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The role of the Academy of Sciences

With the involvement of Russia in the general process of world cultural and scientific development, with the establishment of strong and constant scientific ties with the advanced countries of Western Europe, the creation of scientific institutions in the country became increasingly urgent. The Academy of Sciences, conceived by Peter I as a centralized state form of organization of scientific research, was to become a center for the dissemination of scientific knowledge in the country, as well as the training of national scientific personnel.

Among the sciences that the academy was supposed to deal with was medicine. The initial structure of the new scientific institution provided for the existence of three departments (classes). The second, the so-called physical class, also included medical sciences (anatomy, physiology, chemistry). In addition, the university was supposed to operate a university, which included, among others, a medical faculty. Lectures here were to be given by academicians of the physical class.

Prominent scientists were engaged in medicine (mainly anatomy and physiology) at the St. Petersburg Academy of Sciences. It was primarily Daniel Bernoulli (1700-1782) - a famous mathematician, physicist, physiologist. At the Academy of Sciences, he performed a number of important studies in physiology, in particular, formulated an equation, later called the “Bernoulli equation”. Leonhard Euler (1707-1783), a leading mathematician, mechanic and physicist, was engaged in a wide variety of studies, among which were "works of a semi-physiological nature."

A promising researcher was Josiah Weitbrecht (1702-1747). A native of Germany, he studied medicine in Tübingen, and moved to Russia from Württemberg in 1725. At the St. Petersburg Academy of Sciences, Weitbrecht quickly grew into a major scientist - an anatomist and physiologist. As a professor of anatomy, "sending this title, he took apart a huge number of human corpses", which gave

him the opportunity to write a number of original works on anatomy. His most valuable scientific work was the treatise “Syndesmology or the history of ligaments of the human body, harmoniously presented in accordance with anatomical observations, illustrated by drawings specially made by Weitbrecht, doctor of medicine, member of the St. Petersburg Academy of Sciences and professor of physiology” (1742). This scientific work, the first syndesmology manual, extremely important for surgeons, was subsequently translated and published in Paris in French (1752) and in Strasbourg in German (1779). Veitbrecht is rightfully considered the founder of the theory of ligaments, and Russia is the birthplace of the world's first monograph on syndesmology.

Johann Duvernois (1691-1750) worked fruitfully at the Petersburg Academy of Sciences; Before arriving in Russia, he lived in Germany and was an extraordinary professor at the University of Tübingen. In St. Petersburg, he often gave lectures and scientific reports, performed autopsies, prepared many different anatomical preparations and animal skeletons.

One of the most striking pages in the work of the St. Petersburg Academy of Sciences, which has become the foremost scientific center of Europe in the Age of Enlightenment, is connected with the brilliant encyclopedic scientist Mikhail Lomonosov. An outstanding natural scientist, a passionate fighter for education and culture, he had a tremendous influence on the development of Russian science. Lomonosov showed constant interest in medicine. A thinker, he emphasized the need to build practical medicine on the basis of knowledge of science, especially anatomy. His attention was also attracted by physiology, especially the physiology of the nervous system, sensory organs, color perception, and color vision. Lomonosov recognized the need for practical medicine to be based only on scientific data.

Lomonosov also took care of the training of Russian surgeons. For example, the fact is known when one of the few “academic students”, the soldier’s son Gerasim Shpynev, in 1762 asked to be sent abroad to study surgery. However, the academy refused him. Lomonosov stood up for his soldier’s son, however, apparently, he didn’t become a surgeon Shpynev.

The main, most significant, most fruitful influence exerted by M.V. Lomonosov on the development of Russian medicine, as the medical historian S.M. Grombach manifested itself not so much in private matters as in the general nature of the approach to solving these issues, in the world outlook and world outlook characteristic of advanced Russian doctors of the 18th and early 19th centuries. The Lomonosov influence, of course, also affected the spread of the experimental research method in domestic medicine and surgery. Anatomical and anatomophysiological studies performed by scientists of the St. Petersburg Academy of Sciences, not only contributed to the development and improvement of operational skills, but also helped to establish the most advanced anatomical direction in surgery. It is regrettable that there were few such studies. Practical medicine and surgery received much more from the daily practice of doctors, operators, healers of general and other hospitals, from the activities of teachers and professors of hospital schools that trained future doctors and surgeons.

The Moscow General Hospital, which was headed by Nikolai Bidloo, remained the flagship of Russian medicine and surgery for almost a decade. The main thing in his activity was the “treatment of sick people” and the preparation of doctors: both of them, Dr. Bidloo paid much attention, since he combined the work of the chief doctor of the hospital with the management of the hospital school. In the hospital, he himself did all the surgical operations and only instructed other unimportant other doctors.

For example, Bidloo successfully engaged in “removing nuclei” (tumors) from the human body and persistently taught his students this art. He proposed his technique for breast amputation for cancer and invented a number of tools for this operation. During amputation of the mammary gland, he recommended expanding the scope of surgical intervention - removing part of the pectoralis major muscle during germination by a tumor, and pointed out the harm associated with postoperative bleeding.

Despite the fact that Bidloo himself was an outstanding surgeon, a highly educated theorist and highly experienced practitioner, he taught future doctors to use the most rational methods. So, talking about true and false aneurysms, he drew attention to a particularly dangerous false aneurysm arising from a dissection or rupture of an artery, emphasizing that it "can end fatally if it is not prevented."

Dr. Bidloo showed and substantively taught how to perform operations in case of aneurysm: describing in detail the course of this operation, using the turnstile, he indicated that at the final stage “the needle and thread are held under the artery, and the thread over the wound is tied with a surgical knot”, the wound is filled with tow , put a napkin, patch, three compresses and a bandage on top.

In the treatment of varix (varicose veins), it was recommended to use three methods - constriction, compression or bandaging, incision, and Dr. Bidloo did not reject such a radical variation of the third method as ligation of the vessel on both sides of the tumor, followed by opening and extruding a blood clot. Characteristically, he also paid attention to such a relatively new operation then, which he obviously performed himself, like a tendon suture. This operation was known even to Avicenna, but then it was forgotten, and only at the end of the XVII century. reported about it by the French surgeon Jean Biennez.

At the beginning of the century of the Enlightenment, surgery already had a rather large set of various surgical instruments. In Russia, as evidenced by the collection of Peter the Great preserved in the State Hermitage Museum (St. Petersburg), there were a lot of them. Indeed, already in 1719, according to the verbal decree of Peter I, it was ordered at the Main Pharmacy in the Pharmaceutical Garden to produce medicinal tools: a master hut was created, which later became a medical-instrumental factory. Russian master craftsmen produced “most demanding” surgical instruments here.

Dr. Bidloo used most of the instruments prepared in Russia and imported from abroad, although in his work he described only the most important of them, recommending how to use them, in which cases they may be needed. For example, for cutting, separating, cutting, various scalpels, straight, curved and sickle-shaped scissors were needed. Removal operations required a razor, a straight and sickle-shaped scalpel, a scalpel and a lancet for opening apostems (abscesses), a variety of cauterizers, tongs for clamping a cut vessel, a probe for examining wounds and ulcers, a scraping scalpel to remove carious parts, a powder spoon, an elevator for powders, an elevator for powders, lifting crushed bones of the skull, a file for cutting an infected area between two joints of the fingers.

At the same time, Bidloo did not forget about such obligatory accessories of surgical operations as turundas from a lint, cloth or sponge; silver, gold or lead cannulas; napkins made of lint, tow or linen; plasters, compresses, pads and various dressings - he used all this in his daily practice, he acquainted all his students with this - future doctors or, as they were initially called, medical surgeons. All this was reported in the first section of training at a hospital school - now such a course is included in the program of general (or propaedeutic) surgery. Only having mastered this necessary initial knowledge, did the future doctors begin to study “head-to-toe operations”.

Dr. Bidloo introduced his students to a wide range of operations that were then used in surgery.
Most likely, he used most of them in his surgical practice and demonstrated to his pupils. Teaching surgical interventions, Bidloo described in detail the indications and contraindications to them, scrupulously listed the necessary apparatus of the operation, i.e. tools, dressings, medications - all that may be required during surgery. This was followed by additional guidelines - such as, for example, where, where, in which room to perform this or that operation, in which conditions - in warm or cold; then all this was considered extremely important. Then, the technique of operations was explained - starting from the first incisions, from operative access, and ending with dressing the wound and preventing possible complications. According to this general scheme, he explained to his students operations on the head, neck, chest, lower abdomen, limbs, as well as operations and bandaging of fractures, bandaging and fixing of dislocated bones, operations of extraction of foreign bodies and operations of tumors.

Bidloo presented to his students a full course of surgery of that time and, of course, reported on various methods of treating certain diseases, on the use of various surgical methods. However, he not only mechanically enumerated the existing operations, but also singled out the most rational of them; the criteria most often served as his own experience. For example, mentioning that after aneurysm surgery “some prefer to close the artery with a cauterizer,” Bidloo did not recommend

to do this, "for when the eshara is separated, blood flows again." After listing the methods of treating varix, he actually spoke out for the most radical of them - vessel ligation.

Pointing to the numerous existing methods of suturing the external integument after suturing the wound of the intestine, Bidloo rejected everything except for the suture he had used with two needles. He not only criticized, but ridiculed the method used by many to probe foreign bodies in a wound with a wax candle, strongly speaking out for the use of metal tools and even “his own finger”. During paracentesis surgery in the lower abdomen with ascites, Bidloo rejected the methods of scarification, cauterization, and "opening of the ancients" (using a lancet), recognizing the most rational and modern method - surgery using a trocar. All this confirms Bidloo's rich practical experience: his surgical knowledge, the operations that he performed, fully corresponded to the state of medicine and surgery in the first half of the 18th century.

It is important that surgical operations in a hospital school were taught both in the anatomical theater (on corpses) and in clinical conditions (in a hospital, on living people). This was the most progressive method of training, which is used in medicine to this day. In Moscow hospital school, Dr. Bidloo himself usually performed clinical operations, and in the anatomical theater the students were taught by the Repken doctor.

“At the time we are considering,” wrote about the 18th century. historian of surgery V.A. Oppel, - along with the senior and junior doctors in the hospitals there were operators, i.e. the doctor who performed the surgery and trained in anatomy. ” The doctor Repken was such an operator. On the corpses, the operator Repken showed the students even those operations that for some reason could not be performed in the hospital (for example, due to the lack of patients), but which were included in the course of surgery. In addition, in the anatomical theater, both he and Dr. Bidloo conducted rehearsals (repetitions) of the training material “to train students”. They taught desmurgy on people, and on phantoms or stuffed animals.

At that time, operations of the widest range were used to treat patients and wounded in the Moscow General Hospital, and in other hospitals, too; This was quite convincingly evidenced by the surgeon's large stock of surgical instruments. The list of surgical instruments that were prepared for surgeons and doctors was constantly updated and expanded. So, during the Russo-Turkish war of 1735-1739. Field physician Nitsch offered to supplement the regimental instrumental chest with turnstiles. His offer was accepted. The instrumental master Ivan Noskov listed a part of the tools he had made in 1737: “I saw one with one towel, two knives of large curves, three small knives, one tong, two chisels, five large lancets, four scissors, one fuzz, three different cauteris and seven needles, one mouth tool, one stone disease tool, two teeth with which the root is taken out, one water tool, one big spindle, three anatomical tools, one curve tool, and moreover I won’t mention it, I’m ready to spine and forty-seven, and in this tale told the real truth. "

The Moscow Hospital School has long kept catalogs of tools compiled in 1738 on the occasion of damage to most of them during a fire. Among these instruments were “puncturas”, “cataract chaser”, “steel forceps for pressing in the mouth”, “steel needles for cetone”, various knives - “steel, small curve”, “lithotomy small silver straightened”, phlebotomy, “ long acute on both sides ”,“ knocking ”,“ particular ”,“ steel curved catheters ”,“ cutting forceps ”,“ apostomatic silver lancets set up ”,“ phlebotomy ”, scissors,“ round and flat forceps and much more. About these tools, which, no doubt, Bidlo, as well as other Russian surgeons used in everyday practice, he wrote in his work, taught future doctors to own them, use them in various operations.

A feature of Moscow, and then other Russian hospital schools, was that the training in practical surgery and other clinical disciplines took place directly at the bedside of patients and went in parallel with the study of theoretical subjects. From the very beginning, students worked in the clinical departments of the hospital, performing initially duties, which later became the main ones for paramedics (then there were no paramedics in Russia yet). This was, in fact, the beginning of their teachings.

The clinical nature of the training of medical surgeons, the emphasis on the study of surgery was maintained at the Moscow Hospital School even when Bidloo's successor, Dr. De-Theils, worked here.

Often difficulties, even the fires of 1721 and 1737 that destroyed the hospital buildings, could not interfere with the activities of the Moscow Hospital School and the training of certified surgeons. In 1712, the first graduation took place - the school was graduated by Stefan Blessed (Nevsky), Egor Zhukov, Ivan Belyaev and Ivan Orlov. Subsequent issues took place in 1713, 1714, 1719, 1721, 1723, 1730 and in other years. Strict exams each time confirmed the knowledge of young doctors and the validity of awarding them the title of healers (doctors). Dr. Bidloo praised his first pupils.

It is regrettable, but a fact that cannot be said about: the first graduates of the hospital school at first met a rather cold, if not hostile, attitude from fellow doctors. In the first half of the XVIII century. many foreign doctors worked in Russia, among them were those who came to us only for a long ruble, "to catch happiness and ranks." Jealously guarding their privileges, such doctors sought to prevent young Russian doctors from entering the medical environment, and if they accepted them, they kept them in the position of servants.

Действительно, в 1712 г. в Петербурге уже окончившим госпитальную школу двум ученикам доктора Бидлоо Стефану Блаженному (Невскому) и Ивану Беляеву комиссия из четырех иностранных врачей устроила дополнительный экзамен, на котором фактически провалила молодых врачей, при этом один из членов комиссии голосовал... заочно. Однако вмешательство доктора Бидлоо сыграло свою роль - оба молодых врача были приняты на службу в Балтийский флот. Туда же, кстати, в последующие годы были направлены и многие другие воспитанники Московской госпитальной школы.

В защите молодых русских лекарей важную роль сыграл Петр I. Желая поощрить, а может быть, и ускорить подготовку врачей в Московской госпитальной школе, Петр I распорядился выплачивать доктору Бидлоо по 100 рублей за подготовленного лекаря и 50 рублей за подлекаря. Царская премия не побудила, однако, честного и неподкупного доктора Бидлоо поступиться своими принципами и увеличить количество выпускников в ущерб качеству их подготовки.

Характерно, что доктор Бидлоо считал работу в госпитале и обучение будущих врачей и хирургов своим главным делом. В середине 1727 г. он на несколько месяцев стал лейб-медиком малолетнего императора Петра II, а в 1730 г. указом императрицы Анны Иоанновны Николай Бидлоо как один из авторитетнейших российских докторов был включен в руководившую Медицинской канцелярией коллегию (так называемое Докторское собрание) и в течение почти двух лет оставался одним из руководителей всей российской медицины. И даже в эти нелегкие для него времена доктор Бидлоо постоянно работал и в госпитале, и в госпитальной школе. Это свое любимое «двуединое детище», которое он возглавлял до последних дней жизни, Бидлоо заботливо пестовал, отбиваясь от всяческих посягательств.

Успехами на медицинском поприще выпускники Московской госпитальной школы принесли своей alma mater и ее руководителю Николаю Бидлоо заслуженную известность, а главное - заложили прочный фундамент для грядущих достижений российской хирургии.
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