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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.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Gamalija M.F.



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