Hygiene (from the Greek. Hygiis - healthy) - the science of maintaining and improving health. As a field of empirical knowledge, it originated in ancient times and developed along with folk healing.

The formation of hygiene as a science is associated with the success of natural science and in many countries of the world occurred during the period of the formation of manufacturing production and the formation of capitalist relations. Hygiene became an independent scientific discipline in the second half of the XIX century.

Public (social) medicine (lat. Socialis — public, comradely) in the broad sense of the word is understood as the science of preserving public health, warning and treating diseases.

In different countries, the term “social (social) medicine” is understood in different ways: from a more general understanding of social medicine — the science of population health preservation (in most countries of the world) to a more specific definition of social medicine as a social medical activity of advanced medical workers. and other segments of society to improve the health care of the population (the definition of prof. M. M. Levit, referring to pre-revolutionary "Russia).

The formation of social (social) medicine as a science in different countries of the world took place at the same time - in those periods of the history of each country, when capitalist production was affirmed and bourgeois society was formed.

In Russia, social and medical activities began in the first half of the nineteenth century (in close connection with the ideas of the Russian Enlightenment and the Decembrist movement) and took shape in the 1950s and 1960s. XIX century. (in the period of the movement of revolutionary raznochintsev).

In Western Europe, in the most economically advanced countries (the Netherlands, England, France), capitalist production relations originated in the XVI century.

The first form of capitalist production — simple cooperation — led to the emergence in the middle of the 16th century. manufactory production, which dominated in Europe until the last quarter of the XVIII century, i.e.; down to the industrial revolution in England.

Manufacturing (from the Latin. Manus - hand; factare - to do); was based on the division of labor! between wage workers and apply-! nii manual equipment. This led to a further increase in productivity | labor and labor concentration.

The ranks of workers manufactories replenished ravaged artisans, bush-! ri and peasants. The most haves; Representatives of the estates of the medieval city — merchants, usurers, and individual workshop masters — turned into the bourgeoisie. Thus, at the (stage of manufacturing): the formation of two new social classes — the bourgeoisie and the wage-workers — was already under way.

Developing manual production, the bourgeoisie was interested in increasing the number of hired workers. This was prevented by the high mortality rate of the population, which could lead to an economic catastrophe. There was a need for at least an approximate account of the number of employees. It was first made in England - a classic country of primitive accumulation of capital. In 1527 (according to some sources in 1517) “bills of mortality” began to be issued in London. In the difficult years of epidemics, they came out weekly. The data presented in them were incomplete and largely inaccurate, and therefore could not yet objectively reflect the real state. Nevertheless, the very fact of the compilation of mortality tables, the attempt to record, store and initial analysis of data on mortality of the population were of great social importance.

The first analysis of mortality tables in London for 1603-1653. John Graunt made (Graunt, John, 1620— 1674) —the merchant of haberdashery and music teacher, who became one of the founders of demographic statistics (from the Greek. Demos — the people; grapho — I write; Lat. status — the state, position).

In 1662, J. Graunt published the book Natural and Political Observations on the Records of the Dead, mainly in relation to management, religion, profession, population growth, air, disease, etc., of the City of London (“Natural and political observation on the goverment of the city of London It was reprinted five times in a short time. In his work, J. Graunt made an attempt to establish statistical patterns of mortality in relation to age, sex, lifestyle, and certain diseases. He also showed that the death rate in London exceeds the birth rate and that the growth of the city’s population is due to the influx of rural population. A month after the publication of the first edition of the book, J. Graunt was elected a member of the Royal Society - the Royal Society of England - the first in the new history of the Academy of Sciences, which still exists under the same name.

Originally, demographic statistics were called political arithmetic. This term was introduced by William Petty (Petty, William, 1623— 1687) —the English revolutionary doctor. Cromwell’s army, O. Cromwell’s personal physician, England’s “general surveyor”, member of the Royal Society (1662).

The interest of some doctors in political economy and their participation in solving state economic problems were characteristic of the time when mathematics, becoming the “queen of sciences”, was widely used in the study of phenomena of living nature (Yatro-Mathematics, Yatro Mechanics, Yatrophysics). “There is nothing more convincing than the number, measure and weight, if only they are correct,” wrote W. Petty. He believed that "the good of the country must be sought in the productive force of the man himself," and therefore "a country with eight million inhabitants is more than twice as rich as the country where four million live on the same territory."

The main works of W. Petty are “Notes on the Dublin Mortality Bulletin” (1666) and “Political Arithmetic” (1683). Studying the mortality of the population as a doctor and statesman, W. Petty went further than J. Graunt. He was interested in the number of doctors, the number and condition of hospitals and shelters, the effect of epidemics on population decline, and also tried to determine the dependence of morbidity and mortality on their professional occupations.

The first attempts to link the diseases of miners and foundry workers with professional poisoning with lead, mercury and antimony were undertaken by an outstanding Renaissance scholar, a Swiss physician and chemist Theophrast Bombast von Hohenheim (Paracelsus, 1493-1541) (see p. 190). Even then, he was talking about an individual approach to the treatment of diseases of workers in various professions: the doctor should know “what can help a blacksmith, that a painter, a tanner, a woodcutter, a woodworker, a hunter, a fisherman, or a warrior ... ". A contemporary of Paracelsus, the German doctor, metallurgist and mineralogist Georg Agriko-la (Bauer, 1494–1555), describing the diseases of the workers, offered not only treatments, but also measures to prevent them: protective shoes and clothing, enhanced nutrition, and the installation of ventilation “ventilation machines” and Mine ladders, strengthening of the arches of the mines with special supports, removal of groundwater, etc. After the work of Paracels and Agricola, the diseases arising from the hardships of manufactory production became the subject of special attention: cing Europe.

The founder of occupational pathology and occupational health as a branch of medicine was the Italian doctor Bernardino Ramazzini (Ramaz-zini, Bernardino, 1633-1714, fig. 150). Being a city doctor in various parts of Italy, and then a university professor in Modena and Padua, he “did not stop to visit the most unsightly workshops and learn the secrets of mechanical crafts”.

“It is clear to everyone,” he wrote, “that there are different crafts in different areas and that different diseases may arise in connection with them. Exactly at; artisan workshops ... I tried to get information on how to prevent diseases that artisans usually suffer, and how! treat them. ”

B. Ramazzini summarized his long-term research in the classic treatise “On the Diseases of Artisans” (“De morbis artificum diatri-ba”, 1700), which was. translated into many European languages ​​and reprinted over 25 times. It describes the working conditions and diseases of workers in more than 60 professions, those “whose work is painful and dirty, but all | as necessary, it creates a lot of benefits that people enjoy>. B. Ramazzini analyzed the causes of diseases, suggested possible methods for their treatment and prevention, and demanded improvement in the working conditions of manufacturing workers.

The work of B. Ramazzini went far beyond the limits of clinical medicine; it provided materials and an incentive for studying industrial pathology.

In Russia, the first attempts to account for the size of the (male) population of the country were undertaken under Peter I and are associated with conscription. The “spiritual regulations” (1722) ordered the priests to “have everyone in them books, which usually denied metrics, that is, notebooks in which to record the birth of their babies, birth and baptism with the meaning of the year and day and with the name of the parents” registration of the dead before baptism and every four months “to notify about this in writing to the synod”. However, in the first half of the XVIII century. birth and death records were made with large gaps and did not give a true idea of ​​the size of the male population, especially after the death of Peter.

One of the companions of Peter I, a prominent statesman of Russia V.N. Tatishchev (1686-1750) - historian, geographer, creator of the military industry in Russia and, in particular, workshops in the Urals (now the Nizhny Tagil plant) - was in 1724 and sent around the country an extensive questionnaire from the Academy of Sciences (198 items) on local epidemics of general diseases and the means of their treatment. Later, MV Lomonosov developed a 30-point questionnaire that was more convenient for filling in and analyzing. And despite the fact that they did not manage to collect complete answers to these questionnaires, they served as the beginning of future medical topographic descriptions that played an important role in the study and development of the Russian economy.

M. V. Lomonosov (see p. 262) repeatedly paid attention to protecting the health of the Russian people, whose increment he considered "the most important thing," for it "consists of the majesty, power and wealth of the entire state, and not in vastness, in vain without inhabitants.

In 1761, M. V. Lomonosov wrote an extensive letter “On the Reproduction and Preservation of the Russian People,” which he sent to a major statesman of Russia, Count I. I. Shuvalov. In the letter, which was the result of in-depth scientific research, he made an attempt to directly account for newborns and showed the damage inflicted on Russia by high infant mortality: “Let us suppose that there are 12 million males in Russia ... half a million will be born each year of which in three years half or more will die, due to local neglect, and more, so every year. get on a hundred thousand babies no more than three years. Is it not worth our work and care for us, so that at least a tenth, that is, 10 thousand, could be kept in convenient ways in life? ”

He drew attention to the insufficient number of doctors and pharmacies, poor assistance during childbirth, condemned the custom to baptize children in cold water, spoke about the dangers of "gluttony and drunkenness" during religious holidays, etc., and, based on his analysis, set specific objectives aimed at developing a medical business in Russia. This is the preparation of a sufficient number of healers and midwives from the “born Russians”, the creation of a textbook on midwives, the organization of the struggle against “morons fad” ), etc. The advanced ideas of M. V. Lomonosov largely determined the further development of the medical business in the country. Their implementation stretched out over many decades and was carried out by his students and followers.

At the end of the XVIII century. Mathematics, physiologist and physician D. Bernoulli (1700–1782) and physicist L. Yu. Kraft (1743–1814), who was involved in “political arithmetic”, developed questions of sanitary statistics in Russia.

At the turn of the XVIII and XIX centuries. The work of S. G. was devoted to the development of sanitary statistics. Zybelina, the first professor of the Moscow University of the “born Russians” (see p. 262) and N. M ~. Maksimovich a-Ambodika (see p. 300), who wrote: “Common sense dictates more about the reproduction of people by diligent observance [of newborn children than by the population of uncultivated land by unknown foreign aliens” (the epigraph to “Art. business ").

In the first half of the XIX century. P. P. Pelekhin (1794–1871), Professor of Forensic Medicine and Medical Police at the St. Petersburg Medico-Surgical Academy, studied the issues of demography and sanitary statistics.

A major role in the development and implementation of sanitary statistics in Russia was played by scientific societies: the Society of Nature Testers and the Phyto-Medical Society at Moscow University, the Free Economic Society “to encourage agriculture and house building in Russia and] Dr.

The period of the end of the XVIII - beginning of the XIX century. was the time of the establishment of capitalism on an international scale. The production technique developed at a rapid pace. In 1733, in j of England, Kay’s flying shuttle was invented, which radically transformed the straps. weaving and weaving. The use of a steam engine (J. Watt, 1774–1784) - | survived the industrial revolution. Began machine production means of production.

The industrial revolution, that is, the transition from the manufactory stage to industrial (machine) production, had previously occurred in England. During the XIX century. it embraced the countries of Western Europe and the USA and caused enormous social consequences. The growth of industrial production led to an increase in the number of cities and the urban population. This led to crowding of the population and a further deterioration in the work and living conditions of the workers. At the initiative of advanced doctors, sanitary inspections of cities and industrial enterprises began to be conducted.

Among the prominent figures of public medicine in England of that time, a special place is occupied by Dokon Simon (Simon, John, 1816-1904) —the sanitary doctor and surgeon, one of the founders of public hygiene in England. In 1848, he was appointed to the post of sanitary doctor in London, in 1854 he became the medical inspector of the General Board of Health, and from 1858 to 1876 he was the senior medical inspector of the Secret Royal Council, that is, head of the British Sanitary Police. He was a member of the Royal Society (since 1848) and its vice-president (1879–1880).

J. Simon created a large school of English public doctors, workers of sanitary and sanitary-industrial supervision. Together with his co-workers, he studied the causes of death among workers in connection with their working conditions, the sanitary condition of their homes, food, etc.

He associated the early death of workers (often between the ages of 15-17 years) with both unsanitary and social conditions. His classic work, The History of the English Sanitary Institutions, as well as the annual Public Health Reports, which he edited, contain objective material on the plight of the working class in England, on the detrimental effect of harmful conditions and hard work on the health of workers. And it is not by chance that it was in England that the first public health law in the world (Public Health Act, 1848) was issued and the first public health institution in the world (General Board of Health, 1848) was created.

For the first time, the idea of ​​a state organization of medical affairs was substantiated and scientifically developed by an Austrian clinical physician and hygienist Johann Peter Frank (Frank, Johann Peter, 1745-1821), the author of the six-volume work "System of the General Medical Police" (1779-1819). “The primary source of the country's wealth,” he wrote, “is in a large and healthy population, in healthy working hands, in the productive power of a healthy person, in systematically conducted by the state measures on the medical police.” I.P. Frank made a great contribution to the development of medicine and public medical thought in Russia: in 1805–1808. He was rector of the St. Petersburg Medical-Surgical Academy, where he developed his ideas for the general medical police.

In Russia, the idea of ​​state participation in the organization of medical affairs goes back, as already noted, to V. N. Tatischev and M. V. Lomonosov. At the end of the 18th century — the first half of the 19th century, when, under the influence of the ideas of the Russian Enlightenment and Decembrism, social and medical activities arose in Russia, questions of the state organization of the medical business became the subject of special scientific research. Thus, in 1784, the Russian doctor I. "L. Danilevsky defended his doctoral dissertation at the University of Göttingen" State power is the best doctor. "In 1785, Professor at Moscow University F. F. Keresturi delivered an act of speech" About the Medical Police in Russia. ”The idea of ​​the state basis of medicine in its preliminary form was formulated in the program documents of the Decembrists, Russkaya Pravda (1823) and the charter of the Union of Welfare: state (at the expense of the parish) serving the poor and the organization of hospitals and pharmacies, improving medicine Skogen provision in the Russian army, the negative attitude towards charity as the primary means of addressing conservation narod1 Foot health, the idea of ​​the future of social security and the principle of the parish of medical care (the future zemstvo medicine). It is clear that the implementation of these ideas drew back a century.

The emergence of social medicine, morbidity and mortality accounting and the associated analysis of harmful working conditions led to the need to develop scientifically based hygienic standards, resulting in an experimental science of hygienic science, founded by the German doctor Max Pettenkofer (Pettenkofer, Max Josef von, 1818— 1901, Fig. 151).

M. Pettenkofer introduced an experimental research method into hygiene. He developed an objective method of hygienic assessment of air, clothing and soil, was engaged in the hygiene of water supply, along with K. Foyt established hygienic norms of nutrition.

Attaching special importance to soil hygiene, he proved the importance of draining it and carrying out hygienic measures for the removal of sewage and the improvement of populated areas. Thanks to his activities in Munich and other German cities, the incidence of intestinal infections has decreased significantly. However, M. Pettenkofer overestimated the "soil" factor. This was most clearly manifested in his position regarding the causes of cholera epidemics. Adhering to the "soil" theory, he spoke out against the "bacteriological" theory of R. Koch.

The discovery of cholera vibrio (1883) R. Koch proved the decisive role of the microbial origin in the spread of infection, however, considering the vibrio as a necessary and sufficient cause of an epidemic, he did not take into account environmental conditions and social factors. "Infectious diseases," said R. Koch in 1888 in his report I, "On the fight against infectious diseases," never arise ... neither as a result of hunger, poverty, deprivation, and generally not as a result of a combination of factors covered usually the term “social poverty”, but only as a result of the penetration of their specific embryos, their reproduction and distribution. ”

M. Pettenkofer did not deny the existence of a live pathogen, but at the same time did not believe in its simple transmission. “There are territorial and temporary factors conducive to the emergence of an epidemic,” he argued. M. Pettenkofer could not check his point of view in the experiment on animals: cholera is a disease of people. And he decided to experiment on himself: being confident in the “healthy” soil of Munich, M. Pettenkofer October 7, 1892 drank the culture of the cholera vibrio. By luck, he did not get cholera (it is possible that the culture was weakened). This further confirmed him in his opinion.

Today we know that M. Pettenkofer formally stood on the wrong path, but this does not detract from the meaning of the selfless deed of a scientist who checks his terrias in an experiment on himself. The position of R. Koch, who denied the importance of social conditions in the occurrence of infectious diseases, in its categorical nature was one-sided and was used as a cover by opponents of social transformations.

After M. Pettenkofer and the properties of Vibrio cholerae in experiments on himself were studied by his successor R. Emmerich, I. I. Mechnikov, N. F. Gamaleya, DK Zabolotny, V.- M. Khavkin and others. Their heroic experiments were a valuable contribution to the development of epidemiology and experimental hygiene.

In Russia, the formation of scientific hygiene took place in the second half of the XIX century. One of its founders was Alexei Petrovich Dobroslavin (1842–1889).

In 1868, he defended his doctoral thesis “Materials for the physiology of metamorphosis” (exchange of substances). Then, for two years, he worked in the laboratories of A. Würz, M. Pettenkofer and K. Voith. Upon returning home, he headed the first Russian Department of Hygiene at the St. Petersburg Medical-Surgical Academy (1871). At the Department, on its initiative, an experimental laboratory was created for research and practical training with students of the Academy. A. P. Dobroslavin is the author of the first Russian hygiene textbooks: “Hygiene. vennogo Health "(1882-1884) and" Military Hygiene Course "(1885-1887). His scientific works are devoted to the study of metabolism, food hygiene and military hygiene.

A.P. Dobroslavin made a great contribution to the development of public medicine in Russia. He took part in the improvement of St. Petersburg. On his initiative, in 1878, the Russian Society for the Conservation of Public Health and the scientific and practical journal Zdorovie, which he edited for 10 years (1874— 1884), was founded.

The second Department of Hygiene in Russia was established in 1882 at Moscow University. It was headed by Fedor Fedorovich Erisman (1842–1915) - an outstanding Russian hygienist (Swiss by birth), one of the founders of experimental hygiene in Russia, an active leader of social medicine. In 1869, having arrived in Russia, he “turned from a Swiss into a Russian, sincerely loved Russia and gave all the best years of his life to serve her” (I. M. Sechenov).

Activities F. f. Erisman wore a social character. He paid much attention to school hygiene and. hygiene of the house, first published materials about the blatant unsanitary condition of the basement dwellings and shelters of St. Petersburg, fought for the improvement of sewage systems and the "proper construction of sanitary facilities in Russia." To increase the level of his training in the field of public hygiene and sanitation, F. F. Erisman worked for a number of years (from 1872) in the laboratories of M. Pettenkofer and K. Voith. Returning to Russia, he took part in the Russian-Turkish war of 1877-1878.

In 1879, the Moscow Zemstvo (about the Zemstvo, see p. 273), concerned about the growing incidence and the severe sanitary and hygienic condition of enterprises in the Moscow province, invited F. F. Erisman to conduct an in-depth sanitary and hygienic survey of factories and plants. Over the course of six years (1879–1885), F. F. Erisman and two of his employees examined 1080 enterprises with a total number of 114,000 workers. The results of this uniquely large-scale work were published in The Materials for Researching Factories and Plants of the Moscow Gubernia (1890 ). Their data have been used repeatedly in works on the development of capitalism in Russia and are considered the best in modern literature on factory statistics.

In 1881, F. F. Erisman was elected a professor at Moscow University, and in 1882 he headed the first in Moscow (second in Russia) department of hygiene. At the university, F. F. Erisman occupied the "extreme left wing." His lectures and scientific works were distinguished by a broad public approach to solving the problems of medicine. He took an active site in the construction of new university clinics, and in particular the hygienic building (Fig. 152), where his department was located; led the design of sewage design in Moscow and participated in the construction of the Moscow (Rublevsky) water supply; was an active participant in the Pirogov Society and chairman of the Pirogov Congresses. In 1896, when Professor Erisman spoke in support of advanced students, he was dismissed from the university: Russia's largest hygienist was prevented from working. His stay in Russia became impossible, and F. F. Eisman was forced to return to Switzerland.

F. F. Erisman created the scientific school of Russian hygienists. One of his students was the outstanding Soviet hygienist G. V. Khtopin (1863-1929).

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The special attention of the RSDLP was directed to the development of a system of state insurance for workers. This question was discussed in detail in 1912 at the VI (Prague) All-Russian Conference of the RSDLP. The report on the main issue was made by N. A. Semashko. The conference participants did not agree with the draft law on social insurance, discussed in the State Duma, and expressed their opinion in the resolution “On the attitude to the Duma draft law on state insurance of workers”. In particular, the resolution noted that:

The best form of insurance for workers is their state insurance, built on the following grounds:

a) it must provide for workers in all cases of their incapacity for work (injury, illness, old age, disability; workers, in addition, pregnancy and childbirth; remuneration of widows and orphans after the death of the earner) or in case of loss of earnings as a result of unemployment;

b) insurance should cover all wage earners and their families;

c) all insured persons should be remunerated on the basis of full earnings compensation, all insurance costs should fall on entrepreneurs and the state;

d) all types of insurance should be managed by single insurance organizations built according to the territorial type and on the basis of full self-management of the insured ...

These principles subsequently formed the basis of the legislation on insurance of workers of the USSR.

MI Barsukov, A. N. Vinokurov, MF Vladimirsky actively participated in the implementation of the RSDLP plans in the field of health care after coming to power. S. Ya. Mitskevich, I. V. Rusakov, I. A. Semashko, 3. P. Soloviev, D. I. Ulyanov, and many others.

USSR - Union of Soviet Socialist Republics. It was formed at the First Congress of Soviets (in Moscow) on December 30, 1922, when the delegations of the Republics of Belarus, the Transcaucasus, the RSFSR (Russian Soviet Federative Socialist Republic) and Ukraine signed the Treaty on the Formation of the USSR.

The concept of the “history of the USSR” (as well as the history of medicine of the USSR) includes the history of the people of the USSR (fifteen Union Republics) from deep antiquity until December 8, 1991, when the leaders of the Republic of Belarus, the Russian Federation and Ukraine signed an agreement to create Commonwealth of Independent States (CIS).