Clinics

CLINICS (from the Greek kline-bed, couch), medical institutions for in-patients, which serve chiefly for educational purposes. While serving to teach at the medical faculty, clinics differ sharply in character and structure in different countries (see below - the history of clinics). Being a component part of university departments, clinics in some countries simultaneously serve as centers of scientific research work, as modern human pathological physiology was primarily developed and created in them. With the development of medical knowledge, a certain specialization can be noted not only according to diseases of various organs but also according to individual methods of work. The purely scientific character of clinical research is primarily characteristic of German and to some extent Russian clinics. French and to some extent English clinics were and still represent institutions of a predominantly practical-educational character. Along with students, entire generations of experienced practical physicians were trained in them. History of clinics. The first clinical institution where physicians could acquire theoretical and practical training in obstetrics was established in 1728 in Strasbourg, and then Johann Georg Röderer (1726-63) founded a model obstetric clinic in Göttingen, which became a school from which a whole series of prominent obstetricians emerged. In 1748, the first surgical clinic was opened in Dresden. In the first half of the 18th century, thanks to the famous Boerhaave, clinics arose in Leiden. After this, clinics were established by the famous van Swieten in Vienna and finally under the influence of De Haen and Frank (De Haen, Peter Frank), clinics were gradually introduced at all universities in Germany. In Frank's work ("Plan d'ecole clinique ou methode d'enseigner la pratique de la medecine dans un h6pital academique", Vienna, 1792), there is already an exact exposition of the methods of clinical teaching practiced at that time and an exact definition of the relationship of clinics to city hospitals. Although Frank found it sufficient to have only 10 beds for clinical teaching, at the same time he demanded the unlimited right to transfer from city hospitals to clinics all cases suitable for clinical demonstrations, and when they were no longer needed, to return them to the hospitals. This relationship of clinics to city hospitals existed for a long time in all major university cities in Germany. In later times this situation changed, and the most significant hospitals in university cities were converted into clinics. The first stationary clinics were under the undivided management of one physician, and until the beginning of the 19th century, both surgical and internal diseases were treated by the same "doctor of medicine". In France in the 17th and 18th centuries, the teaching of practical medicine was concentrated mainly in the hospital institutions of Paris and Montpellier. In 1798, the higher medical school in Paris was reformed, and its own clinics were created. Since 1777, France has had 7 medical faculties with clinical institutions, and alongside them there are also 18 ecoles préparatoires, which, while partly having the same functions as the medical faculties and being municipal institutions, also have various clinics. In Russia, the General Hospital founded in Moscow on November 21, 1707, played a major role as a practical medical school, where the first Medical-Surgical School in Russia emerged, in which students performed the same role as curators as students do in modern university clinics. The beginning of systematic medical education in Russia was laid by the founding of the medical faculty at Moscow University in 1755. For many years, clinical teaching (as a separate subject) did not exist. Only by the statute of 1835 was a department of clinics established with division into a) private pathology and therapy and b) clinic in the hospital. The statute of 1863 separated private pathology and therapy from clinics into a separate department of "special pathology and therapy" and at it: a) systematic and clinical exposition of the doctrine of nervous and mental diseases and b) systematic and clinical exposition of the doctrine of skin rashes. At the end of the 18th and beginning of the 19th centuries, the clinical institution serving for the teaching of practical medicine at Moscow University was the Novo-Yekaterininskaya Hospital, which had been a medical school for students of the Medical-Surgical Academy, and from 1845 the entire Novo-Yekaterininskaya Hospital was converted into hospital clinics of Moscow University. In 1888, the clinics of Moscow University were transferred from the Novo-Yekaterininskaya Hospital to Devichye Pole, and a "Clinical Town" was created, which later made Russian clinical medicine world-famous. In St. Petersburg, practical clinical instruction in therapy, surgery, and obstetrics was introduced at the Medical-Surgical Academy in 1805, and from 1806 special clinics were arranged. In 1840, the 2nd Military-Land Hospital was attached to the academy as a clinic, whereby a very significant contingent of patients was made available for students' instruction. In 1881, the Medical-Surgical Academy was transformed into the Military-Medical Academy, and over time model clinics were also arranged there. Being in the 18th and early 19th centuries almost the only breeding grounds of medical knowledge and medical thought in Russia, the medical faculty of Moscow University and the Military-Medical Academy produced a number of famous clinicians who were the founders of entire medical schools (Botkin, Zakhar'in, Ostroumov, Veliaminov, Pirogov, Snegirev, Filatov, Kozhevnikov, Korsakov, and others). The establishment of independent surgical and therapeutic clinics took place only in the middle of the 19th century; even later separate obstetric clinics emerged, because until the 1830s of the 19th century obstetrics was usually taught by professors of surgery. The formation of other special clinics - ophthalmological, ear, throat and nose, dermatological-syphilitic, etc. - began only in the 1860-1870s of the 19th century. While in Germany, Austria, France, Russia and Italy the development of clinical teaching expanded widely during the 19th century, in England, where only in 1800 did barbers separate from real surgeons, almost in all universities except Scottish ones there were no separate clinical institutions entirely intended for the clinical education of students. In Japan and especially in America, the organization of clinical teaching has advanced widely in recent decades, and this can especially be said about the USA, where in recent years a number of clinics have emerged remarkable both in their organization and in their very productive scientific work. In the USA, the name clinic in most cases is borne by outpatient departments in all specialties. A typical and excellently organized institution of this kind is the Mayo Clinic, located in the small town of Rochester in the state of Minnesota. Unlike foreign clinics, where at medical faculties teaching provides only unified therapeutic and surgical clinics, in Russian clinics all teaching of internal and surgical diseases until recently was divided into the following main clinics: propaedeutic, which is taught in the 3rd year of the medical faculty, faculty clinics in the 4th year and hospital clinics in the 5th year. Until 1924, in medical higher educational institutions of the USSR, there existed in the 3rd year of the medical faculty a special therapeutic clinic at the department of private pathology and therapy of internal diseases, whose task was to give a schematic description of the most well-known diseases of organs. In subsequent years, the teaching of private pathology and therapy of internal diseases was included in the course of medical diagnostics, read at the propaedeutic clinic. The task of the propaedeutic clinic is to teach the methods of clinical research and the study of pathological symptoms. The task of the faculty clinic is to teach students as complete an examination of the patient as possible and, on the basis of detailed and scientifically conducted study of patients, to teach them clinical thinking, differential diagnosis and therapy. The task of the hospital clinic is to teach students to quickly orient themselves in the conditions of a regular hospital-hospital setting, to make a diagnosis and prescribe appropriate therapy on a relatively large number of patients. At the present time (1930), in connection with the radical reform of medical education being carried out, the character of clinics and all clinical teaching is also changing. The approach of higher education to the tasks and needs of socialist construction requires a fundamental restructuring of clinics. If previously clinics were to a large extent a collection of casuistic material and their work proceeded without any connection with the general medical network, then now the task of bringing clinics closer to life acquires special importance. The strengthening of the class line in the work of health care authorities requires that clinics be placed at the service of the proletariat and that qualified clinical assistance cover in the first place and predominantly the leading groups of industrial workers. Along with this, the improvement of medical care in hospitals, the introduction of continuous production practice forces the widest possible use of hospitals for the purposes of clinical teaching. Thus, the boundaries between clinics and hospitals are erased. This especially applies to those medical higher educational institutions whose clinics are in general hospitals, and such are the majority. In accordance with the general policy of the party on bringing higher and secondary education closer to production and the transfer of medical higher educational institutions to the jurisdiction of the People's Commissariat of Health.

Clinics are transferred to health authorities according to decisions of the Council of People's Commissars of the RSFSR, which eliminates dual leadership and achieves their integration with the general network of medical institutions. In parallel with this, the restructuring of Clinics is proceeding in the direction of their prevention orientation, which naturally follows from the entire system of Soviet healthcare. This is expressed in the supplementation of clinical examinations with data from socio-professional anamnesis, in the use of the dispensary method when accepting outpatients to Clinics, in participation in dispensary examinations of certain professional groups, etc. Along with this, the transition to a 4-year course of study and the change in the teaching method itself necessitate raising the question of the need for the further existence of three therapeutic and surgical Clinics. With the change in the selection of patients and the teaching system, it will be quite appropriate for all 2 years of study in the senior department for a student to work in the same Clinic. A significant change in university Clinics is also in regard to their role as a scientific research center. The general progress of science and the colossal growth of scientific research work have required the creation of a powerful network of scientific research institutes (see Scientific Research Institutes), to which a outflow of scientific forces and the transfer of the development of a number of scientific problems has begun.