History of Ukrainian medicine

History of Ukrainian medicine. Medicine of the New Time. XX-th ncentury medicine. Contemporary medicine and health protection in Ukraine.

 

HISTORY OF UKRAINIAN MEDICINE

 

 1.     Folk nmedicine

 The nhistory of medicine in Ukraine begins with the history of folk medicine.

The origin of nUkrainian medicine may be traced back to the folk medicine of the Kyiv Ukraine-Rus epoch. It developed as a nmonastery medicine and medicine of the Cossacks state.

Medical schools

 

The first nmedical hospitals in Kyiv Rus were founded in the 11-th century and were mostly nin the form of alms houses attached to churches.

In 1653 in the city of Zamostya (near Lviv) Zamostya’s academy was norganized under the initiative of graph Yan Zamoyskyi.

Yan Zamoyskyi ngraduated from the University of Padua. He desided to open a similar school in his motherland. The Pope of nRome Clement VIII confirmed the Academy status and gave it the right to adjudge nthe degree of the doctors of philosophy, low and medicine. Medical Faculty of nthe Academy was weaker than that of Cracow. Only 1-2 professors taught medicine nthere.

The relatiobetween Zamostya’s academy and Padua University was very strong during many nyears. For example, rector of the Academy asked Padua’s medical faculty aadvice about the causes and treatment of Kovtun (Plica Polonica). At that time nit was spread on Halychyna territory, especially among Hutsuls, who lived imountain regions of Carpathians.

The academy nwas existing only for 190 years. But it played a positive role in the ndissemination of scientific medical knowledge among the population.  

Some graduates nof the academy, especially Ukrainians and Byelorussians went on a service to nthe feudal lords. Some graduates continued their education at the universities nof Italy where they received a degree of the doctor of medicine.

One of such doctors of medicine was Yuriy Drohobych-Kotermak n(1450-1494).

Yuriy nDrohobych-Kotermak was a philosopher, astrologist, writer, medical doctor, nrector of the University of Bologna, professor of Krakow Academy, first publisher nof a Ukrainian printed text. He is the author of “Iudicium Pronosticon Anni nCurrentis”, 1483.

In 1478 nDrohobych received his doctorate in philosophy, but he continued his nstudies. This time he took up medicine.

At that time nnatural philosophy disciplines were closely connected. Almost all contemporary nphilosophers demonstrated equally strong knowledge in astronomy and medicine, nwhich allowed university professors to transfer from one department to another. nSimilar methods were used in teaching both disciplines. It was done through nreading and interpretation of Latin translations of Greek and Arab classical nauthors.

Medicine was nconsidered the key to understanding nature.

Shortly after Drohobych ncompleted his medical studies, he was offered a position to teach astronomy at nBologna University. At the beginning of 1481, the student body of the nUniversity elected Drohobych to become the rector of the school of Medicine and nFree Arts.

In 1486 Drohobych nreturned to Krakow. He started his medical practice and also taught medicine at nKrakow University. Similar to his peers from Bologna, he based his lectures othe works of Hippocrates, Galen, and Avicenna.

 A few years later, he received his nprofessorship in medicine and became the doctor of the Polish king Casimir IV nJagiellon. In 1492 he became the Dean of the Department of Medicine. It nwas customary at that time for professors to have off-site meetings to discuss nwith students issues that did not fit the official scientific doctrine.

Copernicus attended nDrohobych’s meetings, however it is not certain whether the former had ainfluence on the latter.

The history f nUkraine in XVI-XVII centuries is characterized by struggle of Ukrainians for ntheir independence.

In the 14th nand 15th centuries new hospitals were built and many physicians gave the first naid to the inhabitants of Ukraine and the soldiers of Bogdan Khmelnitsky’s ntroops.

 

Medical assistance in the army

of Bogdan Khmelnitsky

 At the end of the XVI ncentury the main Kossacks hospital was the hospital in Trahtemyrivskyi monastery below the Dnieper.

Military nhospitals were in monasteries: Lebedinsky near Chyhyryn and Levkovsky near nOvruch. Monasteries willingly took care over the Cossacks.

In Cossack hospitals, opposed to civilians in towns and villages, the ndisabled found refuge as well as treatment the wounded was practiced. Those nwere the first military hospitals in Ukraine.

  Cossacks medicine is very interesting too. nTheir practice off medicine is full of mysteries and legends.

Pauline, nthyme, mint, borschivnyk were the main components of content of Kossack pipe. nThat is why Cossacks almost newer were sick with asthma and bronchitis.

Moreover nsmoking was able to reduce pressure, calm nerves, improve appetite, sleep and neven eyesight.

Vitamins and nother necessary substances lacking in conventional food Cossacks received ithis form.

Epifany Slavinetsky

 Among famous doctors of that time it is important to nmention Epifany Slavinetsky.

In the 1620s, he attended the Kyiv Brotherhood School and later ncontinued his education abroad.

Epifany was one of the most educated people of his period that came nfrom Central and Eastern Europe. He came to master the Latin, Polish, Ancient nGreek and Hebrew languages.

Epifany nSlavinetsky translated into Slavic languages the book of anatomy by Andreas nVesalius.  

Epifany nSlavinetsky revising service-books

 Kyiv-Mohyla nacademy

 Kyiv-Mohyla academy played a significant role in the preparing of medical stuff, with norganization of hospital’s medical schools. During 14 years (1784-1798) more nthan 300 persons who were studying at academy, entered medical schools. The nAcademy was first opened in 1615 as the Kyiv Brotherhood School.

In 1632 the nKyiv Pechersk Lavra school and Kyiv Brotherhood School merged into the nKyiv-Mohyla Collegium (Latin: Collegium Kiyovense Mohileanum). The Collegium nwas named after Petro Mohyla.

 Among the famous graduates of the Kyiv-Mohyla Academy nthere are names of Peter Doroshenko, Philip Orlik, nYuri Khmelnitsky, Paul Teterya, Gregory Skovoroda, nIvan Skoropadskyi, Ivan Mazepa etc.

Many graduates nof the Academy continued to enrich their knowledge abroad and received their ndoctors’ degrees there. Many former students of this Academy have become the nwell-known scientists. They are the nepidemiologist D. S. Samoilovych, the obstetriciaN. M. Ambodyk-Maximovych, the podiatrist S. F. Chotovytsky, nthe anatomist O. Shumlyansky and many others.

 The nmain building of Kiev-Mohyla Academy in the seventeenth century.

 In 1686 nthe first bacteriological station was organized in Odessa which was of great nimportance in the development of microbiology and epidemiology. The famous scientists I. I. Mechnikov and M. F. nGamaliya worked at this station and succeeded much in their investigations. Ispite of favorable conditions for the successful development of natural nsciences in Russia many outstanding scientists worked in Ukraine. It is knowthat the brilliant scientist M. I. Pirogov and his followers (V. O. Karavayev, nO. F. Shimanovsky, M. V. Sklifosovsky and others) made valuable contribution to nthe development of Ukrainian medicine.

The painting “Future doctors”

In the XVIII ncentury medical schools were the main educational institutions on preparatioof the doctors. About 2000 men had received rank of the doctors. The period of ntraining at these schools varied from 5 till 10 years. It is necessary to nrecollect the professors and scientists of our medical schools: O. Shumlanskiy, nM. Terehovskiy and others.

O. Shumlanskiy (1748-1795) in 1793 finished his scientific work devoted to a nstructure of kidneys.

He was the nfirst who describe a structure of kidneys. He established that malpigiy body nwas not gland, which was concerned at that time.

 M. Terehovsky (1740-1796) in his ndoctoral studies proved that the microorganisms in the calm water do not appear nthemselves but are coming from outside.

Nestor Maksymovitch-Ambodyck (1744-1812) published the dictionary, nwhere he showed a lay of new terms. He published the books on botany.

At the end of nthe 18th and during the 19th centuries the medical departments were formed at nthe Universities of Kharkiv, Kyiv, Lviv and Odessa. The total number of nphysicians has increased in Ukraine. The medicine of Zemstvo was widely used at nthat time.

During the Crimean War (1854-1856), upon Pirogov’s ninitiative the first detachment of nurses was trained and sent to Sevastopol to nhelp its defenders. It gave the beginning of the organization of “Red nCross”.

 Kharkiv State Medical University

The Kharkiv State Medical University is one of the oldest higher neducational establishments in Ukraine.

It was founded nin 1805 as the Medical Faculty of the Kharkov University. At present, over 600 nteachers work at the departments of this Medical University.

Odessa State Medical University

 In year n2000 Odessa State Medical University has completed its 100 years of nexistence. Odessa State Medical University is the first university of Ukraine nwhich started medical education in English medium in 1996.

 Modern Ukrainian medicine

 The first steps towards modern Ukrainian medicine nwere made in 1898-1910, when the first scientific associations of Ukrainiadoctors were established: the Ukrainian scientific Society in Kyiv and the nShevchenko Scientific Society in Lviv. The first works on medicine iUkrainian were published and the first disease prevention and treatment ninstitutions of clearly Ukrainian orientation were established. At the same ntime, Ukrainian doctors made themselves heard at European medical forums iParis, Madrid, Prague and Belgrade and the Ukrainian Halitska army health nservice established the new Ukrainian military medicine.

In January 1918, he first medical journal in Eastern Ukraine “Ukrainski  nMedychni Visti” was published. In its editorial “Our tasks ntoday” Ovksentiy Korchak-Chepurkovskyi, the oldest Ukrainiaprofessor-hygienist, the founder of social hygiene, wrote the following: “Our nmain task is to develop Ukrainiaational medicine as a science and practical nfield of knowledge”. To achieve this goal, it was necessary to “open our nscientific and educational medical establishments, draw upon the experience of nmedicine…”.

Korchak-Chepurkovskyi norganized and headed the first Ukrainian medical university department.

He was one of nthe founders of the Ukrainian Academy of Science, where he established a nmedical section which made the functions of a center of Ukrainian medical nscience development, and organized a health research department, a prototype of nlater academic institute. He also researched Ukrainian medical terminology as nwell as the health and demography of the Ukrainian population.

Among the first national scientific schools were those of surgeons (by nYevhen Cherniakhivskyi), obstetrician-gynecologist (by Oleksaner Krupskyi), nphysician-gerontologist (by Ivan Bzylevych), otolaryngologists (by Oleksander nPuchkivsky), microbiologists (by Marko Neshadymenko) and others.

 The Ukrainian National Museum of Medicine

 The nNational Museum of Medicine of Ukraine is an exposition modernly equipped and nshowing the path of medicine and public health development in Ukraine from nancient times to the present day. The need for such museum is obvious: it is nthe base for teaching the history of medicine and other disciplines in medical nschools.
nThe National Museum of Medicine of Ukraine was nestablished in 1973. It is located in the building of the former nanatomical theatre of Kyiv University. The nfirst chief of the museum was its founder, Honoured Science Worker of Ukraine, nDoctor of Medical Sciences, Professor O.A. Grando.

The creators nof the museum took a fresh approach to its organization. Poster exhibitions, noriginal interiors, portraits of famous scientists and physicians, dioramas of nthe most significant events in Ukrainian medicine – all this make the nexhibition bright and exciting. The National nMuseum of Medicine of Ukraine is the largest of all European medical museums. n

The special npainful pages of our history are the Holodomor of 1932-1933 and Chernobyl which nare reflected in the halls of the museum.

The nUkrainian National Museum of Medicine

Mykola Amosov

 

Mykola nAmosov was a Ukrainian doctor, heart surgeon, inventor, nenthusiast, known for his inventions of several surgical procedures for ntreating heart  defects.

In 1955 nhe was the first in Ukraine  who began treatment for heart diseases nsurgically. In 1958, he was one of the first in the Soviet Union to nintroduce into the practice the method of artificial blood circulation (i1963). Amosov nwas first in the Soviet Union to perform the mitral valve replacement, and i1965 for the first time in the world he created and introduced into practice nthe antithrombotic heart valves prosthethesis. Amosov elaborated a number of nnew methods of surgical treatment of heart lesions, the original model of nheart-lung machine.

His work othe surgical treatment of heart diseases won a State nPrize of Ukraine (1988) gold medals and Silver Medal (1978) of the Exhibition of Economic nAchievements of the USSR.

The clinic established by nAmosov, produced about 7000 lung resections, more than 95000 operations for nheart diseases, including about 36000 operations with extracorporeal blood ncirculation.

In 1983 Amosov’s cardiac surgery clinic was reorganized in Kiev Research nInstitute of Cardiovascular Surgery and in the Ukrainian Republicacardiovascular surgical center. Each year, the institute fulfilled about 3000 nheart operations, including over 1500 – with extracorporeal blood circulation. nAmosov was the first director of the Institute, and since 1988 – Honorary Director nof the Institute.

I1955, Amosov created and nheaded the first in the USSR Chair of Thoracic Surgery for the postgraduate nstudies and later the Chair of Anesthesiology. These Chairs have prepared more nthan 700 specialists for Ukraine and other republics.

 

Volodymyr Petrovych Filatov

 

Volodymyr Filatov was a Ukrainian ophthalmologist and surgeon best nknown for his development of tissue therapy. He introduced the tube flap ngrafting method, corneal transplantation and preservation of grafts from ncadaver eyes. He founded The Filatov Institute of Eye Diseases & Tissue nTherapy in Odessa. Filatov is also credited for restoring Vasily Zaytsev’s sight when he suffered an injury to nhis eyes from a mortar attack during Battle of Stalingrad.

First corneal ntransplantation was attempted by Filatov on 28 of February 1912, but the graft ngrew opaque. After numerous attempts over the course of many years, Filatov nachieved a successful transplantation of cornea from a diseased person on 6 of nMay 1931.

MEDICINE nIN THE NEW TIME

In 1575 Pare npublished, The Collected Works of Surgery. This work was initially attacked by nthe French Faculty of Physicians, but thanks to the support of Henry II, the nKing, the book began to spread Pare’s ideas across Europe. Over time these nideas began to change the way that surgeons approached their work – especially nwhen treating wounds and performing amputations. Surgeons now knew that for noperations to be successful they would have to combat pain, infection and nbleeding using methods similar to those used by Pare.

Pare’s method, nalthough groundbreaking, still left some problems to be solved in the nfuture.

 * Even though nPare’s use of a digestive (ointment) when treating wounds reduced the risk of ninfection, many patients still died from infection as effective antiseptics had nnot yet been invented.

* Pare’s nmethod of using silk thread to tie off arteries could actually cause infection. nInstruments used during operations were not often clean – there was no nknowledge of germs – therefore bacteria on those instruments (and the silk nthread) was often transferred to the wound and sealed inside.

William nHarvey nwas born in England in 1578. He studied medicine at Padua University betwee1598 and 1602. He was very interested in anatomy, particularly the work of nVesalius. After leaving university he worked as a doctor at St Bartholomew’s nHospital, London, and then as a lecturer in anatomy at the Royal College of nSurgeons. He was also physician to both James I and Charles I.

Although nVesalius had proven that some of Galen’s ideas were incorrect, Galen’s nexplanation of the function of the heart was still accepted. Galen said that nblood was made in the liver, and got into the arteries through holes in the nseptum of the heart. He said that blood was continually being made – to make up nfor the fact that it was used up by the body.

William Harvey nobserved how blood flowed around the body. Drawings like this demonstrate that nveins have valves and return blood to the heart.

Like Pare and nVesalius, Harvey believed in the importance of careful observation, dissectioand experiments in order to improve his knowledge of how the body worked. I1615 Harvey began to work on the idea that blood circulated around the body. nAround this time, water pumps were invented. This gave Harvey the idea that nperhaps the heart worked in the same way as a water pump, and pumped blood naround the body.

Harvey wanted to study the body nas a living system, so he needed to dissect things which were still alive. He nchose to study cold-blooded animals like frogs because their hearts beat nslowly. This enabled him to see each separate expansion and contraction of the nheart. He also dissected the bodies of dead criminals to ensure that the humaheart was the same as that of the live animals he had studied.

Harvey’s study of beating hearts nshowed him that the heart was pushing out large volumes of blood. He proved nthat each push happened at the same time as the pulse which could be felt at nthe neck and at the wrist. He realised that so much blood was being pumped out nby the heart, that it could not be used up and replaced by new blood as Galehad said. This suggested that there was a fixed amount of blood in the body, nand that it was circulating.

Harvey now needed to prove his ntheory. By trying to pump liquids the wrong way past the valves in veins and narteries, Harvey proved that they were all ‘one-way’ systems. This proved his ntheory that blood flowed out from the heart through the arteries, and it flowed nback through the veins to the heart where it was recycled again. He also ndevised a simple experiment that anyone could use on themselves to prove that nblood only flows one way through the veins. By bandaging the upper arm, the nvalves show up as nodules on the vein. If your finger is pushed along the veifrom one valve to the next, away from the heart, the section of vein will be nemptied of blood. It will stay empty until you take your finger off. Harvey published his theory of the circulation of blood in his book, On the Motion of nthe Heart, in 1628. He included a sketch of how to perform this simple nexperiment, to prove his theory to readers.

Harvey’s theory met with nopposition because it suggested that if there was a fixed amount of blood ithe body, then there was no need for the practice of blood letting. Blood nletting was a very common and well respected medical practice, which had beeused ever since ancient times, (e.g. in the Four Humours). After his book was npublished he actually lost patients, as his ideas were considered strange for nthe time. Despite this, soon after his death, his theory was soon widely naccepted. Over the next 300 years his theory was used to build up knowledge of nwhat the blood did in various parts of the body as it circulated. Harvey made a great contribution to medical knowledge, but it was not until the 1900’s nthat the knowledge was used in medical practices. Medical practices in the nRenaissance were not changed by Harvey’s work. Blood letting still continued to nbe a popular practice, and it was only in the 1900’s that doctors realised the nimportance of checking a patient’s blood flow by checking their pulse.

The portrayal nof the history of medicine becomes more difficult in the 19th century. nDiscoveries multiply, and the number of eminent doctors is so great that the nhistory is apt to become a series of biographies. Nevertheless, it is possible nto discern the leading trends in modern medical thought.

 

MEDICINE nIN THE 19-20TH CENTURIES

Development nof Physiology

By the nbeginning of the 19th century, the structure of the human body was almost nfully known, due to new methods of microscopy and of injections. Even the nbody’s microscopic structure was understood. But as important as nanatomical knowledge was an understanding of physiological processes, which nwere rapidly being elucidated, especially in Germany. There, physiology became established nas a distinct science under the guidance of Johannes Müller, who nwas a professor at Bonn and then at the University of Berlin. An energetic nworker and an inspiring teacher, he described his discoveries in a famous ntextbook, Handbuch der Physiologie des Menschen (“Manual of HumaPhysiology”), published in the 1830s.

Among nMüller’s illustrious pupils were Hermann von Helmholtz, who made nsignificant discoveries relating to sight and hearing and who invented the nophthalmoscope; and Rudolf Virchow, one of the century’s great medical nscientists, whose outstanding achievement was his conception of the cell as the ncentre of all pathological changes. Virchow, German pathologist and statesman, none of the most prominent physicians of the 19th century, pioneered the moderconcept of pathological processes by his application of the cell theory to nexplain the effects of disease in the organs and tissues of the body. He nemphasized that diseases arose, not in organs or tissues in general, but nprimarily in their individual cells. Virchow’s work Die Cellularpathologie, npublished in 1858, gave the deathblow to the outmoded view that disease is due nto an imbalance of the four humours.

Hermanvon Helmholtz

 

Rudolf nVirchow

 

In France the most brilliant physiologist of the time was Claude Bernard, whose many nimportant discoveries were the outcome of carefully planned experiments. His nresearches clarified the role of the pancreas in digestion, revealed the npresence of glycogen in the liver, and explained how the contraction and nexpansion of the blood vessels are controlled by vasomotor nerves. He proposed nthe concept of the internal environment—the chemical balance in and around the ncells—and the importance of its stability. His Introduction à nl’étude de la médecine expérimentale (1865; AIntroduction to the Study of Experimental Medicine) is still worthy of nstudy by all who undertake research.

Verificatioof the germ theory

Perhaps the noverarching medical advance of the 19th century, certainly the most nspectacular, was the conclusive demonstration that certain diseases, as nwell as the infection of surgical wounds, were directly caused by minute nliving organisms. This discovery changed the whole face of pathology and neffected a complete revolution in the practice of surgery.

The idea that ndisease was caused by entry into the body of imperceptible particles was of nancient date. It had been expressed by the Roman encyclopaedist Varro as early nas 100 BC, by Fracastoro in 1546, by Athanasius Kircher and Pierre Borel about na century later, and by Francesco Redi, who in 1684 wrote his Osservazioni nintorno agli animali viventi che si trovano negli animali viventi (“Observations non Living Animals Which Are to Be Found Within Other Living Animals”), iwhich he sought to disprove the idea of spontaneous generation. Everything must nhave a parent, he wrote; only life produces life.

A 19th-century npioneer in this field, regarded by some as founder of the parasitic theory nof infection, was Agostino Bassi of Italy, who showed that a disease nof silkworms was caused by a fungus that could be destroyed by chemical agents.

Agostino nBassi, pioneer Italian bacteriologist, anticipated the work of Louis Pasteur by n10 years in discovering that numerous diseases are caused by microorganisms.

In 1807 he nbegan an investigation of the silkworm disease mal de segno (commonly known as nmuscardine), which was causingserious economic losses in Italy and France. After 25 years of research and experimentation, he was able to demonstrate that nthe disease was contagious and was caused by a microscopic, parasitic fungus. nHe concluded that the organism,later named Botrytis paradoxa (now Beauvaria) bassiana, nwastransmitted among the worms by contact and by infected food.

Bassi nannounced his discoveries in Del mal del segno, calcinaccio o nmoscardino (1835; “The Disease of the Sign, Calcinaccio or Muscardine”) and nproceeded to make the important generalization that many diseases of plants, nanimals, and man are caused by animal or vegetable parasites. Thus, he preceded nboth Pasteur and Robert Koch in formulating a germ theory of disease. He nprescribed methods for the prevention and elimination of muscardine, the nsuccess of which earned him considerable honours.

The maicredit for establishing the science of bacteriology must be accorded to nthe French chemist Louis Pasteur. It was Pasteur who, by a brilliant nseries of experiments, proved that the fermentation of wine and the souring of nmilk are caused by living microorganisms. His work led to the pasteurization of nmilk and solved problems of agriculture and industry as well as those of animal nand human diseases. He successfully employed inoculations to prevent anthrax isheep and cattle, chicken cholera in fowl, and finally rabies in humans and ndogs. The latter resulted in the widespread establishment of Pasteur ninstitutes.

Louis nPasteur

 

Louis Pasteur nwas born in 1822: he was the son of a tanner. He early showed considerable ntalent and at the age of twenty he received his bachelor of science degree. He nheard the lectures on chemistry at the Sorbonne and was appointed laboratory nassistant. He studied crystals but soon Pasteur’s interest was turned away from nthe study of crystals to the investigation of fermentation.

In 1857 Louis nPasteur sent to the Little Scientific Society a paper on “Alcoholic nFermentation” in which he concluded that “the deduplication of sugar ninto al­cohol and carbolic acid is correlative to a phenomenon of life”. A nnew era in medicine dates from those two publications.

The facts that nfever were catching, that epidemics spread, that infection could remaiattached to articles of clothing, etc… all gave support to the view that the nactual cause was something alive, a contagium vivum. It was really a very old nview which first clearly expressed by Fracastorius. The Veronese physician ithe sixteenth century, who spoke of the seeds of contagion passing from one nperson to another; and he was the first to draw a parallel between the nprocesses of contagion and the fermentation of wine. But it was a study of the nprocesses of fermentation that led Pasteur to the sure ground on which we now nstand.

Pasteur nstudied alcoholic fermentation and lactic fermentation in sour milk; he found nthat both fermentations were caused by minute organisms, and were hastened by nexposure to the air. He proved that the microscopic organisms were not nspontaneously generated but were introduced by air.

All along the nanalogy between disease and fermentation must have been in Pasteur’s mind: and nthen came the suggestion. “What would be most desirable is to push those nstudies far enough to prepare the road for a serious research into the origin of nvarious diseases”. If the changes in lactic alcoholic and butyric nfermentations are due to minute living organisms, why should not the same tiny ncreatures make the changes which occur in the body in the putrid and nsuppurative diseases?

Fermentations nof every sort held Pasteur’s attention during the years 1857 to 1863. This was nthe period of consolidation of his observation, which led ultimately to nrecognition of the germ theory of disease. For each type of fermentation there nwas a specific organism. Diseases of beer and wine could be traced to nundesirable microorganisms, which set up fermentation of their own and ninterrupted the activities of the yeast. Spoilage of vinegar, he also found, nwas due to uncontrolled growth of a specific organism. The difficulty was novercome by sterilization at a temperature of about 130 degrees Fahrenheit, nslopping its further development. Thus “pasteurization” was invented.

So impressed nwas he with the analogy between fermentation and the infectious diseases that, nin 1863, he assured the French Government of his ambition “to arrive at nthe knowledge of the causes of putrid and contagious diseases”.

After a study nupon the diseases of wines, which has had most important practical bearings, aopportunity arose which changed the whole course of his career, and profoundly ninfluenced the development of medical science.

A disease of nthe silkworm had, for some years, ruined one of the most important industries nin France, and in 1865 the Government asked Pasteur to give up his laboratory nwork and teaching, and to devote his whole energies to the task of ninvestigating this disease and its causes. Notwithstanding all the difficulties nand obstacles encountered in the problem, Pasteur carried his silkworm studies nto a successful conclusion.

From Pasteur, Joseph nLister derived the concepts that enabled him to introduce the antiseptic nprinciple into surgery. In 1865 Lister, a professor of surgery at Glasgow University, began placing an antiseptic barrier of carbolic acid between the wound nand the germ-containing atmosphere. Infections and deaths fell dramatically, nand his pioneering work led to more refined techniques of sterilizing the nsurgical environment.

Joseph nLister

 

Although paihad been banished from the operating-room after different methods of nanaesthesia had been introduced, the spectre of infection still remained ipre-Listcrian days. Erysipelas, pyemia, septicemia and hospital gangrene were nendemic in most surgical wards. The man who changed all this was Joseph Lister.

 

In Edinburgh he received the position of lecture on surgery at the College of Physicians and assistant surgeon to the Royal Infirmary.

Lister soobecame a very busy man, taught surgery at the College of Physicians, operated nat the Royal Infirmary and worked in the laboratory, studying par­ticulary ninflammation, gangrene and the coagulation of the blood and publishing papers non these subjects.

In 1860, at nthe age of 33, he went to Glasgow where he was appointed professor of surgery nat the University. There he found the same scourges haunting the surgical wards n- suppuration and gangrene.

He was struck nby the fact that simple fractures healed without complications, whereas ncompound fractures with laceration of the skin were followed by suppuration and noften gangrene and death. Furthermore, inflammation, or even suppuration, was nsure to follow any wound.

Lister saw nthat sepsis was the principal obstacle to any great advantage in surgery. nFinally, noting that closed wounds did not suppurate while open ones ex­posed nto the air did, he concluded that suppuration was in some manner due to contact nwith the air but that the air alone did not cause suppuration.

He found the nsolution of his problem in the work of Louis Pasteur on fermentation and putrefaction; nit was not the air but the germs in the air that produced suppuration. He saw nat once that putrefaction could only be avoided by preventing germs from ngaining access to wounds. He looked around for a suitable antiseptic, and chose ncarbolic acid. With it Lister made his first antiseptic dressing in March, n1865.

The case was a ncompound fracture of the leg, the sort of wound which previously had almost ninvariably become infected, often with fatal results. He washed the wound out nwith the carbolic solution, and applied a piece of lint soaked with the nsolution over it. Healing was astonishingly good and Lister was encouraged to ntry this method in other cases. By March 1867 he was able to report a total of neleven cases of compound fracture treated by the antiseptic method, with nine nrecoveries, one amputation and one death. This was an unprecedented result.

In April, n1867, he was able to write: “Since the antiseptic treatment has beebrought into full operation… my wards, though in other respects under precisely nthe same circumstances as before, have completely changed their character, so nthat during the last nine months not a single instance of pyemia, hospital ngangrene, or erysipelas has occurred in them.” Lister was only 40 when he nwrote these words.

The antiseptic ndoctrine did not have a sympathetic reception in England: it was attacked by nsome medical men. Lister nevertheless went ahead with his experi­ments to nimprove his method. After a while he stopped using undiluted carbolic acid to npurify recent wounds because he found that it caused superficial sloughing. A nfive per cent watery solution proved to be strong enough for his purposes.

In 1869, nLister returned to Edinburgh as professor of clinical surgery, remaining in Edinburgh nine years. He continued to work on his antiseptic methods, carried out nlaboratory experiments on putrefaction and fermentation, and began his nimportant studies on ligatures. Noting that infection often came from nligatures, he soaked first silk ligatures and later catgut in carbolic acid nbefore employing them and found that this method prevented putrefaction.

He became so nobsessed with the fear that microbes might fall upon the wound during aoperation that he introduced in 1870 the carbolic spray to purify the natmosphere. He clung obstinately to this practice for 17 years but finally nadmitted that it was superfluous.

In 1877, after nan absence of 25 years. Lister retumed as professor of clinical surgery at nKing’s College Hospital, London. He occupied the chair of surgery for 15 years.

English nsurgeons in general remained hostile to Lister’s doctrine. As late as 1880 in all the British Isles there were only one or two clinics where his methods were used. But nabroad Lister’s methods were promptly and thoroughly tested, and his discovery nconfirmed. Surgeons not only adopted Lister’s methods of controlling surgical ninfections, but they greatly improved upon them.

Slowly but nsurely Lister’s great eminence was recognised at home. In 1883 he was elected npresident of the Royal Society. Lister died in 1912.

Obstetrics had already been robbed of nsome of its terrors by Alexander Gordon at Aberdeen, Scotland, Oliver Wendell Holmes at Boston, and Ignaz Semmelweis at Vienna and Pest (Budapest), who advocated disinfection of the hands and clothing of midwives and medical nstudents who attended confinements. These measures produced a marked reductioin cases of puerperal fever, the bacterial scourge of women following nchildbirth.

Another npioneer in bacteriology was the German physician Robert Koch, who showed nhow bacteria could be cultivated, isolated, and examined in the laboratory. A nmeticulous investigator, Koch discovered the organisms of tuberculosis, nin 1882, and cholera, in 1883. By the end of the century many other ndisease-producing microorganisms had been identified.

Robert Koch is a prominent Germabacteriologist, the founder of modern microbiology. He was born in 1843, died nin 1910. When Koch became a doctor he carried on many experiments on mice in a nsmall laboratory. In 1882 Koch discovered tuberculosis bacilli. In his report nmade in the Berlin Physiological Society Koch described in detail the nmorphology of tuberculosis bacilli and the ways to reveal then. Due to his ndiscovery Koch became known all over the world. In 1884 Koch published his book non cholera. This book included the investigations of his research work carried nout during the cholera epidemic in Egypt and India. From the intestines of the nmen with cholera Koch isolated a small comma-shaped bacterium. He determined nthat these bacteria spread through drinking water. In 1905 Koch got the Nobel nprize for his important scientific discoveries.

In 1883 Koch nwent to Egypt to study cholera. At that time there was a widespread epidemic of ncholera in Egypt.

Nobody knew nthe origin of this disease, there were not any protective measures against it.

The disease nspread very rapidly from one place to another and thousands of healthy people ndied. But sometimes some people who were in a constant contact with the diseased nperson did not catch cholera.

As soon as nKoch came to Alexandria he and his two assistants Gaffcky and Fisher begatheir investigations. In the blood, kidneys, spleen, liver and lungs of the npeople who died of cholera Koch found many microorganisms but all of them were nnot the agents of cholera. However in the walls of the intestines and in stools nKoch always found a microorganism which looked like a comma. Many times Koch ntried to grow this bacterium on gelatin but he failed to do it. Many times Koch ninoculated this bacterium to the experimental animals, but none became ill with ncholera. As the epidemic of cholera became less in Egypt, Koch went to India to continue his investigations there. In Kalcutta Koch often walked along its muddy nstreets, where the poor lived. Once Koch saw some muddy water on the ground nnear a small house.

Koch looked ninto that water and he thought he saw there those “commas”. He took some of nthis water, analysed it under the microscope many times and found there the nsame bacteria which he had so many times revealed in the people with cholera. nKoch also established that animals could not catch this disease. The source of nthe disease was the water which people drank.

DISCOVERIES nIN CLINICAL MEDICINE AND ANAESTHESIA

n     nThere nwas perhaps some danger that in the search for bacteria other causes of disease nwould escape detection. Many physicians, however, were working along different nlines in the 19th century. Among them were a group attached to Guy’s Hospital, nin London: Richard Bright, Thomas Addison, and Sir William Gull. nBright contributed significantly to the knowledge of kidney diseases, including nBright’s disease, and Addison gave his name to disorders of the adrenal glands nand the blood. Gull, a famous clinical teacher, left a legacy of pithy naphorisms that might well rank with those of Hippocrates.

n     nIn Dublin Robert Graves and William Stokes introduced new methods in clinical ndiagnosis and medical training; while in Paris a leading clinician, Pierre-Charles-Alexandre nLouis, was attracting many students from America by the excellence of his nteaching.

n     nThe nmost famous contribution by the United States to medical progress at this nperiod was undoubtedly the introduction of general anaesthesia, a nprocedure that not only liberated the patient from the fearful pain of surgery nbut also enabled the surgeon to perform more extensive operations. The ndiscovery was marred by controversy. Crawford Long, Gardner Colton, and Horace nWells are all claimants for priority.

n     nCrawford nLong, nAmerican physician, is traditionally considered the first to have used ether as nan anesthetic in surgery. He observed that persons injured in “ether frolics” n(social gatherings of people who were in a playful state of ether-induced nintoxication) seemed to suffer no pain, and in 1842 he painlessly removed a ntumour from the neck of a patient to whom he had administered ether.

n     nGardner nColton, nAmerican anesthetist and inventor, was among the first to utilize the nanesthetic properties of nitrous oxide in medical practice. After a dentist nsuggested the use of the gas as an anesthetic, Colton safely used it iextracting thousands of teeth. As he was studying medicine in New York (without ntaking a degree), Colton learned that the inhalation of nitrous oxide, or nlaughing gas, produced exhilaration. After a public demonstration of its neffects in New York City proved to be a financial success, he began a lecture ntour of other cities.

n     nHorace nWells, nAmerican dentist, was a pioneer in the use of surgical anesthesia. While npracticing in Hartford, Connecticut, in 1844, Wells noted the pain-killing nproperties of nitrous oxide (“laughing gas”) during a laughing-gas road show nand thereafter used it in performing painless dental operations. He was allowed nto demonstrate the method at the Massachusetts General Hospital in January n1845, but when the patient proved unresponsive to the gas, Wells was exposed to nridicule.

n     nIt was nWilliam Thomas Morton who, on Oct. 16, 1846, at Massachusetts General nHospital, in Boston, first demonstrated before a gathering of physicians the nuse of ether as a general anaesthetic. He is credited with gaining the medical nworld’s acceptance of surgical anesthesia. The news quickly reached Europe, and general anaesthesia soon became prevalent in surgery.

n     nAt Edinburgh, the professor of midwifery, James Young Simpson, had been experimenting nupon himself and his assistants, inhaling various vapours with the object of ndiscovering an effective anaesthetic. He was the first to use chloroform iobstetrics and the first in Britain to use ether. In November 1847 chloroform nwas tried with complete success, and soon it was preferred to ether and became nthe anaesthetic of choice.

ADVANCES AT nTHE END OF THE CENTURY

n     nPatrick nManson, a nBritish pioneer in tropical medicine, showed in China, in 1877, how insects cacarry disease and how the embryos of the Filaria worm, which can cause nelephantiasis, are transmitted by the mosquito. Manson explained his views to a nBritish army surgeon, Ronald Ross, then working on the problem of malaria, and nRoss discovered the malarial parasite in the stomach of the Anopheles mosquito nin 1897.

n     nIn Cuba, Carlos Finlay expressed the view, in 1881, that yellow fever is carried by the nStegomyia mosquito. Following his lead, the Americans Walter Reed, William nGorgas, and others were able to conquer the scourge of yellow fever in Panama and made possible the completion of the Panama Canal by reducing the death rate there from n176 per 1,000 to 6 per 1,000.

n     nOther nvictories in preventive medicine ensued, because the maintenance of nhealth was now becoming as important a concern as the cure of disease; and the n20th century was to witness the evolution and progress of national health nservices in a number of countries.

n     nIaddition, spectacular advances in diagnosis and treatment followed the ndiscovery of X rays by Wilhelm Conrad Röntgen, in 1895, and of radium by nPierre and Marie Curie in 1898. Before the turn of the century, too, the vast nnew field of psychiatry had been opened up by Sigmund Freud.

n     nThe ntremendous increase in scientific knowledge during the 19th century radically naltered and expanded the practice of medicine. Concern for upholding the nquality of services led to the establishment of public and professional nbodies to govern the standards for medical training and practice.

 

The 20th ncentury has produced such a plethora of discoveries and advances that in some nways the face of medicine has changed out of all recognition. In 1901, for ninstance, in the United Kingdom the expectation of life at birth, a primary nindicator of the effect of health care on mortality (but also reflecting the nstate of health education, housing, and nutrition), was 48 years for males and n51.6 years for females. After steady increases, by the 1980s life expectancy nhad reached 71.4 years for males and 77.2 years for females. Other nindustrialized nations showed similar dramatic increases. Indeed, the outlook nhas so altered that, with the exception of diseases such as cancer and AIDS, nattention has become focused on morbidity rather than mortality, and the nemphasis has changed from keeping people alive to keeping them fit.

 

The rapid nprogress of medicine in this era was reinforced by enormous improvements icommunication between scientists throughout the world. Through publications, nconferences, and later computers and electronic media, they freely exchanged nideas and reported on their endeavours. No longer was it common for aindividual to work in isolation. Although specialization increased, teamwork nbecame the norm. It consequently has become more difficult to ascribe medical naccomplishments to particular individuals.

 

In the first nhalf of the century, emphasis continued to be placed on combating infection, nand notable landmarks were also attained in endocrinology, nutrition, and other nareas. In the years following World War II, insights derived from cell biology naltered basic concepts of the disease process; new discoveries in biochemistry nand physiology opened the way for more precise diagnostic tests and more neffective therapies; and spectacular advances in biomedical engineering enabled nthe physician and surgeon to probe into the structures and functions of the nbody by non-invasive imaging techniques like ultrasound (sonar), computerized naxial tomography (CAT), and nuclear magnetic resonance (NMR). With each new nscientific development, medical practices of just a few years earlier became nobsolete.

 

 

 

Infectious ndiseases and chemotherapy

 

In the years nfollowing the turn of the century, ongoing research concentrated on the nature nof infectious diseases and their means of transmission. Increasing numbers of npathogenic organisms were discovered and classified. Some, such as the nrickettsias, which cause diseases like typhus, were smaller than bacteria; some nwere larger, such as the protozoans that engender malaria and other tropical ndiseases. The smallest to be identified were the viruses, producers of many ndiseases, among them mumps, measles, German measles, and poliomyelitis; and i1910 Peyton Rous showed that a virus could also cause a malignant tumour, a nsarcoma in chickens.

 

There was nstill little to be done for the victims of most infectious organisms beyond ndrainage, poultices, and ointments, in the case of local infections, and rest nand nourishment for severe diseases. The search for treatments aimed at both nvaccines and chemical remedies.

 

Germany was well to the forefront nin medical progress. The scientific approach to medicine had been developed nthere long before it spread to other countries, and postgraduates flocked to nGerman medical schools from all over the world. The opening decade of the 20th ncentury has been well described as the golden age of German medicine. nOutstanding among its leaders was Paul Ehrlich.

 

While still a nstudent, Ehrlich carried out some work on lead poisoning from which he evolved nthe theory that was to guide much of his subsequent work—that certain tissues nhave a selective affinity for certain chemicals. He experimented with the neffects of various chemical substances on disease organisms. In 1910, with his ncolleague Sahachiro Hata, he conducted tests on arsphenamine, once sold under nthe commercial name Salvarsan. Their success inaugurated the chemotherapeutic nera, which was to revolutionize the treatment and control of infectious ndiseases. Salvarsan, a synthetic preparation containing arsenic, is lethal to nthe microorganism responsible for syphilis. Until the introduction of npenicillin, Salvarsan or one of its modifications remained the standard ntreatment of syphilis and went far toward bringing this social and medical nscourge under control.

 

Sulfonamide ndrugs

 

In 1932 the nGerman bacteriologist Gerhard Domagk announced that the red dye Prontosil is nactive against streptococcal infections in mice and humans. Soon afterward nFrench workers showed that its active antibacterial agent is sulphanilamide. I1936 the English physician Leonard Colebrook and his colleagues provided noverwhelming evidence of the efficacy of both Prontosil and sulphanilamide istreptococcal septicemia (bloodstream infection), thereby ushering in the nsulphonamide era. New sulphonamides, which appeared with astonishing rapidity, nhad greater potency, wider antibacterial range, or lower toxicity. Some stood nthe test of time; others, like the original sulphanilamide and its immediate nsuccessor, sulfapyridine, were replaced by safer and more powerful successors.

 

Antibiotics

 

A dramatic nepisode in medical history occurred in 1928, when Alexander Fleming noticed the ninhibitory action of a stray mold on a plate culture of staphylococcus bacteria nin his laboratory at St. Mary’s Hospital, London. Many other bacteriologists nmust have made the observation, but none had realized the possible nimplications. The mold was a strain of Penicillium—P. notatum—which gave its nname to the now-famous drug penicillin. In spite of his conviction that npenicillin was a potent antibacterial agent, Fleming was unable to carry his nwork to fruition, mainly because biochemists at the time were unable to isolate nit in sufficient quantities or in a sufficiently pure form to allow its use opatients.

 

 

Alexander nFleming

 

Ten years nlater Howard Florey, Ernst Chain, and their colleagues at Oxford University took up the problem again they isolated penicillin in a form that was fairly pure n(by standards then current) and demonstrated its potency and relative lack of ntoxicity. By then World War II had begun, and techniques to facilitate ncommercial production were developed in the United States. By 1944 adequate namounts were available to meet the extraordinary needs of wartime.

 

Antituberculous ndrugs

 

While npenicillin is the most useful and the safest antibiotic, it suffers from ncertain disadvantages. The most important of these is that it is not active nagainst Mycobacterium tuberculosis, the bacillus of tuberculosis. In view of nthe importance of tuberculosis as a public health hazard, this is a serious ndefect. The position was rapidly rectified when, in 1944, Selman Waksman, nAlbert Schatz, and Elizabeth Bugie announced the discovery of streptomycin from ncultures of a soil organism, Streptomyces griseus, and stated that it was nactive against M. tuberculosis. Subsequent clinical trials amply confirmed this nclaim. Streptomycin suffers, however, from the great disadvantage that the ntubercle bacillus tends to become resistant to it. Fortunately, other drugs nbecame available to supplement it, the two most important being npara-aminosalicylic acid (PAS) and isoniazid. With a combination of two or more nof these preparations, the outlook in tuberculosis improved immeasurably. The ndisease was not conquered, but it was brought well under control.

 

Other nantibiotics

 

Penicillin is nnot effective over the entire field of microorganisms pathogenic to humans. nDuring the 1950s the search for antibiotics to fill this gap resulted in a nsteady stream of them, some with a much wider antibacterial range thapenicillin (the so-called broad-spectrum antibiotics) and some capable of ncoping with those microorganisms that are inherently resistant to penicillin or nthat have developed resistance through exposure to penicillin.

 

This tendency nof microorganisms to develop resistance to penicillin at one time threatened to nbecome almost as serious a problem as the development of resistance to nstreptomycin by the bacillus of tuberculosis. Fortunately, early appreciation of nthe problem by clinicians resulted in more discriminate use of penicillin. nScientists continued to look for means of obtaining new varieties of npenicillin, and their researches produced the so-called semisynthetic nantibiotics, some of which are active when taken by mouth, while others are neffective against microorganisms that have developed resistance to the earlier nform of penicillin.

 

Immunology

 

Dramatic nthough they undoubtedly were, the advances in chemotherapy still left one nimportant area vulnerable, that of the viruses. It was in bringing viruses nunder control that advances in immunology – the study of immunity – played such na striking part. One of the paradoxes of medicine is that the first large-scale nimmunization against a viral disease was instituted and established long before nviruses were discovered. When Edward Jenner introduced vaccination against the nvirus that causes smallpox, the identification of viruses was still 100 years nin the future. It took almost another half century to discover an effective nmethod of producing antiviral vaccines that were both safe and effective.

 

In the nmeantime, however, the process by which the body reacts against infectious norganisms to generate immunity became better understood. In Paris, Élie nMetchnikoff had already detected the role of white blood cells in the immune nreaction, and Jules Bordet had identified antibodies in the blood serum. The nmechanisms of antibody activity were used to devise diagnostic tests for a nnumber of diseases. In 1906 August von Wassermann gave his name to the blood ntest for syphilis, and in 1908 the tuberculin test – the skin test for ntuberculosis – came into use. At the same time, methods of producing effective nsubstances for inoculation were improved, and immunization against bacterial ndiseases made rapid progress.

 

 

 

Antibacterial nvaccination

 

Typhoid

 

In 1897 the nEnglish bacteriologist Almroth Wright introduced a vaccine prepared from nkilled typhoid bacilli as a preventive of typhoid. Preliminary trials in the nIndian army produced excellent results, and typhoid vaccination was adopted for nthe use of British troops serving in the South African War. Unfortunately, the nmethod of administration was inadequately controlled, and the government nsanctioned inoculations only for soldiers that “voluntarily presented nthemselves for this purpose prior to their embarkation for the seat of war.” nThe result was that, according to the official records, only 14,626 mevolunteered out of a total strength of 328,244 who served during the three years nof the war. Although later analysis showed that inoculation had had a nbeneficial effect, there were 57,684 cases of typhoid – approximately one isix of the British troops engaged – with 9,022 deaths.

 

A bitter ncontroversy over the merits of the vaccine followed, but before the outbreak of nWorld War I immunization had been officially adopted by the army. Comparative nstatistics would seem to provide striking confirmation of the value of nantityphoid inoculation, even allowing for the better sanitary arrangements ithe latter war. In the South African War the annual incidence of enteric ninfections (typhoid and paratyphoid) was 105 per 1,000 troops, and the annual ndeath rate was 14.6 per 1,000; the comparable figures for World War I were 2.35 nand 0.139, respectively.

 

It is perhaps na sign of the increasingly critical outlook that developed in medicine in the npost-1945 era that experts continued to differ on some aspects of typhoid nimmunization. There was no question as to its fundamental efficacy, but there was nconsiderable variation of opinion as to the best vaccine to use and the most neffective way of administering it. Moreover, it was often difficult to decide nto what extent the decline in typhoid was attributable to improved sanitary nconditions and what to the greater use of the vaccine.

 

 Tetanus

 

The other ngreat hazard of war that was brought under control in World War I was tetanus. nThis was achieved by the prophylactic injection of tetanus antitoxin into all nwounded men. The serum was originally prepared by the bacteriologists Emil voBehring and Shibasaburo Kitasato in 1890 – 92, and the results of this first nlarge-scale trial amply confirmed its efficacy. (Tetanus antitoxin is a sterile nsolution of antibody globulins – a type of blood protein – from immunized nhorses or cattle.)

 

It was not nuntil the 1930s, however, that an efficient vaccine, or toxoid, as it is knowin the cases of tetanus and diphtheria,was produced against tetanus. (Tetanus ntoxoid is a preparation of the toxin – or poison – produced by the nmicroorganism; injected into humans, it stimulates the body’s own defences nagainst the disease, thus bringing about immunity.) Again, a war was to provide nthe opportunity for testing on a large scale, and experience with tetanus ntoxoid in World War II indicated that it gave a high degree of protection.

 

Diphtheria

 

The story of ndiphtheria is comparable to that of tetanus, though even more dramatic. First, nas with tetanus antitoxin, came the preparation of diphtheria antitoxin by Behring nand Kitasato in 1890. As the antitoxin came into general use for the ntreatment of cases, the death rate began to decline. There was no significant nfall in the number of cases, however, until a toxin–antitoxin mixture, nintroduced by Behring in 1913, was used to immunize children. A more effective ntoxoid was introduced by the French bacteriologist Gaston Ramon in 1923, and nwith subsequent improvements this became one of the most effective vaccines navailable in medicine. Where mass immunization of children with the toxoid was npracticed, as in the United States and Canada beginning in the late 1930s and nin England and Wales in the early 1940s, cases of diphtheria and deaths from nthe disease became almost nonexistent. In England and Wales, for instance, the number of deaths fell from an annual average of 1,830 in 1940 – 44 to zero in 1969. Administration of a combined vaccine against diphtheria, npertussis (whooping cough), and tetanus (DPT) is recommended for young nchildren. Although an increasing number of dangerous side effects from the DPT nvaccine have been reported, it continues to be used in most countries because nof the protection it affords.

 

BCG vaccine nfor tuberculosis

 

If, as is nuniversally accepted, prevention is better than cure, immunization is the ideal nway of dealing with diseases caused by microorganisms. An effective, safe nvaccine protects the individual from disease, whereas chemotherapy merely copes nwith the infection once the individual has been affected. In spite of its nundoubted value, however, immunization has been a recurring source of dispute. nLike vaccination against typhoid (and against poliomyelitis later), ntuberculosis immunization evoked widespread contention.

 

In 1908 Albert nCalmette, a pupil of Pasteur, and Camille Guérin produced an avirulent n(weakened) strain of the tubercle bacillus. About 13 years later, vaccinatioof children against tuberculosis was introduced, with a vaccine made from this navirulent strain and known as BCG (bacillus Calmette-Guérin) vaccine. nAlthough it was adopted in France, Scandinavia, and elsewhere, British and U.S. authorities frowned upon its use on the grounds that it was not safe and that the nstatistical evidence in its favour was not convincing.

 

One of the nstumbling blocks in the way of its widespread adoption was what came to be nknown as the Lübeck disaster. In the spring of 1930, 249 infants were nvaccinated with BCG vaccine in Lübeck, Ger.; by autumn, 73 of the 249 were ndead. Criminal proceedings were instituted against those responsible for giving nthe vaccine. The final verdict was that the vaccine had been contaminated, and nthe BCG vaccine itself was exonerated from any responsibility for the deaths. A nbitter controversy followed, but in the end the protagonists of the vaccine wowhen a further trial showed that the vaccine was safe and that it protected nfour out of five of those vaccinated.

 

Immunizatioagainst viral diseases

 

With the nexception of smallpox, it was not until well into the 20th century that nefficient viral vaccines became available. In fact, it was not until the 1930s nthat much began to be known about viruses. The two developments that ncontributed most to the rapid growth in knowledge after that time were the nintroduction of tissue culture as a means of growing viruses in the laboratory nand the availability of the electron microscope. Once the virus could be ncultivated with comparative ease in the laboratory, the research worker could nstudy it with care and evolve methods for producing one of the two requirements nfor a safe and effective vaccine: either a virus that was so attenuated, or nweakened, that it could not produce the disease for which it was responsible iits normally virulent form; or a killed virus that retained the faculty of ninducing a protective antibody response in the vaccinated individual.

 

The first of nthe viral vaccines to result from these advances was for yellow fever, ndeveloped by the microbiologist Max Theiler in the late 1930s. About 1945 the nfirst relatively effective vaccine was produced for influenza; in 1954 the nAmerican physician Jonas E. Salk introduced a vaccine for poliomyelitis; and i1960 an oral poliomyelitis vaccine, developed by the virologist Albert B. nSabin, came into wide use.

 

These vaccines nwent far toward bringing under control three of the major diseases of the time nalthough, in the case of influenza, a major complication is the disturbing nproclivity of the virus to change its character from one epidemic to another. nEven so, sufficient progress has been made to ensure that a pandemic like the none that swept the world in 1918 – 19, killing more than 15,000,000 people, is nunlikely to occur again. Centres are now equipped to monitor outbreaks of ninfluenza throughout the world in order to establish the identity of the nresponsible viruses and, if necessary, take steps to produce appropriate nvaccines.

 

During the n1960s effective vaccines came into use for measles and rubella (Germameasles). Both evoked a certain amount of controversy. In the case of measles nin the Western world it was contended that, if acquired in childhood, it is not na particularly hazardous malady, and the naturally acquired disease evokes npermanent immunity in the vast majority of cases. Conversely, the vaccine ninduces a certaiumber of adverse reactions, and the duration of the immunity nit produces is problematical. In the end the official view was that universal nmeasles vaccination is to be commended.

 

The situatiowith rubella vaccination was different. This is a fundamentally mild naffliction, and the only cause for anxiety is its proclivity to induce ncongenital deformities if a pregnant woman should acquire the disease. Once aeffective vaccine was available, the problem was the extent to which it should nbe used. Ultimately the consensus was reached that all girls who had not nalready had the disease should be vaccinated at about 12 years. In the United States children are routinely immunized against measles, mumps, and rubella at the nage of 15 months.

 

The immune nresponse

 

With advances nin cell biology in the second half of the 20th century came a more profound nunderstanding of both normal and abnormal conditions in the body. Electromicroscopy enabled observers to peer more deeply into the structures of the ncell, and chemical investigations revealed clues to their functions in the cell’s nintricate metabolism. The overriding importance of the nuclear genetic material nDNA (deoxyribonucleic acid) in regulating the cell’s protein and enzyme nproduction lines became evident. A clearer comprehension also emerged of the nways in which the cells of the body defend themselves by modifying their nchemical activities to produce antibodies against injurious agents.

 

Up until the nturn of the century, immunity referred mostly to the means of resistance of aanimal to invasion by a parasite or microorganism. Around mid-century there narose a growing realization that immunity and immunology cover a much wider nfield and are concerned with mechanisms for preserving the integrity of the nindividual. The introduction of organ transplantation, with its dreaded complicatioof tissue rejection, brought this broader concept of immunology to the fore.

 

At the same ntime, research workers and clinicians began to appreciate the far-reaching nimplications of immunity in relation to endocrinology, genetics, tumour nbiology, and the biology of a number of other maladies. The so-called nautoimmune diseases are caused by an aberrant series of immune responses by nwhich the bodies own cells are attacked. Suspicion is growing that a number of nmajor disorders such as diabetes, rheumatoid arthritis, and multiple sclerosis nmay be caused by similar mechanisms.

 

In some nconditions viruses invade the genetic material of cells and distort their nmetabolic processes. Such viruses may lie dormant for many years before nbecoming active. This may be the underlying cause of many cancers, in which ncells escape from the usual constraints imposed upon them by the normal body. nThe dreaded affliction of acquired immune deficiency syndrome (AIDS) is caused nby a virus that has a long dormant period and then attacks the cells that nproduce antibodies. The result is that the affected person is not able to ngenerate an immune response to infections or malignancies.

 

Endocrinology

 

At the nbeginning of the 20th century, endocrinology was in its infancy. Indeed, it was nnot until 1905 that Ernest H. Starling, one of the many brilliant pupils of nEdward Sharpey-Schafer, the dean of British physiology during the early decades nof the century, introduced the term hormone for the internal secretions of the nendocrine glands. In 1891 the English physician George Redmayne Murray achieved nthe first success in treating myxedema (the common form of hypothyroidism) with nan extract of the thyroid gland. Three years later, Sharpey-Schafer and George nOliver demonstrated in extracts of the adrenal glands a substance that raised nthe blood pressure; and in 1901 Jokichi Takamine, a Japanese chemist working ithe United States, isolated this active principle, known as epinephrine or nadrenaline.

 

Insulin

 

During the nfirst two decades of the century, steady progress was made in the isolation, nidentification, and study of the active principles of the various endocrine nglands, but the outstanding event of the early years was the discovery of ninsulin by Frederick Banting, Charles H. Best, and J.J.R. Macleodin 1921. nAlmost overnight the lot of the diabetic patient changed from a sentence of nalmost certain death to a prospect not only of survival but of a long and nhealthy life.

 

 

Frederick nBanting

 

Charles nH. Best

 

J.J.R. nMacleodin

 

 

For more tha30 years, some of the greatest minds in physiology had been seeking the cause nof diabetes mellitus. In 1889 the German physicians Joseph von Mering and Oskar nMinkowski had shown that removal of the pancreas in dogs produced the disease. nIn 1901 the American pathologist Eugene L. Opie described degenerative changes nin the clumps of cells in the pancreas known as the islets of Langerhans, thus nconfirming the association between failure in the function of these cells and ndiabetes. Sharpey-Schafer concluded that the islets of Langerhans secrete a nsubstance that controls the metabolism of carbohydrate. Then Banting, Best, and nMacleod, working at the University of Toronto, succeeded in isolating the nelusive hormone and gave it the name insulin.

 

Insulin was navailable in a variety of forms, but synthesis on a commercial scale was not nachieved, and the only source of the hormone was the pancreas of animals. One nof its practical disadvantages is that it has to be given by injection; nconsequently an intense search was conducted for some alternative substance nthat would be active when taken by mouth. Various preparations – oral nhypoglycemic agents, as they are known – appeared that were effective to a ncertain extent in controlling diabetes, but evidence indicated that these were nonly of value in relatively mild cases of the disease. For the person with nadvanced diabetes, a normal, healthy life remained dependent upon the ncontinuing use of insulin injections.

 

Cortisone

 

Another major nadvance in endocrinology came from the Mayo Clinic, in Rochester, Minn. In 1949 Philip S. Hench and his colleagues announced that a substance isolated from nthe cortex of the adrenal gland had a dramatic effect upon rheumatoid narthritis. This was compound E, or cortisone, as it came to be known, which had nbeen isolated by Edward C. Kendall in 1935. Cortisone and its many derivatives nproved to be potent as anti-inflammatory agents. Although it is not a cure for nrheumatoid arthritis, as a temporary measure cortisone can often control the nacute exacerbation caused by the disease and can provide relief in other nconditions, such as acute rheumatic fever, certain kidney diseases, certaiserious diseases of the skin, and some allergic conditions, including acute nexacerbations of asthma. Of even more long-term importance is the valuable role nit has as a research tool.

 

Sex nhormones

 

Not the least nof the advances in endocrinology was the increasing knowledge and understanding nof the sex hormones. This culminated in the application of this knowledge to nthe problem of birth control. After an initial stage of hesitancy, the ncontraceptive pill, with its basic rationale of preventing ovulation, was naccepted by the vast majority of family-planning organizations and many ngynecologists as the most satisfactory method of contraception. Its risks, npractical and theoretical, introduced a note of caution, but this was not nsufficient to detract from the wide appeal induced by its effectiveness and nease of use.

 

Vitamins

 

In the field nof nutrition, the outstanding advance of the 20th century was the discovery and nthe appreciation of the importance to health of the “accessory food factors,” nor vitamins. Various workers had shown that animals did not thrive on a nsynthetic diet containing all the correct amounts of protein, fat, and ncarbohydrate; they even suggested that there must be some unknown ingredients niatural food that were essential for growth and the maintenance of health. But nlittle progress was made in this field until the classical experiments of the nEnglish biologist F. Gowland Hopkins were published in 1912. These were so nconclusive that there could be no doubt that what he termed “accessory nsubstances” were essential for health and growth.

 

The name nvitamine was suggested for these substances by the biochemist Casimir Funk ithe belief that they were amines, certain compounds derived from ammonia. Idue course, when it was realized that they were not amines, the term was naltered to vitamin.

 

Once the nconcept of vitamins was established on a firm scientific basis it was not long nbefore their identity began to be revealed. Soon there was a long series of nvitamins, best known by the letters of the alphabet after which they were noriginally named when their chemical identity was still unknown. By nsupplementing the diet with foods containing particular vitamins, deficiency ndiseases such as rickets (due to deficiency of vitamin D) and scurvy (due to nlack of vitamin C, or ascorbic acid) practically disappeared from Westercountries, while deficiency diseases such as beriberi (caused by lack of nvitamin B1, or thiamine), which were endemic in Eastern countries, either ndisappeared or could be remedied with the greatest of ease.

 

The isolatioof vitamin B12, or cyanocobalamin, was of particular interest because it almost nrounded off the fascinating story of how pernicious anemia was brought under ncontrol. Throughout the first two decades of the century, the diagnosis of npernicious anemia, like that of diabetes mellitus, was nearly equivalent to a ndeath sentence. Unlike the more common form of so-called secondary anemia, it ndid not respond to the administration of suitable iron salts, and no other form nof treatment touched it; hence, the grimly appropriate title of pernicious nanemia.

 

In the early n1920s, George R. Minot, one of the many brilliant investigators that Harvard University has contributed to medical research, became interested in work being ndone by the American pathologist George H. Whipple on the beneficial effects of nraw beef liver in severe experimental anemia. With a Harvard colleague, William nP. Murphy, he decided to investigate the effect of raw liver in patients with npernicious anemia, and in 1926 they were able to announce that this form of ntherapy was successful. The validity of their findings was amply confirmed, and nthe fear of pernicious anemia came to an end.

 

As so oftehappens in medicine, many years were to pass before the rationale of liver ntherapy in pernicious anemia was fully understood. In 1948, however, almost nsimultaneously in the United States and Britain, the active principle, ncyanocobalamin, was isolated from liver, and this vitamin became the standard ntreatment for pernicious anemia.

 

Malignant ndisease

 

While progress nwas the hallmark of medicine after the beginning of the 20th century, there is none field in which a gloomier picture must be painted, that of malignant ndisease, or cancer. It is the second most common cause of death in most Westercountries in the second half of the 20th century, being exceeded only by deaths nfrom heart disease. Some progress, however, has been achieved. The causes of nthe various types of malignancies are not known, but many more methods are navailable for attacking the problem; surgery remains the principal therapeutic nstandby, but radiotherapy and chemotherapy are increasingly used.

 

Soon after the ndiscovery of radium was announced, in 1898, its potentialities in treating ncancer were realized; in due course it assumed an important role in therapy. nSimultaneously, deep X-ray therapy was developed, and with the atomic age came nthe use of radioactive isotopes. (A radioactive isotope is an unstable variant nof a substance that has a stable form; during the process of breaking down, the nunstable form emits radiation.) High-voltage X-ray therapy and radioactive nisotopes have largely replaced radium. Whereas irradiation long depended upon X nrays generated at 250 kilovolts, machines that are capable of producing X rays ngenerated at 8,000 kilovolts and betatrons of up to 22,000,000 electron volts n(MeV) have come into clinical use.

 

The most neffective of the isotopes is radioactive cobalt. Telecobalt machines (those nthat hold the cobalt at a distance from the body) are available containing n2,000 curies or more of the isotope, an amount equivalent to 3,000 grams of radium and sending out a beam equivalent to that from a 3,000-kilovolt X-ray machine.

 

Of even more nsignificance have been the developments in the chemotherapy of cancer. Nothing nremotely resembling a chemotherapeutic cure has been achieved, but in certaiforms of malignant disease, such as leukemia, which cannot be treated by nsurgery, palliative effects have been achieved that prolong life and allow the npatient in many instances to lead a comparatively normal existence.

 

Fundamentally, nhowever, perhaps the most important advance of all in this field has been the nincreasing appreciation of the importance of prevention. The discovery of the nrelationship between cigarette smoking and lung cancer is the classic example. nLess publicized, but of equal import, is the continuing supervision of new ntechniques in industry and food manufacture in an attempt to ensure that they ndo not involve the use of cancer-causing substances.

 

Tropical nmedicine

 

The first half nof the 20th century witnessed the virtual conquest of three of the major ndiseases of the tropics: malaria, yellow fever, and leprosy. At the turn of the ncentury, as for the preceding two centuries, quinine was the only known drug to nhave any appreciable effect on malaria. With the increasing development of ntropical countries and rising standards of public health, it became obvious nthat quinine was not completely satisfactory. Intensive research between World nWars I and II indicated that several synthetic compounds were more effective. nThe first of these to become available, in 1934, was quinacrine (known as nmepacrine, Atabrine, or Atebrin). In World War II it amply fulfilled the nhighest expectations and helped to reduce disease among Allied troops iAfrica, Southeast Asia, and the Far East. A number of other effective nantimalarial drugs subsequently became available.

 

An evebrighter prospect—the virtual eradication of malaria—was opened up by the nintroduction, during World War II, of the insecticide DDT n(1,1,1-trichloro-2,2,-bis[p-chlorophenyl]ethane, or ndichlorodiphenyltrichloro-ethane). It had long been realized that the only neffective way of controlling malaria was to eradicate the anopheline mosquitoes nthat transmit the disease. Older methods of mosquito control, however, were ncumbersome and expensive. The lethal effect of DDT on the mosquito, its nrelative cheapness, and its ease of use on a widespread scale provided the nanswer. An intensive worldwide campaign, sponsored by the World Health nOrganization, was planned and went far toward bringing malaria under control.

 

The major nproblem encountered with respect to effectiveness was that the mosquitoes were nable to develop a resistance to DDT; but the introduction of other insecticides, nsuch as dieldrinand lindane (BHC), helped to overcome this difficulty. Irecent years the use of these and other insecticides has been strongly ncriticized by ecologists, however.

 

Yellow fever nis another mosquito-transmitted disease, and the prophylactic value of moderinsecticides in its control was almost as great as in the case of malaria. The nforest reservoirs of the virus present a more difficult problem, but the ncombined use of immunization and insecticides did much to bring this disease under ncontrol.

 

Until the n1940s the only drugs available for treating leprosy were the chaulmoogra oils nand their derivatives. These, though helpful, were far from satisfactory. Ithe 1940s the group of drugs known as the sulfones appeared, and it soon became napparent that they were infinitely better than any other group of drugs in the ntreatment of leprosy. Several other drugs later proved promising. Although nthere is as yet no known cure – in the strict sense of the term – for leprosy, nthe outlook has so changed that there are good grounds for believing that this nage-old scourge can be brought under control and the victims of the disease nsaved from those dreaded mutilations that have given leprosy such a fearsome nreputation throughout the ages.

 

 

 

Surgery ithe 20th century

 

The opening nphase

 

Three nseemingly insuperable obstacles beset the surgeon in the years before the nmid-19th century: pain, infection, and shock. Once these were overcome, the nsurgeon believed that he could burst the bonds of centuries and become the nmaster of his craft. There is more, however, to anesthesia than putting the npatient to sleep. Infection, despite first antisepsis (destruction of nmicroorganisms present) and later asepsis (avoidance of contamination), is nstill an ever-present menace; and shock continues to perplex physicians. But ithe 20th century, surgery has progressed farther, faster, and more dramatically nthan in all preceding ages.

 

The shape of nsurgery that entered the new century was clearly recognizable as the forerunner nof today’s, blurred and hazy though the outlines may now seem. The operating ntheatre still retained an aura of the past, when the surgeon played to his naudience and the patient was little more than a stage prop. In most hospitals nit was a high room lit by a skylight, with tiers of benches rising above the nnarrow, wooden operating table. The instruments, kept in glazed or woodecupboards around the walls, were of forged steel, unplated, and with handles of nwood or ivory.

 

The means to ncombat infection hovered between antisepsis and asepsis. Instruments and ndressings were mostly sterilized by soaking them in dilute carbolic acid (or nother antiseptic), and the surgeon often endured a gown freshly wrung out ithe same solution. Asepsis gained ground fast, however. It had been born in the Berlin clinic of Ernst von Bergmann where, in 1886, steam sterilization had nbeen introduced. Gradually, this led to the complete aseptic ritual, which has nas its basis the bacterial cleanliness (as opposed to social cleanliness) of neverything that comes in contact with the wound. Hermann Kümmell, of Hamburg, devised the routine of “scrubbing up”. In1890 William Stewart Halsted, of Johns Hopkins University, had rubber gloves specially made for operating, and in 1896 Johannes voMikulicz-Radecki, a Pole working at Breslau, Ger., invented the gauze mask.

 

Many surgeons, nbrought up in a confused misunderstanding of the antiseptic principle – nbelieving that carbolic would cover a multitude of sins, many of which they nwere ignorant of committing – failed to grasp what asepsis was all about. nThomas Annandale, for example, blew through his catheters to make sure that nthey were clear, and many an instrument, dropped accidentally, was simply givea quick wipe and returned to use. Tradition died hard, and asepsis had auphill struggle before it was fully accepted. “I believe firmly that more npatients have died from the use of gloves than have ever been saved from ninfection by their use,” wrote W.P. Carr, an American, in 1911. Over the years, nhowever, a sound technique was evolved as the foundation for the growth of nmodern surgery.

 

Anesthesia, at nthe turn of the century, progressed slowly. Few physicians made a career of the nsubject, and frequently the patient was rendered unconscious by a student, a nnurse, or a porter wielding a rag and bottle. Chloroform was overwhelmingly nmore popular than ether, on account of its ease of administration, despite the nfact that it was liable to kill by stopping the heart.

 

Although by nthe end of the first decade, nitrous oxide (laughing gas) combined with ether nhad displaced – but by no means entirely – the use of chloroform, the surgical nproblems were far from ended. For years to come the abdominal surgeon besought nthe anesthetist to deepen the level of anesthesia and thus relax the abdominal nmuscles; the anesthetist responded to the best of his ability, acutely aware nthat the deeper he went, the closer the patient was to death. When other nanesthetic agents were discovered, the anesthetist came into his own, and many nadvances in spheres such as brain and heart surgery would have been impossible nwithout his skill.

 

The third nobstacle, shock, is perhaps the most complex and the most difficult to define nsatisfactorily. The only major cause properly appreciated at the start of the n20th century was loss of blood, and once that had occurred nothing, in those ndays, could be done. And so, the study of shock – its causes, its effects ohuman physiology, and its prevention and treatment – became allimportant to the nprogress of surgery.

 

In the latter npart of the 19th century, then, surgeons had been liberated from the age-old nbogies of pain, pus, and hospital gangrene. Hitherto, operations had beerestricted to amputations, cutting for stone in the bladder, tying off arterial naneurysms (bulging and thinning of artery walls), repairing hernias, and a nvariety of procedures that could be done without going too deeply beneath the nskin. But the anatomical knowledge, a crude skill derived from practice on dead nbodies, and above all the enthusiasm, were there waiting. Largely ignoring the nmass of problems they uncovered, surgeons launched forth into an exploration of nthe human body.

 

They acquired na reputation for showmanship; but much of their surgery, though speedy and spectacular, nwas rough and ready. There were a few who developed supreme skill and dexterity nand could have undertaken a modern operation with but little practice; indeed, nsome devised the very operations still in use today. One such was Theodor nBillroth, head of the surgical clinic at Vienna, who collected a formidable nlist of successful “first” operations. He represented the best of his ngeneration—a surgical genius, an accomplished musician, and a kind, gentle mawho brought the breath of humanity to his work. Moreover, the men he trained, nincluding von Mikulicz, Vincenz Czerny, and Anton von Eiselsberg, consolidated nthe brilliant start that he had given to abdominal surgery in Europe.

 

Changes nbefore World War I

 

The opening ndecade of the 20th century was a period of transition. Flamboyant exhibitionism nwas falling from favour as surgeons, through experience, learned the merits of npainstaking, conscientious operation – treating the tissues gently and ncarefully controlling every bleeding point. The individualist was not nsubmerged, however, and for many years the development of the various branches nof surgery rested on the shoulders of a few clearly identifiable men. Teamwork non a large scale arrived only after World War II. The surgeon, at first, was nundisputed master in his own wards and theatre. But as time went on and he nfound he could not solve his problems alone, he called for help from nspecialists in other fields of medicine and, even more significantly, from his ncolleagues in other scientific disciplines.

 

The increasing nscope of surgery led to specialization. Admittedly, most general surgeons had a nspecial interest, and for a long time there had been an element of nspecialization in such fields as ophthalmology, orthopedics, obstetrics, and ngynecology; but before long it became apparent that, to achieve progress icertain areas, surgeons had to concentrate their attention on that particular nsubject.

 

Abdominal nsurgery

 

By the start nof the 20th century, abdominal surgery, which provided the general surgeon with nthe bulk of his work, had grown beyond infancy, thanks largely to Billroth. I1881 he had performed the first successful removal of part of the stomach for ncancer. His next two cases were failures, and he was stoned in the streets of Vienna. Yet, he persisted and by 1891 had carried out 41 more of these operations with 16 ndeaths – a remarkable achievement for that era.

 

Peptic ulcers n(gastric and duodenal) appeared on the surgical scene (perhaps as a new ndisease, but more probably because they had not been diagnosed previously), and nin 1881 Ludwig Rydygier cured a young woman of her gastric ulcer by removing nit. Bypass operations – gastroenterostomies – soon became more popular, nhowever, and enjoyed a vogue that lasted into the 1930s, even though fresh nulcers at the site of the juncture were not uncommon.

 

The other end nof the alimentary tract was also subjected to surgical intervention; cancers nwere removed from the large bowel and rectum with mortality rates that ngradually fell from 80 to 60 to 20 to 12 percent as the surgeons developed ntheir skill. In 1908 the British surgeon Ernest Miles carried out the first nabdominoperineal resection for cancer of the rectum; that is, the cancer was nattacked both from the abdomen and from below through the perineum (the area nbetween the anus and the genitals), either by one surgeon, who actually did two noperations, or by two working together. This technique formed the basis for all nfuture developments.

 

Much of the nnew surgery in the abdomen was for cancer, but not all. Appendectomy became the naccepted treatment for appendicitis (in appropriate cases) in the United States nbefore the close of the 19th century; but in Great Britain surgeons were nreluctant to remove the organ until 1902, when King Edward VII’s coronation was ndramatically postponed on account of his appendicitis. The publicity attached nto his operation caused the disease and its surgical treatment to become nfashionable—despite the fact that the royal appendix remained in the King’s nabdomen; the surgeon, Frederic Treves, had merely drained the abscess.

 

Neurosurgery

 

Though nprobably the most demanding of all the surgical specialties, neurosurgery was nnevertheless one of the first to emerge. The techniques and principles of ngeneral surgery were inadequate for work in such a delicate field. William nMacewen, a Scottish general surgeon of outstanding versatility, and Victor nAlexander Haden Horsley, the first British neurosurgeon, showed that the nsurgeon had much to offer in the treatment of disease of the brain and spinal ncord. Macewen, in 1893, recorded 19 patients operated on for brain abscess, 18 nof whom were cured; at that time most other surgeons had 100 percent mortality nrates for the condition. His achievement remained unequaled until the discovery nof penicillin.

 

An American, nHarvey Williams Cushing, almost by himself consolidated neurosurgery as a nspecialty. From 1905 on, he advanced neurosurgery through a series of noperations and through his writings. Tumours, epilepsy, trigeminal neuralgia, nand pituitary disorders were among the conditions he treated successfully.

 

Radiology

 

In 1895 a development at the University of Würzburg had far-reaching effects on medicine and nsurgery, opening up an entirely fresh field of the diagnosis and study of ndisease and leading to a new form of treatment, radiation therapy. This was the ndiscovery of X rays by Wilhelm Conrad Röntgen, a professor of physics. nWithin months of the discovery there was an extensive literature on the nsubject: Robert Jones, a British surgeon, had localized a bullet in a boy’s nwrist before operating; stones in the urinary bladder and gallbladder had beedemonstrated; and fractures had been displayed.

Wilhelm nConrad Röntgen

 

 

Experiments nbegan on introducing substances that are opaque to X rays into the body to nreveal organs and formations, both normal and abnormal. Walter Cannon, a Boston physiologist, used X rays in 1898 in his studies of the alimentary tract. Friedrich nVoelcker, of Heidelberg, devised retrograde pyelography (introduction of the nradiopaque medium into the kidney pelvis by way of the ureter) for the study of nthe urinary tract in 1905; in Paris in 1921, Jean Sicard X-rayed the spinal ncanal with the help of an oily iodine substance, and the next year he did the nsame for the bronchial tree; and in 1924 Evarts Graham, of St. Louis, used a nradiopaque contrast medium to view the gallbladder. Air was also used to nprovide contrast; in 1918, at Johns Hopkins, Walter Dandy injected air into the nventricles (liquid-filled cavities) of the brain.

 

The problems nof injecting contrast media into the blood vessels took longer to solve, and it nwas not until 1927 that António Moniz, of Lisbon, succeeded in obtaining npictures of the arteries of the brain. Eleven years later, George Robb and nIsrael Steinberg of New York overcame some of the difficulties of cardiac ncatheterization (introduction of a small tube into the heart by way of veins or narteries) and were able to visualize the chambers of the heart on X-ray film. nAfter much research, a further refinement came in 1962, when Frank Sones and nEarl K. Shirey of Cleveland showed how to introduce the contrast medium into nthe coronary arteries.

 

World War I

 

The nbattlefields of the 20th century stimulated the progress of surgery and taught nthe surgeon innumerable lessons, which were subsequently applied in civiliapractice. Regrettably, though, the principles of military surgery and casualty nevacuation, which can be traced back to the Napoleonic wars, had to be learned nover again.

 

World War I nbroke, quite dramatically, the existing surgical hierarchy and rule of ntradition. No longer did the European surgeon have to waste his best years iapprenticeship before seating himself in his master’s chair. Suddenly, young nsurgeons in the armed forces began confronting problems that would have daunted ntheir elders. Furthermore, their training had been in “clean” surgery performed nunder aseptic conditions. Now they found themselves faced with the need to ntreat large numbers of grossly contaminated wounds in improvised theatres. They nrediscovered debridement (the surgical excision of dead and dying tissue and nthe removal of foreign matter).

 

The older nsurgeons cried “back to Lister”, but antiseptics, no matter how strong, were no nmatch for putrefaction and gangrene. One method of antiseptic irrigation – ndevised by Alexis Carrel and Henry Dakin and called the Carrel–Dakin treatment n– was, however, beneficial, but only after the wound had been adequately ndebrided. The scourges of tetanus and gas gangrene were controlled to a large nextent by antitoxin and antiserum injections, yet surgical treatment of the nwound remained an essential requirement.

 

Abdominal ncasualties fared badly for the first year of the war, because experience in the nutterly different circumstances of the South African War had led to a belief nthat these men were better left alone surgically. Fortunately, the error of ncontinuing with such a policy 15 years later was soon appreciated, and every neffort was made to deliver the wounded men to a suitable surgical unit with all nspeed. Little progress was made with chest wounds beyond opening up the wound neven further to drain pus from the pleural cavity between the chest wall and nthe lungs.

 

Perhaps the nmost worthwhile and enduring benefit to flow from World War I was nrehabilitation. For almost the first time, surgeons realized that their work ndid not end with a healed wound. In 1915 Robert Jones set up special facilities nfor orthopedic patients, and at about the same time Harold Gillies founded nBritish plastic surgery in a hut at Sidcup, Kent. In 1917Gillies popularized nthe pedicle type of skin graft (the type of graft in which skin and nsubcutaneous tissue are left temporarily attached for nourishment to the site nfrom which the graft was taken). Since then plastic surgery has given many ntechniques and principles to other branches of surgery.

 

Between the nworld wars

 

The years nbetween the two world wars may conveniently be regarded as the time whesurgery consolidated its position. A surprising number of surgical firsts and nan amazing amount of fundamental research had been achieved even in the late n19thcentury, but the knowledge and experience could not be converted to npractical use because the human body could not survive the onslaught. In the nyears between World Wars I and II, it was realized that physiology – in its nwidest sense, including biochemistry and fluid and electrolyte balance – was of nmajor importance along with anatomy, pathology, and surgical technique.

 

The problem nof shock

 

The first nproblem to be tackled was shock, which was, in brief, found to be due to a ndecrease in the effective volume of the circulation. To combat shock, the nvolume had to be restored, and the obvious substance was blood itself. In 1901 nKarl Landsteiner, then in Austria, discovered the ABO blood groups, and in 1914 nsodium citrate was added to freshly drawn blood to prevent clotting. Blood was noccasionally transfused during World War I, but three-quarters of a pint was nconsidered a large amount. These transfusions were given by directly linking nthe vein of a donor with that of the recipient. The continuous drip method, iwhich blood flows from a flask, was introduced by Hugh Marriott and AlaKekwick at the Middlesex Hospital, London, in 1935.

 

 

Karl nLandsteiner

 

 As blood ntransfusions increased in frequency and volume, blood banks were required. nAlthough it took another world war before these were organized on a large nscale, the first tentative steps were taken by Sergey Sergeyevich Yudin, of Moscow, who, in 1933, used cadaver blood, and by Bernard Fantus, of Chicago, who, four nyears later, used living donors as his source of supply. Saline solution, nplasma, artificial plasma expanders, and other solutions are now also used ithe appropriate circumstances.

 

Sometimes nafter operations (especially abdominal operations),the gut becomes paralyzed. nIt is distended, and quantities of fluid pour into it, dehydrating the body. I1932 Owen Wangensteen, at the University of Minnesota, advised decompressing nthe bowel, and in 1934 two other Americans, Thomas Miller and William Abbott, nof Philadelphia, invented an apparatus for this purpose, a tube with ainflatable balloon on the end that could be passed into the small intestine. nThe fluid lost from the tissues was replaced by a continuous intravenous drip nof saline solution on the principle described by Rudolph Matas, of New Orleans, in 1924. These techniques dramatically improved abdominal surgery, especially nin cases of obstruction, peritonitis (inflammation of the abdominal membranes), nand acute emergencies generally, since they made it possible to keep the bowel nempty and at rest.

 

 

Anesthesia nand thoracic surgery

 

The strides ntaken in anesthesia from the 1920s onward allowed surgeons much more freedom. nRectal anesthesia had never proved satisfactory, and the first improvement othe combination of nitrous oxide, oxygen, and ether was the introduction of the ngeneral anesthetic cyclopropane by Ralph Waters of Madison, Wis., in 1933. Sooafterward, intravenous anesthesia was introduced; John Lundy of the Mayo Clinic nbrought to a climax a long series of trials by many workers when he used nPentothal (thiopental sodium, a barbiturate) to put a patient peacefully to nsleep. Then, in 1942, Harold Griffith and G. Enid Johnson, of Montreal, nproduced muscular paralysis by the injection of a purified preparation of ncurare. This was harmless since, by then, the anesthetist was able to control nthe patient’s respiration.

 

If there was none person who was aided more than any other by the progress in anesthesia, it nwas the thoracic (chest) surgeon. What had bothered him previously was the ncollapse of the lung, which occurred whenever the pleural cavity was opened. nSince the end of the 19th century, many and ingenious methods had been devised nto prevent this from happening. The best known was the negative pressure ncabinet of Ernst Ferdinand Sauerbruch, then at Mikulicz’ clinic at Breslau; the cabinet was first demonstrated in 1904 but was destined soon to become nobsolete.

 

The solutiolay in inhalational anesthesia administered under pressure. Indeed, wheThéodore Tuffier, in 1891, successfully removed the apex of a lung for ntuberculosis, this was the technique that he used; he even added an inflatable ncuff around the tube inserted in the trachea to ensure a gas-tight fit. Tuffier nwas ahead of his time, however, and other surgeons and research workers nwandered into confused and complex byways before Ivan Magill and Edgar nRowbotham, working at Gillies’ plastic-surgery unit, found their way back to nthe simplicity of the endotracheal tube and positive pressure. In 1931 Ralph nWaters showed that respiration could be controlled either by squeezing the nanesthetic bag by hand or by using a small motor.

 

These advances nallowed thoracic surgery to move into modern times. In the 1920s, operations nhad been performed mostly for infective conditions and as a last resort. The noperations necessarily were unambitious and confined to collapse therapy, nincluding thoracoplasty (removal of ribs), apicolysis (collapse of a lung apex nand artificially filling the space), and phrenic crush (which paralyzed the ndiaphragm on the chosen side); to isolation of the area of lung to be removed nby first creating pleural adhesions; and to drainage.

 

The technical nproblems of surgery within the chest were daunting until Harold Brunn of San Francisco reported six lobectomies (removals of lung lobes) for bronchiectasis with nonly one death. (In bronchiectasis one or more bronchi or bronchioles are nchronically dilated and inflamed, with copious discharge of mucus mixed with npus.) The secret of Brunn’s success was the use of intermittent suction after nsurgery to keep the cavity free of secretions until the remaining lobes of the nlung could expand to fill the space. In 1931 Rudolf Nissen, in Berlin, removed an entire lung from a girl with bronchiectasis. She recovered to prove that nthe risks were not as bad as had been feared.

 

Cancer of the nlung has become a major disease of the 20th century; perhaps it has genuinely nincreased, or perhaps modern techniques of diagnosis reveal it more often. As nfar back as 1913 a Welshman, Hugh Davies, removed a lower lobe for cancer, but na new era began when Evarts Graham removed a whole lung for cancer in 1933. The npatient, a doctor, was still alive at the time of Graham’s death in 1957.

 

The thoracic npart of the esophagus is particularly difficult to reach, but in 1909 the nBritish surgeon Arthur Evans successfully operated on it for cancer. But nresults were generally poor until, in 1944, John Garlock, of New York, showed nthat it is possible to excise the esophagus and to bring the stomach up through nthe chest and join it to the pharynx. Lengths of colon are also used as grafts nto bridge the gap.

 

 

World War nII and after

 

Once the nprinciples of military surgery were relearned and applied to modern warfare, ninstances of death, deformity, and loss of limb were reduced to levels npreviously unattainable. This was due largely to a thorough reorganization of nthe surgical services, adapting them to prevailing conditions, so that ncasualties received the appropriate treatment at the earliest possible moment. nEvacuation by air (first used in World War I) helped greatly in this respect. nDiagnostic facilities were improved, and progress in anesthesia kept pace with nthe surgeon’s demands. Blood was transfused in adequate – and hitherto nunthinkable – quantities, and the blood transfusion service as it is knowtoday came into being.

 

Surgical nspecialization and teamwork reached new heights with the creation of units to ndeal with the special problems of injuries to different parts of the body. But nthe most revolutionary change was in the approach to wound infections brought nabout by the use of sulphonamides and (after 1941) of penicillin. The fact that nthese drugs could never replace meticulous wound surgery was, however, another nlesson learned only in the bitter school of experience.

 

When the war nended, surgeons returned to civilian life feeling that they were at the start nof a completely new, exciting era; and indeed they were, for the intense nstimulation of the war years had led to developments in many branches of nscience that could now be applied to surgery. Nevertheless, it must be nremembered that these developments merely allowed surgeons to realize the dreams nof their fathers and grandfathers; they opened up remarkably few original navenues. The two outstanding phenomena of the 1950s and 1960s – heart surgery nand organ transplantation – both originated in a real and practical manner at nthe turn of the century.

 

 

 

Support nfrom other technologies

 

At first, nperhaps, the surgeon tried to do too much himself, but before long his failures ntaught him to share his problems with experts in other fields. This was nespecially so with respect to difficulties of biomedical engineering and the nexploitation of new materials. The relative protection from infection given by nantibiotics and chemotherapy allowed the surgeon to become far more adventurous nthan hitherto in repairing and replacing damaged or worn-out tissues with foreigmaterials. Much research was still needed to find the best material for a nparticular purpose and to make sure that it would be acceptable to the body.

 

Plastics, itheir seemingly infinite variety, have come to be used for almost everything nfrom suture material to heart valves; for strengthening the repair of hernias; nfor replacement of the head of the femur (first done by the French surgeon JeaJudet and his brother Robert-Louis Judet in 1950); for replacement of the lens nof the eye after extraction of the natural lens for cataract; for valves to ndrain fluid from the brain in patients with hydrocephalus; and for many other napplications. This is a far cry, indeed, from the unsatisfactory use of ncelluloid to restore bony defects of the face by the German surgeon Fritz nBerndt in the 1890s. Inert metals, such as vitallium, have also found a place nin surgery, largely in orthopedics for the repair of fractures and the nreplacement of joints.

 

The scope of nsurgery was further expanded by the introduction of the operating microscope. nThis brought the benefit of magnification particularly to neurosurgery and to near surgery. In the latter it opened up a whole field of operations on the neardrum and within the middle ear. The principles of these operations were stated nin 1951 and 1952 by two German surgeons, Fritz Zöllner and Horst nWullstein; and in 1952 Samuel Rosen of New York mobilized the footplate of the nstapes to restore hearing in otosclerosis – a procedure attempted by the GermaJean Kessel in 1876.

 

Although nsurgeons aim to preserve as much of the body as disease permits, they are nsometimes forced to take radical measures to save life; when, for instance, ncancer affects the pelvic organs. Pelvic exenteration (surgical removal of the npelvic organs and nearby structures) in two stages was devised by Allen Whipple nof New York City, in 1935, and in one stage by Alexander Brunschwig, of Chicago, in 1937. Then, in 1960, Charles S. Kennedy, of Detroit, after a long discussiowith Brunschwig, put into practice an operation that he had been considering nfor 12 years: hemicorporectomy—surgical removal of the lower part of the body. nThe patient died on the 11th day. The first successful hemicorporectomy (at the nlevel between the lowest lumbar vertebra and the sacrum) was performed 18 nmonths later by J. Bradley Aust and Karel B. Absolon, of Minnesota. This noperation would never have been possible without all the technical, supportive, nand rehabilitative resources of modern medicine.

 

 Heart nsurgery

 

The attitude nof the medical profession toward heart surgery was for long overshadowed by ndoubt and disbelief. Wounds of the heart could be sutured (first done nsuccessfully by Ludwig Rehn, of Frankfurt am Main, in 1896); the pericardial ncavity – the cavity formed by the sac enclosing the heart – could be drained ipurulent infections (as had been done by Larrey in 1824); and the pericardium ncould be partially excised for constrictive pericarditis when it was inflamed nand constricted the movement of the heart (this operation was performed by Rehand Sauerbruch in 1913). But little beyond these procedures found acceptance.

Yet, in the nfirst two decades of the 20th century, much experimental work had been carried nout, notably by the French surgeons Théodore Tuffier and Alexis Carrel. nTuffier, in 1912, operated successfully on the aortic valve. In 1923 Elliott nCutler of Boston used a tenotome, a tendon-cutting instrument, to relieve a ngirl’s mitral stenosis (a narrowing of the mitral valve between the upper and nlower chambers of the left side of the heart) and in 1925, in London, Henry Souttar used a finger to dilate a mitral valve in a manner that was 25 years nahead of its time. Despite these achievements, there was too much experimental nfailure, and heart disease remained a medical, rather than surgical, matter.

 

Resistance nbegan to crumble in 1938, when Robert Gross successfully tied off a persistent nductus arteriosus (a fetal blood vessel between the pulmonary artery and the naorta). It was finally swept aside in World War II by the remarkable record of nDwight Harken, who removed 134 missiles from the chest – 13 in the heart chambers – without the loss of one patient.

 

After the war, nadvances came rapidly, with the initial emphasis on the correction or amelioratioof congenital defects. Gordon Murray, of Toronto, made full use of his amazing ntechnical ingenuity to devise and perform many pioneering operations. And nCharles Bailey of Philadelphia, adopting a more orthodox approach, was nresponsible for establishing numerous basic principles in the growing nspecialty.

 

Until 1953, nhowever, the techniques all had one great disadvantage: they were done “blind.” nThe surgeon’s dream was to stop the heart so that he could see what he was ndoing and be allowed more time in which to do it. In 1952 this dream began to ncome true when Floyd Lewis, of Minnesota, reduced the temperature of the body nso as to lessen its need for oxygen while he closed a hole between the two nupper heart chambers, the atria. The next year John Gibbon, Jr., of Philadelphia brought to fulfilment the research he had begun in 1937; he used his nheart–lung machine to supply oxygen while he closed a hole in the septum nbetween the atria.

 

Unfortunately, nneither method alone was ideal, but intensive research and development led, ithe early 1960s, to their being combined as extracorporeal cooling. That is, nthe blood circulated through a machine outside the body, which cooled it(and, nafter the operation, warmed it); the cooled blood lowered the temperature of nthe whole body. With the heart dry and motionless, the surgeon operated on the ncoronary arteries; he inserted plastic patches over holes; he sometimes almost nremodelled the inside of the heart. But when it came to replacing valves ndestroyed by disease, he was faced with a difficult choice between human tissue nand man-made valves, or even valves from animal sources.

 

Orgatransplantation

 

In 1967 nsurgery arrived at a climax that made the whole world aware of its nmedicosurgical responsibilities when the South African surgeon ChristiaBarnard transplanted the first human heart. Reaction, both medical and lay, ncontained more than an element of hysteria. Yet, in 1964, James Hardy, of the University of Mississippi, had transplanted a chimpanzee’s heart into a man; and in that nyear two prominent research workers, Richard Lower and Norman E. Shumway, had nwritten: “Perhaps the cardiac surgeon should pause while society becomes naccustomed to resurrection of the mythological chimera.” Research had beeremorselessly leading up to just such an operation ever since Charles Guthrie nand Alexis Carrel, at the University of Chicago, perfected the suturing of nblood vessels in 1905 and then carried out experiments in the transplantatioof many organs, including the heart.

ChristiaBarnard

 

New ndevelopments in immunosuppression (the use of drugs to prevent organ rejection) nhave advanced the field of transplantation enormously. Kidney transplantatiois now a routine procedure that is supplemented by dialysis with an artificial nkidney (invented by Willem Kolff in wartime Holland) before and after the noperation; mortality has been reduced to about 10 percent per year. Rejectioof the transplanted heart by the patient’s immune system was overcome to some ndegree in the 1980s with the introduction of the immunosuppressant ncyclosporine; records show that many patients have lived for five or more years nafter the transplant operation.

 

The complexity nof the liver and the unavailability of supplemental therapies such as the nartificial kidney have contributed to the slow progress in liver ntransplantation (first performed in 1963 by Thomas Starzl). An increasing nnumber of patients, especially children, have undergone successful ntransplantation; however, a substantial number may require retransplantatiodue to the failure of the first graft.

 

Lung ntransplants (first performed by Hardy in 1963) are difficult procedures, and nmuch progress is yet to be made in preventing rejection. A combined heart-lung ntransplant is still in the experimental stage, but it is being met with nincreasing success; two-thirds of those receiving transplants are surviving, nalthough complications such as infection are still common. Transplantation of nall or part of the pancreas is not completely successful, and further nrefinements of the procedures (first performed in 1966 by Richard Lillehei) are nneeded.

HISTORY OF REGIONAL MEDICINE AND HISTORY OF THE UNIVERSITY

 

1. History nof Ternopil state medical university.

 

In 1773 by the ndecision of an Austrian Empress Maria Theresa there was founded a medical nschool Collegium Medicum in Lviv. This medical school was a ntwo-year course of study, and during the first year the following subjects nwere studied: anatomy, general pathology, general and special surgery, the nstudy of medicine and compounding. In the second year students studied clinical nmedicine, special therapy and surgery, desmurgy, theoretical and practical nobstetrics. Study has been prepared not only theoretical but also practical. Students nat this school wear taught by very qualified professors, including one of the norganizers and principal teacher  Dr. Andrew Krupynskyy. He taught nanatomy, obstetrics, general pathology and therapy. Krupynskyy was highly neducated person. 

 Prince Constantine Ostrog nin1570 established “Rus hospital” along with the Church of the nNativity. Then the hospital was moved closer to Kremenets gate.

 Thus, nalready at the beginning of the city there were two hospitals. Their staff napparently were monks, especially in the Ukrainian-Basilian Fathers.

 The mentioabout doctors is dated 1830. Names of physician and pharmacist Massynh and nFuchs are under the appeal to the Emperor asking to open the high school in the ncity.

I.Horbachevsky Ternopil State Medical University (TSMU)

 Ternopil, nan ancient picturesque city, lies on the banks of the quiet river Seret. It is none of the administrative, economic and cultural centres of Halychyna and it is ncalled the capital of Halytske Podillya. 

The neducational process is planned and coordinated by the nEducational Department of the University, it directing all the activities of nthe Medical Faculty, Faculty of Pharmacy, Faculty of Dentistry, Faculty of nforeign Students, Institute of Nursing and Post-Graduate Faculty as for nimproving the efficacy of training future specialists and interns. 

The University nprovides the succession of higher medical education: a junior medical nspecialist, a bachelor, a doctor specialist, a master, a post graduate student. nOnly higher schools with the IV-th naccreditation level train specialists by 16 trades, 8 through the nMastership department, 11-through the nPost-graduate department. 410 teachers (with 79 M.Ds and 265 Candidates of Sciences among them) provide the educational process. The pedagogical staff includes 1 Corresponding Member nof the Academy of Medical Sciences of Ukraine, 8 Honourary Workers of Science nand Technology, 3 Honourary Inventors of Ukraine. The Quality index of the nscientific teaching staff is 80,9 %, it being one of the highest indices among nthe higher medical educational establishments in Ukraine. 

The professors deliver lectures, instructors teach students at the npractical lessons and seminars

Since 1999 some famous scientists of the Ukrainiamedical institutions have been delivering their telecommunication lectures to nthe students.

All of the nteachers take part in the educational methodical conferences, “round ntable” discussions and young teachers’ seminars.

Specific attention is paid to improving the professional training of nthe teaching staff of the University. Every 3-5 years or more frequently (in case of nnecessity) they have their specialization and thematic advanced training ncourses at Bogomolets National Medical University, the P.L. Shupik Medical nUniversity of Post-Graduate Education in Kyiv and at the other educational nestablishments of Ukraine.

The Human Anatomy Department Museum

 During the npractical lessons at the Human Anatomy Department the students learn the nstructure of the human body

Since 1999 nquite a great part of the teaching staff attends advanced English courses to nimprove their knowledge level. Having received a Certificate they start nteaching their subject to foreign students in English.

Constant nsessions of the central and profile cyclic methodical commissions are held ithe methodical study. The most important questions concerning teaching methods, norganizing course and state examinations, creating integration educational ncurricula are discussed there. 

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The students learn the diagnostic method of cystoscopy while nstudying the Urology course

Acquaintance with the ultrasound diagnosis method

All the plans, nprogrammes and curricula created at the departments are kept there. Every year nthe teachers of the departments discuss and renovate the curricula, enriching nthem with some new information.

Great work as nfor the equipment of the lecture-halls and classrooms according to modern requirements nis carried out at the University. Contemporary technical devices of training nare installed, the departments are constantly supplied with new equipment nnecessary for the training process, reagents, and computer technique. The nvivarium keeps different animals that are used during the experiments at npractical classes. 

Practical lessons at the surgical clinics are held at the patient’s nbed

 

Demonstration of the pleural puncture method

 Students nlearn the technique of trachea intubation while studying the course of nResuscitation and Anesthesiology.

The teaching nstaff takes an active part in the creation of typical educational curricula. Most of them are approved by the Ministry of Public nHealth. A number of the departments has published some textbooks, nmanuals, and multimedia computer programs. Some other departments are still ndeveloping them.

The teaching nstaff pays specific attention to the conditions of qualified training of nforeign students.

They are provided nwith all the necessary educational literature. The most highly skilled and nfriendly teachers promote the training of future specialists; help them to nacquire the necessary knowledge.

 The pedagogical staff amounts 408 teachers, with 71 nDoctors of Sciences, 59 professors, 124 Ass. Professors, 261 Candidates of nSciences. The pedagogical staff amounts 1 Corresponding member of AMS of nUkraine, 8 Honored Workers of Science and Technology of Ukraine, 3 Honoured nInventors of Ukraine, 4 Honoured Physicians of Ukraine.

The teaching nstaff develops the most modern technologies, methodics, performs numerous nscientific elaborations, provides the effective educational and treatment nprocesses. Every department has made its own optimal plan of lectures, npractical classes and seminars according to the general typical curricula, this nbeing coordinated by the cyclic methodical commission.

Since 2005 students study according to the credit-module system, which will mearecognition of the degree in all countries of the European Union. Since 2006 at nthe University the ‘one-day’ methodic and Z-system of training have beeintroduced. According to the latter the students during the first years learclinical aspects together with the theoretical subjects.

 The Medical nFaculty at TSMU consists of the following departments:

Department nof Internal Medicine, Propedeutics and Phthisiology Department of Internal nMedicine with Clinical Immunology and Allergology Department of Infectious nDiseases with Epidemiology and Dermatovenerology Department of Neurology, nPsychiatry, Narcology, and Medical Psychology Department of Pediatrics and nPediatric Surgery Department of General and Operative Surgery with Topographic Anatomy, nTraumatology and Orthopaedics Department of Surgery with Urology and nAnaesthesiology Department of Obstetrics and Gynaecology, Department of nOtorhinolaryngology, Ophthalmology, and Neurosurgery, Department of Oncology, nRadiology Diagnostics and Therapy and Radiation, Medicine Department of nAmbulatory Care and Family Medicine with Medical Equipment, Department of nMedical Rehabilitation and Sports Medicine, Department of Pharmacology with nClinical Pharmacology and Pharmacy, and Pharmacotherapy, Department of nPathological Anatomy with Dissection Course and Forensic Medicine, Department nof Obstetrics and Gynaecology of FPE Department of Surgery, Traumatology, and nOrthopaedics of FPE, Department of Pediatrics of FPE Department of Therapeutics nand Family Medicine of FPE, Department of Medical Diagnostics and Emergency nCare of FPE.

The nInternational relations department was formed in 2000 for improving and nwidening the partnering contacts with European and American schools. Therefore, nthe department was reorganized into separate independent unit of the university nin 2005.

International relations department contributed in the creating of ncooperational agreements between Ternopil State Medical University and its npartners: nUniversity of South Carolina Upstate (USA) Vienna Medical University (Austria) nGreenville Technical College (USA) Medical University of Silesia (Poland) nCharles University (Czech republic) Slovak Medical University (Slovak republic) nMoscow Medical Stomatological University (Russia) Technical University of nDresden (Germany).

The Teaching nstaff of TSMU takes part in international medical conferences, congresses, nsymposia, congresses in 18 countries of the world. International relations ndepartment contributed in the meeting at TSMU official delegations from such ncountries as India, Pakistan, Malaysia, Sudan, Vietnam, China.

 The nclinical departments of TSMU are specialized centers which provide the npopulation with highly specialized medical aid. Such centers include: regional and ncity gastroenterological departments, regional and city cardiologic ndepartments, regional immunological department, regional thoracic department, nregional vascular department, regional and city neurosurgical department, ndepartment of minimally invasive surgery, regional center of eye microsurgery, nregional otolaryngological department, regional neurologic and psychiatric ncenter, regional oncology dispensary, and regional TB dispensary. Students and ndoctors attend clinical training and practice in the 540 patient’s bed nhospitials in the vicinity of the University.

2. nDr.I.Horbachevsky as one of the most famous scientists of his time.

 

By the ndecision of the Cabinet of Ministers of Ukraine in 1992 the Ternopil State nMedical University was named after Academician Ivan Horbachevsky.

IVAN nHORBACHEVSKY

Born: 15.05.1854 n(Ternopil region, Ukraine)

Died: 24.05.1942 n(Prague)

Field of activity: Organic Chemistry, Biochemistry, Medical nChemistry, Public Health.

Doctor nof Medicine, Professor, Head of Medical Chemistry Department, Dean of Faculty nof Medicine at the Czech University, Prague, Rector of the Czech University, nPrague, Member of the Sanitary Council of the Czech Kingdom, Member of the nHighest Health Council of the Austro-Hungarian Empire in Vienna, Member of the nTechnical Investigation Council in Vienna, a Life Member of Lords’ House of nAustrian Parliament, the1-st Minister of Health of Austro-Hungarian Empire, nRector of the Free Ukrainian University in Prague, Member of the UkrainiaUniversity of Sciences, Full and Honorary Member of the T. Shevchenko nScientific Society, Ukraine.

Dr.Ivan Horbachevsky (Horbaczewski) was one of the most nfamous scientists of his time in the field of chemical organic synthesis. His ninvestigations were a revolution in medical, organic and biological chemistry.

 Dr. IvaHorbachevsky (Horbaczewski) was one of the most famous scientists of his time nin the field of chemical organic synthesis. nHis investigations were a revolution in medical, organic and biological nchemistry.

 ACTIVITIES OF DR. I. HORBACHEVSKY IN AUSTRIA

I 1877 a young graduate of the University of Vienna, Doctor of Medical Sciences nIvan Horbachevsky was appointed as an assistant at the Institute of Medicinal nChemistry, the University of Vienna. In 1882 he was the first person in the nscience world to synthesize uric acid from urea and glycine aminoacid. This ndiscovery brought great glory to Austrian science and to Vienna University.

Ihis works Dr. Ivan Horbachevsky explored the causes and pathogenesis of gout, nmechanisms of catabolism of mononucleotides, which are constituents of nucleic nacids.

His nhypotheses as to the nature and causes of pellagra were proved by the next ngeneration of scientists and provided the groundwork for developing a rational nhumautrition system.

One of his achievements was that he determined the origins of nuric acid in organism.

The nsignificance of his works devoted to the conversion of nucleic acids to end nproducts is highly regarded in the point of view of the regulation of synthesis nand decomposition of nucleic acids, which has an impact on our ideas about the nlife at the molecular level. Due to his great managerial and leadership skills Dr. Horbachevsky was offered a position in the nHighest Sanitary Council in Vienna; later he became the President of the nCouncil.

Being none of the most outstanding scientific and public figures of his time, Dr. nHorbachevsky was appointed as the first Minister of Health in 1918, thus nbecoming the founder of the Ministry of Health in Austria, the first Ministry nof Health in the world.

For nhis outstanding achievements in chemical and medical science and public health, nDr. Horbachevsky was elected as a life member of the House of Lords of the nAustrian Parliament and an advisor to the Austrian royal court.

In 1884 Dr. Horbachevsky became the first professor ever imedical chemistry at the Czech University in Prague. Although being very nyoung, he earned scientific reputation by his paper on the preparation of uric nacid by careful melting a mixture of glycine and urea, published in German ojust 40 lines. (It was the young author’s third publication).

3. nTHE IMPACT OF DR. HORBACHEVSKY ON THE DEVELOPMENT OF UKRAINIAN SCIENCE AND nCULTURE

 He contributed greatly to establishing the UkrainiaUniversity in Lviv. Dr. Horbachevsky was elected as a member of the T. nShevchenko Scientific Society in Lviv.

The nbrilliant scientist was one of the founders and later the first President of nthe Ukrainian Medical Association. In 1926 and 1932 he organized the 1st and nthe 2nd Ukrainian Scientific Congresses. His successful activities promoted nUkrainian science on the world level.

Dr. nHorbachevsky made great efforts to create a national medical school. His nleadership qualities and persistent work contributed greatly to establishing nthe Ukrainian Free University in Prague.