INFECTIOUS DISEASES AND EPIDEMIOLOGY. CLINICAL MEDICINE OF NEW TIME 1640-1918

 

History of medicine

New time

CLINICAL MEDICINE OF NEW TIME (1640-1918)

INFECTIOUS DISEASES AND EPIDEMIOLOGY

 

Epidemiology (Greek. Epidemia - from epi - above, demos - people; logos - teaching) - the science of the causes and laws of the mass spread of infectious diseases, methods of their prevention and elimination.

 

As a science, epidemiology was formed in the 19th century, but its roots go back to the history of the ancient world, when, long before the revealed nature of contagious diseases, doctors were faced with the need to combat them.

 

Indian ayurveda and the laws of Manu, the hieroglyphic writings of ancient China, Homer's Iliad and Odyssey, the works of historians, philosophers and doctors report about contagious diseases. It should be noted here that the work of the “Hippocratic Collection” - “Epidemics” is dedicated not to infectious diseases, but to non-infectious diseases that are widespread among the people (see p. 101). Contagious diseases were especially prevalent in the Middle Ages, when frequent predatory wars and crusades were fought, and the growth of cities contributed to the crowded population and the deterioration of sanitary and hygienic living conditions.

 

The emergence of epidemiology as an independent branch of medicine is associated with the name of the outstanding Renaissance scholar Girolamo Frakastoro (1478-1553), who laid the foundation for the theory of "contagion" - a living, infectious principle secreted by a sick organism (see p. 194). The doctrine of "contagion" significantly shaken the previously existing notions of "miasmas" - "contagious fumes" in the air, which, as supporters of the doctrine of "miasmas" believed, cause epidemics of general diseases, standing out from the soil and water under certain conditions (especially with the processes of decay).

 

Throughout the history of the new time, epidemics continued to rage around the globe — mass infectious diseases across the city, country, region — and pandemics (Greek pandemia — the whole people) —extremely strong epidemics that span across several countries and continents. They hit a huge mass of the population. Their geography has steadily expanded.

 

 

In the XVI — XVII centuries. Smallpox has spread throughout the world, one of the oldest infectious diseases known in the Old World since the 3rd millennium BC. e. At the beginning of the XVI century. It was first introduced by the Spanish conquistadors to the Americas. The number of casualties in the territory of modern Mexico amounted to 3.5 million people. Before the introduction of smallpox according to E. Jenner's method, only in Europe, about 10 million people got smallpox each year, of which between 25 and 40% died.

 

High mortality from infectious diseases, which, as a rule, exceeded casualties during hostilities, was also associated with frequent epidemics of influenza. Only in the XVIII century. Of the seven major influenza epidemics, four have become pandemic.

 

 

In 1817, cholera was first imported from India to Europe, which until that time was spread only within Southeast Asia (the valleys of the Ganges and Brahmaputra rivers were endemic centers of cholera). Over the next century, the world was shaken by six cholera pandemics. They had disastrous consequences for all the continents of the globe. In the XIX century. in Russia alone, there were eight cholera epidemics, in which more than 2 million people died. The beginning of the study of this "new" disease for Russia was laid by the Decembrist doctor N. G. Smirnov (1829), I. Ye. Dyadkovsky, M. Ya. Mudrov (1831).

 

Epidemics of yellow fever and typhus, tetanus and malaria, dysentery and helminthiasis also caused enormous damage to humanity.

 

 

However, plague epidemics were the most devastating. After its second pandemic (1346–1348), which went down in history as the “black death” and killed a third of Europe’s inhabitants, outbreaks of the plague periodically recurred in different countries of the world: England (London, 1665), France (Marseille and Toulon, 1720–1721 ), Russia (Moscow, 1654–1655, 1770–1772), and so on. In 1892, the third pandemic of the plague was born in Southeast Asia. Going beyond, the continent through the port cities, it quickly covered Europe, Africa, Australia, North and South America. During the 10 years of its funeral procession, the third pandemic plague claimed more than 12 million human lives.

 

In Russia, Danila Samoilovich Samoildvich took an active part in the fight against plague epidemics in various cities of the country (1742-1805). Having received a medical education in Petersburg, he continued it in Strasbourg and Leiden, where in 1780, he defended his doctoral dissertation. After that, for three years he became acquainted with the organization of a medical business in England, France, Germany and Austria.

 

DS Samoylovich recognized the wildlife of the causative agent of diseases, was a supporter of the contagious theory of the spread of infection and for the first time put forward the idea of ​​the specificity of the plague. Using one of the first microscopes of the Dellebar system, he attempted to detect this microorganism, the causative agent of the plague, which was discovered almost a century later by the French scientist A. Yers-sen (A. Yersin, 1894), in the patient’s secretions and the tissues of the dead.

 

During the "pestilence in the capital city of Moscow" in 1770-1772. D.S. Samoilovich worked at the Commission for the Prevention and Healing of a Pestilence (Fig. 138), experienced the disinfecting effect of the means proposed by the Commission, and burned his hands so that “marks like potholes and ruptures remained on them after his death. " Samoylovich repeatedly put on his clothes removed from patients with plague and smoke-smoked clothing, thereby proving the effectiveness of the proposed measures to protect against infection. The experience of the struggle of Russian doctors with a “pestilence” in Moscow is summarized in the fundamental work of the senior doctor of the General Land Hospital A. F. Shafonsky.

 

 

As the chief doctor of the South of Russia, D. S. Samoilovich actively participated in the fight against plague epidemics in the Crimea, Kherson and Yekaterinoslav provinces. For the first time in Russia, he gave a detailed description of the clinical picture of the plague, studied the conditions of its spread and the pathological anatomy of the plague.

 

In 1803, he made the first attempt to inoculate against the plague, using the contents of a ripe bubo sick with plague. Thus, he tried to find a way to vaccinate a weakened infectious principle: “... my aspiration will be fulfilled ... and we will see that the deadly ulcer that infects the plague as much as the people will no longer be as dangerous as smallpox grafting. " D.S. Samoilovich's long-term studies are summarized in his fundamental work “Description of Microscopic, Studies on the Essence of the Ulcer Poison” (1792-1794), published in Petersburg, as well as in “Memoi-sur la peste, qui, en 1771, ravagea 1'empire de Russie, surtout Moscow, la capitale "(Paris, 1783) and others. The international recognition of the merit of D.Sa-Moilovich in the fight against plague was his election as an honorary member of 12 foreign academies.

 

In the history of mankind, plague was the most formidable infectious disease. During Napoleon's campaigns in Egypt and Syria (1798-1799), when the victims of the plague exceeded the losses from military operations, Napoleon made a well-known visit to the plague hospital in the ancient city of Jaffa occupied by the French army on the eastern coast of the Mediterranean Sea (Fig. 139). Demonstrating first of all his greatness and courage, he also tried to show that not everyone gets sick in the city afflicted by the plague, and thus calming the population trembling before the plague.

 

 

The study of the plague, as well as other infectious diseases, was empirical until the second half of the XIX century, when a new science was formed - bacteriology, the founder of which was R. Koch (see p. 249). Bacteriology has opened up opportunities for evidence-based anti-plague interventions that culminated in the complete elimination of plague epidemics on the globe in the 20th century. Stages of this. the ways are the discovery of the causative agent of plague (G. I. Minch, 1878; A. Yersen, S. Kitazato, 1894), evidence of the participation of rats (A. Yer-sen, 1894) and the role of fleas (M. Ogata, 1898) in the spread of infection , the development of the theory of natural foci (DK Zabolotny, 1899) and the creation of an effective vaccine against plague (V.M. Khavkin et al., 1897–1926).

 

These are the main milestones of the centuries-old struggle of mankind with the most dangerous infectious diseases.

 

Starting from the second half of the XIX century. epidemiology and the study of infectious diseases developed in close connection with the successes of bacteriology (L. Pasteur, I. I. Mechnikov, R. Koch), immunology (I. I. Mechnikov, P. Er-lih), virology (D. I. Ivanovsky) and other biomedical disciplines, as well as in connection with the commencement of social and hygienic studies (see pp. 313-316).

 

 

The discovery of pathogens of a number of infectious diseases (Table 11) made it possible to scientifically based study them and eliminate these diseases across states, regions, continents, and sometimes the entire globe (for example, the elimination of smallpox).

 

Recognition of merit of scientists in this field of medicine is the award of the Nobel Prizes to R. Ross (1902) for his work on malaria and A. Laveran (1907) for his work on the role of protozoans as causative agents of diseases (including the discovery of the causative agent of malaria), R Koch (1905) for research and discoveries in the field of tuberculosis (including for the discovery of the causative agent of tuberculosis), I. I. Mechnikov and P. Ehrlich (1908) for developing the theory of immunity (see p. 248).

 

 

Discoveries in this field of medicine continue in the period of modern history: the Nobel Prize winners were G. Domagk (1939), who substantiated the use of sulfonamides for the treatment of bacterial infections, A. Fleming, E. B. Chein 'and H. U. Flory (1945) received peny- 'tsillin. and who studied its therapeutic effect in the treatment of various infectious diseases; 3. Wax-Man (1952), who discovered streptomycin is the first antibiotic that is effective against tuberculosis. Soviet scientists DK Zabolotny, N. F. Gamaleya, L. V. Gromashevsky, E. N. Pavlovsky, E. I. Martsinovsky, 3. V. Ermolyeva and many others made a major contribution to the fight against infectious diseases.

 

 

In the history of the fight against infectious diseases, more than in any other field of medicine, the heroism of the medical profession is revealed. It is also present in the everyday risk of the physician being infected with a severe (sometimes incurable) disease, and in a deliberate and purposeful decision to conduct an experiment on himself. Most of the doctors' experiences on themselves ended tragically, and nevertheless, the new enthusiastic doctors again and again exposed themselves to the danger of infection, thus comprehending the ways of transmission, the measures of its prevention and treatment, “shining for others, burning ...” - Aliis inserviendo uror. H. van Tulp.

 

 

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