INTERNAL DISEASES (synonym internal medicine, therapy):
1) the field of clinical medicine studying an etiology, a pathogeny, semiotics, diagnosis, treatment (except for surgical and radiation), the forecast and prevention of diseases of internals;
2) general name of diseases of internals.
the Term «internal diseases» was included into the use in 19 century and forced out the name applied earlier — «therapy». It was caused by two circumstances. First, gradual allocation as independent disciplines of dermatology, neuropathology and psychiatry, infectious diseases, phthisiology, etc. narrowed a framework of the therapy (covering before all medicine, except surgery and obstetrics) and made necessary designation of its own subject of studying. Secondly, achievements of physiology and pathology of the person, use in clinic of methods of percussion, auscultation and palpation, and also laboratory and tool inspection of the patient created premises for scientific studying of an origin, diagnosis and the prevention of diseases thanks to what the name «therapy» ceased to correspond to the new maintenance of this field of clinical medicine.
Still clinical physicians of 19 century noted that the term «internal diseases» exists only for want of something better (N. A. Vinogradov, 1868).
Area B. is beyond an anatomic concept of internals, including along with diseases of the digestive system, breath, blood circulation, kidneys as well systemic lesions of connecting fabric (see. Collagenic diseases ), many diseases of joints (see. Arthrology ), systems of blood, metabolism and closed glands. From methodological positions it is also difficult to agree with division of diseases on internal and outside. The criterion of a possibility of an operative measure allowing to carry earlier a disease to number «surgical» or «therapeutic», considerably lost the value. It is caused by expansion of opportunities in range of application of conservative and surgical methods of treatment. So, with development of surgery and anesthesiology traditionally «therapeutic» diseases — heart diseases — become usual subject to operational correction, operations on coronary arteries at heavy stenocardia are made and so forth. Therefore, V.'s borders. are rather conditional.
In the second half of 20 century special scientific sections — cardiology, gastroenterology, hematology, nephrology, pulmonology, endocrinology, rheumatology, an arthrology etc. were organizationally issued. These sections should not be considered as result of simple branching, V.'s «disintegration». on affiliated disciplines. Parallelism of processes of differentiation and integration of the scientific industries is characteristic of clinical medicine of 20 century. Formation of the complex scientific section studying pathology of a certain body or system of bodies happens to participation of several medical disciplines and specialties. So, the cardiology would arise «on a joint» V., surgeries, anesthesiology, physiology, biochemistry.
Due to the crushing of therapeutic specialties happening by the organ principle, the increasing value is gained by a problem of all-therapeutic training of the doctor and the integrating researches in the area B. V.'s teaching. as main clinical discipline helps formation of the doctor of any specialty. It is mute hundred years ago. clinical physician Freriks (F. T. Frerichs, 1819 — 1885) wrote: «The internal medicine was and remains a plentiful source from which, like streams, different special departments of medicine branch off; in case of their separation from this source they are threatened by danger to get lost in sands and to run low». V.'s universality. received reflection in names of the relevant clinics of German («Medizinische Klinik»), French («Clinique medicale») and other high fur boots. This feature of V. it is caused by the history of medicine: throughout many centuries within V. doctrines were developed about health (see) and diseases (see), diagnosis (see), forecast (see) and treatment (see), general questions semiotics (see) and other fundamental problems of medicine. In the course of studying first of all V. such theoretical medical disciplines as formed pathological anatomy (see), pathological physiology (see), pharmacology (see). Being the main field of medicine, V. were and remain the main arena of fight of natural-science and philosophical views and concepts in medicine. Therefore V.'s studying. creates clinical thinking, including approach to problems of pathology from positions of functional unity of an organism, understanding of a role of the environment, and also social factors in a course of a disease.
Other characteristic feature of modern clinic of V. — continuous expansion of laboratory and tool inspection of the patient. Based on achievements of physics, electronics, cybernetics, biochemistry, genetics and other natural-science and technical disciplines, it enriched diagnostic opportunities of the doctor, allowed to study visually internals by means of endoscopic devices (see. Endoscopy ), to investigate their function by methods radio isotope diagnosis (see) to carry out round-the-clock monitor observation (see) behind a condition of the major functions of an organism. Now it is possible to receive increase in tens of thousands of times (a supermicroscope, section cutting up to 0,02 microns thick). to use diagnostic electronic computers, to decipher molecular bases of diseases, to distinguish genetic disorders which lead to hereditary diseases, etc.
However the progressing technicalization of medicine shall not limit direct contact of the doctor and patient, to belittle value of that indisputable fact that clinical observation and clinical thinking remain decisive components in activity of the doctor-internista. G.F. Lang wrote that it is absolutely wrong to raise a question so: or tool, laboratory direction of a research of patients, or careful direct observation, individual approach etc. One, of course, shall not exclude another at all.
Scientific and technical progress and first of all development of chemistry essentially changed also treatment. At the beginning of 20 accusative Ehrlich, having shown a possibility of the directed synthesis of the drugs influencing on causative agents of diseases laid the foundation of scientific chemotherapy. At the end of 20 — the 30th the era of antibiotics began A. Fleming, G. Florey and Cheyn's opening (E. V. of Chain, 1906 — 1965). Besides time joint researches of the chemist E. Kendall and an internist of Hencha belong (Ph. S. Hench, sort. in 1896) of which the clinical use of a cortisone was result. Streptocides, antibiotics, corticosteroids and other hormonal drugs, cytostatics, psychotropic drugs, cardiac glycosides and diuretics, vaccines and serums changed character of internal medicine: to replace the doctor only observing the patient the doctor who is actively interfering during a disease came. Efficiency and variety of the produced drugs, emergence of the complications caused by their use caused need of careful studying of new pharmaceuticals, their optimum dosage and their possible negative effect. The classical pharmacology is not able to solve these new problems within experimenting on animals. The need for development of new methods of a research of the effect of drugs on the basis of synthesis of pharmacological and clinical approach would lead to origin in the 2nd half of 20 century of the new section B. — clinical pharmacology. Use of such methods of treatment as intra arterial and intracavitary administration of medicines, use of a hemodialysis and peritoneal dialysis, endocardial electrostimulation, cardiac defibrillation and so forth became possible. Methods of a research, boundary with surgery, are applied to diagnosis: catheterization of heart, biopsy of bodies, etc.
Noted features of modern therapy more sharply, than ever. put the ethical and legal problems concerning as relationship of the doctor and patient (see. Deontology medical ), and acceptance limits of medical intervention (medical and diagnostic).
Change of social and economic conditions and achievements of medicine significantly affected all indicators of health of the population and, in particular, changed structure of its incidence. If in former time infectious and parasitic diseases had epidemic distribution and were the main cause of mortality, then in the 70th 20 century they occupied only 1 — 3% in its structure. In economically developed countries the main contingent of patients of therapeutic departments of hospitals and policlinics is made by patients hron, diseases of cardiovascular system, a respiratory organs and digestion. Cardiovascular diseases became the main reason for disability and death: about a half of all cases of death fell to their share by the beginning of the 70th. These high rates are caused, in particular, by demographic shifts (the postareny population). At the same time growth of incidence, disability and cardiovascular diseases mortality and in the most active age groups is noted. The reasons of it connect with influence of such factors increasing risk of a cardiovascular disease as nervous tension, insufficient physical activity, irrational excess food, smoking which communication with the changed way of life of the person is undoubted.
Change-type of pathology promoted distribution in foreign medicine of the theories connecting developing of diseases with the hereditary and constitutional inferiority of the person preventing it to adapt to the social environment or with special influences of the subconscious, erotic sphere etc. Concepts of social disadaptation approve fatality of the diseases caused by discrepancy of rhythms of human life in industrial society and operating with the millennia of biological rhythms of activity of its organism. Supporters of a neofreydizm speak about socially caused «deep forces» of the identity of the patient which define secondary disorders of function of internals. Inherent in these concepts, as well as a neogippokratizm and a nek-eye in other directions of modern medicine of the West, the biologization and a psikhologization of the social phenomena reflects class essence of these theories.
The social and economic and political structure of society defining domination during this era of certain philosophical views always was along with specific achievements of natural sciences, the equipment and development of methods of a research of the patient with the most important driving factor of development of the doctrine about V.
throughout several millennia of a medical profession were limited to therapy (internal medicine), surgery and obstetrics, and therapy made the main part of medicine, and the doctor, i.e. the therapist, was opposed to the surgeon-handicraftsman. Therefore up to 19 century history B. considerably matches history of medicine in general. According to it the most great doctors of the ancient world, the Middle Ages and Renaissance were also founders of the major systems, schools and the directions in V.'s development. So, «the father of medicine» Hippocrates, in works to-rogo is accumulated vast experience of many generations of doctors of Ancient Greece, considered observation at a bed of the patient as actually medical method of a research, considered conditions of the environment, a way of life of the person and hereditary features of an organism the reasons of health and a disease, proved the doctrine about the forecast and the individual approach to treatment of the patient directed preferential to strengthening of natural curative force of an organism.
Representatives of the Alexandria medicine Gerofil and Erazistrat in 3 century BC would enrich V. respectively development of the doctrine about the most important properties of pulse and the description of internals and their changes though the medical systems created by them owing to the insufficient level of knowledge of that time could not become scientific base of applied medicine. Doctor Drevnego Rima Soran Efesscy (2 century AD) developed a symptomatology of diseases, relying on the systematized inspection of the patient including poll, survey, palpation, elementary percussion, direct auscultation, studying of allocations, first of all a phlegm and urine. In its works the prototype of differential diagnosis is given, and art of doctoring reached gippokratovy heights again. In 2 century AD Galen synthesized achievements of antique medicine, turned anatomy and physiology into a basis of diagnosis and treatment and made the first attempt of creation of comprehensive scientific system of medicine. The idea about expediency of all phenomena in an animal organism which was the cornerstone of its anatomic and pilot studies and the system created by it promoted that its heritage apprehended unilaterally in the form of a so-called galenizm got support of Catholic church and dominated in medicine through many centuries.
Exclusive influence on V.'s development., as well as all medicine, «The canon of medical science» (11 century), in Krom rendered encyclopedic and at the same time deeply original work of Ibn-Sina, in particular, development of semiotics of pulse is continued. Obvious progress in understanding of origins and spread of plague, leprosy and other infectious diseases («morbus contagiosus») which led later to creation of the generalized exercise «About an Infection, Infectious Diseases and Treatment» was outlined in Europe in 14 century (the Paduan doctor J. Frakastoro, 1546). However the therapeutic thought in general was in the Middle Ages in a condition of stagnation owing to domination in medicine of scholasticism.
The native of Switzerland Paracelsus rose against the humoral pathology consecrated with Galen and Ibn-Sina's authority and reducing a problem of a disease to the doctrine about juice of an organism and dyscrasias — their wrong mixing. He acted with promotion of pilot knowledge as only fundamentals of natural sciences and doctoring («the theory of the doctor is an experience»), applied many chemical substances, mineral waters to treatment and developed the doctrine about a dosage of drugs. Paracelsus laid the foundation yatrokhimiya (see). Fleming I. Wang-Gelmont was the large representative of a yatrokhimiya, Krom possesses the description of processes of fermentation in gastric digestion. The representation developed by it about «археях» — the divine vital principle defining health and a disease was a link between all-pathological views of Paracelsus, not free from medieval mysticism, and the school of yatrokhimik created in Leiden by Silvius [F. Sylvius (de le Boe)] aiming to update the same humoral pathology by means of chemistry.
The school of yatrofizik, or yatromekhanik adhered to opposite views (see. Yatrofizika ), for a cut the aspiration to explain all phenomena in a healthy and sick organism by means of laws of mechanics is characteristic. Because in 16 — 17 centuries from the fields of natural sciences first of all the mechanics developed, a yatromekhanik (yatrofizik) was the dominating direction and played a positive role. Philosophical concepts of R. Descartes and hl were decisive starting points for this direction. obr. activity of S. Santorio who by means of the special devices and devices constructed by it for the first time studied a metabolism of the person. It developed the doctrine about solidary pathology (Latin of solidus dense), according to Krom the disease occurs owing to disturbance of the movement of the most fine particles of an organism. Very simple scheme of treatment developed by it was a practical consequence of unilateral mechanistic views of S. Santorio, the main place in a cut belonged to diaphoretics. From positions yatromekhanik conducted the researches U. Garve, opened blood circulation (1628).
In 18 century the need to carry out primary systematization of the accumulated natural-science knowledge for an explanation on this basis of the reason of diseases and the principle of their treatment led to emergence of the numerous medical «systems» which replaced the doctrines of yatrokhimik and yatrofizik dominating in 17 century. The greatest fame was gained animism it. doctor Shtal (G. E. Stahl, 1660 — 1734); doctrine of his compatriot, peer and opponent f. Goffmanna, representing new option yatromekhanik; vitalism (see) fr. doctors Borde and Bargez (Th. Bordeu, 1722 — 1776; P. J. Barthez, 1734 — 1806); mesmerism; brounizm; «physiological medicine» of F. Brusse and homeopathy (see) Ganemanna (S. Ch. F. Hahnemann, 1755 — 1843), 19 century relating already to the beginning. Idealistic and metaphysical ideas of an organism and a disease were the cornerstone of these systems, each of them applied for a role of the exhaustive theory of medicine, they made mutually exclusive therapeutic recommendations. The accumulated natural-science knowledge could not become the base yet, on Krom it would be possible to build the building of clinical medicine.
Development of empirical knowledge led the doctors of Renaissance thinking soberly and safely to the aspiration to return to the principles of gippokratovy medicine. In 16 EL of Montano in Padua and in 17 century Silvius in Leiden resumed teaching in hospital — at a bed of the patient. Activity of «the English Hippocrates» of T. Sydenham was top of empirical medicine. It developed applied medicine, a task a cut — to observe the patient, to distinguish a disease (i.e. to try to carry this case to any already known clinical form) and to apply the individual, suitable in this case treatment. He formulated a concept about phases of disease process, described symptoms of gout, rheumatic damage of joints, a chorea and some other diseases; origin of clinical medicine is also connected with his name actually.
On the way laid by Sydenham many doctors of the different countries went. The contemporary and Sydenham's compatriot Morton (R. Morton, 1637 — 1698) published the monograph about a tuberculosis; the London doctor Geberden (W. Heberden, 1710 — 1801) described angina pectoris (1768); E. Jenner developed a method of smallpox vaccination; the fr. doctor Vyessan (R. Vieussens, 1641 — 1715) described a number of anatomic and clinical signs of mitral and aortal heart diseases. But activity of the Leiden prof. G. Burkhave had the greatest value. Its theoretical representations were close to a yatrofizika, edges was combined at it with the doctrine about dyscrasias and the aspiration to revive the main clinical ideas of Hippocrates. The supporter of careful clinical observation and inspection of the patient (for the first time including thermometry), it entered system of clinical teaching and created the large school which exerted strong impact on development of clinic of V. in Europe. Pupils to G. Burkhava G. Van-Sviten and de Gïen (And. de Haen, 1704 — 1776) became founders of the so-called old Vienna school (the 2nd half of 18 century) which played a big role in V.'s development. In particular, the L was a pet of this school. Auenbrugger is an ancestor of percussion in her modern understanding. However its opening (1761) was not estimated by medicine of 18 century.
In parallel with enrichment of the description of symptoms of diseases and their recognitions there was a process of accumulation of data in the field of normal and pathological anatomy and human physiology — that knowledge which would make afterwards the scientific base of V. Here also opening by U. Garvey of blood circulation, A. Galler's work in the field of neuromuscular physiology shall be noted, first of all, A. Vezaliya's reform in anatomy. A special role in the history of V. belongs to the method of kliniko-anatomic comparisons developed by the Paduan anatomist J. Morganyi, Krom possesses also the first nosological classification of V. (1761). If for Morganyi each disease has «seat» in this or that body, then the fr. doctor M. Bisha entered a concept about fabrics (1801) and described morphological changes in them at a number of diseases.
Works of these scientists laid the foundation pathological anatomy (see), with the help the cut was gradually liquidated a gap between rather high level of the description and V.'s diagnosis., on the one hand, and lack of the actual material for a scientific explanation of their essence, with another.
The period of decomposition of the feudal relations and transition to capitalist production (16 — 18 centuries) which was followed by bystry development of pilot knowledge for V. was marked not only progress in creation of their natural-science basis and moving of the main centers of a medical thought to Sowing. Italy (Paduan un-t) and Holland (Leiden un-t). As process of formation of manufactories and growth of number of hired workers most quicker went to Sowing. Italy, here before everything the problem drew attention, occupational diseases (see). In 1700 there was a book of the Paduan doctor B. Ramazzini «A reasoning on diseases of handicraftsmen», in a cut the characteristic of the prof. of pathology of working 52 professions is given. The new period of history B.
would begin with the middle of 19 century. — their development on a natural-science basis. Most it was promoted by activity of the most visible representative of «new Vienna school» K. Rokitansky and outstanding it. the pathologist R. Virkhov, developed the doctrine about pathoanatomical and histologic displays of a disease, and also Zh. Korvizara — the founder of fr. school of sciences of therapists. K. Rokitansky, to-rogo R. Virkhov named «Linney of pathological anatomy», described morfol, symptoms of inborn heart diseases, spontaneous ruptures of an aorta, perforated stomach ulcer etc. His theoretical views proceeded from the concept humoral pathology (see).
R. Virkhov completed creation of the solidary theory: it «Cellular pathology» added J. Morganyi's doctrine about bodies and M. Bisha about fabrics. R. Virkhov's book appeared in 1858, it presented a disease as pathology of a cell. Exclusive value of R. Virkhov in the history of V. is defined by turn of medical thinking — from searches of the «mysterious» reasons of diseases — to a scalpel and a microscope. Fight of the solidary and humoral directions came to the end with a clear victory of the first: the concept of humoral pathology was buried for many decades and revived in 20 century already in the form of the evidence-based doctrine about humoral regulation and its frustration.
Consolidation of a scientific fundamentals of medicine promoted improvement of diagnosis.
Percussion (see). L. Auenbruggera, a cut Zh. Korvizar laid a way to clinic, was added auscultation (see), developed by the pupil Korvizara R. Laennekom. The important role in scientific justification and implementation in medical practice of these methods was played by the largest doctor of «new Vienna school» Y. Shkoda. Together with the systematized anamnesis in details developed in the 2nd half of 19 century by the given Russian therapist G. A. Zakharyin, survey and palpation (see), in improvement the cut made a special contribution the founder of the Kiev school of therapists V.P. Obraztsov, these methods made a basis of an all-clinical direct trial of the patient.
On the way of V.'s development. as sciences, i.e. on the way pathomorphologic and kliniko-experimental, went many therapists first of all in Germany: I. Shenleyn, L. Traube, Freriks (F. T. Frerichs), etc. Purely clinical, descriptive direction was followed K. Gufeland in Germany, by many prominent representatives of fr. clinic of V. led by A. Trusso. There was a bystry accumulation of knowledge concerning semiotics and a systematics of diseases, first of all infectious and heart diseases. So, the sound symptomatology of heart diseases was versatily studied by L. Traube, fr. clinical physicians Zh. Djelafua, Dyurozye (R. L. Duroziez, 1826 — 1897), etc.
Development of diagnosis was not followed, however, by similar progress in treatment. Moreover, the former polypragmasy was succeeded by the therapeutic scepticism and nihilism characteristic, e.g., of «new Vienna school». Y. Shkoda claimed: «We can distinguish, describe and understand a disease, but we shall not even dream of an opportunity to influence her any means». Similar scepticism was defined as the dominating theoretical views (frequent change of various medical systems generated a polypragmasy; the anatomo-lokalistichesky thinking put anatomic defect in the forefront in idea of a disease and in many cases did not give up hopes for success of treatment), and the scanty choice of really effective remedies. Nevertheless there were outstanding clinical physicians who avoided both extremes and showed high art of doctoring. The Vienna doctors Oppoltser (J. Oppolzer, 1808 — 1871) and Notnagel can be carried to them, e.g., (To. W. H. Nothnagel, 1841 — 1905), And. Trusso, founder of scientific therapeutic school in Russia S. P. Botkin, outstanding Russian therapist G. A. Zakharyin, etc.
Along with gradual enrichment of an arsenal of drugs (morphine, a papaverine, codeine, atropine, bromine, etc.) in the middle of 19 century such, e.g., method as the pleurocentesis applied by R. Laennek, Y. Shkoda and especially A. Trusso entered clinical practice. And, on the contrary, is much more rare and according to more strict indications bloodletting (about F. Brusse and his followers said that they shed more blood, than all Napoleonic wars, combined), emetic and other «antiinflammatory» means began to be applied.
Exclusive influence of cellular pathology on medical thinking had also a negative effect: idea of unity of an organism was forced out by a concept about an organism as to the sum of cells. R. Virkhov's followers who turned his doctrine into the finished theory of medicine, i.e. into next medical «system» brought anatomo-lokalistichesky approach to conclusions, fatal for treatment, directing all efforts, e.g., to suppression of fever — a natural consequence of fight of an organism against an infection. Besides, the pathological anatomy left open a question of the reason of the morpho-physiological changes which are the cornerstone of a disease. Important data on this question were submitted by bacteriology. The «bacteriological era» in medicine which began with L. Pasteur and R. Koch's works was followed by opening of causative agents of many infectious diseases and clarification of ways of infection. But it led also to sharp exaggeration of value of a bacterial factor in an origin of diseases in general what, in particular, the Russian scientists I. I. Mechnikov, G. N. Gabrichevsky and F. F. Erisman pointed to.
In fight against anatomo-lokalistichesky thinking and underestimation of a role of an organism of the patient in pato-and a sanogeneza the functional direction in V.'s clinic would form. It grew on the basis of the achievements of physiology and experimental pathology connected with names F. Marangdi and K. Bernard in France, with I. Müller's school in Germany, with works of the Russian physiologist A. M. Filomafitsky. The big role was played by researches of I. M. Sechenov who established value of the highest parts of the nervous system in regulation of function of an organism both pathologies, and theory of higher nervous activity of I. P. Pavlov are normal. For development of this direction S. P. Botkin, A. A. Ostroumov, J. Mackenzie's activity, T was fundamental. Krauss, G. Bergmann, etc. Recognition of an organism uniform functional whole and the device of nervous and humoral control — the carrier of this unity; understanding of a disease as reactions of an organism to an adverse effect of factors of the environment, and functional (pathophysiological and biochemical) disturbances as defining its current and an outcome; the combination of clinical observation and an experiment in scientific research — these main lines of the functional direction become characteristic of internal medicine of 20 century.
In process of development of methods of a research and accumulation of knowledge of an origin, essence and displays of diseases in 19 century conditions for their scientific systematization are created, and process of differentiation of clinical medicine begins. At first from comprehensive therapy were allocated in independent disciplines dermatology [the 1st half of 19 century; R. Willan in Great Britain, Aliber (J. L. Alibert, 1768 — 1837) in France, T. Gebra in Austria] and neuropathology (founders of the first neurologic clinics — • Zh. Sharko, Paris, 1860; A. Ya. Kozhevnikov, Moscow, 1869). Works of fr. doctors of Bretonno (R., 1778 —-1862) and A. Trusso (claimed that «from a rubella measles will never develop, and from chicken pox the real smallpox») drew with F. Bretonneau attention to a problem of specificity of diseases. However only bacterial, proofs of the microbic nature of infectious diseases, opening of causative agents of tuberculosis, cholera etc., development immunology (see), in particular serodiagnosis, created the soil for allocation infectious diseases (see) and phthisiology (see).
Problems of pathology of heart were most intensively developed that was promoted by the progress in studying of physiology of blood circulation and an opportunity which opened using methods of percussion and especially auscultation. Y. Shkoda, L. Traube, Romberg (E.Romberg-) in Austria and Germany were founders of clinical cardiology; Stokes (W. Stokes, 1804 — 1878), J. Mackenzie, U. Osler in Great Britain and the USA; P. Poten, Yushar (H. Huchard, 1844 — 1910) in France etc. The pupil Sh. Korvizara of Zh. Buyo and irrespective of it G. I. Sokolsky in the 30th 19 century determined consistent pattern of damage of heart at acute joint rheumatism and that laid the foundation for studying of rheumatism as general disease. T. Sydenham's follower R. Brayt in the same years described a kliniko-morphological picture of nephrite. However only in 50 — the 60th 20 century on the basis of achievements of theoretical and clinical medicine complex sections were created: cardiology (see); rheumatology (see), studying rheumatism and other collagenoses, and also a number of problems arthrologies (see); nephrology (see).
The doctrine about diseases of a respiratory organs originates in kliniko-anatomic researches of R. Laennek. Only in one and a half centuries in connection with growth of incidence of bronchitis, hron, on the one hand, and on the basis of development of bronkhologichesky and other methods of a research, with another, allocation begins pneumonia, bronchial asthma, new growths of lungs pulmonology (see). From the middle of 20 century there is a formation gastroenterologies (see), the cut is considered the founder it. the therapist I. Boas who wrote at the end of 19 century the textbook about stomach diseases and founded the first special magazine (1895). Several decades before other sections B. isolation began hematology (see); the most important moments of its history in 19 century were the description R. Virkhov of leukoses (1845), T. Addison, and then Birmer (A. Biermer, 1827 — 1892) pernicious anemia; introduction by the fr. doctor Malasse (L. Ch. Malassez, 1842 — 1909) calculation of uniform elements of blood (1870) and Item by Ehrlich, D. L. Romanovsky of methods of their coloring (1878 — 1891). Endocrinology (see), the experimental and clinical foundation a cut was laid in the middle of 19 century by K. Bernard, K. Bazedov, T. Addison's works, turned in 20 century into the independent scientific discipline studying pathology of hemadens, and hormonal regulation of functions in a healthy and sick organism. By the principle of the applied therapeutic methods in independent sections of medicine were allocated also balneology (see), physical therapy (see), clinical nutrition (see).
At a boundary of 19 — 20 centuries of achievement of physics, technical progress and the related blossoming of physiology
would enrich V. by new tool methods of inspection of the patient. Opening of X-ray and bystry development had special value radiodiagnosis (see), introduction electrocardiography (see) a goal. physiologist V. Eyntkhoven and use of an anemic method of determination of arterial pressure [ital. scientific S. Riva-Rocci, 1896; Russian doctor N. S. Korotkov, 1905]. S. P. Botkin's words were confirmed: «The more the clinical medicine will be improved, the less in it will be places to art, and the more it will be scientific».
Development of internal medicine in Russia
Domestic clinic of V., developing in close connection with medicine of Western Europe, had at the same time and distinctive features. Traditions of the scholastic medicine connected with church dogmas of the Middle Ages in Russia, despite domination of doctors foreigners, were much weaker. Influence of materialistic philosophy of M. V. Lomonosov, A. N. Radishchev promoted critical perception of numerous idealistic medical systems.
At the beginning of 18 century military hospital in Moscow, St. Petersburg, Kronstadt were open and at them — hospital schools (see) for training of doctors. At these schools transformed later to medicochirurgical schools the main shots of the Russian doctors in 18 century prepared. Here trained in applied medicine in hospitals — at a bed of the patient.
V. founders. in Russia it is possible to consider professors Moscow un-that S. G. Zybelina, F. G. Politkovsky and M. Ya. Mu firewood which developed the principles of pilot knowledge, characteristic of domestic therapy, a preventive orientation, the individualized approach to treatment. S. G. Zybelin was a follower of Lomonosov, considered experience and reason by the main teachers of the doctor, the environment and a way of life — sources of health and a disease; he emphasized value a gigabyte. measures and individualization of treatment, a cut shall consider interference physical. and mental in the person. His successor at the rate of applied medicine F. G. Politkovsky developed S. G. Zybelin's views, highly appreciated empirical medicine of T. Sydenham, and concerning speculative theories wrote: «On all systems I advise to look impartial eyes with which the reason and experience shall rukovodstvovat. Hippocrates and all great men acted this way. It is the highway, and systems an essence country roads».
Clinical views of M. Ya. Mudrov, the pupil S. G. Zybelin and F. G. Politkovsky, exerted serious impact on domestic therapists of 19 century up to G. A. Zakharyin and A. A. Ostroumov. Some of the principles M. I. Mudrov stated in favourite to them a form of aphorisms: «knowledge of a disease is a half of treatment»; «not the disease takes medicine, and the patient»; «there are also sincere drugs which heal a body»; «your drugstore will be all nature on service to you and your patients»; «it is easier to protect from diseases, than to treat them»; «in iatrotechnics there are no doctors who ended the science» etc. At the heart of a disease he saw morfol, changes in bodies and disorders of their function which lead to disturbance of activity of a complete organism. Developing E. O. Mukhin's views, according to the Crimea «incentives», coming from the environment, influence a nervous system and through it are perceived by an organism, M. Ya. Mudrov continued studying of influence of a nervous system on processes of emergence and treatment of a disease. He developed system of inspection of the patient, the leading place in a cut belonged to inquiry, survey and palpation, and the scheme of a case history as main medical document. He knew percussion, auscultation and applied them. At the end of 18 — the beginning of 19 century also St. Petersburg doctors Ya. O. Sapolovich (1766 — 1830) and F. K. Uden used percussion; the printing message on auscultation in 1828 was made by P. A. Charukovsky.
In disease-producing influence of the environment the advanced doctors looked for the reason of a wide spread occurance of some diseases. Further development of the contagious theory of infectious diseases is connected with a name of the Russian doctor of 18 EL S. Sa-moylovich. In the first half of 19 century these diseases (typhus, measles, whooping cough, scarlet fever, dysentery) took the leading place in scientific research. Due to epidemics of 1829 — 1831 leaves several works containing the fullest description of cholera on that time. Among their authors were E. O. Mukhin, M. Ya. Mudrov and I. E. Dyadkovsky, the doctor-philosopher, whose materialistic views of essence of a disease, the recognition of the leading role of changes of a nervous system in its development which was reflected, in particular, in the classification of diseases offered them exerted a great influence on contemporaries.
The largest representative of domestic clinic of V. the middle of 19 century there was the Moscow therapist G. I. Sokolsky, with a name to-rogo are connected, in addition to the description of rheumatism of heart, the Russia's first kliniko-morphological works about pneumonia and a pulmonary tuberculosis. He emphasized value of the environment in a course of a disease: «than the city is more populous, than more factories in it, especially contain the victims of a pulmonary consumption».
G. I. Sokolsky's activity promoted that methods of percussion and auscultation rather early found broad application in Russia.
Improvement of training of doctors in the second half of 19 century was promoted introduction of the new university charter (1863) and reforms in the St. Petersburg medicochirurgical academy undertaken in 60 — the 70th. V.'s teaching. it was carried out on III, IV and V courses in three clinics: propaedeutic, faculty and hospital. At the end of 19 century at Moscow un-those for the purpose of teaching also therapeutic policlinic was created.
The second half of 19 century — the period of blossoming of domestic clinic of V. of the lake noted by S. P. Botkin, G. A. Zakharyin, A. A. Ostroumov's activity. This blossoming was promoted by achievements of world medicine, influence of materialistic philosophy of revolutionary democrats, achievements of the Russian scientific thought. The works of I. T. Glebov, I. M. Sechenov and other physiologists which allowed to approach in a new way assessment of a role of neuroregulatory frustration in pathology had special value.
The largest Russian clinical physician of the second half of 19 century S. P. Botkin is the founder of the St. Petersburg school of therapists and the scientific direction in domestic clinic of V. — aimed to put applied medicine «in a row natural sciences». Considering necessary to check clinical observations in an experiment, to compare these pathologies and physiology, he in 1861 created laboratory at clinic, the cut since 1878 within 10 years directed I. P. Pavlov and where in practice the close union of physiology with medicine was carried out. Developing the physiological direction in clinic,
S. P. Botkin in the 70th 19 century showed that functional disorders of heart are not proportional to anatomic disturbances and depend on influence of c. N of page. Its descriptions of so-called catarral jaundice as infectious disease (infectious disease), a typhoid etc. enriched clinic of infectious diseases. He considered infectious diseases as result of interaction macro - and microorganisms and warned about danger of purely bacteriological approach to problems of pathology, at Krom «begin to forget not only clinic, but also pathological anatomy of fabrics, forget reaction of an organism to microbes». For S. P. Botkin «reaction of an organism to vrednodeystvuyushchy influences of external environment on it also makes essence of sick life».
S. P. Botkin's contemporary G. A. Zakharyin created original Moscow school of therapists. Art of the systematized research of the patient (both anamnestic, and others by the known then methods), statement of the individual diagnosis and the choice of therapy reached at it high perfection. The essence of inquiry consisted for it in careful studying of working conditions and life of the patient for the purpose of clarification of an etiology, «comprehension of communication of all phenomena of this painful case» and definition of ways of prevention. Exclusive observation helped it to describe brightly clinic of syphilitic damage of heart and lungs, a pulmonary tuberculosis, a zone of a skin hyperesthesia at diseases of internals etc. «The clinic without therapy is similar to contemplation of death» — G. A. Zakharyin taught; he actively developed medicinal therapy (in particular, entered into practice use of calomel as diuretic). But it gave special value in treatment and prevention of diseases to hygienic actions: «it is victorious only hygiene can argue with illnesses of masses».
The clinical method of G. A. Zakharyin which gained world recognition was a new stage of development of medical views of M. Ya. Mudrov, G. I. Sokolsky, the pupil M. Ya. Mudrov and the teacher G. A. Zakharyin of A. I. Over (1804 — 1864). At the same time succession of clinical approach at classics of world internal medicine Sydenham, Laennek, Trusso and G. A. Zakharyin is undoubted. For outstanding Russian therapists of 19 century [just as, e.g., for their contemporaries of Grizinger (W. Griesinger, 1817 — 1868), Kussmaulya (And. Kussmaul, 1822 — 1902), E. Leyden, B. Naunin in Germany] is characteristic the wide interest in clinical problems of pathology of the person which was not limited to a framework of its any area. And if
S. P. Botkin possesses an important role in origin of domestic cardiology, clinic of infectious diseases, to dermatology, otorhinolaryngology, then formation of pediatrics, neuropathology, gynecology is connected with a name of G. A. Zakharyin. But he emphasized that process of specialization of knowledge would only increase value of the general clinic of V.: «What would be both with teaching, and with science if there were only special clinics.?».
G. A. Zakharyin and S. P. Botkin's follower A. A. Ostroumov developed the physiological direction of internal medicine, having given it klinikobiologichesky character. He looked for causes of illness of the person in the environment and in hereditary features of an organism according to what he included data about health of parents of the patient in the scheme of inquiry. He paid special attention to functional diagnosis and a preventive orientation of profession of a physician. S. P. Botkin, G. A. Zakharyin, A. A. Ostroumov's clinical lectures created scientific outlook of many generations of the Russian doctors. E. E. Eykhvald (1837 — 1889) was the bright representative of the physiological direction, creation in St. Petersburg Clinical is connected with a name to-rogo in-that is the first institute of professional development of doctors. In scientific (in the spirit of Botkin school) and public education of the Russian doctor played an exclusive role in 80 — the 90th the weekly medical newspaper of V. A. Manassein is «Doctor».
Moscow and St. Petersburg were the most important centers of a clinical thought in Russia. The Botkin direction was developed also by professor of faculty therapy Kazan un-that N. A. Vinogradov (1831 — 1885) aiming at unity of medical medicine, experimental pathology and hygiene. S. P. Botkin V. P pupil. Obraztsov who developed the method of the sliding palpation of abdominal organs modifying methods of percussion and auscultation became the founder of the Kiev school of therapists. Together with the pupil N. D. Strazhesko it 2 years prior to an amer. therapist Herrick (J. Century of Herrick, 1861 — 1954) gave the classical description of clinic of thrombosis of coronal arteries of heart (1910) that laid the foundation for modern diagnosis of a myocardial infarction. F. G. Yanovsky was other outstanding Kiev doctor who was also standing on kliniko-physiological positions.
In 20 century M. M. Volkov (1861 — 1913), M. V. Yanovsky, V. N. Sirotinin (1855 — 1911) and N. Ya. Chistovich's clinics were successors of Botkin traditions in St. Petersburg.
M. V. Yanovsky laid the foundation of the functional direction in hematology; its school studied peripheric circulation; under its management N. S. Korotkov (1905) developed a sound method of determination of arterial pressure. The prominent clinical physician, the famous cardiologist V. N. Sirotinin (it described a symptom of atherosclerotic and syphilitic damage of an aorta — systolic noise at hands, zakinuty for the head) republished S. P. Botkin's lectures. N. Ya. Chistovich in years, the first after October socialist revolution, released «Clinical lectures» and «Courses of private pathology and therapy of internal diseases» got by the Botkin ideas and views. In Moscow the advanced clinical views were developed by the therapist and the pathologist, one of founders of experimental cardiology A. B. Fokht, the founder of domestic clinical endocrinology V. D. Shervinsky, etc. In a scientific perspective of this period the important place is taken by questions of cardiovascular pathology. Among achievements in this section B. it should be noted the description V. M. Kernigom of an infarctive pericardis (1904) and the first steps of a clinical electrocardiography connected with works of the physiologist A. F. Samoylov and the therapist V. F. Zelenin.
Clinic of internal diseases
V.'s Features. the USSR is defined by character of Soviet health care (see), causing a preventive orientation of scientific research and medical practice (see. Prevention ). After the victory of October socialist revolution health protection of the people was proclaimed one of the most important functions of the state. The material and technical resources of medical science — large clinics, research in-you were created. All-Union in-t of experimental medicine of A. M. Gorky (1932), organized for the purpose of implementation of synthesis of experimental biology and medicine, included therapeutic clinics. In 1944 the Academy of medical sciences was founded, in system a cut Ying t therapies (nowadays Ying t of cardiology of A. L. Myasnikov) and Ying t of rheumatism in Moscow, Ying t of gerontology in Kiev, etc. were created.
In the conditions of free, public and highly skilled medical aid to the population prevention became a basis of health protection of the people. A dispensary method (see. Medical examination ), as the important organizational way of implementation of the preventive direction of medicine to the USSR, widely would be included into V.'s clinic. Problems of preventive medicine were answered by creation of wide network resorts (see). The preventive direction would cause characteristic features of clinic of V.: communication with practice of health care, interest in studying of a condition of a predisease and early stages of a disease, attention to social factors in etiologies of a disease, development of the doctrine about the labor forecast, studying of resort and other factors of secondary prevention and rehabilitations (see).
The theory developed I. P. Pavlov's school nervosism (see) would define progress of the functional direction in V.'s clinic., a cut since 30th years became dominating in the scientific research devoted to diseases of bodies of blood circulation, digestion etc. The preventive, functional direction of internal medicine in the USSR relied on traditions of the Russian therapeutic schools of S. P. Botkin, G. A. Zakharyin, A. A. Ostroumova. Such most visible representatives of clinic of V. would be successors of these traditions first of all., as M. P. Konchalovsky and D. D. Pletnev — in Moscow, G.F. Lang — in Leningrad, N. D. Strazhesko — in Kiev, S. S. Zimnitsky — in Kazan, M. G. Kurlov — in Siberia; they were founders of the Soviet therapeutic school.
Works of M. P. Konchalovsky who was V. D. Shervinsky and L. E pupil. Golubinina (1858 — 1912), common problems of V. would cover. (prepainful states, recurrence of a course of diseases, reactivity of an organism, clinical syndromes, labor forecast, resort therapy, etc.), pathology of blood and digestive organs, rheumatism, infectious and occupational diseases, diabetes mellitus etc. E belong to the large school created by it. M. Tareev, M. S. Dultsin and some other the famous clinical physicians. D. D. Pletnev studied at A. A. Ostroumov, K. M. Pavlinov (1845 — 1933), A. B. Fokhta, L. E. Golubinin; it developed the functional direction in pathologies and functional diagnosis; its klinikoeksperimentalny research of arrhythmias of heart, the description to them differential diagnosis of coronary thrombosis were an important contribution to development of cardiology.
M. V. Yanovsky G. F. pupil. Lang headed the functional direction in cardiology and hematology; belong to it a priority in allocation of an idiopathic hypertensia as nosological form and development of the neurogenic concept of its genesis (1922 — 1948), and also classification of diseases of the blood circulatory system (1935) which became a basis of their further studying in the USSR. It put forward also kliniko-biochemical concept of the dystrophy of a myocardium which is the cornerstone of insufficiency of heart. He created large therapeutic school, to a cut A. L. Myasnikov, B belong. G. Baranov, D. M. Grotel, B. V. Ilyinsky, T. S. Istamanova, M. I. Hvilivitskaya and many other famous therapists. N. D. Strazhesko was a pupil and follower V. P. Obraztsova and I. P. Pavlov. It enriched clinical semiotics of diseases of digestive organs and blood circulation with a number of new observations (in particular, described loud 1st tone at a heart block — «gun tone of Strazhesko»). He proved a hypothesis of a streptococcal etiology of rheumatism (1934), together with the pupil V. X. Vasilenko developed classification of a circulatory unefficiency (1935). Approach to problems of cardiovascular pathology, sepsis, allergy etc. S. S. Zimnitsky who passed school of experimental work at And P. Pavlova is characteristic of N. D. Strazhesko's works and his school complex, first of all physiological and biochemical, developed the physiological direction, first of all in the field of cardiovascular, renal, gastric pathology. His pupils were R. A. Luriya, etc.
The doctrine about diseases (see) continued to develop in works of the Soviet scientists, but already on the basis of methodology of dialectic materialism. Importance for V.'s clinic. had A. A. Bogomolts's works, A. D. Speransky, and is later than K. M. Bykov. However attempts of creation of the theory of a disease on the basis of a universalization of the private patterns concerning a role of certain parts of the nervous system, hemadens, system of connecting fabric failed as the problem of a disease can be solved only as a problem of the versatile disturbance of regulation of functions taking various levels of many physiological systems of an organism.
Studying problems etiologies (see) and pathogeny (see) diseases of internals, the Soviet therapists pay preferential attention roles of social and other environmental factors; it causes interest in identification of premorbidal states (M. P. Konchalovsky, G.F. Lang, etc.). Not the smaller attention is paid to value constitutions (see), typological features of an organism, its nervous and endocrine systems influencing development and the course of a disease (D. D. Pletnev, M. V. Chernorutsky, etc.). In clinicodiagnostic researches the increasing place is taken by methods of functional diagnoses (see), first of all electrocardiography, and methods of a radiology (D. D. Pletnev, P.E. Lukomsky, etc.). In 1927 M. I. Arinkin offered a method of a sternal puncture which gained world recognition and played in hematology the same role as an electrocardiography at a myocardial infarction or roentgenoscopy of a stomach at his diseases. A simple and indicative method of assessment of function of kidneys by name the author received the name of test of Zimnitsky.
In the second half of the 20th and in the 30th the Soviet therapists successfully developed the doctrine about angina pectoris and a myocardial infarction, rheumatism, a circulatory unefficiency (M. P. Konchalovsky, G.F. Lang, D. D. Pletnev, N. D. Strazhesko, M. M. Gubergrits, D. M. Grotel, etc.), pathologies of kidneys (S. S. Zimnitsky, V. N. Vinogradov, M. S. Vovsi, E. M. Tareev, etc.) and systems of blood (A. N. Kryukov, M. P. Konchalovsky, G.F. Lang, etc.) etc.
In days of the Great Patriotic War the harmonious system of therapeutic service of army which provided exclusively high percent of return of patients to a system was created. Scientific research would be devoted to features of a current of V. in the conditions of war and typical «military pathology»: nutritional dystrophy, blockade hypertension, avitaminosis, traumatic shock, traumatosepsis. Not only in the back, but also scientific conferences of therapists were held at the front. The saved-up clinical material was generalized in multivolume collective work of the Soviet physicians «Experience of the Soviet medicine in the Great Patriotic War of 1941 — 1945».
Achievements in V.'s studying. during the post-war period are connected with creation of large scientific centers. Basic bases of development of therapy were it is modern the equipped clinics of the leading medical in-t and in-t of improvement of doctors, specialized research in-you a therapeutic profile of the USSR Academy of Medical Sciences and M3 of the USSR, At extremely cue research in-t of clinical medicine of N. D. Strazhesko and a row other.
The Soviet internist successfully develop the main problems of cardiovascular pathology. G. F. Lang's doctrine about an idiopathic hypertensia gained development in A. L. Myasnikov's researches, E. M. Tareev and their pupils. Kliniko-eksperimentalny and the biochemical approach to a problem of atherosclerosis based on the cholesteric theory of H. N. Anichkova and S. S. Halatov, allowed to study important aspects of his pathogeny (A. L. Myasnikov, P.E. Lukomsky, B. V. Ilyinsky, etc.). V. N. Vinogradov, M. S. Vovsi, P.E. Lukomsky, A. L. Myasnikov, E. M. Gelstein, B. P. Kushelevsky, E. I. Chazov's numerous researches, 3. I. Yanushkevichusa, I. K. Shkhvatsabaya, etc. on a problem of coronary heart disease promoted improvement of diagnosis and treatment of stenocardia and myocardial infarction.
A. I. Nesterov's researches, E became widely known. M. Tareev and their pupils (V. A. Nasonova, etc.) in the field of rheumatism and other collagenic diseases. The problem of respiratory insufficiency, tool diagnosis and treatment of diseases of a respiratory organs was versatily studied (V. N. Vinogradov, B. E. Votchal, B. B. Kogan, N. S. Molchanov, D. D. Yablokov, etc.).
Pathology of digestive organs was investigated by the Soviet internist from positions of the Pavlovsk physiology. The pathogeny, clinic and treatment of gastritises, a peptic ulcer, pancreatitis were successfully studied (V. of X. Vasilenko, R. A. Luriya, N. I. Leporsky, M. I. Pevzner, S. M. Ryss, etc.). Kliniko-patogenetichesky studying acute and hron, hepatitises led to creation of original classification, the managements and monographs by diseases of a liver (A. L. Myasnikov, E. M. Tareev, etc.). The doctrine about nephrite gained development in V. N. Vinogradov's works, M. S. Vovsi, E. M. Tareeva, etc. A. N. Kryukov's school — I. A. Kassirsky possesses a special role in development of the Soviet hematology. B. E. Votchal's works and it sotr. the foundation of development in the USSR of clinical pharmacology is laid. Achievements of clinical endocrinology are connected with N. A. Shereshevsky, V. M. Kogana-Yasny, V. G. Baranov's works, etc. Following traditional interest of founders of the Soviet school of internist in questions of history of therapy (D. D. Pletnev, M. P. Konchalovsky), many famous clinical physicians acted with works of historical and medical character (I. A. Kassirsky, A. L. Myasnikov, E. M. Tareev, L. O. Oganesyan, V. N. Smotrov, N. A. Kurshakov and dr). About achievements in studying of other problems of internal medicine and a scientific contribution of other famous therapists — see in articles devoted to cardiology, hematology, endocrinology and other disciplines and scientific sections of medicine and also in articles devoted to certain scientists.
An important role in development of the doctrine about V. played congresses of therapists. The Russian congresses of therapists (I—VII) took place during the period from 1909 to 1924; the program of each of them would cover many problems B. V.P. Obraztsov and N. D. Strazhesko's report at the I congress in 1909 devoted to diagnosis of thrombosis of coronal arteries of heart can serve as the evidence of relevance in the scientific importance of the discussed questions. Since the VIII congress in Leningrad (1925), congresses received the name of all-Union. The IX All-Union congress of therapists took place in 1926 (Moscow) and discussed problems of a long septic endocarditis, a diabetes mellitus, diseases of a stomach; The X congress (1928, Leningrad) was devoted to problems of «peripheral heart», visceral syphilis and endocrine diseases; (1931, Moscow) rheumatism and hron, nonspecific diseases of lungs were program subjects of the XI congress. The XII congress (1935, Leningrad) discussed and accepted the classification of diseases of the blood circulatory system developed by Lang: this classification, in a cut the principle of multistaging of the diagnosis and the functional direction of internal medicine are reflected, it would be recognized as a sample for creation of classifications in other sections B. The XIII congress (1947, Leningrad) generalized the experience of therapists accumulated in days of the Great Patriotic War, considered questions of pathology of lungs and a pulmonary heart, a peptic ulcer of a stomach and duodenum. The XIV congress (1956, Moscow) was devoted to the main problems of cardiovascular diseases, the XV congress (1962, Moscow) — pathologies of lungs, the XVI congress (1968, Moscow) — to problems hron, gastritis and rheumatism, the XVII congress (1974, Moscow) — to genetic, immunological and biochemical aspects of V.
More than 30 thousand (1974) doctors studying V., are combined by All-Union society of therapists (it is created in 1922), a cut directs activity of republican and regional (city) societies and enters into the International society of internal medicine (it is founded in 1948). The international congresses are carried out as on common problems of internal medicine (since 1950), and according to its separate scientific sections (e.g., the congresses of rheumatologists — since 1926, gastroenterologists — since 1935, nephrologists — since 1960). Researches in the area B. the USSR lights magazines «Therapeutic Archive» (it is created by M. P. Konchalovsky and G. F. Lang in 1923) and «Clinical medicine», specialized («Cardiology» etc.) and republican magazines.
Shots of therapists are prepared medical in-you and f-you high fur boots. System of teaching V. constantly is exposed to reforms and it is improved. On the III—VI courses students study methods of a medical research, fundamentals of semiotics and private pathology, the main forms B. in a systematic statement and their treatment, differential diagnosis, etc. Students practice independent work (kuration) in a hospital and on outpatient appointment. After the termination of higher education institution the young doctor within one more year trains (internship) in the conditions of a regional or municipal hospital. The seven-year system of training allows to train already in higher education institution V. specialist., but not to release «therapist» of the doctor who does not have specialization. Century. are taught as the main discipline also in medical schools which train paramedics and nurses. Professional development and further specialization of therapists are carried out at departments of in-t of improvement of doctors and on the basis of local to lay down. - professional, institutions, in an internship and a postgraduate study.
History — Borodulin F. R. S. P. Botkin and neurogenic theory of medicine, M., 1953, bibliogr.; Ghukasyan A. G. Evolution of a domestic therapeutic thought, M., 1973, bibliogr.; L. F dragons. The Russian vrachebnik, a research in the field of our ancient medical writing, SPb., 1895; about N, Readings on medical history of Russia, SPb., 1896; Lushnikov A. G. Clinic of internal diseases in Russia of the first half of the 19th century, M., 1959, bibliogr.; it, Clinic of internal diseases in Russia, M., 1962, bibliogr.; it, Clinic of internal diseases to the USSR, the Main directions of a clinical thought, M., 1972, bibliogr.; Pletnev D. D. The Russian therapeutic schools, M. — Pg., 1923, bibliogr.; Russian D. M. Russian therapeutic schools, Klin, medical, t. 24, No. 3, page 9, 1946; it, History of general and domestic medicine and zdravookhr * neniya (996 — 1954), Bibliography, M., 1956; T a p e e in E. M. School of the Russian therapists and its role in development of medical science, Klin, medical, t. 45, No. 11, page 6, 1967. See also bibliogr, to the Art. about the separate industries of internal diseases and in the station, it is devoted, otd. the scientist — to therapists.
Guides, textbooks — Botkin S. P. Course of clinic of internal diseases and clinical lectures, t. 1 — 2, M., 1950; Zakharyin G. A. Clinical lectures, M., 1889; Konchalovsky M. P. The textbook of internal diseases, M. — L., 1939; Lang G. F. Textbook of internal diseases, t. 1, p.1, L., 1938; it, Chosen works, L., 1975; The Multivolume guide to internal diseases, under the editorship of A. L. Myasnikov, t. 1 — 10, M., 1962 — 1966; A. L. Butchers. Internal diseases, M., 1967; Ostroumov A. A. Chosen works, M., 1950; Strazhesko N. D. Chosen works, t. 1 — 2, Kiev, 1955 — 1956; T a p e e in E. M. Internal diseases, M., 1951; Chernoruts-k and y M. V. Diagnosis of internal diseases, L., 1953.
Periodicals — The military-medical magazine, M., since 1823; Clinical medicine, M., since 1920; The Medical abstract magazine, the Section I — Internal diseases, Balneology, physical therapy and physiotherapy exercises, Sports medicine and medical control, M., since 1957; The Soviet medicine, M., since 1937; Therapeutic archive, M., since 1923; Acta medica Scandinavica (1869 — 1919 — Nordiskt medicinskt Arkiv), Stockholm, since 1927; Annals of Internal Medicine, Philadelphia, since 1928; Archives of Internal Medicine, Chicago, since 1908; Clinical Science, L., since 1933; Deutsches Archiv fiir klinische Medizin, Lpz., since 1868; Ergebnisse der inneren Medizin und Kinderheilkunde, V., since 1908; Excerpta medica, Section VI. — Internal Medicine, Amsterdam, since 1947; Internist, B. u.a., since 1960; Klinische Wochenschrift, B. — Miinchen, since 1922; Presse medicale, P., since 1897; Wiener Zeitschrift fiir innere Medizin und ihre Grenzgebiete, Wien, since 1947; Zeitschrift fiir die gesamte innere Medizin und ihre Grenzgebiete, Lpz., since 1946.
A. A. Kedrov; V. I. Borodulin (ist.).