History

Medicine of the “modern” epoch

Since the Crimean War, medicine in the Empire developed following the three directions. The first, most powerful direction was the military or, so to say, the “conveyer-type” medicine, which has transformed under the Soviet system into the all-nation medicine. Initially, the main goal of the military medicine, specifically of the military surgery (established during the three military campaigns – the Crimean War (1853 – 1856), the Prussian-French War (1853 – 1856) and the Russo-Turkish War (1877-1888) by Nikolay Ivanovich Pirogov, a prominent Russian surgeon, anatomist, naturalist, pedagogue, corresponding-member of the Russian Academy of Sciences) was to minimize casualties and secure the fastest recovery of the army personnel.

Pursuing this goal, quite logical in war conditions, Pirogov, along with purely professional surgical innovations (e.g. in-the-field anesthesia, plaster bandage, a number of techniques to avoid limb amputation), had introduced the new methods of nursing the wounded. So, the wounded were thoroughly selected and diagnosed just at the dressing area: depending on the severity of wounds, some of them were immediately referred for surgery in the field conditions, while the others were transported to the rear hospitals. The same approach made it possible “to sort” the wounded and form special “units” among the medical personnel.

Similar procedure stood in good stead during the Russo-Japanese War and the First World War. The Empire entered these wars having a well-organized medical service.

Perhaps, it was precisely this direction that developed in the Empire most rapidly – at least it was adopted and used with maximum efficiency by the soviet medicine. Within the framework of a “conveyer-type” approach practically no attention was given to individual features and peculiarities of a patient: the stake was on maximum mass effectiveness. It was justified in many respects: both the imperial and the soviet mass medicine were far from perfection in terms of patient care, and poorly responded to “individual cases” (this is still strongly felt in the current state medicine), although being quite able to ensure mass health and mass access to medical services for a huge population of the country.

The second and, perhaps, the oldest direction was the district medicine. By today’s standards (and functions as well), a district doctor resembled an ambulance doctor, with one but extremely important distinction. The task of today’s ambulance doctor may be defined as establishing a primary diagnosis, “stabilizing” a patient and sending him/her to a hospital, i.e. to the above mentioned medical “conveyer”, excluding the cases where a problem may be solved in situ via using ambulance techniques and medications. Unlike an ambulance doctor, a district doctor had no “rear” behind him, except for his own small hospital (or reception office): he himself was the first and the last medical instance, a surgeon and a therapist.

Taking into account the fact that a district doctor had to serve several (sometimes dozens) villages, the load upon him was colossal. This position gave a tremendous experience (the best Russian physicians underwent practice as district doctors), but in terms of work intensity it could be compared with the war time conditions.

One of the most valuable memoirs dated, however, by the late 1917 have been left by Mikhail Afanasiyevich Bulgakov in “The notes of a young doctor”. He wrote there of his work at the Muriyevskaya village hospital, where just upon graduation from the university he had to perform amputations, handle the delivery and treat skin diseases.

 "My reception was increasingly growing. The day has come when I received 110 people. That day we started at 9 a.m. and finished at 8 p.m. I was taking off my gown, staggering. The senior midwife-doctor’s assistant said to me: - You have to thank tracheotomy for the reception like this. Do you know what people in villages say? Allegedly you have replaced sick Lidka’s throat with a steel one and sewed it in. People specially come to this village to look at her. That’s the glory, doctor. My congratulations! - Is she still living with that steel? – I asked. - Yes, she is. Well done, doctor! You are doing everything in cold blood. Great! - Well, .I never worry, - I said nobody knows why, but felt so dog tired that was unable to be ashamed, and just took my eyes off. Then I sad good-bye and left for my home. The thick snow was falling down covering everything around, the lantern was flashing, and my home was lonely, calm and important. And when walking, I wanted the only thing – to sleep…” (Mikhail Bulgakov, "The notes of a young doctor")

The third direction was the private medicine. The simplest way for a reader to make an impression of this kind of medicine is to recollect Prof. Preobrazhenskiy, the character from the famous “The Dog’s Heart” by Bulgakov: his medical interest lied in the personal approach to a patient, to individual features and wishes.

We are mentioning here these three tendencies because minimum two of them have become the impetus to the development of plastic surgery, pioneered, as commonly recognized, by Yuliy Karlovich Shimanovskiy, M.D., ordinary professor of operative and military surgery at the St. Vladimir University (now the T.G. Shevchenko Kiev National University) and consultant at the Kiev Military Hospital.

According to the best in the Empire encyclopedic source - a 86-volume “Encyclopedic Dictionary by Brockhaus and Efron” (1890—1907):

"Shimanovskiy Yuliy Karlovich (1829 - 1868) – a surgeon, received education from the Revel gymnasium and the Derpt University, having graduated from the university (1856) was left therein as an assistant at the surgical clinic and soon was appointed an assistant-professor (1857). In 1858 – 1860 he worked as an extraordinary professor at the Chair of Surgery with the Helsingfors University and as professor-consultant with the Helsingfors and Sveaborg hospitals. Then he was transferred as an extraordinary professor at the Chair of Chemistry with the St. Vladimir University and appointed consultant at the Kiev Military Hospital. In 1864 he was approved as an ordinary professor at the same Chair. In 1866 he was sent abroad with scientific mission. For presenting in 1867 the collection of surgical instruments devised by himself at the Paris Exhibition he received an honorable testimonial. He has published: "Additamenta ad ossium resectionem" (thesis, Derpt, 1856); "Der Gypsverband mit besonderen Berucksichtigung der Militarchirurgie" (Leipzig., 1857); "Adnotationes ad rhinoplasticen" (Derpt, 1857); "Desmologische Bilder zum Selbstunterrichte" (Derpt, 1857); "Neue Bearbeitung der N. Pirogoff'schen Anatomie der Arterien-Stamme und Fascien" (Leipzig and Heidelberg, 1864; Russian translation by Dr. W. Zwerner., 1861); "Brief Manual on Practical Exercises in Desmology for Doctors and Students" (translation from German, Kiev, 1862), monograph: "Plaster Bandage" (in cooperation with Drs. Kishko-Zgerskiy, Heinaz and Shatkovskiy., 1863); "Operative Surgery" Part I , Kiev, 1864, Part II, 1865, Part III, editions 1 and 2, 1869); "Military-Surgical Letters. Brief Outline of the Most Important Areas of Operative Surgery" (Kiev, 1868, 2 edition, 1877) and a number of articles in the Russian and foreign medical journals (see the list in the "Biographical Dictionary of Professors and Teachers of the St. Vladimir University", Kiev, 1884). Moreover, when young, Shimanovskiy had a bent for poetry and painting, his “Collection of Verses” was published after his death, under pseudonym Yuliy Steinborn , Braunsweig, 1868)."

A brief reference in the respectful edition – an analog of today’s Internet in the Empire - has omitted the most important aspect: Shimanovskiy was an initiator of the plastic surgery, not only in Russia but also at the international scale.

As a student of the internationally known professor Adelman (the Derpt University) and the person who replaced professor Karavayev at the Chair of Operative Surgery with the Kiev University, Shimanovskiy was the first highest class specialist whose interests focused on the plastic surgery directly. He devoted to this subject his doctorate and a fundamental work “Operations on the Human Body Surface” (1865), which is still being used by today’s physicians as a valuable source. Shimanovskiy has virtually created the first classification of skin defects and a clear algorithm of their elimination by a surgical method, which resembled the methods of solving geometric problems. It should be added that Shimanovskiy has invented over 40 new surgical instruments and a numbers of procedures (e.g. rotation of skin area on pedicle) that are in use nowadays.

Neither before nor long after Shimanovskiy (until the mid-ХХ century, if to speak of the phenomenon as of the mass one), the plastic surgery has no been isolated from the general surgery as a separate direction. However, the theoretical and practical basis created by Shimanovskiy, has enabled surgeons since the late XIX century - from the very beginning of the “modern” period – to include the elements of plastic operations in their plans of the general surgical, wherever necessary.

But with regard for the fact that the XX century appeared to be, softly speaking, the most troubled in the history of mankind, this necessity arose rarely.