From the history of medicine. The life of wonderful doctors. Sergei Petrovich Botkin. Botkin Sergey Petrovich - biography. Russian Doctor-Therapist Public Figure Botkin’s contribution to science

September 17, 2012 marks the 180th anniversary of the birth of Sergei Petrovich Botkin.

Russian physician-therapist, scientist, founder of the physiological direction in clinical medicine, public figure Sergei Petrovich Botkin was born in Moscow into a merchant family on September 17 (September 5, old style) 1832.

He was the 11th child in the family, born from his father’s second marriage and raised under the supervision and influence of his brother Vasily. Already at an early age he was distinguished by outstanding abilities and curiosity. The Botkins' house was often visited by leading people of that time, among whom were Alexander Herzen, Nikolai Stankevich, Vissarion Belinsky, Timofey Granovsky, Pavel Pikulin. Their ideas had a great influence on the formation of Botkin's worldview.

Until the age of 15, Botkin was raised at home; in 1847 he entered the private boarding school of Ennes, where he studied for three years. At the boarding school he was considered one of the best students.

In August 1850, Botkin became a student at the Faculty of Medicine at Moscow University, graduating in 1855. Botkin was the only one in his class who passed the exam not for the title of doctor, but for the degree of doctor.

After graduating from the university, he, together with the sanitary detachment of surgeon Nikolai Pirogov, took part in the Crimean campaign, acting as a resident of the Simferopol military hospital. Working in a military hospital gave the doctor the necessary practical skills.

In December 1855, Botkin returned to Moscow and then went abroad to complete his education.

In 1856-1860, Sergei Botkin was on a business trip abroad. He visited Germany, Austria, Switzerland, England and France. During a business trip in Vienna, Botkin married the daughter of a Moscow official, Anastasia Krylova.

In 1860, Botkin moved to St. Petersburg, where he defended his doctoral dissertation “On the absorption of fat in the intestines” at the Medical-Surgical Academy.

In 1861 he was elected professor of the department of the academic therapeutic clinic.

In 1860-1861, Botkin was the first in Russia to create an experimental laboratory at his clinic, where he performed physical and chemical analyzes and studied the physiological and pharmacological effects of medicinal substances. He also studied questions of physiology and pathology of the body, artificially reproduced various pathological processes in animals (aortic aneurysm, nephritis, trophic skin disorders) in order to reveal their patterns. Research carried out in Botkin's laboratory laid the foundation for experimental pharmacology, therapy and pathology in Russian medicine.

In 1861, Sergei Botkin opened the first free outpatient clinic in the history of clinical treatment of patients at his clinic.

In 1862, he was subjected to a search and interrogation in connection with his visit to Alexander Herzen in London.

Since 1870, Botkin worked as an honorary physician. In 1871, he was entrusted with the treatment of Empress Maria Alexandrovna. In subsequent years, he accompanied the empress several times abroad and to the south of Russia, for which he had to stop lecturing at the academy.

In 1872, Botkin received the title of academician.

In the same year, in St. Petersburg, with his participation, women's medical courses were opened - the world's first higher medical school for women.

In 1875, his wife Anastasia Alexandrovna died. Botkin married a second time to Ekaterina Mordvinova, née Princess Obolenskaya.

In 1877, during the Russian-Turkish War, Botkin spent about seven months on the Balkan front, where he accompanied Emperor Alexander II. As a physician of Alexander II, he achieved preventive quinization of troops, fought to improve the nutrition of soldiers, made rounds of hospitals, and gave consultations.

In 1878, he was elected chairman of the Society of Russian Doctors in memory of Nikolai Ivanovich Pirogov and remained in this post until the end of his life. He achieved the construction of a free hospital by the society, which was opened in 1880 (Alexandrovskaya Barracks Hospital, now the S.P. Botkin Hospital). Botkin’s initiative was taken up, and free hospitals began to be built in other large cities of Russia with funds from medical societies.

Since 1881, Botkin, being a member of the St. Petersburg City Duma and deputy chairman of the Duma Commission of Public Health, laid the foundation for the organization of sanitary affairs in St. Petersburg, introduced the institute of sanitary doctors, laid the foundation for free home care, organized the institute of “Duma” doctors, created the institute of school sanitary doctors, Council of Chief Physicians of St. Petersburg Hospitals.

Botkin was the chairman of the government commission to develop measures to improve the sanitary condition of the country and reduce mortality in Russia (1886).

By the end of his career, he was an honorary member of 35 Russian medical scientific societies and nine foreign ones.

Botkin became the founder of scientific clinical medicine. He outlined his clinical and theoretical views on medical issues in three editions of the “Course of the Clinic of Internal Diseases” (1867, 1868, 1875) and in 35 lectures recorded and published by his students (“Clinical Lectures of Professor S.P. Botkin”, 3rd issue , 1885‑1891).

In his views, Botkin proceeded from an understanding of the organism as a whole, located in inextricable unity and connection with its environment. Botkin created a new direction in medicine, characterized by Ivan Pavlov as the direction of nervism. Botkin is responsible for a large number of outstanding discoveries in the field of medicine. He was the first to express the idea of ​​the specificity of protein structure in various organs; was the first (1883) to point out that catarrhal jaundice is an infectious disease (nowadays this disease is called “Botkin’s disease”), developed the diagnosis and clinic of a prolapsed and “wandering” kidney.

Botkin published the “Archive of the Clinic of Internal Diseases of Professor S. P. Botkin” (1869‑1889) and the “Weekly Clinical Newspaper” (1881‑1889), renamed in 1890 into the “Botkin Hospital Newspaper”. These publications published the scientific works of his students, among whom were Ivan Pavlov, Alexey Polotebnov, Vyacheslav Manassein and many other outstanding Russian doctors and scientists.

Among Botkin's students there are 85 doctors of science, including Alexander Nechaev, Mikhail Yanovsky, Nikolai Chistovich, Timofey Pavlov, Nikolai Simanovsky.

Botkin died of heart disease on December 24 (December 12 of the old style) 1889 in Menton (France) and was buried in St. Petersburg.

In two marriages he had 12 children. Two sons, Sergei and Evgeniy, inherited their father’s profession. After Botkin’s death, his son Evgeniy became a physician at court. Yevgeny Botkin was shot along with the royal family in 1918.

The material was prepared based on information from RIA Novosti and open sources

S. P. Botkin had a particularly significant influence on the development of domestic medical science among scientists of the 19th century. The study of his work is of interest for our time.

S.P. Botkin was born in Moscow on September 5 (old style) 1832. His father, Pyotr Kononovich Botkin, conducted large trade with China. The Botkins' house on Maroseyka, in Petroverigsky Lane, was known in the 40s to the cultural circles of Moscow society.

After studying at a private boarding school, S.P. Botkin entered the medical faculty of Moscow University. Among Botkin's teachers who influenced him, it should be noted the physiologist I. T. Glebov, pathologist A. I. Polunin, and therapist I. V. Varvinsky.

In 1855, S.P. Botkin, as a military doctor, went to the Crimea to the theater of military operations, where he worked under the leadership of N.I. Pirogov. After the end of the war, in 1856, he went abroad, where he visited clinics and laboratories of the universities of Berlin, Vienna and Paris. Botkin stayed abroad until 1860. During this period, he wrote several scientific works and a doctoral dissertation “On the absorption of fat in the intestines.”

At the end of the 50s, there was a noticeable revival in the scientific life of the St. Petersburg Medical-Surgical Academy. The President of the Academy N.A. Dubovitsky and his assistant Vice-President I.T. Glebov, striving to improve teaching, invited new professors and among them S.P. Botkin. Despite protests from the reactionary professors, the young scientist in November 1861 was confirmed with the rank of ordinary professor of the therapeutic clinic instead of the departed prof. P. D. Shipulinsky.

Sergei Petrovich worked at the academy until the end of his life. For many years he suffered from attacks of cholelithiasis and angina pectoris. In 1889, feeling his health deteriorating, Botkin went to France for medicinal purposes and died in Menton on December 12 of the same year.

S. P. Botkin’s worldview was formed under the influence of the best people of that time - T. N. Granovsky, V. G. Belinsky and others. The works of N. G. Chernyshevsky, as well as personal friendship with I. M. Sechenov and meetings with A. I. Herzen.

According to S.P. Botkin, any pathological process occurs under the influence of external conditions. Disease is not something separate from the body. It is impossible to talk about the clinical picture of the disease in general, without connection with this patient. Diseases always develop differently, depending on the characteristics of the individual. This implies the need for a comprehensive examination of the sick person. Objective research alone is not enough; it is necessary to study the patient’s environment and become familiar with his past in detail. It is known that S.P. Botkin, when analyzing patients at lectures, paid a lot of attention to questioning.

Mastering the method of tapping and listening like a virtuoso, using the necessary laboratory research, S. P. Botkin was also distinguished by his remarkable powers of observation. This gave him the opportunity to describe many new, previously unknown signs of diseases. S.P. Botkin pointed out a number of symptoms observed with organic heart defects. He described with great depth the clinical picture of narrowing of the left venous orifice. Botkin drew attention to the extreme diversity of symptoms depending on the period of the disease.

Describing the symptoms he first discovered and pointing out their significance, the great clinician, however, warned that the heart, as well as other organs, cannot be looked at “through anatomical glasses,” since ultimately all organs are influenced by the influences of the nervous system. devices. Investigating, where possible, the anatomical basis of the disease, S. P. Botkin always sought to emphasize the functional connections of organs and systems. Studying the disease, S.P. Botkin delved into the development of the process. Establishing dynamic diagnostics, made possible by deep penetration into the pathophysiology of the body through the analytical-synthetic method of thinking, opened up the opportunity, on the one hand, to foresee the further course of the disease, to draw the correct conclusion regarding prognosis and therapy, and on the other, to make excursions into the history of pathology of this patient.

S.P. Botkin’s great merit was his focus on understanding the history of the development of a disease process in a given organism. Describing this or that disease, Botkin refused any ready-made schemes. He understood that it is impossible to study the body in parts. Any one-sided experimentation is harmful if you forget about the whole. S.P. Botkin argued that clinical medicine is an independent science, which has as its object the most complex thing in the world - the living human body. You cannot experiment on patients, and experiments on animals cannot always be used by doctors.

On this occasion, S.P. Botkin said: “You must look for... specific means, and you have the right to also follow the path of theoretical considerations, but the place for applying the latter should be a laboratory, not a clinic. You cannot afford to experiment, without great caution, on a living person. You must remember that our medicine is still far from being based on exact science, and always keep in mind that saving fear, so as not to harm the patient, not to worsen his condition in any way.”

Having expanded the boundaries of symptomatology by identifying new signs of diseases, understood in terms of the body as a whole, S. P. Botkin introduced a lot of new things into private therapy.

The achievements of S.P. Botkin in the field of studying diseases of the cardiovascular system are especially significant. Studying the clinical picture of arteriosclerosis, S.P. Botkin proved that this disease usually leads to damage to the heart muscle with a subsequent compensation disorder. In the area of ​​peripheral circulation SP. Botkin opened a new page in medical science. He pointed out that arteries and veins are not simple mechanical devices for distributing blood, but are independent, periodically contracting and expanding blood organs. S. P. Botkin’s student S. V. Levashov argued that, in addition to normal physiological contractions of blood vessels, altered, pathological ones can sometimes occur in them (for example, with epilepsy).

Understanding issues of internal pathology, S.P. Botkin always focused especially on the state of the cardiovascular system. Describing the clinic of Graves' disease, he drew attention to shortness of breath of cardiac origin, to the unevenness of atrial contractions, to the contrast between the large filling and sharp pulsation of the arteries belonging to the common carotid artery system, and the small, barely palpable pulse of the radial arteries. By the way, one cannot help but recall that S.P. Botkin considered the most characteristic symptom in the picture of this disease to be the mental state of patients - their fearfulness, anxiety, and indecisiveness. “The influence of mental factors not only on the course, but also on the development of this form is not subject to the slightest doubt,” he asserted. Studying the clinical work of S.P. Botkin, we see that in his desire to understand the origins of diseases as deeply as possible, he invariably came to the importance of the role of the nervous system. “It is very possible,” he wrote, that under the influence of a mental shock, not only functional, but also some anatomical changes in the brain centers suddenly developed, which had a paralyzing effect on the function of the vagus nerve or, conversely, excited the accelerating apparatus, which is more probably".

S.P. Botkin has also done a lot to study rheumatic diseases. Regarding rheumatic endocarditis, he pointed out to doctors that the diagnosis of this disease should not be approached as frivolously as the French clinician Buyot, who found endocarditis in 60% of cases of articular rheumatism. Often the development of systolic murmur is associated with damage to the papillary muscles and their weakening, and not at all with the presence of endocarditis.

In his doctrine of nephritis, S.P. Botkin did not agree with the view that arose in connection with pathological studies, according to which interstitial and parenchymal forms allegedly constituted different pathological units and had their own special clinical course. S.S. Zimnitsky wrote in the 30s of the 20th century on this subject that on the issue of nephritis, it is time for clinicians to return to the views of S.P. Botkin, expressed more than 50 years ago, and talk generally about Bright’s disease.

The diagnosis of a wandering kidney was known before the work of S.P. Botkin, but only he brought clarity to the clinic of this disease. Botkin showed the way to correct diagnosis and combined into one a number of phenomena that were erroneously associated with the heart, liver and other organs. They proposed a special examination method, in which the abdomen was examined not only in the supine position, but also in the standing position of the patient. “A moving kidney,” wrote S.P. Botkin, “disturbs patients mostly due to irritation of the nervous apparatus,” which is why various disorders arise.

S.P. Botkin left a noticeable mark in the study of infectious diseases. Seeing doctors' passion for microbiology, he said that we must not forget about the body's defenses. “We in the clinic are convinced at every step of the actual existence of those unknown to us physiological conditions in the body that give it the opportunity to fight the disease.” It is hardly necessary to dwell on the well-known fact that gastrointestinal catarrh with mechanical bile retention was correctly understood by an outstanding Russian clinician as one of the symptoms of the parenchymal hepatitis he described, now called Botkin’s disease.

The diagnostic talent of S.P. Botkin was based on an in-depth analysis of all the found signs of the disease and their subsequent synthesis. In this regard, an indicative case is when, at the beginning of his medical and teaching career, he made a diagnosis of portal vein thrombosis, which was subsequently confirmed by an autopsy. Throughout his scientific career, the great clinician improved diagnostic and therapeutic techniques. The laboratory at his clinic tested various drugs; some of them were taken from traditional medicine. Along with drug treatment, Botkin paid attention to improving the living conditions of patients, the need for physical and mental rest, and climatic treatment.

The works of S.P. Botkin also influenced the development of military field therapy. In this regard, he was based on the experience of two wars - the Crimean campaign and the Russian-Turkish war of 1877. While for some time at the headquarters of the commander-in-chief in the Balkans, Botkin inspected hospitals, observed the work of doctors, and the general sanitary condition of the army. As a patriotic doctor, the mediocrity of the highest administration and the predatory work of various trading “private partnerships”, to which the Russian army was at the mercy, made a grave impression on him. He saw how the soldiers were starving, being in a country with rich supplies of grain. Regarding everything he saw, S.P. Botkin wrote: “We will hope for the Russian man, for his power, for his star in the future. Maybe he, with his invincible strength, will be able to get out of trouble, despite the strategists, quartermasters and the like.”

As chairman of the Society of Russian Doctors in St. Petersburg and as editor of a medical journal in which exclusively original articles were published, S. P. Botkin contributed to the development of domestic medical science. But S.P. Botkin’s importance as a teacher is especially great. He trained hundreds of doctors and prepared dozens of medical scientists for professorships.

His students were professors of therapy V. G. Lashkevich (Kharkov), M. V. Yanovsky (St. Petersburg), N. A. Vinogradov (Kazan), V. P. Obraztsov (Kiev), N. Ya. Chistovich (St. Petersburg), V. N. Sirotinin (St. Petersburg), A. A. Nechaev (St. Petersburg) and many others. Under the influence of the ideas of nervism, the clinic of S.P. Botkin began to develop such medical disciplines as dermatology, otolaryngology, nervous and mental diseases, as well as domestic physiology. The works of I.P. Pavlov and his students were a direct creative development of those ideas of nervism with which they became acquainted in the clinic and laboratory of the great Russian doctor.

S.P. Botkin’s lectures and his outpatient appointments were remembered for life. Dr. P. Gratsianov wrote: “I was then in my fourth year at the Medical-Surgical Academy, where one of the most popular and most beloved professors was Sergei Petrovich Botkin. There were about 40 of us on the course, but we were not the only ones who listened to the brilliant professor; His lectures were also attended by fifth-year students, to whom the same subject was taught by Prof. Eichwald. Physicians were also regular visitors to Botkin’s lectures, and especially many of them were assigned to the academy that year (after the Turkish campaign). We also met strangers at the lectures who were not involved in medicine. These lectures had the same number of listeners during meetings, when other auditoriums were empty. “I was at Botkin’s” served as a sufficient excuse for not attending the meeting. Thanks to the interest of Sergei Petrovich’s lectures, his auditorium, designed for almost 500 people, was always crowded from top to bottom.”

S.P. Botkin was not an orator, his speech did not shine with beautiful phrases with which usually clever people compensate for the lack of thought and content. His lectures were filled with in-depth analysis of clinical cases, broad scientific and philosophical generalizations, and bold, well-founded hypotheses.

Despite the exceptional talent of S.P. Botkin, his life path was not easy. A democrat and a humanist, he often encountered obstacles put in his way by foreign professors who tried in every possible way to hamper the development of advanced domestic science. Attempts were made to discredit the work of S.P. Botkin, to deny the significance of his achievements, and thereby the achievements of the entire Russian clinical school in later times. The basis of this “criticism” both during Botkin’s life and after his death was a biased, arrogant attitude towards domestic science, mixed with ignorance and admiration for foreign science.

Regarding such attacks that took place at different times, one can recall the words of the Czech scientist Skoda: “Following someone else’s and doubt, extended to everything that is one’s own, quite often served as a mask of intelligence for weak thinkers.” S.P. Botkin devoted all his energy to serving the people, and he taught his listeners the same.

S.P. Botkin avoided talking about himself. Only, perhaps, once in letters to his wife from Bulgaria in 1877 did he write: “... Without fear of reproaches for self-praise, I still have the gratifying consciousness that I made my contribution to the good moral level on which they stood our doctors during this campaign. I will allow this thought to be expressed only to you, knowing that you will not see in this a trace of self-delusion, which has never been and will never be characteristic of me. Looking at the labors of our youth, at their self-sacrifice, at their honest attitude to work, I have more than once said to myself that it was not in vain that I lost my moral strength in the various trials that my fate threw at me.”

S.P. Botkin was one of the most outstanding representatives of the Russian medical school, which originated in the second half of the 18th century and found strong philosophical and scientific foundations in the activities of the classics of Russian science in the first half of the 19th century. Under the conditions of his time, S.P. Botkin continued and developed the achievements of his predecessors. In his work they found scientific substantiation and further development of the idea of ​​early materialistic nervism. In an era when the anatomical direction reached its extreme development in Virchow’s cellular pathology, domestic clinical thought opposed this direction with the most fruitful ideas of nervism, substantiated by the research of Russian physiologists.

The main idea of ​​S.P. Botkin as a clinician, which he bequeathed to future doctors, was the idea of ​​the need for a deep, comprehensive study of nature. “It cannot be allowed,” he said in a speech on December 7, 1886, “that preliminary theoretical knowledge lies only in special branches of medicine proper, for example, normal and pathological anatomy, physiology, etc. For a future doctor of a scientific direction, it is necessary to study nature in in the full sense of the word.

Knowledge of physics, chemistry, natural sciences, with the broadest possible general education of a person, constitutes the best preparatory school for the study of scientific practical medicine.”

Sergei Petrovich Botkin

Therapist.

Botkin's father was engaged in tea wholesale trade in China. His three sons left a noticeable mark in art and science: the eldest Vasily was a famous writer, Mikhail an artist. The younger Sergei dreamed of studying mathematics, but when he entered Moscow University in 1850, he chose the Faculty of Medicine.

The choice turned out to be correct.

However, Botkin subsequently assessed his years of study strictly.

“While studying at Moscow University, I witnessed the direction of an entire medical school at that time,” he wrote in 1881 in the Weekly Clinical Newspaper. – Most of our professors studied in Germany and more or less talentedly passed on to us the knowledge they acquired; we listened to them diligently and at the end of the course considered ourselves ready-made doctors, with ready answers to every question that presented itself in practical life. There is no doubt that with such direction of completion of the course it was difficult to wait for future researchers. Our future was destroyed by our school, which, teaching us knowledge in the form of catechismal truths, did not arouse in us that inquisitiveness that determines further development.”

In 1885, straight from his student days, Botkin went to the theater of military operations - to the Crimea. He worked for three and a half months in a Simferopol military hospital under the direct supervision of the famous surgeon Pirogov.

In 1856, after the end of the Crimean campaign, Botkin went on a business trip abroad. In Germany, he studied the clinic of internal diseases at the Institute of Pathology with R. Virchow, the creator of the theory of cellular pathology. There he studied physiological and pathological chemistry. He continued the studies he began with Virchow in Paris in the laboratory of Claude Bernard.

Botkin did not like the Parisian clinicians.

“Trousseau (the famous French doctor) runs the clinic routinely; Having been satisfied with the hospital diagnosis of the patient, he prescribes completely empirical treatment. Trousseau is considered one of the best therapists here: his audience is always full. In my opinion, one of the main reasons for his success is his oratorical ability, which greatly captivates the French ... "

In 1860, Botkin brilliantly defended his doctoral dissertation at the St. Petersburg Medical-Surgical Academy - “On the absorption of fat in the intestines.” In the same year, he received an adjunct position with Professor Shipulinsky at the Medical-Surgical Academy. And a year later, after Shipulinsky retired, he began to head the department of the Academic Therapeutic Clinic. The main task in life for Botkin was to equip doctors with methods of precise natural science. He was the first in Russia to create an experimental laboratory at the clinic, in which physical and chemical analyzes were carried out, and the effect of drugs was carefully studied. There, in the laboratories, issues of physiology and pathology of the body were studied, for example, a variety of pathological processes were artificially reproduced on experimental animals - aortic aneurysm, nephritis, some trophic skin disorders. At the same time, Botkin was quite careful and warned doctors against the temptation to transfer all the results of such experiments to humans.

“In order to save the patient from accidents, and himself from personal remorse,” Botkin said in the introductory lecture of the autumn semester of 1862, given at the Medical-Surgical Academy, “and to bring true benefit to humanity, the inevitable path for this is scientific. In the clinic you must learn rational practical medicine, which studies a sick person and finds means to study or alleviate his suffering, and therefore occupies one of the most honorable places in the ranks of natural science. And if practical medicine should be placed among the natural sciences, then it is clear that the techniques used in practice for research, observation and treatment of the patient should be the techniques of a natural scientist, basing his conclusion on the largest possible number of strictly and scientifically observed facts. Therefore, you will understand that scientific practical medicine, basing its actions on such conclusions, cannot allow arbitrariness, which sometimes appears here and there under the beautiful mantle of art, medical instinct, tact, and so on. The presenting patient is the subject of your scientific research, enriched with all modern methods; Having collected the sum of the anatomical, physiological and pathological facts of a given subject, grouping these facts on the basis of your theoretical knowledge, you make a conclusion that is no longer a diagnosis of the disease, but a diagnosis of the patient, because by collecting the facts that appear in the subject under study, in the way of a natural scientist, you will not get only the pathological phenomena of one or another organ, on the basis of which you will give the name of the disease, but at the same time you will see the state of all other organs that are in more or less close connection with the disease and are modified in each subject. It is this individualization of each case, based on tangible scientific data, that constitutes the task of clinical medicine and at the same time the very solid basis of treatment, directed not against the disease, but against the suffering of the patient...”

The laboratory organized by Botkin became the prototype of the future largest research institution in Russia - the Institute of Experimental Medicine. Botkin's works freed Russian medicine from crude empiricism. Botkin outlined his views on medicine as a science in detail in three special issues of the “Course of the Clinic of Internal Diseases” (1867, 1968, 1875) and in thirty-five lectures recorded and published by his students (“Clinical lectures of Professor S. P. Botkin”, 1885–1891). In his scientific views, Botkin proceeded, first of all, from the understanding that the organism, as a whole, is always in constant, inextricable connection with the environment. This connection is expressed in the form of metabolism between the organism and the environment, as well as in the form of adaptation of the organism to the environment. Thanks to this, the organism lives, maintains a certain independence in relation to the environment and develops new properties, which, further strengthened, can be inherited. Botkin inextricably linked the origin of numerous diseases with causes caused by the influence of the external environment. This led Botkin to the idea that the task of medicine is not just to treat diseases, but, above all, to prevent them.

Botkin developed the doctrine of the internal mechanisms of the development of the pathological process in the body, the so-called doctrine of pathogenesis. Criticizing one-sided concepts in pathology, widespread in contemporary medicine, Botkin convincingly argued that one of these concepts, the so-called humoral theory, with its teaching about movement disorders and the ratio of various life-giving “juices” in the body, does not at all resolve the problem of pathogenesis, and the other, the so-called cellular, explains only some particular cases of pathogenesis, for example, the spread of a disease by its direct transfer from one cell to another, or its spread by transfer by blood or lymph. Botkin contrasted Virchow’s teaching about the body as a “federation” of individual cellular states, in no way connected with the activity of the nervous system and environment, with his own – neurogenic – teaching, closely related to Sechenov’s teaching on reflexes. Pathological processes in the body develop along reflex nerve pathways, Botkin argued, and, therefore, very special importance should be given to those brain centers that control nerve pathways. The neurogenic theory developed by Botkin obliged every doctor to consider the human body as a whole, in other words, to diagnose not only the disease, but also the patient himself.

Many of Botkin’s views on physiology and clinical pathology remain valid today. For example, Botkin was right in pointing out the functional relationship between organs, the importance of the so-called peripheral heart (active wave-like contraction of the walls of the arteries that push blood like the central heart), the role of infection in the manifestations of cholelithiasis, and finally, the infectious origin of jaundice. Long before the English physiologist Barcroft, Botkin revealed the role of the spleen as a depot organ in the circulatory system and made a bold assumption about the existence of centers of lymph circulation and hematopoiesis, which was later confirmed experimentally.

Botkin treated in a unique way.

This is how I. P. Pavlov’s wife, who was treated by Botkin for a severe nervous illness, recalled this:

“After examining me, Sergei Petrovich first of all asked if I could leave. When I said “no way,” he replied: “Well, let’s not talk about it.”

“Tell me, do you like milk?”

“I don’t like it at all and I don’t drink.”

“But we will still drink milk. You're a Southerner, and you're probably used to drinking at dinner."

"Never, not a bit."

“We will drink, though. Do you play cards?

“What are you, Sergei Petrovich, never in your life.”

“Well, let's play. Have you read Dumas and such a wonderful thing as Rocambole?

“What do you think about me, Sergei Petrovich? After all, I recently finished my courses, and we are not used to being interested in such trifles.”

"That's fine. This means that you will drink first half a glass of milk a day, then a glass. This will take you up to eight glasses a day, and then back down to half a glass. You will pour a teaspoon of good, strong cognac into each glass. Then, after lunch, you will lie down for an hour and a half. Every day you will play screw, robert three or four, and you will read Dumas. And walk every day in any weather for at least an hour. Yes, you will still be wiping yourself with room water at night and rubbing yourself with a thick peasant sheet. Now goodbye. I am sure that you will soon recover if you follow all my instructions.”

Indeed, following exactly all his advice, after three months I was a healthy woman.”

Almost at Botkin’s expense, the “Archive of the Clinic of Internal Diseases” was published for many years (1869–1889). The Weekly Clinical Newspaper (1881–1889) was published under the editorship of Botkin, which in 1890 was renamed the Botkin Hospital Newspaper. Such outstanding Russian scientists as I.P. Pavlov and V.A. Manassein considered themselves Botkin’s students.

In 1861, Botkin opened the first free outpatient clinic in Russia for the clinical treatment of patients at his clinic. In 1878, as chairman of the Society of Russian Doctors in St. Petersburg, he achieved the construction of a free hospital, opened in 1880. The hospital, named Alexandrovskaya at the opening, immediately became known in Moscow as Botkinskaya. This wonderful initiative was taken up by medical societies, and such free hospitals appeared in many large cities of Russia. With the equally active participation of Botkin, women's medical courses were opened in St. Petersburg in 1872.

During the Russian-Turkish War (1877–1878), Botkin was appointed physician to Emperor Alexander II. This gave him the opportunity to carry out almost complete treatment of troops with quinine, which eliminated the possibility of mass diseases; deploy field hospitals; to achieve truly efficient work of all medical departments.

After eight months spent in the war, Botkin wrote to his wife, who begged him to return to St. Petersburg:

“...Don’t blame me for being quixotic; I always tried to live in accordance with my conscience, without thinking about the pedagogical side of this way of life; but now, without fear of the reproach of self-praise, I still have the gratifying consciousness that I made my contribution to the good moral level on which our doctors stood during this campaign. I will allow this thought to be expressed only to you, knowing that you will not see in this a trace of self-delusion, which was not and will never be characteristic of me. Looking at the work of our youth, at their self-sacrifice, at their honest attitude to work, I more than once said to myself that it was not in vain, not fruitlessly, that I lost my moral strength in the various trials that fate threw at me. Medical practitioners who stand in the public eye influence it not so much with their sermons as with their lives. Zakharyin, who set the golden calf as his ideal of life, formed a whole phalanx of doctors whose first task was to fill their pockets as quickly as possible. If people knew that fulfilling my duty was not associated with any suffering or torment for me, then, of course, this fulfillment of duty would not have anything instructive for others. You won’t believe what inner contempt - no, not contempt, but pity - is inspired in me by people who do not know how to fulfill their duty. That’s how I looked at at least every parasite who left here. There were not so few of them: after all, not many had the strength to endure their present life without complaint and in good faith regarding their duty.”

Botkin was the first Russian doctor to take the place of life physician under the Russian emperor. Before this, it only went to foreigners. Newspapers, which had recently scolded Botkin on occasion, now began to endlessly praise the new academician and publish his portraits. With the family of Alexander II, he visited Sorrento, Rome, Albano, and Ems. He spent two winters with the empress on the Mediterranean coast, in San Remo.

Having become a member of the St. Petersburg City Duma and deputy chairman of the Duma Commission of Public Health in 1881, Botkin laid the foundation for the sanitary organization of St. Petersburg. He introduced a special institute of sanitary doctors and laid the foundation for free home care. Thanks to Botkin’s efforts, the Institute of “Duma” Doctors, the Institute of School Sanitary Doctors and the Council of Chief Doctors of St. Petersburg Hospitals were organized. About Botkin himself, one of his colleagues wrote: “Like all strong people, he was of a gentle and accommodating disposition, and, completely absorbed in business, did not pay attention to everyday trifles, avoided quarrels and did not like idle arguments. He, like a small child, did not know the value of money; earning a lot by his labor, he lived almost everything, spending large sums on the maintenance of his family, on the exemplary upbringing of his children, on his extensive library; he lived simply, without frills, but well, his house was always open to close acquaintances, of whom he had quite a few. It is known that his wallet was also open for all kinds of charity, and hardly any of those who asked for help left him with a refusal; at least that was Botkin’s reputation, because his left hand never knew what his right hand was doing; and he himself never even mentioned to those closest to him about his expenses of this kind ... "

In 1886, Botkin headed the government Commission to develop measures to improve the sanitary condition of the country and reduce mortality in Russia.

Unfortunately, his death, which occurred on December 24, 1889, when Botkin was on vacation in Switzerland, cut short the broad plans of the remarkable scientist.

Academician Pavlov, a student of Botkin, said, remembering his teacher:

“I had the honor for ten years to stand close to the work of the late clinician in her laboratory industry. His mind, not deluded by immediate success, was looking for the key to the great mystery: what is a sick person and how to help him - in the laboratory, in a living experiment. Before my eyes, dozens of his students were sent to his laboratory. And this high assessment of the experiment by the clinician constitutes, in my opinion, no less glory for Sergei Petrovich than his clinical activity, known throughout Russia.”

His eleventh son is the richest tea merchant Petr Kononovich Botkin considered him a failure. His older children showed great hope for continuing their father’s work and played a noticeable role in the social and cultural life of the capital, but this boy could not learn to read until he was 9 years old. His stern father predicted an unenviable future for him as a soldier. However, it later turned out that Seryozha simply cannot distinguish letters due to severe astigmatism - a disease in which a person sees lines unclearly. After correcting the boy’s vision, he was sent to one of the best Moscow boarding houses.

There the famous collector of fairy tales became his teachers A. N. Afanasyev and mathematician Yu. K. Davidov, who later headed the department at Moscow University. Under his influence, Sergei began to show excellent success in mathematics and was planning to enter the mathematics department of the university. However, a decree was issued Nicholas I, which prohibited “persons of non-noble rank,” which included the merchants Botkins, from studying at any university faculties other than medicine. This is how Russia found one of its most outstanding therapists.

Scientist and teacher

Sergei Botkin graduated from the university with honors, but the real school of life began for him during the Crimean War, where he worked side by side with N. I. Pirogov and earned the high praise of the great surgeon. Working in military field conditions left a difficult impression on him, primarily due to the dishonesty of military officials. The book “Images of Great Surgeons” describes the conditions in which Pirogov and his team had to fight for the rights of patients. “We took meat by weight in the kitchen, sealed the cauldrons so that it was impossible to take out the voluminous contents from it - nevertheless, our broth was not successful: we found the opportunity, even with such supervision, to deprive the sick of their rightful portion,” - bitterly recalled Sergei Petrovich.

Returning from Crimea, he interned in Berlin, Vienna, Paris, devoting all his time to scientific research. Botkin's interests at this time concentrated on physiological and microscopic research, he published two important works on blood and completed his doctoral dissertation on the absorption of fat in the intestines.

curious

Immediately after defending his dissertation in St. Petersburg, Sergei Petrovich was invited to the therapeutic clinic of the Medical-Surgical Academy, where he set up a clinical laboratory using the latest word in medical science, one of the first in Europe. Many doctors sought to work there and attend Botkin’s classes and clinical discussions. In 1861 he became the head of the clinic.

Sergei Petrovich at that time worked from 8 am to 1 am, taking breaks only for one hour of lunch, one hour of rest and half an hour for cello exercises, which he loved very much. He devoted the entire evening and part of the night to preparing for classes with students the next day. Soon a school of the best clinicians of that time formed around Botkin.

The peculiarity of Botkin’s method was its attentive and multifaceted approach to the patient. He advised starting with a detailed physical examination of the patient, only then asking him about subjective sensations and complaints - and then bringing everything together. Botkin laid the foundations of a natural-scientific approach to medical practice, arguing that “knowledge of physics, chemistry, natural sciences, with the broadest possible general education, constitutes the best preparatory school in the study of scientific practical medicine.”

Doctor and Christian

The fame of Dr. Botkin as a wonderful doctor and diagnostician resounded throughout Russia. Many patients sought to see him. Nekrasov dedicated one of the chapters of his poem “Who Lives Well in Rus'” to the doctor. Botkin treated Saltykova-Shchedrin, saving from death for twelve years.

In his activities, Sergei Petrovich clearly followed Christian principles: on his initiative, medical complexes were opened in the capital and then in other cities for the poorest population. They consisted of an outpatient clinic and a hospital, and treatment there was free. For Botkin there were no important or unimportant patients. With equal responsibility, he treated both members of the imperial family (in 1873 Sergei Petrovich became a physician) and unknown patients in the city’s “contagious barracks.”

In these barracks, under his care, disinfection chambers were installed, and the first “sanitary carriage” was created for the transportation of infectious patients. In 1886, Botkin was elected honorary trustee of all city hospitals and almshouses, and he made radical improvements everywhere.

Just one wrong diagnosis

All his life Botkin was engaged in scientific research with great persistence. His works on the pathology of biliary colic, on heart disease, on typhoid, typhus and relapsing fever, on the mobile kidney, on changes in the spleen in various diseases, on gastrointestinal catarrh laid the foundations for a new therapeutic treatment. In 1888, he substantiated his point of view on the disease, which was later named after him, - he proved the infectious nature of jaundice, and focused on liver damage.

In the last year of his life, he worked on the problem of old age, although he himself did not manage to live to see it - he died when he was only 57 years old. Working without rest undermined his strength. Sergei Petrovich began to develop heart disease, which worsened after the death of his beloved son. It was then that Botkin made the only incorrect diagnosis - to himself: he stubbornly believed that he was suffering from hepatic colic. The disciples insisted that he listen to his heart with a stethoscope, but he soon put the instrument away, saying: “Yes, the noise is quite sharp!” And he didn’t want to change his mind. In 1889, as the newspapers wrote, “death took from this world its most implacable enemy.”

Addresses in St. Petersburg

(5 (17) September 1832, Moscow - 12 (24) December 1889, Menton) - Russian general practitioner and public figure, created the doctrine of the body as a single whole, subject to the will. N. S. Professor of the Medical-Surgical Academy (since 1861). Participant in the Crimean (1855) and Russian-Turkish (1877) wars.

Biography

Sergei Petrovich Botkin comes from a merchant family involved in the tea trade. As a child, I wanted to become a mathematician, but by the time I entered the university, Emperor Nicholas issued a decree that allowed free access only to the medical faculty. He studied at the medical faculty of Moscow University, studied with famous professors - physiologist I. T. Glebov, pathologist A. I. Polunin, surgeon F. I. Inozemtsev, therapist I. V. Varvinsky. During his studies he was friends with I.M. Sechenov. In the summer of 1854 he participated in the elimination of the cholera epidemic in Moscow. In 1855 he graduated from the university and received the title of “doctor with honors.” In the same year, he participated in the Crimean campaign under the leadership of N.I. Pirogov as a resident of the Simferopol hospital. Already during this period, S. P. Botkin formed the concept of military medicine and proper nutrition of soldiers:

Received extensive training in various areas of medicine abroad. In the clinic of Professor Hirsch in Königsberg, in the pathological institute of R. Wichow in Würzburg and Berlin, in the laboratory of Hoppe-Seyler, in the clinic of the famous therapist L. Traube, neurologist Romberg, syphilidologist Berensprung in Berlin, in the physiologist K. Ludwig and clinician Oppolzer in Vienna, in England, as well as in the laboratory of experimental physiologist C. Bernard, in the clinics of Barthez, Bushu, Trusseau and others in Paris. Botkin's first works are published in the Virchow Archive.

At the end of 1859, Yakubovich, Botkin, Sechenov, Bockers and Jung were invited to the therapy clinic of the Medical-Surgical Academy (St. Petersburg). On August 10, 1860, Botkin moved to St. Petersburg, defended his dissertation for the degree of Doctor of Medicine on the topic: “On the absorption of fat in the intestines” and was appointed acting adjunct at the therapeutic clinic headed by Professor P. D. Shipulinsky. Soon, however, the relationship between Botkin and Shipulinsky deteriorated, and the latter was forced to resign. However, the academy conference did not want to transfer the leadership of the clinic to the talented Botkin; only a letter from students and doctors allowed him to take the vacant position in 1861, and at the age of 29 he received the title of professor.

S.P. Botkin was elected to the department of faculty therapy at the age of 28 and headed it for 30 years. Botkin’s daily routine looked like this: he arrived at the clinic at 10 a.m., from 11 a.m. chemical and microscopic studies carried out by students and young doctors began, as well as research work with senior students, from 1 p.m. he gave lectures to students, after the lecture he followed rounds and examination of outpatients, from 17 to 19 hours - evening rounds of the clinic, from 19 to 21 hours - lectures for associate professors, to which everyone was allowed. After this, Botkin returned home, where he had dinner and prepared for the next day, but after 12 o’clock at night he devoted attention to his favorite activity - playing the cello. In his letter to N.A. Belogolovy, Botkin notes:

The first stone of S.P. Botkin’s fame as a fine diagnostician was laid in 1862 after his lifetime diagnosis of portal vein thrombosis. After the diagnosis was made, the patient lived for several weeks. Ill-wishers hoped for a mistake. S.P. Botkin paid a lot of attention to cholelithiasis, which he himself suffered from for a long time. He pointed to the role of infection in the formation of stones. He emphasized the clinical diversity of this disease. The scientist believed that until the doctor discovered the erupted stone, his diagnosis remained a hypothesis. In his work “On reflex phenomena in the vessels of the skin and on reflex sweat,” S. P. Botkin gives a number of interesting clinical observations, one of which demonstrates that when a stone passes through the bile ducts, the upper and lower extremities become cold, the skin of the chest becomes hot and the temperature in armpit rises to 40°C.

Thanks to their outstanding teaching abilities, Botkin’s clinic produced professors who headed departments at medical faculties of Russian universities V. T. Pokrovsky, N. I. Sokolov, V. N. Sirotinin, V. A. Manassein, Yu. T. Chudnovsky, A. G. Polotebnov, N. P. Simanovsky, A. F. Prussak, P. I. Uspensky, D. I. Koshlakov, L. V. Popov, A. A. Nechaev, M. V. Yanovsky, M. M. Volkov , N. Ya. Chistovich, etc. A total of 87 graduates of his clinic became doctors of medicine, of which more than 40 were awarded the title of professor in 12 medical specialties. S.P. Botkin acted as an official opponent on dissertations 66 times.

In 1865, S.P. Botkin initiated the creation of an epidemiological society, the purpose of which was to combat the spread of epidemic diseases. The society was small, but active; its printed organ was the Epidemic Leaflet. As part of the society's work, Botkin studied the epidemic of plague, cholera, typhus, smallpox, diphtheria and scarlet fever. Observing liver diseases occurring with high fever, S.P. Botkin was the first to describe a disease that before him was considered gastrointestinal catarrh with mechanical retention of bile. This disease was manifested not only by jaundice, but also by an enlarged spleen, and sometimes by kidney disease. The disease, as S.P. Botkin pointed out, lasts for several weeks, and in the future can lead to a serious complication - cirrhosis of the liver. Looking for the causes of the disease, S.P. Botkin came to the conclusion that the source of infection was contaminated food products. He classified this type of catarrhal jaundice as an infectious disease, which was later confirmed (Botkin's disease, viral hepatitis A).

Botkin stood at the origins of women's medical education in Russia. In 1874 he organized a school for paramedics, and in 1876 - “Women’s medical courses”. In 1866, Botkin was appointed a member of the Medical Council of the Ministry of the Interior. An active life position and interest in social activities allowed the medical community to elect S.P. Botkin in 1878 as chairman of the Society of Russian Doctors, which he led until his death. At the same time, he was a member of the main management of the Society for the Care of the Wounded, a member of the St. Petersburg Duma and deputy chairman of the Public Health Commission of St. Petersburg. Fame and medical talent played a role, and S.P. Botkin became the first Russian physician of the imperial family in history. S.P. Botkin laid the foundation for sanitary organizations in St. Petersburg. From the first years of the existence of the Alexander Barracks Hospital (now the Clinical Infectious Diseases Hospital named after S.P. Botkin), he became its medical trustee. Largely thanks to the activities of S.P. Botkin, the first ambulance appeared as a prototype of the future Ambulance.

He died on December 24, 1889 at 12:30 in Menton. Botkin was buried at the Novodevichy cemetery. At this time there was a congress of Russian doctors, the work of which was interrupted. The coffin with Botkin’s body was carried in their arms for 4 miles.

Family

Father - Pyotr Kononovich Botkin, merchant of the first guild and owner of a large tea company, mother - Anna Ivanovna Postnikova. There were 25 children in the family of S.P. Botkin’s parents; Sergei was the 11th child from his father’s second marriage.

Brothers: collector D. P. Botkin, writer V. P. Botkin, artist M. P. Botkin. Sisters: M. P. Botkina - wife of the poet A. A. Fet

Children: Alexander Botkin (naval officer), Pyotr Botkin (c. 1865-1937, diplomat), Sergei Botkin, Evgeny Botkin (1865-1918, life physician), Victor Botkin.

Addresses in St. Petersburg

• 1860-1864 - Spasskaya street, building 1;
• 1878-12/12/1889 - Galernaya street, house 77 (memorial plaque).

Memory

There are Botkin hospitals in Moscow and St. Petersburg. Also in the city of Orel, a hospital is named after him.

In 1898, in memory of the services of the outstanding doctor, Samarskaya Street in St. Petersburg was renamed Botkinskaya Street. There is a memorial plaque on house number 20.

On May 25, 1908, a monument was erected in the park in front of the clinic at the corner of Botkinskaya Street and Bolshoy Sampsonievsky Prospekt (sculptor V. A. Beklemishev).

In the 1920s, a bust by I. Ya. Ginzburg (1896) was installed on the territory of the Botkin Hospital.