Medicine

Image - Kyiv Military Hospital (ca 1915). Image - Kyiv Military Hospital (ca 1915). Image - Zemstvo medicine in Kherson region (museum exhibit).

Medicine. The science and the art of diagnosis, prevention, and treatment of diseases (see also Public health, Hygiene, Sanitation; and Folk medicine).

During the Scythian period (7th–3rd centuries BC), herbal medicine and some surgical procedures were in common use, including tooth-pulling, debridement, suturing with horsehair, the bandaging of wounds, phlebotomy, the reduction of fractures, amputation, trepanation, embalming, and mummification. The physicians Anakharsis Abaris and Toxaris used medicinal plants to increase blood coagulability, to treat ulcers, and to induce anesthesia. The therapeutic use of bathhouses was widespread. The Scythian ruler Mithridates VI, King of Pontus, was an experimenter in mithridatism.

In Kyivan Rus’ the profession of physician was officially acknowledged by legal statutes of grand princes Volodymyr the Great and Yaroslav the Wise. Hospitals were regulated by a statute of Volodymyr the Great. The monk-physician Saint Anthony of the Caves founded the Kyivan Cave Monastery, where a hospital was organized in 1070 by Saint Theodosius of the Caves.

In general, medicine was practiced by folk healers, monk-physicians (Saint Anthony of the Caves, Ahapit, Master Olimpii, Pymen, and Kozma), and secular physicians (Ivan Smera, Petro Sirianyn, Fevronia, Maryna, Yevfrosyniia, and Danylo Zatochnyk). Princess Yevpraksiia Mstyslavivna wrote a scholarly medical treatise on salves (Allima, Constantinople 1130; see also Folk medicine). Kyivan physicians were acquainted with many conditions, including itching, jaundice, dermatoses, eye disorders, pleurisy, arthritis, bronchial asthma, angina pectoris, meningocele, epilepsy, stroke, brain contusion, tuberculosis, typhoid fever, malaria, plague, and anthrax. Treatment consisted of the application of medicinal plants and herbs, the use of sedatives and narcotics, hypnosis, massage, hydrotherapy, hygiene, and isolation. Maternal and child care was in the hands of midwives. Barber-surgeons (tsyrulnyky, rizalnyky, or rukodily) performed bandaging, tooth extractions, cauterizations, removal of lymphatic gland tumors, amputations, and trepanations of the skull (10th–11th centuries).

Knowledge of the natural sciences and of medicine was accumulated in Kyivan Rus’ in translations of Byzantine medical books, such as Exarch John of Bulgaria’s Shestodnev (Hexaemeron, 1263) and Fiziolog (Physiologist), and others, and in original local zilnyky or travnyky (herbaria) that contained descriptions of healing herbs, baths, the treatment of some diseases, and bloodletting. Possibly as early as the 11th to 13th centuries Kyivan Rus’ herbaria made the transition into likarstvenni or lechebnyky (medicinal compendiums) that contained both folk medicine and scientific medicine. Segments of Mefodiivskyi likarstvennyk have survived.

During the 13th century Ukraine was overrun by the Mongols and Tatars, and progress was halted in all fields of endeavor, including medicine. Nevertheless, Vasylii Ruthenus of Kyiv opened the first pharmacy in Lviv (1445), and Yurii Drohobych wrote Iudicium prognosticon (Rome 1483) on astronomy and infectious diseases (plague). M. Bulev translated Hortus sanitatus (Lübeck 1432) into Old Ukrainian (1534).

Hospitals were founded in Peremyshl (1461), Lviv (1591), Kyiv (1629), Chernihiv, and Lutsk, as well as homes for the aged, sick, and infirm, pharmacies in Kyiv (military in 1715, civilian in 1728), and guilds for tsyrulnyky (see Surgery and Feldsher) in Kyiv and Lviv.

Military medicine developed in the Zaporozhian Sich in the first half of the 16th century. During Bohdan Khmelnytsky’s hetmancy (1648–57) every regiment of his army had a physician, and each company had a tsyrulnyk. Treatment of wounded Cossacks was carried out in hospitals of the Mezhyhiria Transfiguration Monastery and Trakhtemyriv Monastery. With the creation of gubernias in the Russian Empire, the Prikaz of Public Charity (1775–1864) initiated organized medicine, including the establishment of medical schools, hospitals, infirmaries, pharmacies, and public health services.

During the 18th century notable medical scholars, researchers, and practitioners in Ukraine included Ivan Poletyka; M. Terekhovsky, whose thesis, De chao infusorio Linnaei (1775), concluded that liquorous animalcules represent living organisms which die on heating or cooling; the epidemiologist Danylo Samoilovych; the obstetrician and encyclopedist Nestor Ambodyk-Maksymovych, who wrote an anatomical-physiological dictionary (1783) and a medical-pathological-surgical dictionary (1785); the organizer of health care in Western Ukraine, A. Krupiński; the histologist Oleksander Shumliansky; M. Hamaliia, who wrote a monograph on the Siberian plague (1792); the veterinarian S. Andriievsky, who proved that human and animal anthrax were identical (1786); the anatomist Petro Zahorsky; the physiotherapist E. Mukhin, who pioneered ‘nervism’ in medicine (reflex theory, 1800) and prescribed resuscitation for victims of drowning, strangulation, and choking (1805); and the scholar Ivan Orlai.

During the 19th century in the Russian Empire, medical education was managed by the Ministry of Education, health care by the Ministry of Internal Affairs, and military medicine by the Department of Land and Navy Forces. Zemstvo medicine served rural areas (1864–1917). Among the medical specialists in Ukraine were the anatomist I. Kamensky, who wrote a dissertation on ‘squeezing the heart’ (1802); the biologist Petro Peremezhko; the anatomist Volodymyr Bets; the ophthalmologist Oleksander Ivanov, who studied the microanatomy of the eye; O. Kovalevsky, who discovered the neuroenteric (Kovalevsky’s) canal; and M. Kulchytsky, who described argentaffine (Kulchytsky’s) cells (1897). The physiologist O. Filomafitsky introduced the theory of the cyclical function of the nervous system (1836–40), performed a gastrostomy (1842), and investigated intravascular administration of ether, chloroform, and benzine for anesthesia (1849); Alexander Walter proved the vasoconstrictive effect of the sympathetic nerves on blood vessels (1842) and described the effect of cooling on the safety of an operation (1862) and thus defined hypothermia; I. Sechenov discovered the reflex inhibitory (Sechenov’s) center in the medulla oblongata and spinal cord (1862); the physiologist Vasyl Danylevsky demonstrated the biochemical activity of the cerebral cortex (1876); and B. Veriho (1899) described displacement of the oxyhemoglobin dissociation curve by a change in partial pressure of carbon dioxide or in pH (Veriho-Bohr effect). In biochemistry, Oleksander Danylevsky isolated amylase and trypsin (1863), observed the hydrolysis of proteins by pancreatic juice, demonstrated the synthesis of proteins from peptones in the presence of ferments (1886), and formulated the theory of protein structure (1888–91); Ivan Ya. Horbachevsky synthesized uric acid (1882) proving that it derived from cell nuclei (1889) and that it increases in neoplasms (1891–2), thereby introducing a biochemical screening to oncology; Oleksii Bakh developed a theory of slow oxygenation and cellular respiration (1897); and F. Selivanov described a test for fructose in the urine (Selivanov’s test, 1887). Among microbiologists and immunologists, were Grigorii Minkh, Yosyp Mochutkovsky, Nobel laureate Illia Mechnikov, Volodymyr Vysokovych, Mykola Hamaliia, who discovered bacteriophages (1898), Yakiv Bardakh, and the plague researchers Ivan Savchenko and Danylo Zabolotny. In pathology Danylo Vellansky approached diseases from a more rationalistic Naturphilosophie; the Kyivan school of pathologists was organized by Volodymyr Pidvysotsky; and the origin of radiology could be traced, perhaps, to the construction of the cathode ray lamp by Ivan Puliui (1882).

In the field of internal medicine (Ukrainian: terapiia) a systematic description of clinical symptoms, complications, and treatment of ulcers of the stomach and duodenum was given by F. Uden (1809–22); V. Lambl discovered Lamblia intestinalis and lambliosis (1859); F. Loesh discovered Entamoeba histolytica and amoebic dysentery; and M. Tolochnikov reported on the interventricular septal defect of the heart (1874). The development of hygiene was promoted by Viktor Subbotin; a sign of costovertebral angle tenderness was described by F. Pasternatsky; Serhii Podolynsky wrote on protein ferments of the pancreatic glands (1876); and H. Shapiro noted bradycardia in the course of myocarditis (Shapiro sign). An early separation of the epidermis from the basal layer of the skin in pemphigus vulgaris was described by P. Nikolsky (Nikolsky sign, 1896); H. Rossolimo introduced a reflex of plantar flexion of toes (Rossolimo reflex, 1902); and D. Romanovsky developed the prototype of eosin–methylene blue (Romanovsky’s stains for blood cells and parasites, 1890–1).

In surgery Illia Buialsky introduced a method of sectional sawing of frozen cadavers for anatomical dissection (1836); Tito Vanzetti noted that in sciatica with scoliosis the pelvis is always horizontal, but that in other lesions with scoliosis the pelvis is inclined (Vanzetti sign); Nikolai Pirogov introduced rectal and intravenous anesthesia (1847), performed a mastectomy for breast carcinoma (1847), invented an osteoplastic amputation of the leg at the ankle in which a part of the calcaneus bone is left in the lower end of the stump (Pirogov’s amputation, 1852), outlined a venous (Pirogov’s) angle formed by the junction of the internal jugular and subclavian veins and the angles of the teeth (Pirogov’s point), and introduced an extraperitoneal approach to the external iliac artery (Pirogov’s incision, 1881); O. Karavaiev performed pericardiocentesis (1840) and organized the Clinic of Eye Diseases in Kyiv (1844); Yulii Shimanovsky designed a flap reconstruction of the cleft lip and palate, transplanted the cornea, and performed an amputation of the thigh through the knee using a patella as an osteoplastic flap over the end of the femur; O. Yatsenko introduced blepharoplasty with full-thickness free skin graft (1871) and bouginage of a stenosed esophagus through gastrostomy. Nikolai Sklifosovsky introduced the compression lock for fixation of fractures complicated by delayed union or nonunion (Sklifosovsky lock, 1875), propagated metalo-osteosynthesis (1893), and resected a prolapsed rectum followed by mucomuscular anastomosis (Sklifosovsky operation); Ovksentii Bohaievsky performed a gastrostomy and removal of echinococcal cysts of the liver, paracentesis, and gastric resection (1888); M. Subbotin designed an artificial urinary bladder and urethra using the anterior portion of the lower rectum (Subbotin operation) and a suction drainage for wounds and abscesses (1902–6); Apollinarii Pidriz closed a bullet wound of the heart (1897); Ivan Sabaneev designed an osteoplastic intercondyloidar amputation of the thigh (Sabaneev operation, 1890) and a gastrostomy by pulling a cone of the stomach through an incision in the left rectus muscle (1890); Mykola Volkovych founded modern surgery in Ukraine; and Aleksandr Matveev introduced prophylaxis of neonatal blennorhea by the routine subconjuctival application of a 2 percent silver nitrate solution (1853). Child psychology and psychopathology were developed by Ivan Sikorsky.

In the 20th century, contributions to medicine continued to be made by specialists in Ukraine and Ukrainians throughout the world, including the anatomist Volodymyr Vorobiov, who described the subepicardial nervous plexus of the heart; the physiologist Volodymyr Pravdych-Nemynsky, who recorded the electroencephalogram (EEG) in a dog, using a stringed galvanometer (1913); the pathophysiologist Oleksander Bohomolets, who did pioneering work on the theory of stress and developed the concept of the reticuloendothelial system; Georgii Folbort, who established the principles of the physiology of exhaustion and recovery; D. Alpern, who proved the desensitizing and anti-inflammatory action of the hypophyseal cortex (1935); the pathophysiologist Mykola Syrotynin, who proposed practical recommendations regarding hypoxia in space medicine (1973); J. Walawski, who discovered enterogastrone in the small bowel (1928) and proposed a theory of the etiology of gastric ulcers based on the function of enterogastrone; and Ye. Babsky, who improved ballistography (1956–63).

In biochemistry Jakub Parnas discovered the pathway of glucose metabolism (Embden-Mayerhoff-Parnas pathway, 1935); Aleksandr Palladin researched vitamin synthesis (1938), muscle function, and biochemical topography (1965–72); the geneticist Serhii Hershenzon demonstrated the mutagenic activity of exogenic DNA (1939); I. Kochan introduced the concept of nutritional immunity (1973); and the pharmacist Oleh Hornykiewicz noted the dopamine depletion of the striatum in Parkinson’s disease (1960) and introduced L-dopa for its treatment. In microbiology and immunology M. Weinberg developed a complement fixation (Weinberg) test for hydatid disease, introduced culture (Weinberg media) for the growth of anaerobes, and discovered the bacteria causing gas gangrene (Bacillus oedematicus and histolyticus, 1918); O. Bezredka discovered the Bezredka antivirus (1903), filtered and heated bacteria cultures for local immunity (1925), described a complement deviation test for tuberculosis (Bezredka reaction), and introduced a desensitization (Bezredka) method during immunization with tetanus toxoid or immune globulin (1930); Viktor Drobotko formulated the bacterial dissociation theory; and Nobel laureate Selman Waxman obtained streptomycin from Streptomyces griseus and proved its effectiveness against tuberculosis (1944).

In pathology, work was done by Mykola Melnikov-Razvedenkov, who studied the fixation of anatomical preparations (1896), the pathology of alveolar echinococcus, tumors of the brain and stomach, and rhabdomyoma of the heart; Pavlo Kucherenko; Rostyslav Kavetsky, who applied lasers to oncology (1969); and the immunologist and oncologist Leon Dmochowski. Evolutionary genetics was established by T. Dobzhansky, who applied Mendelian genetics to Darwinian evolution. In radiology E. Zavoisky did pioneering work in nuclear magnetic resonance (1944); and L. Bilaniuk was among the first (1982) to report diagnostic application of magnetic resonance imaging.

In internal medicine Vasilii Obraztsov and Mykola Strazhesko clinically diagnosed acute myocardial infarction due to thrombosis of the coronary artery; the work of Feofil Yanovsky centered on the diagnosis of kidney diseases (1927); L. Dmytrenko described a velvety sound in endocarditis; professional and ethical standards of medical practice were created by Mariian Panchyshyn; disturbances of bronchial conductivity in bronchitis and bronchial emphysema were found by B. Votchal; V. Vasylenko reported metabolic alkalosis and (with M. Strazhesko) proposed a clinical classification of congestive heart failure (1939); Vadym Ivanov contributed to the evaluation of gastric mobility and secretion (1926–8); Dmytro Panchenko constructed a barometric chamber for the treatment of essential hypertension and neuropsychiatric disorders (Panchenko biotrom, 1960); Oleksander Hrytsiuk demonstrated a transition of the subendocardial into the transmural myocardial infarction (1973); a Nobel laureate, Yevgenii Chazov introduced intracoronary thrombolysis for acute myocardinal infraction (1975). Anesthesia in Ukraine was developed by A. Treshchynsky and L. Chepky.

In surgery, surgical oncology was founded by Hryhorii Bykhovsky, who also described a test for albumin in the urine (Bychovsky test); M. Dieterichs invented a transport splint (1932); the cofounder of neurosurgery, Nikolai Burdenko, advanced military field surgery; the ophthalmologist Vladimir Filatov coinvented the tubed or pedicle (Filatov-Gillies) flap (1917), advanced keratoplasty, and initiated the use of cadaver corneas (1931); Yakiv Halpern proposed to substitute the esophagus with a greater curvature of the stomach (1911); Vladimir Shamov employed electrocoagulation to destroy malignant tumors (1910–11) and initiated the transfusion of cadaver blood (1928); and O. Melnykov developed an anatomical basis for extrapleural approaches to the subphrenic spaces and abscesses (1929–3) and the concept of precancerous lesions of the stomach (1950–4). Neurosurgery was pioneered by Ivan Ishchenko; T. Hryntschak introduced suprapubic transurinary prostatectomy with a primary closure of the prostatic bed and urinary bladder (Hryntschak prostatectomy); Yurii Vorony described the immunologic character of graft rejection (1929), performed the first human kidney allograft (1933), and introduced the mechanical suture in vascular surgery (1949); Mykola Novachenko developed original operations for arthrodesis and for reconstruction of the hip joint; V. Kolesov created internal thoracic–coronary artery grafting (1964–8); Aleksandr Arutiunov and A. Romodanov contributed to the diagnosis and surgery of craniocerebral trauma, vascular abnormalities, and tumors of the brain and spinal cord; Ivan T. Shevchenko recommended preoperative radiation for malignant tumors and combined intraoperative roentgen-radium therapy with the resection of lung cancer (1962); Mykola Amosov, introduced mechanical sutures in thoracic surgery (1957), advanced the use of computers in medicine (1960), simplified the heart-lung machine (1962), and constructed bileaflet and cuffed heart valve prostheses (1962–5); Paul Dzul pioneered methods of microsurgery of the middle ear (1960) and introduced the intracavitary treatment of maxillary carcinoma (1967); K. Syvash developed endoprostheses for total hip (1959) and total knee (1978) replacement; W. Bobetchko designed the Toronto braces for Legg-Calve-Perthes disease (1968); H. Knyshov performed the first coronary artery bypass graft in Ukraine using a vein (1973); and L. Kuzmak designed stoma adjustable gastric banding for morbid obesity (1983).

Contributions to pediatrics and obstetrics were made by the psychoneurologist Kostiantyn Platonov; Anatolii Nikolaiev, who proposed administering oxygen, glucose, and cardiac stimulants (Nikolaiev’s triad, 1952) to alleviate intrauterine asphyxia; and V. Hryshchenko, who applied hypothermia and cryosurgery and used echocardiography for the diagnosis of fetal heart abnormalities (1977–8). The work of O. Khokhol focused on nutritional diseases in infants.

The neurologist Oleksander Shcherbak developed a clinical classification of psychiatric disorders and introduced a segmental collar and lumbar reflex physiotherapy. The psychiatrist Viktor Protopopov introduced physiology and biochemistry in the evaluation of patients. The neurologists V. Hakkebush, T. Heier, and Oleksander Heimanovych defined a senile dementia due to atherosclerosis of the cortical arteries of the brain (Hakkebush-Heier-Heimanovych syndrome, 1912–15). The philosopher-pedagogue Stepan Balei was a pioneer of childhood (1931), pedagogic (1938), and social (1959) psychology. One of the founders of forensic medicine, Mykola Bokarius, proposed the classic sperm test and methods for examining a strangulation furrow (1925–30). Space medicine originated from the work of the aeronautical engineer Serhii Korolov. Biological and medical computers for space technology were developed at the Division of Biological Cybernetics (organized by Mykola Amosov in 1960) of the Institute of Cybernetics of the Academy of Sciences of the Ukrainian SSR in Kyiv (1957) and at the Kyiv Scientific Research Institute of Tuberculosis, Pulmonology, and Thoracic Surgery.

The medical library of Ukraine (est 1930), located in a building formerly the property of the Tereshchenko family in Kyiv, housed over one million volumes in 1980, and had 24,000 individual and 3,000 group subscribers. The Ukrainian Medical Museum (est 1973 by A. Grando) is located in the former Anatomy Theater of the Kyiv Medical Institute.

(For more medical history, see Health education, Medical education, Medical journals, Medical scientific societies, Veterinary medicine, and Zemstvo medicine.)

BIBLIOGRAPHY
Garrison, F. An Introduction to the History of Medicine, with Medical Chronology: Suggestions for Study and Bibliographic Data (Philadelphia 1929)
Mikhn’ov, A. (ed). Narysy istoriï terapiï v URSR (Kyiv 1960)
Petrov, B. Ocherki istorii otechestvennoi meditsiny (Moscow 1962)
Olearchyk, A.; Olearchyk, R. Concise History of Medicine, vol 38, no. 3 (1991) of Journal of the Ukrainian Medical Association of North America

Andrew Olearchyk

[This article originally appeared in the Encyclopedia of Ukraine, vol. 3 (1993).]




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