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FROM THE HISTORY OF THE RUSSIAN OTORINOLARINGOLOGY

The beginning of otorhinolaryngology as an independent branch of medical knowledge was laid in the middle of the last century due to the development of endoscopy techniques. An ordinary mirror with an amalgam cleaned in the middle, then a concave mirror with a handle for receiving a focused beam of light and, finally, its improvement in the form of a frontal reflector made it possible to well illuminate the object under study. The use of the ear funnel, nasal dilator, putty knife and mirrors with a handle inserted into the pharynx made it possible to see the ear cavities and upper respiratory tracts hidden from direct examination.

Especially significant was the invention of the laryngoscope - the laryngeal mirror. It was invented in 1854 by the Spanish singer and one of the largest teachers of singing, professor of the Paris Conservatory and the Royal Academy of Music in London Manuel Garcia. He introduced a mirror on his long handle into his oropharynx and saw a reflection of the laryngeal cavity in a large mirror set in front of him. Using a laryngeal mirror, Garcia studied the physiology of the singers' voices. He owns the book "A Complete Treatise on the Art of Singing," which was reprinted and translated into Russian. The method of specular or indirect laryngoscopy developed by Garcia has become widespread in medical practice. In Russia, this technique was first used by the outstanding pediatrician and pediatric otorhinolaryngologist K.A. Rauchfusom. In the future, along with indirect research methods, direct ones began to be used. We are talking about direct hypopharyngo- and laryngoscopy, tracheo- and bronchoesophagoscopy.

Although otorhinolaryngology began in the middle of the last century, as early as the first half of the 19th century, a number of Russian professors, both surgeons and therapists, paid considerable attention to the diagnosis and treatment of diseases of the ear, nose and throat (I.F. Bush, K.F. Uden, H.H. Salomon, P.P. Zabolotsky-Desyatovsky, etc.). The ingenious Russian surgeon N.I. Pirogov, who often touched on the issues of ENT traumatology in his works, is rightly considered the founder of military otorhinolaryngology.

The 60-70s of the last century, characterized by the abolition of serfdom and the development of capitalism in Russia, were the years of a powerful and comprehensive upsurge of Russian culture. This rapid upsurge of Russian culture was in direct connection with the social democratic movement of the 60s. The culture of the Russian people in the second half of the XIX century reaches an exceptional height in all areas of knowledge. The advanced materialistic philosophy of the great Russian revolutionary democrats developed inextricably linked with natural science. The ideas of revolutionary democrats contributed to the general upsurge of Russian natural science and, in particular, medicine, put forward a brilliant galaxy of natural scientists, materialists, and advanced medical thinkers.

The Medical and Surgical Academy of the 60s, where the best representatives of Russian natural sciences worked, was the concentration of materialistic ideas in natural science and, in particular, in medicine. In this respect, particularly great achievements belong to the brilliant Russian scientist I.M.Sechenov, who worked at the Academy for ten years (1860-1870), which laid the foundation for the Russian physiological school. Professor SP Botkin, one of the founders of Russian scientific clinical medicine, sought to establish a close connection between clinical medicine and experimental physiology. To this end, S.P. Botkin for the first time in Russia creates in 1860-1861. at the academic therapeutic clinic, an experimental laboratory, and in 1878 invites I.P. Pavlov, then still a fifth-year student of the Medical and Surgical Academy, to head this laboratory. “For ten years of hard work, the two largest representatives of science - the physiologist Pavlov and the therapist Botkin - laid the foundations of modern scientific medicine," wrote Academician K.M. Bykov, one of the closest students of I.P. Pavlov.

In the middle of the last century, otorhinolaryngology was not yet taught as a separate medical specialty. S.P. Botkin closely watched the development of this young science. The famous therapist was well acquainted with the method of laryngoscopy, which is confirmed by one of his clinical lectures - "Paralysis of the left vocal cord, developed due to the pressure of the enlarged lymphatic gland on the return nerve during chronic pneumonia."

Thanks to the assistance of S.P. Botkin, in 1866, for the first time in Russia, the teaching of the course "Analysis of secretions, laryngoscopy and diseases of the larynx" was organized at the academic therapeutic clinic of the Medical and Surgical Academy under the guidance of privatocent D.I.Koshlakov. In 1870, at the clinic of S.P. Botkin, an otiatric office was also opened. Botkin resident A.F. Prussak became an associate professor in otiatrics.

In 1884, in connection with the election of D.I.Koshlakov as an ordinary professor at the hospital therapeutic clinic, the teaching of nasal and throat diseases was entrusted to resident S.P. Botkin N.P. Simanovsky.

Thus, S.P. Botkin owes a great merit to the development of domestic otorhinolaryngology. In 1901 addressing his students congratulating him on the 25th anniversary of his medical career, Simanovsky said that the main undertaking and the establishment in Russia of teaching ear, nose and throat diseases was to be owed to Sergei Petrovich Botkin, who had taken away our earlier than this abroad specialties befitting place and strongly supported the development of young science.

Already in the academic year 1884–85, Simanovsky systematically conducted theoretical and practical classes in “laryngology, nose and throat diseases” with fifth-year students, seconded by military doctors, as well as with a group of civilian doctors. The theoretical course was taught throughout the school year (1 hour per week).

Practical classes were held 2 hours 2 times a week and were organized in such a way that in each group they were conducted once a week with the analysis of outpatients, another time they were devoted to a more detailed clinical analysis of both inpatient and the most demonstrative outpatients. In addition, Simanovsky established contact with other clinics of the Academy, in particular, with the syphilitic clinic of Professor V.M. Tarnovsky and showed students various lesions of the upper respiratory tract in patients from these clinics. During the practical exercises, various operations were performed - tonsillectomy, tracheostomy, removal of foreign bodies, benign neoplasms of the larynx and others.

Every year the number of patients visiting the department increased. The number of military and civilian doctors who wanted to get acquainted with the new specialty also increased significantly. However, the conditions in which the department was located continued to be extremely difficult. The small "laryngeal department" naturally could not satisfy the requirements of medical, educational and research work. The absence of training facilities and the scarcity of tools were sharply felt. "The entire ENT equipment of N.P. Simanovsky (lamps, basins with tools, etc.), - V.I. Voyachek noted, - was so simple that it fit in one linen cart. " The Department of Otiatrics, headed by extraordinary professor A.F. Prussak, the author of the classical scientific works on otiatry, which brought him world fame, was even worse off. This department literally huddled in an academic therapeutic clinic, not having either a hospital or a special room for outpatient admission.

Recognizing the urgent need to open a special clinic and taking into account their repeated neglect of the leadership of the Military Medical Academy, N.P.Simanovsky and A.F. Prussak took decisive measures. In October 1890, they filed reports in which they reported that due to the lack of a rhinolaryngological and otiatric clinic and even a room specially designed to receive appropriate patients, as well as the lack of assistant assistants, they refused to give lectures on their specialties to doctors seconded to the academy for improvement. In connection with such decisive actions, a commission was created, which concluded that the establishment of a special clinic is extremely necessary for the successful teaching of diseases of the ear, nose and throat. At the end of 1892. it was allowed to allocate for the clinic of ear, nose and throat diseases part of the old building of the academy, which had previously been occupied by the clinic of psychiatry. The placement of the clinic and its equipment was carried out under the direct supervision of N.P. Simanovsky.

On December 27, 1892, the reception of outpatients was started in the new clinic, and on March 23, 1893 the clinic was opened for inpatients. On January 9, 1893, the head of the clinic was entrusted to an extraordinary professor N.P. Simanovsky. This was a major event in domestic medicine: in St. Petersburg, the first clinic of diseases of the ear, nose and throat was organized at the Military Medical Academy in St. Petersburg. In the year the new clinic was opened, the outstanding Russian realist artist N.A. Yaroshenko painted a very expressive portrait of Simanovsky. The scientist is depicted behind the pondering of the experiment, energetic, spiritualized.

Back in May 1892 The conference (the so-called Scientific Council of the Military Medical Academy) was deemed advisable to combine the Department of Ear Diseases with the Department of Nasal and Throat Diseases (at the same time it was found expedient to combine the Department of Syphilidology with the Department of Dermatology). On November 10, 1893, after A.F. Prussak resigned after seniority, the joint department of ear, nose, and throat diseases was transferred to the management of N.P. Simanovsky. Thus, Simanovsky was the first professor of otorhinolaryngology in Russia.

In 1893 at the insistence of Simanovsky, otorhinolaryngology was included in the number of compulsory subjects studied by students of the Military Medical Academy. "In this regard," said V.I. Voyachek, "the academy was far ahead of the most cultured countries of the West."

In accordance with the aforementioned, 1892-1893, the years of opening the first clinic in Russia of ear, nose and throat diseases, the association of the departments of otiatrics and rhinolaryngology, the inclusion of otorhinolaryngology in the subjects required for students (though only the Military Medical Academy) are very significant in the history of domestic otorhinolaryngology.

Nikolai Petrovich Simanovsky - the organizer of the first department and clinic of ear, nose and throat diseases in Russia, the creator of the first Russian school in this specialty - is rightfully considered the founder of Russian otorhinolaryngology. Motivated by a feeling of ardent patriotism and love for his specialty, N.P. Simanovsky obtained funds for the construction of a new building for the clinic, which fully meets the requirements of developing otorhinolaryngology. The new clinic was built in 1902, later it was expanded and reconstructed.

There were several professorships at the Military Medical Academy: associate professor, extraordinary professor, ordinary professor, honored ordinary professor. Since 1885 N.P. Simanovsky is affirmed in each of them. In 1907, he was awarded the highest academic title of academician.

Among the scientific works of academician N.P. Simanovsky’s work on physiology, therapy and otorhinolaryngology. His dissertation on the degree of doctor of medicine is called "On the question of the effect of sensory nerve irritations on the administration and nutrition of the heart." The topic was proposed by S.P. Botkin, the dissertation was carried out in a physiological laboratory led by I.P. Pavlov. This work was the first to present experimental data on the reflex origin of both changes in cardiac activity and trophic changes in the heart muscle under the influence of chronic irritation of the ends of the sensory nerves of internal organs, in particular the stomach and gall bladder.

Throughout his life, N.P. Simanovsky maintained close contact with I.P. Pavlov, was his great friend. In a collection devoted to the 75th birthday of I.P. Pavlov, one of his students V.V. Savich recalled: "One while Ivan Petrovich had to endure complete lack of money, he was forced to part with his family and lived alone in the apartment of his friend N. P. Simanovsky. " Information about the friendship between Simanovsky and I.P. Pavlov is also in the memoirs of S.V. Pavlova, the wife of Ivan Petrovich.

The creative connection and friendship of Simanovsky with I.P. Pavlov contributed to a certain orientation of a number of works both by Nikolai Petrovich himself and his textbooks, constantly aroused interest in the research of the great Russian physiologist.
So, Simanovsky is keenly interested in the work of the physiology department, led by I.P. Pavlov at the Institute of Experimental Medicine, organized in 1890, is actively involved in servicing the performances of Ivan Petrovich in the society of Russian doctors. Subsequently and I.P. Pavlov often used the ear and upper airways for his experiments. The objects of special study were auditory and olfactory analyzers. Until the last years of his life, Ivan Petrovich was interested in labyrinth reflexes.

N.P.Simanovsky owns classic studies of the nervous and muscle apparatus of the larynx, its lesions in tuberculosis. He is the author of monographs “On the epidemic ulcerative lesion of the mucous membrane of the mouth and pharynx”, “On inflammatory diseases of the lymphatic glandular tissue embedded in the root of the tongue”, and the guide “Diseases of the nose and its adnexal cavities”. He proposed a number of tools, including a frontal reflector on a cloth bandage, lubricants for the nasopharynx and larynx, grooved chisels, a sickle-shaped knife for opening a paratonsillar abscess.

N.P. Simanovsky founded the St. Petersburg Society of Otorhinolaryngologists and the journal Herald of Ear, Nose and Throat Diseases. To develop otorhinolaryngology in the Volga region, Simanovsky donates a large sum of labor savings to the construction of an ENT clinic at the University of Saratov and sends his student, M.F. Tsytovich, to lead it. This clinic is now named after Academician N.P. Simanovsky.

N.P.Simanovsky was a great master of the word, had a brilliant talent as a lecturer, his audience was always crowded with listeners. The richly illustrated, fascinating lectures of Nikolai Petrovich greatly contributed to the popularization of otorhinolaryngology, and attracted many students and young doctors to devote themselves to this specialty. In 1913, fourth-year students of the Military Medical Academy A. Melnikov, I. Nabatov, A. Pokrovsky, on their own initiative, using their notes, publish Lectures on Ear, Throat and Nasal Diseases, delivered in academic year 1912/13 by Academician Nikolai Petrovich Simanovsky. " In their preface, the publishers noted: “Of course, we acknowledge that, despite all efforts, our record cannot restore the impression of the lively, fascinating speech of our beloved professor teacher Nikolai Petrovich, who is always crowded with intense attention and deep interest. But we consider that by publishing this manual we will satisfy the urgent need of our fellow students, who wish to preserve the memory of what they heard and seen at the lectures of their talented professor. "

The founder of domestic otorhinolaryngology Nikolai Petrovich Simanovsky died in 1922.

The formation and development of otorhinolaryngology was largely facilitated by the outstanding therapist, reformer of higher medical education, Professor G.A. Zakharyin (1829-1897), who led the faculty of therapeutic clinic of Moscow University.

In Moscow, the first clinic of diseases of the ear, nose and throat was created with private funds in 1896. Its head from 1896 to 1914. was a private assistant professor S.F. Stein (in 1918 he headed the Department of Otorhinolaryngology, Faculty of Natural Sciences, People’s University in Tashkent, where he received the title of professor). The studies of S.F. Stein on the physiology and pathology of the inner ear. For an experimental study of dizziness, he proposed and introduced quantitative centrifugation into practical otiatrics. To provide the population with specialized medical care in our country, much attention is paid to the training of qualified otorhinolaryngologists; the network of ENT clinics and ENT departments is systematically expanding. In 1922 otorhinolaryngology was included in the program as a compulsory subject in all medical higher educational institutions. Research institutes were organized in our specialty - in Saratov, Leningrad, Moscow (now they operate in St. Petersburg and Moscow). New branches of otorhinolaryngology have been created and are successfully developing: pediatric otorhinolaryngology, military otorhinolaryngology, otoneurology, phoniatrics, surdology, ENT oncology, phthisiolaryngology.

The successor of N.P.Simanovsky in the department, Vladimir Ignatievich Voyachek, is rightfully considered one of the founders of otorhinolaryngology. V.I. Voyachek - author of manuals, textbooks and monographs, among which "Military otorhinolaryngology", M., 1946, "Fundamentals of otorhinolaryngology", L., 1953, "Methods of sparing otorhinolaryngological (diagnostic and therapeutic) effects", L., 1957.

He was the editor of the section "Gunshot wounds and injuries of the nose, throat and ear" in the multi-volume work "The Experience of Soviet Medicine in the Great Patriotic War of 1941-1945." Many of his scientific works are devoted to physiology, pathology, research methods of auditory and vestibular analyzers, motion sickness, deafness and speech defects. He proposed a uniform acumetric and vestibulometric formula (auditory and vestibular passports), a table of Russian words for examining hearing with speech, a method for studying barofunction of the ear (Voyachek ear gauge), double experiment with rotation (Voyachek otolithic reaction) to evaluate the function of the semicircular ducts and sacs of the vestibule . He developed a number of surgical interventions on the ear (trepanation with the help of Voyachek chisels), nasal septum (its reduction), larynx (counter-blast laryngomy), and also designed various tools to facilitate and simplify the operation technique.

From 1917 to 1956 V.I.Voyachek headed the Department of Otorhinolaryngology of the Military Medical Academy, in 1930 with his direct participation the Leningrad Research Institute of Ear, Throat, Nose and Speech was founded, the scientific director of which he was until the end of his life. Continuing the best traditions of N .P. Simanovsky, V.I. Voyachek created the largest school of otorhinolaryngologists. Many students of V.I.Voyachek became professors, prominent figures in otorhinolaryngology: V.F. Undrits, K.L. Khilov, R.A. Zasosov, G.G. Kulikovsky, N.A. Pautov and others.

A pleiad of prominent otorhinolaryngologists was brought up by a student and follower of N.P. Simanovsky, professor M.F. Tsytovich, who heads the Department of Otorhinolaryngology and the country's first research institute in this specialty in Saratov. The scientific and practical activities of MF Tsytovich and his students took place under the motto of a preventive orientation. In the epigraph to each issue of the Saratov otorhinolaryngological journal, it was indicated that this independent scientific discipline is most preventive. Many studies of the Tsytovich school are devoted to the study of the physiology of the upper respiratory tract, their functional connection with other organs and systems. MF Tsytovich - author of a textbook on otorhinolaryngology published in 1922.

Among other representatives of the school, academician Simanovsky, professors B.V. Verkhovsky, N.V. Belogolov, N.M. Aspisov, P.P. Shevelev, M.V. Bogdanov-Berezovsky should be especially noted.

The successes of domestic otorhinolaryngology were largely promoted by its outstanding figures A.F. Ivanov, L.I. Sverzhevsky, B.S. Preobrazhensky, A.G. Likhachev, A.I. Feldman, V.K. Trutnev, Ya.S. Temkin , I.I. Potapov (Moscow), L.T. Levin, L.E. Komendantov, D.M. Rutenburg, N.A. Karpov (Leningrad), S.M. Kompaneyets (Kharkov), A.I. Kolomiychenko (Kiev), N.N. Lozanov (Kazan), N.D. Khodyakov (Riga), A.R. Khanimirov (Rostov-on-Don) and many others.

The creator of one of the largest scientific and pedagogical schools in otorhinolaryngology was Boris Sergeevich Preobrazhensky. In 1936-1941 he headed the department of otorhinolaryngology of the 3rd Moscow Medical Institute, and from 1941 until the last days of his life - the department of the same name of the 2nd Moscow Medical Institute. Prepared 18 reports and 50 candidates of medical sciences. Among his scientific works are the monographs “Lumbar puncture as a therapeutic factor in ear diseases”, M., 1926; "Deafness", M., 1933; "Military-traumatic injuries of the ear, throat and nose", M., 1944; "Allergic diseases of the upper respiratory tract", M., 1969 (shared with others); "Sore throat, chronic tonsillitis and associated general diseases", M., 1970 (jointly with G.N. Popova). In collaboration with A.G. Likhachev and Ya.S. Temkin, he wrote a textbook on otorhinolaryngology, withstood 7 editions. B.S. Preobrazhensky is the author of the chapter on the history of otorhinolaryngology in the first volume of a multivolume guide to this specialty (M., 1960-1963).

In our country, the highest state scientific organization, the headquarters of medical sciences is the Russian Academy of Medical Sciences, which unites scientists who have made a major contribution to medical science and healthcare. The high scientific authority of Russian otorhinolaryngology is evidenced by the election of its representatives by academics and corresponding members of the Academy of Medical Sciences. These are academicians V.I. Voyachek (since 1944), B.S. Preobrazhensky (since 1950), N.A. Preobrazhensky (since 1975), I.B. Soldatov (since 1978), S.N. Khechinashvili (since 1980) and Corresponding Members of the Academy of Medical Sciences V.F. Undrits (since 1946), A.G. Likhachev (since 1963), Yu.B. Iskhaki (since 1978), Yu.M. Ovchinnikov (since 1994); V.R. Hoffman in 1994 was elected a corresponding member of the Academy of Cosmonautics.

For a large contribution to the development of medical science and the training of highly qualified specialists, three otorhinolaryngologists were awarded the highest State award - the title of Hero of Socialist Labor: V.I. Voyachek in 1961, B.S. Preobrazhensky in 1962, I.B. Soldiers in 1990

Otorhinolaryngologists group - A.I. Kolomiychenko, V.F. Nikitina, N.A. Preobrazhensky, S.N. Khechinashvili and K.L. Khilov - for the improvement and widespread introduction in medical practice of operations to improve and restore hearing in patients with otosclerosis in 1964 was awarded the Lenin Prize.

Among the Russian otorhinolaryngologists there are laureates of the USSR State Prize (A.A. Gorlin, Yu.K. Revskaya), many were awarded the honorary titles of Honored Scientist and Honored Doctor of the Republic.

The educational and methodical work of the departments of otorhinolaryngology of Russian medical universities is planned and carried out under the guidance of the Problem of the educational and methodological commission for otorhinolaryngology at the All-Russian Educational and Scientific-Methodological Center for Continuing Medical and Pharmaceutical Education of the Ministry of Health of the Russian Federation. The basic departments are the Department of Otorhinolaryngology of the Samara State Medical University and the Department of Otorhinolaryngology of the Moscow Medical Academy. The chairman of the commission is Academician of the Russian Academy of Medical Sciences I. B. Soldatov, Deputy Chairman - Corresponding Member of the Russian Academy of Medical Sciences Yu.M. Ovchinnikov.

The commission compiled a single integrated program, guidelines for self-training for practical exercises. They are approved and published. These important educational and methodological documents must be used when studying otorhinolaryngology.

In 1993, the All-Russian Scientific Conference dedicated to the 100th anniversary of the first in our country Department of Otorhinolaryngology was held in St. Petersburg. At the plenary session, reports were presented "NP Simanovsky - a student of SP Botkin and a friend of IP Pavlov" and "The role of the school of VI Voyachek in the development of domestic otorhinolaryngology." Summarizing reports were made on the published theses: "The role of the Military Medical Academy in the development of military otorhinolaryngology", "Questions of physiology and pathology of hearing", "Vestibulology - theory and practice", "Laryngology - development and modern problems", "Rhinology - treatment, surgery, methods research "," Actual problems of the pathology of the pharynx and tonsils "," Development of domestic otorhinolaryngology and the organization of ENT care "," Problems of pediatric otorhinolaryngology. Conference participants attended the opening of the memorial plaque to Academician V.I. They visited Voyachek and the Theological Cemetery, where they laid wreaths on the graves of the Masters - V.I. Voyacheka, K.L. Khilova, R.A. Zasosova. For the anniversary conference in St. Petersburg, the second edition of the book "N.P.Simanovsky - the founder of Russian otorhinolaryngology" was published.
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FROM THE HISTORY OF THE RUSSIAN OTORINOLARINGOLOGY

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