Gynecology

GYNECOLOGY (from the Greek gyne—woman and logos—science), literally means "the science of woman." As such, its proper subject of study should be all those anatomical and biological features that distinguish the female organism, in both its healthy and diseased states, from the male organism; it should, therefore, include as constituent parts obstetrics, the study of diseases of the female reproductive apparatus, and those branches of other medical disciplines—embryology, anatomy, physiology, general pathology, etc.—that pertain to the female organism. In reality, however, due to historically established patterns, the concept of Gynecology is usually significantly narrowed, and this name refers to the medical discipline whose subject is only the diseases of the female reproductive parts, specifically the diseases of women who are not in a state of pregnancy, labor, or the postpartum period. Containing a systematic presentation of our knowledge of diseases of the female reproductive sphere, Gynecology in the narrow sense of the word can primarily be divided into two departments: a) general Gynecology, which in turn is divided into gynecological diagnostics, the pathology of women's diseases, and their therapy, both non-operative and operative; and b) special Gynecology, or the special pathology and therapy of women's diseases. The latter is usually subdivided into sections detailing the diseases of various parts and organs of the female reproductive sphere, namely: 1) diseases of the external female genitalia, 2) diseases of the vagina, 3) the uterus, 4) the Fallopian tubes, 5) the ovaries, 6) the uterine ligaments, 7) the pelvic peritoneum, and 8) the pelvic cellular tissue. The first traces of knowledge relating to the field of such gynecology in the strict sense of the word are found even in remote antiquity—in the literary monuments of ancient Egypt and India. Among the ancient Greeks, Hippocrates (5th century BCE) was the father not only of medicine in general but of Gynecology in particular. He paved the way followed for centuries by his numerous successors, the physician-writers of Greece, Egypt during the Ptolemaic era, and Rome, which inherited Greek culture. During the darkness of the Middle Ages, amidst the general decline of medical knowledge, Gynecology suffered a particularly severe regression, which is quite understandable: what could claim the name of science in general and medical science in particular was concentrated in the Middle Ages in the hands of the Arabs, but the latter achieved very little specifically in the field of Gynecology; this was related to the position of women in the Muslim world. In Western Europe, the faint light of enlightenment flickered in the monasteries during the Middle Ages, and the monks, by their relationship to women, were too far removed from her sufferings. Like other branches of medicine, Gynecology took a major step forward with the onset of the period known in history as the Renaissance. During this era, the anatomical and physiological foundations upon which Gynecology rests as a branch of practical medicine began to be intensively developed, and subsequently, the clinical side began to be developed on this foundation. The creation of specialized hospital institutions for women particularly contributed to this development. The extent to which Gynecology developed in that era is best indicated by the appearance in print of extensive manuals dedicated specifically to women's diseases, such as the book by Professor Mercado of the University of Toledo (1520–1606), which is a voluminous tome of 567 pages. The progress of Gynecology, like its related field of obstetrics, continued in the 17th and 18th centuries following the Renaissance, although the successes of Gynecology in the narrow sense were generally significantly weaker than those of obstetrics. In the system of higher medical education throughout this period, Gynecology continued to remain a kind of appendage to obstetrics. It became an independent medical discipline, equal to obstetrics, only in the 19th century. However, even in that century, it did not reach its modern position immediately; in the first half of the century, it continued to occupy a secondary place. Only in the second half of the 19th century, when the operative treatment of women's diseases made enormous strides, did the situation change, and gynecology finally took its current honorable place among the applied medical sciences. As in previous times, the progress of Gynecology on this occasion was closely linked to the successes of the so-called basic medical sciences. Of particularly important significance for it was the reworking of pathological anatomy on new principles and the creation of so-called cellular pathology, which was the merit of Virchow. An even greater influence on the progress of Gynecology in the second half of the 19th century was exerted by the brilliant discoveries of Pasteur and his students in the fields of bacteriology, infectious pathology, and immunity. By clarifying the origin and course of a whole range of gynecological diseases, they gave gynecologists the opportunity to fearlessly perform operations that they had not dared to dream of before, and those operations that previously resulted in colossal mortality became, thanks to the use of prophylactic antisepsis and asepsis, almost completely safe. Strictly speaking, the nature of septic diseases—those deadly enemies of surgical patients and puerperal women—as well as rational methods for combating them, were clarified even before Pasteur, at the end of the first half of the 19th century, by Semmelweis, who first applied his discoveries to puerperal women and in 1863 performed the first ovariotomy observing the rules of preventive antisepsis; but Semmelweis's works were not correctly valued by his contemporaries. Only after Pasteur's discoveries did Lister in 1867 begin to apply his method of combating wound infection. This method undoubtedly represents a step backward compared to what Semmelweis taught, but it attracted universal attention; Listerism found numerous adherents everywhere, and from it, modern asepsis gradually developed. In any case, thanks to Pasteur's discoveries, surgeons and gynecologists gained the ability to perform the most complex and risky operations with favorable outcomes. The use of various types of anesthesia, and primarily inhalation chloroform anesthesia, introduced into practice at the end of the first half of the 19th century by Simpson, further facilitated this task, and as a result, operative Gynecology reached an almost fabulous peak by the beginning of the current century. Some gynecologists, carried away by its successes, were ready to reduce all treatment of women's diseases to surgical intervention; only very recently has the introduction of such therapeutic methods as radiotherapy, radium therapy, opotherapy, serotherapy, vaccinotherapy, psychotherapy, etc., begun to narrow the scope of surgical intervention in Gynecology. This narrowing of the scope of operative treatment of women's diseases in favor of non-operative methods constitutes the most characteristic feature of modern gynecology in the field of therapy. As for the other two main parts of Gynecology—diagnostics and the pathology of women's diseases—the application of so-called biological reactions for diagnostic purposes has particularly come to the fore in the former in recent times; in the latter, questions regarding the role of internal secretion, constitution, and occupational hazards in the pathogenesis of gynecological diseases are now being especially developed. If we turn to the history of Gynecology in the USSR, three periods can be distinguished. The first covers the beginning of the 19th century. In this period, Gynecology first appears on our stage as an independent branch of medicine. Its teaching in the higher medical schools of Russia at that time was, however, limited only to theory. There were no specialized gynecological departments in any of the hospital institutions then existing in Russia. All the gynecological literature of this period in the Russian language consisted of a few translated textbooks and equally few casuistic reports. In the second period, covering the time from the 1840s to the 1880s, Gynecology, having already separated into an independent discipline, became a subject of clinical study here, for which gynecological departments were organized alongside obstetric clinical departments in all Russian higher medical schools. At the head of these departments, we see major representatives of Russian science (Krassovsky in St. Petersburg, Snegirev in Moscow, Slavyansky in Kazan, Lazarevich in Kharkov, Matveev in Kiev). Under their leadership, obstetric-gynecological clinics significantly expanded their activities and served not only the purposes of general medical education but also the development of scientific questions and the specialization of physicians. At this time, gynecological departments also began to be established at the maternity hospitals existing in Russia, as well as in the Zemstvo hospitals that were beginning to arise everywhere. Among the methods of gynecological treatment, the surgical method began to be cultivated more and more in this period. In 1862, Krassovsky began to perform his ovariotomies with success; his example found numerous imitators.

Russian gynecological literature in this period was enriched by a whole series of original works based on the personal experience of the authors and on their independent clinical and laboratory research; among these works are two systematic manuals on Gynecology—by Kiter and Florinsky. In the third period, the beginning of which coincides with the introduction of Listerian antisepsis in our country, later replaced by prophylactic antisepsis and asepsis, the fruitful seeds that had already emerged in the previous era reached full development and placed Gynecology in Russia on the same level as in Western Europe. Thanks to the efforts of the zemstvos, gynecological care became much more accessible to the population not only of cities but also of villages. In the zemstvo hospitals of all provincial and some district towns, gynecological departments led by specialist physicians were organized, where complex operations were successfully performed. Alongside the obstetric-gynecological clinics of the higher medical schools, which continued to serve as breeding grounds not only for practicing specialists but also for scientific researchers in the field of Gynecology, special institutions were established during this period with the aim of improving the qualifications of physicians in Gynecology along with obstetrics. Russian Gynecology made a significant step forward, among other things, because with the opening of women's medical courses, Russian women gained access to medical activity with equal rights to men. The independent scientific development of Russian Gynecology showed tremendous progress in this era, greatly aided by the emerging obstetric-gynecological societies in Russia, congresses of Russian gynecologists, and specialized obstetric-gynecological journals. The honorable place that Russian Gynecology occupied among its European sisters during this period is evidenced by the fact that the V International Congress of Obstetricians and Gynecologists, which gathered representatives of these specialties from the entire civilized world, took place in 1910 in St. Petersburg. The World War, as everywhere else, had an extremely heavy impact on the state of all branches of science in our country, including Gynecology; the influence of the Civil War and general devastation was also felt. Many physicians, including gynecologists, fell victim to the war, famine, and typhus; some of them found themselves abroad. Hospitals and clinics fell into decline and reduced their work to a minimum due to the lack of heating, lighting, food, instruments, medicines, etc. Gynecological literature came to a standstill. With the end of the Civil War, the construction of life on new principles began, in which science began to play a larger role than before, and Gynecology again occupied its corresponding place among other branches of medicine. In the gynecological clinics of higher medical schools and in the corresponding departments of hospitals in the USSR, scientific and practical work began to boil again, and the very number of these clinics, thanks to the opening of new universities, medical institutes, and institutes for the advanced training of physicians (in Moscow, Leningrad, Kazan, Krasnodar, Smolensk, Astrakhan, Tomsk, Irkutsk, Omsk, Tashkent, Dnepropetrovsk, Minsk, Tiflis, Baku, Erivan, and other cities), increased almost threefold compared to before. To the previously existing Obstetric-Gynecological Institute in Leningrad, new institutes specifically for the study of obstetrics and Gynecology were added (for example, the Institute for the Protection of Motherhood and Infancy in Moscow). The Leningrad Institute significantly expanded its activities: in 1918, a department for pregnant women was opened there; in the following year, a consultation clinic for the latter; in 1921, a department (with a clinic) for postpartum diseases; in 1923, departments of pathological anatomy and physiology and the pathology of newborns; in 1926, biological and physiological laboratories were organized. In connection with this, the number of teachers at the institute, which equaled only 7 in 1918, rose to 24 by 1927; the number of courses taught rose from 10 in 1918 to 31 in 1927; the number of physician-students, which equaled only 17 in 1918, reached 535 in 1925; the quantity of scientific works published by the institute rose from 6 in 1919 to 69 in 1927. Literature is an eloquent indicator of the successes of Gynecology in our country: to the previously existing single specialized journal in the Russian language, Journal of Obstetrics and Women's Diseases (Leningrad), a second was added—Gynecology and Obstetrics (Moscow). Russian gynecological literature, in addition to a huge number of special works in this field, was enriched by extensive manuals, such as the Manual on Women's Diseases (published in 1927, edited by Prof. L. A. Krivsky, with the participation of a number of prominent gynecologists of the USSR). The number of specialized obstetric-gynecological scientific societies increased; new societies opened (in Saratov, Rostov, and other cities), and those previously existing in Moscow, Leningrad, and Kiev resumed their activities on an expanded scale. The congresses of gynecologists, which had ceased in 1913, began to meet again in 1924. In that year, the VI All-Union Congress was held in Moscow, attracting 555 members and up to 190 reports; in 1926, the VII All-Union Congress was convened in Leningrad, the number of members of which equaled 800; and in 1928, the VIII Congress in Kiev attracted slightly fewer than 1,000 members, with the number of reports at this congress reaching almost 250. In addition to the All-Union congresses, local gynecological congresses have recently begun to meet, also passing with great success (thus, the I Ukrainian Congress held in 1927 in Kiev gathered 700 participants, and the number of reports presented to the congress exceeded 200). Parallel to the quantitative rise in gynecological activity, its character in the USSR has also noticeably changed in the post-revolutionary period: in accordance with the needs dictated by life, more attention began to be paid to the training of gynecological specialists for the working population; both in the scientific development of questions of Gynecology and in their practical implementation, questions of the prevention of women's diseases and the study of occupational diseases have come to the fore. This promising trend constitutes the most characteristic feature of our Gynecology, as well as other branches of Soviet medicine.