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History of Medical Geography in Ukraine
Pyrogov M.I.
Zabolotnyj D.K. |
Only after Ukraine gained its independence from the
Soviet rule ukrainian scientists got access to the
literature sources which were hidden and prohibited for
public usage for a long time. This brought them
possibility to start deep investigations of the modern
science history development and state an adequate
development assessment. This concerns medical geography
as well. The development of medical geography is being
viewed according to the set of historical peculiarities.
These peculiarities display finall influence on it
creation and development as an independent branch of
science in present days. Medical geography began its
creation in Ukraine very long time ago according to the
first peculiarity. It is necessary to emphasize that
under medical-geographical knowledge we should understand
the data about environmental influence on population's
health, the spreadings of different diseases in the
certain regions, about population's way of life in the
result of possible diseseas on certain territories, etc.
Such knowledge was passed from one generation to another
by oral retelling, by songs, by people's habits, and
later by the medical treatment. Professor S.A.
Verchrachkyj, the famous researcher of medical history in
Ukraine stated that our people long, long time ago had
medical knowledge of ancient Greece, Romans and Arabic
countries. Medical-geographical knowledge was gained
first of all by people which were working on medicine.
So, in Ukraine were so called pharmacists which were
medical workers in twelfth century. One of the best known
pharmacist's places was created in Lviv in 1512.
Pharmacist's place in Kiev was created in 15 century. At
this point it is necessary to emphasize that pharmatists
with medical education began to prepare in Ruusia only in
1741. Doctor Andrew Krupynskuj was first organizer of
first training cources for pharmatists in Lviv in 1775.
He also published the first manuscript which was written
in Polish language for pharmatists. This textbook
contained anatomy information , description of different
diseases and ways of their treatment, etc. The great role
in gaining medical-geographical knowledge was addressed
to the church community. Thanks to them appeared such
medical institutions today known as hospitals. Gaining
medical-geographical knowledge was quite evident in 17
century when Kyiv bratstvo (community) was organized in
1515 and then in the middle of 18 century in organized
medical schools in Chernigiv, Perejaslav, Charcov.
Medical activities of Kyiv bratstvo (preparing medical
teachers, scientific work, etc.) were widely recognized
and resulted in calling group of ukrainian scientists to
Moscow in 1649. Among them were well-known scientist
Semen Polochkyj who later became a techer of Char Oleksij
Mychaylovuch and Epifanij Slavinechkuj who was the first
to translate into slavic language the pearl of the world
medical science "Anatomy" of Andrew Vezalija.
It is necessary to emphasize that Kyiv academy bratstvo
played an important role in realization the task in the
short term given by Petro the First. This task required
to organize the military - medical service in the army.
The Kyiv bratstvo send their graduates to the Moscow
medical school which after graduation worked as regiment
doctors. In order to attract ukrainian students which had
a very high level of preparation (they knew well latin,
anatomy, etc.) the russian government funded their travel
expences and annual scholarships. Russian government
created conditions which were different from that
ukrainian youth had in Ukraine. According to the prof.
S.A.Verchratskogo medical - surgical schools spread
across Russian empire were admitted 300 students from
Kyiv bratstvo academy during the period of 1754-1768. A
lot of ukrainian youth studying at russian special
schools became famous scientists. Among them: Bujalskyj,
Zagorskyj, Maksymovych-Ambodyk, Trechovskyj, Chotovskyj,
Shmulanskyj etc. The second peculiarity of medical
geography development was that the official mother land
of medical geography is recognized Italy despite of
strong basis of medical employees preparation and
extremly high accumulation of unique medical-geographical
knowledge within its boundaries.Italian scientist B.
Rjamachin introduced the term "medical
geography" and opened the theme of this meaning in
17 century. The first works in medical geography were not
published in Ukraine as well. For example, one of the
first work in medical geography is the book
"Generalization of common medical practical
geography" by german scientist Finke. He wrote that
if in the work country after country are mentioned and
described the position of each of them: land condition,
water, weather, product consumption which are being used
by population; if report the moral, people habits which
influence population's health , if telling about just
diseases and ways of treatment which are being used in
these countries; and finally if report everything that is
necessary to know about medical state in every country,
isn't it worth calling medical geography? Fuke published
a work "Medical geography" in which medical
geography is being viewed as science which engaged in
"law study according to which diseases are
distributed and expanded on the Earth" in 1853 in
Berlin. French doctor of military hospital Buden (1843)
wrote in his work "Experience of medical
geography" that birth, life, illness and death - all
have a tention to change with the climate and soil, with
tribe and nationality. This different manifestation of
life and death, health and illness, this frequent changes
in the space that influence people's origin compose a
special subject of medical geography". Essential
addition in development of medical-geographical science
were brought by scientists of Russian Empire. They were
formed under the influence of ukrainian medical school.
They were brought up from different parts of it but were
known to the world as russian scientists. Doctor of
kutajiskogo military hospital H.I. Toropov determined
medical geography as following in 1864: "First of
all to warn any kind of diseases and you have to know
what it arises from and where it happens. It means that
you have to know the reason of it development in the
organism and places of it spreding on the Earth. The
answer on the first question we may find studying illness
nature itself. Answer on the second question can give
young science of medical geography that only in 40th
began its existence." About at the same time E.
Ikavitsa stated the object of medical geography:
"Variety of life and death occurrences in different
countries of the world and among different people form
the subject of medical geography". S.P.Lovchov
attemps to open content and task of medical geography:
"To imagine the picture of nature condition and
human society in certain area. To show interaction
between them as well as good man behaviour with nature,
etc." (1870). Quite an interst dispalys a work of
P.A. Peskova (1874) who considered that the subject of
medical geography is "investigation of patalogical
peculiarities which are caused by influence of physical
factors (different geographical widths, climates and
territories) and etnographical conditions. He viewed
medical geography as a part of medical statistics that
studies "laws of patalogical processes in the
organisms in regard to their usage in different countries
, teritories and nationalities". P.A. Peskov
emphasized that there is no doubt that all this sciences
(general statistics, medical statistics, medical
geography) would separate and form independent
branches". Professor I.P. Skvorchov (1875) confirmed
that medical geography investigates itself different
territories of the Earth. Medical geography like physical
geography has its own hills, valleys, places of smooth
influence either agency or even their total sum".
The work of G.M. Gerchenshtejna was issued in 1896 called
as "Medical geography and statistics" in which
stated that medical geography "...embrace not just
full metereology, physical, medical and political
geography of certain area but statistical laws of
population, comparative tribe's pathology, geographical
spredings and illness displacement". He pays
attention to two sides of medical-geographical
researches: 1. using geography of illness as the object
2. using territory as an investigational object and
existing within its borders illnesses as inherented
peculiarities. In the middle of 19 century medical
geography was being viewed as a branch of general
geography. The essence of the third peculiarity is that
medical-geographical knowledge as the first
medical-geographical works belonged medicians. Even
though in 20th century when geographers proved their
right on medical geography, medicians displayed not last
role in this science development. The unique fact is that
well-known ukrainian parasitologist Pavlovskyj E.M. was
president of Geographical Society in USSR during
1952-1954 and who created study about people's natural
diseases and parasitopenozy. Today is the time when we
need to give reassessment of scientific inheritance of
ukrainian medical scientists M.I.Pyrogova, I.I.
Mechnikova, I.M. Sechenova, D.K. Zabolotnogo, M.F.
Gamalij, V.V. Pidvysochkogo, V.J. Danylevskogo, O.J.
Danylevskogo, O.O. Bogomolchja and others. The fourth
peculiarity of medical geography development in Ukraine
fall into the catagery that works of ukrainian scientists
were represented to the world population as
medical-geographical researches and discoveries as of
russian scientists. To be a scientist not just of one
country but several is a very prestigious in the world.
This tendency could become a unique unless it was used
with the one theme as to decrease the role and
significance of ukrainian scientists and ukrainian
science and to think of russian science up to the myth
extent. As an exapmle, the name of famous ukrainian
microbiologists Danula Zaboltnogo (1866-1929). He was
known as founder of epidemoideology in USSR. His work
dedicated to the study of plague, cholera, syfilis, gas
gangrene, typhus etc. Zabolotnyj created study about
natural bonfire of plague. He investigated that plague
causes rodents. He was in charge of many antiepidemic
expeditions. He was studying plague in India, Mongolia,
etc. D.K. Zabolotnyj was one of the founders of
international society microbiologists. For some time D.K.
Zabolotnuj was living in Russia. He organized in
Peterburg medical institute - the first bacteriology
chair in Russia in 1989. However, most of his life
activities were held in Ukraine. Zabolotnyj was studying
and working in Ukraine till 1898. He organized the first
in the world epidemiology chair in Odessa in 1920 and he
organized an institute of microbiology and epidemiology
in1929 in Kyiv. The village Chobotarka of Vinnychka
region in which he was born was renamed into his name. In
the role of fifth peculiarity we should view
stigmatization of some scientists whose works were
introduced to the people as harmful and inappropriate.
This did not bring a chance to make an assessment of
there scientific medical-geographical inheritance. It is
enough just to mention the name of famous ukrainian
geographer V. Kubivovucha who in his "Atlas of
Ukraine and bordering areas" (Lviv, 1937) displayed
maps of general population death, children death etc.
This is an excellent example of medical geographical
population assessment and medical-geographical maping.
Study and reassessmnet of scientific inharitance of such
scientists in our days can give a new push to the
development of medical geography as a separate branch of
knowleadge. The essence of the sixth peculiarity is that
despite hard historical conditions ukrainian scientists
were able to deposit one of the biggest payment in the
development of the world's medical geography. Ukrainian
scientists played the leading role in discussions about
subject, object and task of medical geography. This
discussion started in 1929 during the meeting on studying
of race pathology and geography of illnesses in Moscow.
During this time under geography was meant only studying
of spreading geogrpical illnesses. This point of view
from the past level of knowledge was settled by ukrainian
scientist D.K. Zabolotnyj: "Medical geography is a
branch of medicine that studies spreading of different
diseases on the Earth. The task of medical geography
includes determining the territory of most stinged by
this form of illness as well as studying of external
factors that have impact on map changing of diseases
expansion". Sysin A.N. (1879-1956) was considered
one of the organizers and leaders of sanitary -
epidemiological work in USSR. In the task of medical
geography he saw not just determining ties of different
illnesses (not just epidemical) with the conditions of
territory but these diseases ties with local external
environment (alive and dead) (1929). This discussion was
continued by medical geographers of different countries
of the world with further participation of ukrainian
scientists. Ripman considered that under medical
geography should be meant such direction of geography
which attemps to investigate and explain population and
enimal impact of factors that are not included into
geographical spatial of the Earth, its impact on the
life". Oberchulemer (1935) stresses attention on the
following meaning and contest of medical geography that
arise from the fact of spreading certain diseases in
fixed regions of the world. They found its expression in
old medical literature as well as in first attemps of
their maping". American scientist Lajt (1994) wrote
that two discipline medicine and geography united their
means and possibilities for environment studying and
apearence in people's different types of diseases.
Shevelev considered medical geography in 1947 as method
of population sanitary condition. The article
"Medical geography, its methods and objectives"
of the head of medical geography department of American
geographical society appeared in 1950. Their he wrote
that medical geography is engaged in studying of
corelation between pathological factors which called as
"pathogens" and geographical factors which we
suggest to call as "geogenamy". This science
about ties that exist between geographical factors and
disease appearence or simply ecology of health and
diseases". A commission on medical geography of
Geographical society (city of Leningrad) was organised in
1954 which during short period of time has made huge work
on discussing theoretical basis of medical geography,
program elaboration and methods of medical-geographical
researches, bringing up methodological assistance in
helding medical-geogrsphical territory studying of
countries and regions. Analogical commissions of medical
geography were formed in Nowosybirsk, Omsk, East-Sybirsk
(city of Irkutsk), Pryamursk (city of Chavarivsk),
Sachalinsk department of Geographical Society of the
former Soviet Union. In 1960 the second scientific
meeting in Irkutsk, in Vladivostok in 1962 symposium on
"Medical geographical researches in deciding complex
geographical problems". But scientist did not come
to the common point of of the subject and task of medical
geography. Discussion were folowed. E.N. Pavlovskuj in
1955-1956 wrote that important branch of medical science
is medical geography which studies the spreadings and
causes of population illnesses on the Earth." The
same definition was given by N.P. Sokolov (1958). The
japanist scientist M.Asako in his presentation on the
topic "Methods and subject of medical
geography" pointed out subject of medical geography
as study of patalogical peculiarities in corelation with
geographical aspects of people's life". Sasne ide la
Kalsada in his work "The basis of medical
geography" in 1958 gives a historical review of
medical geography development. The first scientific
meeting on problems of medical geography was held in
Leningrad in November 19-24. The aim of this conference
was to familiarize the participants with the main
scientific directions of medical geography as well as
discussing urgent problems of this science and ways of
the rapid implication into practice results of
medical-geographical researches as well as determining
perspectives of further developing of scientific works.
Ukrainian scientists during all conferences which were
held in different cities of the former Soviey Union
presented valuable theoretical information on medical
geography. That's why they possessed the leading
positions in developing of this branch and knowledge. The
seventh peculiarity of medical-geographical development
in Ukraine is that that we have a right to confirm
existance of the firm national medical geographical
school in Ukraine. It is being presented first of all by
geographers (medical-geographers), doctors, specialists
of different branches. Medical geographical researches
were held by Medical institutes in Ukraine (Lviv, Kyiv,
Ternopil, Ivano-Franfivsk, etc) as well as Kyiv
scientific research institute of common and municipal
hygiene, Charkiv scientific-research institute in
protecting children's health. The conference
"Regional peculiarities of population's health in
USSR and experience of realization of complex programs
"Health" in time of increasing Scientific
Technical Progress (STP)" During this conference
were discussed regional population peculiarities in
Ukraine, demographical situation in the country and data
was presented of the most common diseases such as system
of blood circular flow, digestion organs,etc. The great
attention was also paid to the problems of realisation
regional and city complex programs "Health"
which were developed in 1980th for all big regions and
huge cities. International seminar of the World
organisation of health protection was held in Lviv in
1988. There scientific workers of the health protection
menagement chair of Lviv medical institute attemped to
draw first standings of creation of modern population
health protection system. After Ukraine gained its
independence on August 24, 1991 these activities became
very active. A few concepts were elaborated by the
deputie's commission of health protection of the Lviv
regional and city administration, Lviv medical institute
and ukrainian doctor's society in Lviv. In the result of
common unification of all these materials was elaborated
single project of ukrainian population health
protectiion. This concept was excepted by the population
health Commission of Ukrainian Supreme Court. It was
brought to the discussion in scientific-practical
conference in Lviv on April 10, 1992. In the resolution
of this conference was said that the concept is a
theoretical basis for creation of national policy in the
branch of helth protection, elaboration and passing
legislative acts and realization of practical activities
in the area of medicine and health protection in Ukraine.
The conference participants agreed to pass Concept
Project of Health protection of ukrainian people. But
this did not mean that all theoretical problems were
solved and all questions were answered. To the above
listed historical peculiarities of medical geographical
developmnet in Ukraine can be added couple of others. The
most important among them is activisation of
medical-geographical researches in Ukraine after tragedy
at Chornobyl nuclear power station, medical geographical
differentiation on separate sciences (medical maping
represented scientists such as J.I. Gupanskuj, V.A.
Shevchenko etc.), new views on subject and goals of
medical geography from today reality (it is necessary to
pay attention on the determining subject and goals of
medical geography stated by the professor of the Lviv
State University O. Shablij published in the materials of
"Health and Environmnet" conference which was
held in Ljublin (Poland) in 1993), colaboration of
ukrainian scientists with medical-geographers of other
countries of the world (The most prominent was Lviv
Geography School) etc. Medical geography as a separate
branch of science has the set of theoretical and
practical problems on the present state of its
development. Quantity and nature of this problems is the
development measure of this scientific branch today. The
theoretical level of medical geography development can be
judged by the level of its language development, so
called understanding terminological aparatus, existance
of medical geographers as scientists, quality of books,
textbooks, journals. It is necessary to emphasize that
understanding terminological aparatus is being at the
level of its forming. One of the reason of it is that
this science is very young (the term "medical
geogrphy" first was used in 17 century), as well as
peculiarities formation of its scientific language, such
as necessity for using terms as geographical and medical
sciences, by expediency of old ukrainian terms renewal,
creation of new terms according to the gramatical and
phonetical rules of ukrainian language. Nowadays new
medical geographical textbooks is just necessary to have
and to be pubished in ukrainian language. It is just
necessary to have chairs of medical geography within
geography faculties for preparation of highlyqualified
medical-geographers. One of the most important
theoretical problems facing medical geography is the
elaboration of medical-geographical region division in
Ukraine. Solution of this problem has also and practical
usage. Expedient economical and social country regional
development strategy is possible only in condition
considering medical - geographical regional division. Not
less important theoretical problem that is being faced is
the spreading of methods of medical geographical
environmental assessment, peculiarities of people
adjustment to the environment. Despite the fact that
medical geography was formed as an independent branch of
knowleadge, it is very important to specify the subject
of medical geography, to specify its functions, etc. The
necessity for it imideate solution was emphisized by
professor Oleg Shablij in the article "Problems and
task of medical geography development in Ukraine"
which was published in the materials of international
conference "Health and Environment" held in
Lublin (Poland) on September 14-15 1993. In this work
prof. Shablij expressed his own view on the subject of
medical geography: "The subject of medical geography
is a spatial structure those aspects of society which
have direct influence on the health and of its
representatives and health itself". Otherwords it is
the spatial structure of health branch. Furthermore he
specified the object of medical geography investigation:
"It investigates, first of all, the forms of
geographical organization of the health sphere. Such
forms are as territorial medical systems, beginning from
the innitial up to common state, international and even
global". Besides, O.I.Shablij (1993) stresses an
importance on the solution necessity in the nearest time
the following theoretical problems of medical geography.:
1. humanisation of the medical geographical science; 2.
theoretical social factors of spatial health branch
organisation forms; 3. geographical aspects of
geographical and social health, etc. There are also some
practical problems of medical geography. Among them are:
1. medical-geographical assessment separate components of
natural, man made and social environmenrt - assessment
methods, expected assessment results. etc; 2.
methodical-geographical assessment of separate
territorial complexes; 3. geography study of some
diseases and environmnet factors which causes them; 4.
regional medical-geographical researchers - study of
concrete state territories; 5. medical-geographical study
of foreign countries with the aim of influence
determining on the medical-geographical situation in
Ukraine, etc. The most important medical-geographical
practical problem today is the territory assessment,
polluted in the result of Chornobyl explosion. This
problem is being investigated by professors in the
Insitute of Geography of Ukrainian National Academy of
Science: T.V. Balabanov, I.O. Gorlenko, V.S. Davudchuk,
R.P. Cyprash, S.M. Maljuk, V.P. Palienko, L.G.Rudenko, M.
I.Fashevskyj, L.M. Shevchenko, T.E. Jasnjuk. At this
point it is very valuable research made by Ljubov
Kovalevska and results published in her book
"Chornobul DSP" (K., 1995). Not less important
practical medical-geographical problem which was raised
in 1993 by scientists in Lviv State University by
O.I.Shablij and L.T. Shevchuk is investigation of
regional peculiarities of labour resources exhaust in the
conditions of present crisis which paralised all spheres
of social life in Ukraine. S.B. Visna and I.P. Kovalchuk
(Lviv State University ) made an attempt to open tasks
and directions of medical-geographical researches. They
presented their ideas at the confernce "Problems of
ukrainian geography" which was held in October
25-27, 1994 in Lviv. To their mind on the present level
of medical-geographical researches it is the most
important to solve the following problems: 1. Study and
assessment of radiological, noise, electromagnetic and
thermal environment contamination on population health;
2. concentration analysis of toxic elements in
consumption products and consequence assessment of their
consumption; 3. corelation assessment in the system
"Vegetative and Animal life- people health"
etc. Listed above theoretical and practical problems -
are only small part of the problems which just necessary
to solve by medical geography in the future perspective.
Solution of these problems would not just enrich medical
geography as a separate scientific branch but would
become an essential part in choosing people behaviour in
the enviroment with the aim of maximum health preserving.
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Gamalija M.F. |
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