OBSTETRICS AND GYNECOLOGY

 

History of medicine

New time

CLINICAL MEDICINE OF NEW TIME (1640-1918)

OBSTETRICS AND GYNECOLOGY

 

Obstetrics (from. Accoucher to help with childbirth) —the study of pregnancy, childbirth and the postpartum period and gynecology (from the Greek. Gyne, gynaik (os) - woman; logos - teaching) - in the broad sense of the word - the theory of woman, in narrow sense - the study of women's diseases - are the oldest branches of medical knowledge. Until the XIX century. they were not separated, and the teaching of women's diseases was an integral part of the teaching of obstetrics.

 

The first information about obstetrics and women's diseases is contained in the medical texts of the ancient East :, Chinese hieroglyphic manuscripts, Egyptian papyrus ("gynecological papyrus" from Kahun, XIX century BC., And papyrus G. Ebers, XVI century! BC e.), Babylonian and Assyrian cuneiform tablets, (II — I millennium BC.), Indian Ayurvedic texts. They talk about women's diseases (displacement of the uterus, tumors, inflammation), dietetics of pregnant, normal and complicated childbirth. In the samhita of a famous surgeon in ancient India, Sushruta mentions the wrong position of the fetus in the uterus and the operations of turning the fetus on the pedicle and on the head, and in necessary cases about fetal extraction by fruit-destroying operations.

 

 

The Hippocratic Collection contains a number of special works: On the Nature of a Woman, On Female Diseases, On Infertility, and others, which describe the symptoms of uterine diseases and methods for removing tumors with forceps, a knife, and red-hot iron. The ancient Greeks also knew about Cesarean section, but they only produced it on a dead woman in order to extract the living fetus (according to mythology, this is how the Askulepius god of healing was born). Note that the first reliable information about the successful operation of cesarean section on a live woman in labor refers to 1610, it was produced by German obstetrician I. Trautmann (I. Trautmann) in Wittenberg. In the final period of the history of ancient Greece, the epoch of Hellenism, when Alexandrian doctors began to perform anatomical dissections, the practice of obstetrics and gynecology began to stand out as an independent profession. Thus, the famous obstetrician of his time was a student of Herophilus Demetri from Apamea (II century BC). He studied the development of pregnancy, the causes of pathological labor, gave an analysis of various kinds of bleeding and divided them into groups. Another Alexandrian doctor Kleofant (II century BC) compiled an extensive essay on obstetrics and female diseases.

 

 

In the I — II centuries. n e. in Rome, he worked as a surgeon and obstetrician Archivist, who for the first time applied a mirror to him, when he examined the vagina and cervix, called a diopter. Gynecological mirrors and other surgical instruments were discovered during the excavations of the ancient Roman cities of Pompeii and Herculaneum, buried under the ashes of the volcano of Vesuvius in 79 gn (see Fig. 59 on p. 127).

 

Very valuable special works of Roman doctors on obstetrics and female diseases have come down to us. Among them is the work of the female midwife Aspasia (II cent.), Which describes the methods of conservative and operative treatment of female diseases, pregnancy hygiene, care for the newborn, and the classroom of renowned doctors of ancient Rome —A. C. Celsus, Soran of Ephesus, Galén of Pergamum. They were aware of various methods of obstetric and gynecological examination, the operation of rotating the fetus on the leg, extracting it by the pelvic end, embryotomy; they were familiar with gineta-lye tumors (fioromyoma, cancer), uterine displacement and prolapse, inflammatory diseases, and universities were mainly engaged in compiling and commenting on individual manuscripts of ancient authors, the doctors and philosophers of the medieval East retained a valuable empirical heritage of the ancient world (and Abu Bakr ar-Razi, Ibn Sina, Ibn Rushd and others).

 

 

In the Renaissance, the development of scientific anatomy (A. Vesalius, J. Fabrizius, G. Fallopius, V. Evstakhiy) and physiological knowledge created the prerequisites for the development of scientific obstetrics and gynecology. The first extensive guide to women's diseases “De mulierum affectioni-bus” in Western Europe was compiled in 1579 by Luis Mer-Cado (Mercado, Luis, 1525–1606) - professor at the University of Toledo (Spain).

 

Ambrois-Páre activity (see p. 194) was of great importance for the development of obstetrics and gynecology, which returned to obstetrics the neglected operation of turning the fetus on the leg, introduced gynecological mirrors into a wide practice and organized the first obstetric department at the Paris hospital Hotel-Dieu and the first in Europe obstetric school. Only women were accepted into it; The training lasted 3 months, of which 6 weeks were devoted to practical training.

 

 

The formation of obstetrics as an independent clinical discipline began in France at the turn of the 17th — 18th centuries. To a large extent, this was facilitated by the organization of obstetric clinics. The first one was opened in Paris (XVII .th century) in the Hotel-Dieu hospital. The first school of French obstetricians was formed here, a prominent representative of which was Francois Morisso (Mauri-ceau, Francois, 1637-1709) —the author of the capital guidance on the diseases of pregnant women (“Traite des maladies des femmes grosses et accouchees”, 1668), who proposed several new obstetric operations and instruments.

 

The XVIII century was the period of the formation of obstetrics in England, Holland, Germany, France, Russia and other countries. So, in 1729 the first maternity hospital in Europe was opened in Strasbourg. In 1751 the first university obstetric clinic was organized in Göttingen, where students were taught:

 

 

The formation of obstetric education in Russia is associated with the name of P. 3. Kondoidi (1710-1760). In the 50s of the XVIII century. he was appointed to the post of arhiatra - senior doctor of the Medical Office, established instead of Aptekarsky order. 1723 in accordance with the reforms of Peter I. At the suggestion of P. 3. Kon ~ doidi Senate in 1754 issued a decree "On the decent establishment of Babichiev case in favor of society." In 1757, “Babicha schools” were created in Moscow and St. Petersburg, which prepared “jurors” (educated midwives, or midwives). They were taught in them. Initially, foreigners: one doctor (a professor of medical care) and one doctor (obstetrician). In the first years of study was only theoretical. Then, after the opening of the first mid-term (maternity) departments in Russia for 20 beds at the Moscow (1764) and St. Petersburg (1771) Nursing Homes, it became practical and practical. awesome course. At first, education in the Babish schools was ineffective. There were significant difficulties in recruiting students: for example, in 1757 there were 11 registered in Petersburg, and 4 midwives in Moscow — they made up a very limited reserve of enrollment. As a result, in the first 20 years, the Moscow School prepared a total of 35 midwives (five of whom were from Russians and the rest were foreigners).

 

In 1784, Nestor Maksimovich Maksimovich-Ambodik (1744–1812) began to teach at the Petersburg Babich’s School — the first Russian professor of the secondary arts (1782), one of the founders of scientific obstetrics, pediatrics and pharmacognosy in Russia. In 1770, after graduating from the St. Petersburg Hospital School, he was sent on a special scholarship to the Medical Faculty of the University of Strasbourg, in which in 1775 he defended his doctoral dissertation on the human liver (“De hepate humano”).

 

Returning to Russia, N. M. Maksimovich-Ambodik organized the teaching of a woman's business at a high level for his time: he acquired obstetric tools, accompanied by lectures with demonstrations on the phantom and at the bed of women in labor, Phantom of the female pelvis with a wooden child, and straight and curved steel tongs ("Pincers") with wooden arms, a silver catheter and other instruments were made according to his own models and designs.

 

His capital work, The Art of Pawing, or the Science of the Babi Case (Fig. 148), was the first original Russian manual on obstetrics and pediatrics. N. M. Maksimovich-Ambodik first began teaching obstetrics in Russian. One of the first in Russia, he used obstetric forceps (Fig. 148).

 

The first model of obstetric forceps was developed in England in 1569 by doctor Guilom Chamberlain (Chamberlen, Guillaume, 1540-1596) and improved by his eldest son Peter Chamberlain (Chamberlen, Peter, 1560-1631). Unfortunately, this invention remained the secret of the Chamberlain dynasty for several generations; Obstetric forceps began to enter the wide clinical practice only in 1723, when the Dutch anatomist and surgeon J. Palfin (Palfyn, Jean, 1650-1730) presented several samples of his own invention to the Paris Academy of Sciences for testing. Palfin's tongs differed significantly from what we know today, first of all, by the imperfection of the design: they consisted of two wide, non-intersecting steel spoons on wooden handles that were tied together after being applied to the head.

 

However, this does not diminish the value of its discovery. The first description of Palfin's forceps appeared in 1724 in the second edition of the “Surgery” manual by L. Geister (see p. 288), and new modifications were immediately created on their basis. The French obstetrician Andre Levre-Re (Levret, Andre, 1703-1780) gave his long forceps pelvic curvature, improved the lock, bent the ends of thin-crooked arms outwards, established the indications and methods of using his model. The tongs of the English obstetrician William Smelli (Smelli, William, 1697-1763) were very short and had a very perfect lock that became typical of all subsequent English systems. James Simpson’s tongs (Simpson, James sir, 1811–1870), on the contrary, were long, but light, and distinguished by the mobility of a castle.

 

 

In Russia, obstetric forceps began to be used in 1765, when the first professor of the Medical Faculty of Moscow University, I. F. Erasmus, who began teaching obstetrics at the Department of Anatomy, Surgery, and Woman's Art in 1765, began using them in labor.

 

Among the numerous modifications of obstetric forceps created in Russia, the most famous are the shchitspy of Kharkov professor I. P. Lazarevich (1829-1902). They differed insignificant pelvic curvature and the absence of overlapping spoons. Over time, many models of obstetric forceps were created in different countries of the world. Some of them were good only in the hands of their creators, others became world famous, but one thing is for sure - their invention significantly reduced the number of fruit-destroying operations and mortality in childbirth.

 

 

In the second half of the 18th century, Moscow and St. Petersburg became centers of Russian obstetric science. In 1797, a maternity hospital with 20 beds was established in St. Petersburg, and under it: - A secondary school for 22 students (now the Institute of Obstetrics and Gynecology of the Russian Academy of Medical Sciences).

 

Since 1798, after the establishment in St. Petersburg and Moscow medical and surgical. At the same time, the obstetrics teaching began to be conducted at independent departments of midwifery science. The first professor of obstetrics at the Moscow Medico-Surgical Academy was G. Frese. The first professor. Obstetrics at the St. Petersburg Academy of Medical Surgical became I. Conradi.

 

 

In 1790, Wilhelm M. Richter (1783-1822) headed the department of midwifery at Moscow University. After graduating from the Faculty of Medicine in Moscow, he received a doctorate in medicine from the University of Erlangen. Return to Alma Mater, V. M. Richter opened at the Clinical Institute of Moscow University a Grading Institute for 3 beds (in 1820 their number increased to 6). Thus, the idea of ​​clinical teaching of obstetrics in Russia was carried out in practice.

 

The introduction of ether (1846) and chloroform (1847) narcosis, the onset of prophylaxis of puerperal fever (1847, see p. 245), as well as the development of teaching about antisepsis and asepsis (see p. 246) opened wide opportunities for obstetric and gynecological practice. All this, together with the achievements in the field of morphology and physiology of the female body, contributed to the successful development of gynecology and its release in the middle of the XIX century. in independent medical discipline.

 

 

In Russia, the first gynecological departments were opened in St. Petersburg (1842) and Moscow (1875). Alexander Aleksandrovich Kiter (1813–1879), a talented student of N. I. Pirogov, initiated the surgical area in Russian gynecology. For 10 years (1848-1858), A. A. Kiter headed the Department of Obstetrics with a study on women's and children's diseases at the St. Petersburg Medical and Surgical Academy; He wrote the first gynecology textbook in Russia, “A Guide to the Study of Female Diseases” (1858), and produced the country's first successful intravaginal surgery for the removal of a uterus affected by cancer (1842). A major contribution to the development of operative gynecology and operative obstetrics was made by the student A. A. Kiter and Anton Yakovlevich Krassovsky (1821-1898). He was the first in Russia to perform successful operations of ovariotomy (oophorectomy) and uterus removal, and he constantly improved the technique of these operative interventions; proposed an original classification of narrow pelvis forms, clearly separating the concepts of “anatomically narrow pelvis” and “clinically narrow pelvis”, and developed indications for overlay obstetric forceps, limiting their undue use in a narrow pelvis.

 

 

For the first time in Russia, on the basis of the Medical-Surgical Academy, he organized a broad clinical training of obstetricians and gynecologists, introduced a system of postgraduate improvement in this area. His "Course of practical obstetrics" has long served as the main guide for domestic obstetricians and gynecologists. A. Ya-Krassovsky organized the first in Russia Petersburg Obstetric-Gynecological Scientific Society (1887) and the first in this area “Journal of Obstetrics and Women's Diseases” (1887). The teaching of gynecology as an independent discipline was introduced in Russia on the initiative of Vladimir Fedorovich Snegirev (1847–1916) —one of the founders of Russian gynecology. In 1889, he set up the first gynecological clinic in our country at Moscow University, which he managed until 1900.

 

A great contribution to the development of obstetrics and gynecology in Russia was also made by Frese, I. Konradi, SA Gromov, S. F. Khotovitsky, G. P. Popov, 'D. I. Levitsky, I. P. Lazarevich, V. V. Stroganov and others.

 

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