide: title page – subject, author, logo;

the 2nd slide: contents; subsequent slides – information related to the topic; the penultimate slide: general conclusions; the last slide – a list of references and the sources used. 12. To ensure clarity, you can use illustrations, tables, charts, etc. Distortion of illustration proportions is unacceptable. When you give a presentation, remember that you speak to the audience. The presenter should make his/her information interesting and useful for the audience. After you have prepared a presentation, it is recommended that you reviewed the tips again to make sure that you have made a good use of all of them.

Educational edition

Orlova Irina Vyacheslavovna

HISTORY OF MEDICINE:

Textbook