Otorhinolaryngology

OTORHINOLARYNGOLOGY (from Greek ous, otos - ear, rhis, rhinos - nose, larynx - throat and logos - doctrine), the doctrine of diseases of the ear, nose, throat, and adjacent areas, and of the connection of these organs with each other and with the entire organism. Having been united comparatively recently (at the end of the 19th century) into one general discipline, O. at present represents a specialty equal in status to all other branches of medicine, dealing with the study and treatment not only of the ear, nose, throat, and larynx, but also of the esophagus, trachea, bronchi, parts of the brain adjacent to the ear, the eye, etc. They are united together by both the proximity of their anatomical location, the frequent dependence of the diseases of one organ on another, and the commonality of the endoscopic method of research. O. is predominantly a surgical specialty, since the majority of diseases of the ear, nose, and larynx require the application of operative methods for their treatment. In recent times, the dominant role of diseases of the ear, nose, and larynx in the pathogenesis of a whole series of diseases, in particular a large group of infectious diseases, has especially become apparent. Hence - the importance of O. in questions of general and local immunity, as well as in the prevention of various diseases. In the most diverse infections, the upper respiratory tract are the first and most frequently affected, often giving significant complications from the ear, nose, and throat. - The professional significance of O. is determined primarily by the anatomical location of the nose, throat, and larynx, which represent the beginning of the respiratory and digestive tracts. The structure and functional adequacy of these organs determine whether the majority of professional harmful substances (dust, smoke, vapors, gases, etc.) will be retained within the upper respiratory tract, or will penetrate into the deeper respiratory pathways and thereby exert a more harmful influence on the entire organism. The professional nature of a large number of diseases of the ear (known forms of deafness, diseases of the vestibular apparatus), nose and larynx (voice disorders due to improper setting and overuse in orators, teachers, military personnel, singers, etc.) further emphasizes the professional significance of O. The importance of nasal breathing for the organism, the role of the nose as the most important reflex organ, its close connection with the autonomic nervous system, etc. - all this has not only theoretical but also enormous practical importance, especially in the field of prevention. In addition, in otorhinolaryngological diseases, not only are the organs of higher senses often affected, such as hearing, smell, taste, speech, but often, especially in the absence of specialized medical supervision, these diseases are dangerous, and sometimes fatal, due to the spread of the process to the brain, large vessels, etc. A whole series of otorhinolaryngological diseases also has social significance, such as deaf-mutism (see), ozaena (see), tuberculosis (see), speech defects, etc. The present state of O. was preceded by a long period of accumulation of factual material and the struggle for unification. O. is a part of general medicine, which is why the successes of general medicine were reflected and continue to influence the course of development of O. The history of the development of O. can be divided into three periods: the first - the period of dominance of mystical views - lasted until the beginning of the 16th century; the second period - the development of anatomical and partly physiological knowledge in O. - from the 16th century to the middle of the 19th century; the third period - the development of modern O. - is characterized by the discovery of methods of endoscopic research and the unification of O. The concept of O. among the ancient peoples of the East was very primitive, which was conditioned by the almost complete absence of knowledge of anatomy and physiology. In the works of Hippocrates (460-377 BCE) and Galen (130-200 CE), there are already the beginnings of clinical observations of diseases of the ear, nose, and throat, their initial systematization and empirical methods of treatment, as well as some operative methods (tracheotomy). The doctrine of Galen, with some minor changes, dominated throughout the Middle Ages and even further - until the 18th century. In the 16th century, the development of the anatomy of the ear, nose, and throat began through the works of the Italian school (Vesalius and his students). In the 17th century, knowledge of anatomy was clarified (Valsalva, 1666-1723). Physiology began to be developed and the clinic of ear diseases received more precise formulation (du Verney, 1688). In the 18th century, macroscopic anatomy was finally established, and physiology and pathology of O. received further development. From the end of the 18th and in the early 19th centuries, histology and embryology in O. began to be developed. In the 19th century, advances in research techniques (microscope), physics, and chemistry led to the further, more rapid growth of medicine, including O., although O. compared to other specialties was still lagging behind. Histological research began to appear, establishing the structure of the eardrum (Huschke, 1844). The division of labyrinthine fluid into endo- and perilymph was established (Breschet). Detailed data on the comparative anatomy of the human ear and mammals (Hyrtl) and the embryology of the ear were also published. The specific sensitivity of the auditory nerve (Magendie) and the air conduction of sound through the eardrum and the chain of ossicles (Johannes Müller, 1837) were established. Through the work of Flourens (1824), the significance of the semicircular canals for maintaining equilibrium was first clarified. At the same time, Hoffmann in 1841 proposed using a mirror with a hole in the middle for examination, which became the progenitor of the modern reflector and played a huge role in the methodology of examining the ear, nose, and throat. In the same year, Neuburg and Gruber proposed an ear funnel similar to the modern one, and in 1842, Curtis - the otoscope. However, direct examination of the eardrum was still given little importance, being satisfied with probing the ear and the result of the Valsalva test. Hearing examination was done with pocket watches. By that time, otology had already reached a certain development, which is why specialized departments for ear diseases began to be opened. For the first time, a hospital for sufferers of ear, nose, throat, and eye diseases was opened in London in 1805. In 1820, similar hospitals existed in Hull (England) and New York (America). In France, institutes for training the deaf-mute were opened, which gave impetus to the development of O. in France. This was also facilitated by the book of Itard, published in 1821, "Doctrine of Diseases of the Ear and Hearing," second in importance after the book of du Verney. Itart improved the classification of ear diseases proposed by du Verney, clarified the diagnosis and substantiated rational therapy. The successes of rhinolaryngology were significantly smaller, although already in 1804 the first work on nasal diseases appeared (Dechamps fils). The doctrine of diphtheria, its distinction from scarlatinal diphtheria and croup (Bretonneau, 1826) was clarified. The essence of laryngeal edemas and their distinction from tumors was also clarified (Bichat and Bayle, 1819). Tonsillectomy was performed more often and special instrumentation for this purpose - the tonsillotome (Fahnenstock, 1832) - was proposed. From the second half of the 19th century, a rapid growth of O. is outlined, conditioned both by the general development of medicine and mainly by the improvement and widespread dissemination of methods of direct examination of the ear, nose, and larynx. From this time begins the third period of the development of modern O. O. was enriched by a whole series of studies of various details, variants of structure and development, and topographic relationships of the ear, especially important during operations; the histological structure of the end apparatus of hearing, Corti's organ, described by Corti in 1851 and first supplemented by Reissner in 1852, and then by Deiters, Hensen, Ovsyannikov, Retzius and many others, became known. Anatomical-histological data and the development of the doctrine of sound (works of Müller) made it possible for Helmholtz (1856-59) to construct the modern theory of hearing. On the basis of these achievements, pathology and the clinic of ear diseases began to develop more rapidly. This development first occurred in France (Itard, Deleau, Saissy), but the lack of specialized hospitals or departments in hospitals there hindered further growth of otology. On the contrary, in England by this time, special otorhinological departments already existed in all large cities, which made it possible to accumulate a large clinical material and to develop the science further. The activity of Toynbee (1815-1866) was of particularly great importance here, who became famous mainly as a pathologist. His work with data from 1849 autopsies of patients with ear diseases laid the cornerstone of the pathological anatomy of the ear. He dealt less with the clinic, but here he was supplemented by his contemporary, the brilliant clinician Wilde (1815-1877). England and France became as it were the cradle of modern otology, and the scientific works of French and English authors were translated into most European languages. To study otology, doctors traveled to London and Paris. The further development of otiatrics occurs in Austria and Germany, where a whole series of schools develop. Here, first of all, the work of Troltsch (v. Troltsch, 1824-1890) in Würzburg should be mentioned, who improved and zealously propagated the direct examination of the ear with the help of a reflector and funnel. True, earlier attempts of this kind were already known (Toynbee in England, Bonnafont in France), but they did not receive widespread dissemination.

Only after the works of Treltsch (1855) did this method, which is still in use today, become widespread. Furthermore, the merits of the Vienna school, led by Politzer and Gruber (Politzer, Gruber) from 1863, should be particularly noted. The merits of Politzer were especially great. His school rightfully took first place not only among scientists in Germany and Austria, but throughout the world. Hundreds of doctors came to Vienna to study under Politzer. His work began initially in the outpatient clinic, and only from 1877 did he receive a small clinic with 10 beds, where he continued his brilliant activities. He was not only a brilliant clinician but also an excellent anatomist, preparator, and artist. The methodology he created for examining the ear, methods for preparing specimens, and the atlas of images of the eardrum have not been surpassed to this day. During this same period, outpatient clinics were first established in almost all universities in Germany, Austria, and other European countries, followed by clinics and specialized departments in city hospitals, where otology began to be diligently developed and taught. In the second half of the 19th century, through the work of numerous scientists, otiatry was almost completely revised. The successes of bacteriology, the application of radiation therapy (X-rays, Finsen), and the newly proposed surgical methods of treatment marked a significant advance in this field. The doctrine of catarrhal diseases of the middle ear was completely revised on the basis of extensive pathological-anatomical material and clinical observations. A division of these forms into exudative and adhesive types was established. The influence of diseases of the nose, nasopharynx, and Eustachian tube, as well as the rational foundations of therapy, were clarified. The doctrine of purulent diseases of the middle ear also advanced significantly in terms of establishing their bacterial nature, the importance of the nasopharynx for the origin and course of otitis, and the introduction of modern surgical principles for their treatment; otosurgery was newly created, i.e., the 'operative treatment of acute and chronic purulent discharges from the ear and their complications.' The credit for introducing and popularizing antrotomy undoubtedly belongs to Schwarze (Schwartze), who in 1873 proposed his developed method for opening the cells of the mastoid process and antri mastoidei, which soon gained wide recognition and spread. In chronic otitis, the same Schwarze operation was initially used, and in 1889 it was replaced by the so-called radical operation developed by Stacke and Zaufal (Stacke, Zaufal) according to the principles of Küster and Bergmann (Kiister, Bergmann). In recent years, the principle of performing such operations has somewhat changed in the direction of greater radicalism in antrotomies and a more conservative approach in the radical operation or even replacement of the latter by an operation through the auditory canal (Barany, Thiess). Also, starting from 1890, the doctrine of labyrinth diseases arising on the basis of purulent otitis and their surgical treatment was developed. The diagnosis of diseases of the mastoid process was facilitated by the use of X-ray photographs. The doctrine of complications in purulent otitis, both from the brain and its membranes and from the circulatory system (sinus sigmoideus), was also developed. Great work was done in terms of the pathology of diseases and the fundamental principles regarding the location and method of performing operations. The old dispute between advocates of performing operations for brain abscesses through the temporal squama or along the path of infection through the middle ear was resolved in favor of the latter. The doctrine of ligation of the jugular vein was also developed. A new doctrine of otosclerosis was created (Politzer, 1893), which was previously poorly known and often confused with other pathological forms; a new doctrine of labyrinth diseases, methods for examining labyrinth functions and their treatment (von Stein-Barani), developed. Thus, modern otology was created, encompassing the doctrine of the structure, functions, and diseases of the ear, its connection with the entire organism, and the complications of its diseases from neighboring organs and the entire organism. The development of modern laryngology began in the second half of the 19th century. The successes of pathological anatomy and physical research methods contributed to accelerating this process, but the most important thing was missing—a method for examining the larynx, which is why diagnosis and treatment were carried out indirectly. Attempts to examine the human larynx were made from the beginning of the 19th century, but only in 1855 was the laryngeal mirror-laryngoscope invented. Apparently, this discovery remained unknown to medical circles. Among doctors, Turk (Turk, 1857) and Professor of Physiology Czermak (Czermak) were the first to report on their examination of the larynx in living people. Initially, the examination was performed in sunlight. Later, Czermak proposed using artificial light for this purpose, which gained widespread use. Laryngology owes the propagation of laryngoscopy to Czermak. He traveled almost all of Europe, everywhere demonstrating and propagating the method he proposed. From that time, clinical material began to accumulate, which allowed Turk to publish his book 'Clinic of Diseases of the Larynx and Upper Respiratory Tracts' in 1866. Thus, in the course of 9 years, a new science—laryngology—was born. The efforts of the initial period of laryngology were directed both at further improving the technique and at collecting case material. Here, the merits of Turk, who replaced the hand reflector with a forehead reflector, and Bruns (Brims, 1862), who removed a polyp from the larynx through natural passages, should be noted. In 1859, Czermak proposed posterior rhinoscopy for examining the nasopharynx and the posterior part of the nose. The application of the stroboscope for studying the movement of the vocal cords was first proposed by Oertel in 1895. The successes of the clinic, in turn, were also reinforced by successes in the field of anatomy, physiology, and pathology of the larynx. Merkel (Merkel) in 1857 and Luschka (Lu-schka) in 1868 finally developed the anatomy of the larynx. The physiology of voice and speech was established by the works of Brücke (Brücke) in 1856 and Du Bois Reymond in 1862. The centers of voice and speech were established by Krause in 1883, confirmed by Bechterev and many others. The classification of catarrhal diseases was given as early as 1862 and later supplemented by Stern and Turk. The connection of the larynx with the entire organism began to be particularly emphasized from the time of the works of Lori (Lori, 1885). The course and forms of tuberculosis of the larynx were also studied; the favorable influence of tracheotomy on its course, surgical treatment (Schmidt, 1880; Hering, 1886), and galvanocautery in tuberculosis of the larynx (Mermod, 1903). The treatment of stenosis of the larynx of any origin took the surgical path—operation of laryngotomy and laryngostomy with the subsequent insertion of T-shaped tubes and suturing the opening formed (Mikulicz, 1894; Ivanov, 1906). The difficulty of interventions in the larynx was especially due to the lack of reliable local anesthetic agents. For this, the larynx was smeared with a mixture of morphine, chloroform, and alcohol. This method was not always safe, and anesthesia occurred after several hours. Therefore, when Freud discovered the anesthetic properties of cocaine, and Jellinek introduced it for anesthesia of the nose and larynx in 1884, otology significantly advanced. The technique of examination and surgical measures, previously available only to a limited circle of specialists, became widespread. The application of adrenaline, proposed in 1901 and allowing almost bloodless operations, further improved the situation. The improvement of antisepsis and asepsis contributed to the development of laryngeal surgery, in particular—its extirpation. First proposed by Billroth, this operation was especially thoroughly developed by Glück and is now widely used. Laryngeal neurology also developed, the beginning of which was laid by Turk in 1862 and Mackenzie in 1868. Ziemssen introduced electrization in the late 1860s. Rosenbach in 1880 and Semon in 1881 developed the law on laryngeal paralyses. Foreign bodies were removed under the control of Czermak's mirror in 1865 and Schröter in 1876. With the introduction of cocaine, their removal was significantly facilitated, then gradually broncho-esophagoscopy and methods of direct examination of the respiratory tract developed. The introduction of a tube into the esophagus—esophagoscopy (see)—began earlier. Direct examination of the larynx was first proposed by Kirstein in 1896. This method was thoroughly developed by Killian, who also first removed a foreign body from the bronchus. Brüning improved the instrumentation and technique, after which the method gained widespread use. In 1911, Killian proposed suspension laryngoscopy (Schwebelaryngoskopie), which did not become widespread. Recently, autoscopes by Seifert, Haslinger, and Henke have been recommended. While laryngoscopy and diseases of the larynx in general had already emerged as a distinct chapter in medicine—laryngology—in the 1870s, rhinology and anterior rhinoscopy developed somewhat later. Posterior rhinoscopy was proposed by Czermak in 1859. Then the doctrine of adenoid vegetations in the nasopharynx, the connection of this disease with the nose and ears, and its influence on the entire organism appeared. Meyer (W. Meyer, 1868-1874) gave an exhaustive treatment of this question.

The methodology of surgical treatment was improved by Gottstein (1886). Anterior rhinoscopy began to develop only in the 1870s after the introduction of nasal specula proposed by Frankel and Duplay. In 1876, Frankel's book 'Diseases of the Nose' was published, and rhinology received a definite form. Surgical procedures also began to develop: galvanocautery proposed by Voltolini, and removal of polyps with a cold loop (Zauffal). The doctrine of reflex nasal neuroses also developed (Voltolini, 1871; Frankel, 1881 and Hayek, 1881-84) and their treatment with galvanocautery. A significant shift in rhinology occurred with the discovery of cocaine. Both diagnosis and especially surgical techniques became easier. At the same time, the anatomy and physiology of the nose were particularly thoroughly studied (Zuckerkandl, 1882 and 1892). The study of diseases of the nasal cavity was also extended to the accessory sinuses. The apparent and hidden forms of inflammation of the accessory sinuses were studied and diagnostic methods were established - diagnostic puncture (Lichwitz and Ziem, 1888) and diaphanoscopy (Hering, 1889; Vohsen, 1890). Zuckerkandl (1882-1892) gave a clear pathological-anatomical picture of diseases of the accessory sinuses. Grunwald expressed the conviction that all diseases of the nose are not independent, but depend on diseases of the accessory sinuses (1896). The surgical technique for opening the accessory sinuses was improved in the direction of improving methods for surgical opening of the maxillary sinus (Galdwell, 1893; Luc, 1897) up to the most radical variant proposed by Descom in 1906. Then the operation on the frontal sinus was developed (Killian and others) and finally intranasal surgery developed - operation of resection of the septum (Krieg, 1884; Killian, 1906; Freer, 1908; Voyacheck) and operations on the turbinates (removal of anterior and posterior ends and the entire inferior turbinate, resection of the middle turbinate, etc.), which are now performed only for strict indications. Plastic surgery of the nose, correction of unsightly and depressed noses by methods of intranasal surgery (Joseph) gave brilliant results. Thus, these three disciplines, which now constitute the subject of O., developed. Each of them went its own way, first as part of general medicine, and then gradually emerging as an independent discipline. This development, however, proceeded mainly along two separate channels: on the one hand, otology and on the other hand, rhino-laryngology. This was facilitated by some anatomical proximity as well as the presence of certain organizational factors (separate departments in some countries). Only after their development and formation as disciplines did they begin to merge into one common discipline in the 1880s and 1890s. In a number of countries (England, Belgium, Spain, etc.), these departments of science existed together from the very beginning. In others, such a merger occurred after a more intense (Germany) or weak (Italy) struggle. In any case, the division of O. in scientific and practical respects went quite far. In particular, international scientific congresses were convened separately for otology and laryngology until the war of 1914-18. At present, in the vast majority of countries, O. represents one common specialty both in teaching and in practice. The development of O. in Russia began in the 1870s. Apparently individual specialists from foreign physicians were also in St. Petersburg earlier, but due to the poor formation of the specialty, their activity was little known. The first otologist in St. Petersburg was Dr. Friedrich Eckel (1814-1879), founder of the first otorhinolaryngological outpatient clinic in the Maximilianian institution, the first laryngologist - Rauchfus, who specialized in Vienna with Turk and Czermak. The founder of scientific otology was R. Vreden (1837-1893). He published about 30 scientific works and established an ear department in a military infirmary. Prof. S.P. Botkin did much for the development of O. Even then he foresaw the further growth of O., which is why he first encouraged his students to study this specialty abroad and allocated an outpatient clinic and several beds for otorhinolaryngological patients in his clinic. His ordinators, A.F. Prussak and D.I. Koshlakov, were pioneers of O. in Russia. After D.I. Koshlakov's foreign trip, he was first approved as a docent and then as a professor of laryngology at the Military Medical Academy, holding this chair from 1856 to 1883. The first professor of the Military Medical Academy in otology was A.F. Prussak, who held this chair from 1870 to 1893. Engaging exclusively in otology, he left a significant number of specialized works, known abroad as well. Then teaching of laryngology was transferred to N.P. Simanovsky. In 1893, upon the retirement of Prof. A.F. Prussak, N.P. Simanovsky combined in his hands the teaching of all of O. The needs of the military department forced the introduction of O. as a compulsory subject studied by students of the Military Medical Academy, and thus the first Russian otorhinolaryngological school was created. In other universities, there was no compulsory teaching of O., and only privat-docent positions existed. However, the conditions for teaching at the Military Medical Academy were very unsatisfactory, as teaching had to be conducted on outpatients. A special clinic was opened only in 1893 (with 27 beds). Subsequently in 1900, a special new building for the clinic with 60 beds was constructed, which exists to this day. Since the beginning of Russian O. was laid in the Military Medical Academy, the pioneers of O. in Russia were mainly military physicians. Many physicians also specialized abroad. The work of the first otorhinolaryngologists took place in the conditions of private practice, since special departments and outpatient clinics did not exist. Somewhat later, O. began to develop in Moscow. Here the first otorhinolaryngologist was G.N. Shkott (1837-1904), who specialized abroad. He founded the first stationary department in the former Ekaterinin Hospital with 20 beds. He was also the founder of the first otorhinolaryngological society in Russia - the Moscow Otorhinolaryngological Society (1897). Besides him, M. Uspensky and Zinoviev (1845-1887), E.M. Stepanov (1856-1922), A.F. Belyaev and especially S.F. von-Stein (1855-1918) contributed much to the development of O. - founder of the otorhinolaryngological clinic of Moscow University, opened in 1896 with 25 beds and richly supplied with special equipment as well as scientific inventory, laboratory and library. Here the second Russian school of otorhinolaryngologists after St. Petersburg was founded, where specialists received their special education.

Most Moscow physicians, as well as many provincial zemstvo physicians who worked and still work in many places in the USSR. From the beginning of the 1880s, individual specialists began to appear in provincial university cities—Kiev, Odessa, Kharkov, and later in other provincial cities. Among the specialists who worked both in the capitals and in the provinces, should be mentioned the names of A. F. Ivanov, L. P. Svezhevsky, B. V. Verkhovsky, M. F. Tsitovich and others, who became continuers and propagandists of otorhinolaryngology in Russia. Nevertheless, the state of otorhinolaryngology in tsarist Russia was very unsatisfactory. The number of specialists by 1913 did not exceed 400, the number of specialized outpatient clinics in urban and zemstvo hospitals could be counted on one's fingers, and the number of specialized beds was in the tens. Meanwhile, abroad at the same time, the matter had already progressed significantly. In England by the 1860s, all cities already had specialized departments with beds. The same movement began in the 1880s in Germany, Italy and France. During the imperialist war, the situation in tsarist Russia deteriorated even more, as many physicians were called to military service and consequently ceased to engage in their specialty. The development of Russian otorhinolaryngology began with the October Revolution. From the very beginning of the work of Soviet healthcare, the provision of specialized assistance to the broad masses of working people began to develop. Special medical receptions were opened, and a certain number of specialized beds were allocated. The further development of these initiatives was delayed by the civil war and typhus epidemics, and only after their completion was further construction undertaken. From 1922, rapid growth of Soviet otorhinolaryngology began. By 1930, the number of specialists had increased to 2,800, specialized beds to 1,700, and further development promises even more rapid progress forward. It can be considered that by the tenth anniversary of Soviet power, otorhinolaryngology became an equal discipline among all other medical specialties. Schools of the new period of otorhinolaryngology began to be created from the second half of the 19th century. Modern otorhinolaryngology distinguishes the following schools: the Vienna otological school, which at present deals with the problems of physiology and pathology of the labyrinth (Barany, Alexander, Ruttin and others), the Utrecht (Dutch) school of Magnus and de Kleijn (Magnus, de Kleijn), particularly interested in the physiology and pathology of the otolith apparatus, the German school of Eiken (v. Eicken, Berlin), which mainly develops questions of direct laryngoscopy and broncho-esophagoscopy, the German school of Wittmann (Wittmann, Hamburg), which became famous for its pathological-anatomical works in the field of the ear. Among the modern schools in the USSR should be mentioned the first in time school in the Military Medical Academy, currently headed by Prof. V. I. Voyachek. Numerous works devoted to the influence of constitution, heredity, operations on the nasal septum, the experimental method of resolving a number of questions, examination and professional selection of pilots, have brought the clinic fame far beyond the borders of the USSR. In Leningrad, the school of Prof. L. T. Levin became famous, particularly interested in questions of operations on the ear labyrinth. In Moscow, the schools of Prof. A. F. Ivanov emerged, developing a number of problems on diseases of the larynx, laryngeal stenoses, diseases of the paranasal sinuses, tonsils, physiology of the voice and questions of prevention and professional selection in otorhinolaryngology, and the school of Prof. L. I. Svezhevsky, particularly interested in the experimental resolution of questions of prevention, the influence of cerebrospinal fluid on the ear, the treatment of malignant tumors, etc. Among the provincial clinics should be mentioned the school of Prof. M. F. Tsitovich in Saratov, which has numerous students. The school mainly studies the influence of diseases of the nose and especially the maxillary sinus on diseases of neighboring organs and the entire organism, as well as the significance of pharyngeal tonsils as portals of entry for various infections. Much attention is paid to the physiology of the upper respiratory tract and the statistics of professional diseases in various industries. The direction of Soviet otorhinolaryngology differs significantly from foreign otorhinolaryngology in accordance with the general provisions of all Soviet medicine. First of all, this is expressed in the preventive direction of otorhinolaryngology (participation in general dispensary work, development of methods for preventing diseases of the upper respiratory tract in preschool and school-age children, prevention of professional diseases of the ear and upper respiratory tract). Special attention is paid in leading industries to diseases, which mainly concern noise damage to the ear. Here should be mentioned a number of works both on the precise determination of the nature of noise in various industries (Bonchkovsky), and the experimental and clinical verification of the influence of noises (Preobrazhensky, Temkin, Vol'kovich). Unfortunately, the methodology for protection against strong and prolonged noises has not yet given tangible results. In addition, almost all areas of industry have been examined from the point of view of the development of otorhinolaryngological diseases in them, and it has been established with certainty that these organs are significantly affected in various professions. These data formed the basis of organizational preventive and therapeutic measures in various industries. From the same point of view, the necessity of professional selection of youth directed to various branches of labor became clear. Professional selection is carried out in preventive outpatient clinics, through which all personnel of factory-zavuch pass. The norms of this professional selection have in general been established (Vol'kovich). Great work is also being done to spread otorhinolaryngological knowledge among the broad masses of the proletariat and collective farm peasantry, both in the form of reading lectures and conversations on individual questions of otorhinolaryngology, and by organizing a three-day event 'Protect Your Hearing', which aims to acquaint the broad public with questions of prevention in otorhinolaryngology. In addition, work is being done to improve the qualifications of physicians, middle and junior medical personnel by organizing refresher courses, seminars on individual questions, reading lectures and conducting classes with middle and junior medical personnel. Large otorhinolaryngological institutions take patronage over provincial institutions, carrying out the same work by sending qualified workers to the places. Great work is also being done on the research and struggle against deaf-mutism (see). The tasks facing otorhinolaryngology consist in the further development of the prevention of otorhinolaryngological diseases, the struggle with infection penetrating through the upper respiratory tract, and the prevention of professional diseases. Teaching of otorhinolaryngology At present, otorhinolaryngology is taught in medical universities of all countries. In Germany as early as 1878, out of 20 existing universities, teaching of otorhinolaryngology was already conducted in 14. From 1911, otorhinolaryngology has been taught in all medical universities of Germany. Initially, teaching corresponded to the separate existence of otology and laryngology and was separate, but at present it is united. In England, France and other countries, teaching was conducted from the very beginning on a unified department. In the vast majority of countries, teaching of otorhinolaryngology is compulsory. The state examination in otorhinolaryngology exists in Germany, England and others. In other countries—in Austria, Belgium, Denmark, etc.—such an examination does not exist. The time allocated for teaching otorhinolaryngology varies from one (Germany, Switzerland) to 2 semesters (USSR, England, France, etc.); teaching consists of lectures and a small number of practical exercises. In tsarist Russia, compulsory teaching of otorhinolaryngology was only in the Military Medical Academy and in women's medical institutes. Compulsory teaching in all medical universities of the USSR began in 1922-1924 after the introduction of a new curriculum plan. At present, all medical universities in the USSR have departments of otorhinolaryngology. Teaching is allocated 40-60 hours depending on the specialization, passed cyclically. Classes consist of laboratory study of theoretical material under the guidance of teachers and practical exercises with patients in the order of continuous production practice. Accounting of knowledge is conducted in the process of work. In the USSR at present there are three scientific research institutes for otorhinolaryngology: in Saratov, Leningrad and Kharkov, where scientific and practical development of questions is carried out. Otorhinolaryngological clinics exist in all medical universities; they are partly housed in special buildings (Military Medical Academy, 1st Moscow Medical Institute, Saratov, Rostov, Irkutsk, Perm Institutes), but mostly in urban Soviet hospitals. Improvement of physicians in otorhinolaryngology is partly conducted in the clinics of medical institutes, partly in special institutes for the improvement of physicians (Leningrad, Moscow, Kazan, Tomsk, Kharkov, Odessa), which have specialized clinics. Scientific otorhinolaryngological societies began to be founded in the 1890s of the 19th century. The first was founded in 1897 the Moscow Otolaryngological Society, then 2 societies in Petersburg (now merged), in Kiev and in Odessa. At present, otorhinolaryngological societies or sections of general medical societies exist in all university cities of the USSR. Congresses of otorhinolaryngologists in Russia were first held in the form of otorhinolaryngological sections of the Pirogov congresses of physicians.

Such sections were held at the Pirogov Congresses: VIII in Moscow (1902), IX in St. Petersburg (1904), and X in Moscow (1907). The number of participants and reports presented was small. The first special otorhinological congress was convened in St. Petersburg in 1908. Subsequently, before the 1914-18 war, 3 All-Russian congresses were held, and under Soviet power, 3 All-Union congresses. The number of participants and reports can be seen from the following table. Congress City Time of convening Number of participants Number of reports I All-Russian II » III > 1(4) All-Union 11(5) » 111(6) » St. Petersburg Moscow Kiev Leningrad Moscow Odessa 26-30/XII 1908 26-30/XII 1910 9-12/IV 1914 25-31/XII 1924 26-30/IV 1927 26-31/VIII 1929 115 people 166 » 136 » 252 » 420 » 501 » 28 32 62 97 55 In addition, during the Soviet period, several (three) regional otorhinolaryngological congresses were held (in Saratov, Rostov, and Kazan) and special otorhinolaryngological sections of regional medical congresses. Before the 1914-18 war, there existed in Russia 2 special journals: 'Monthly Journal of Ear, Throat, and Nose Diseases', founded in 1906, and 'Bulletin of Ear, Throat, and Nose Diseases' from 1907. Both journals were published in St. Petersburg; from 1917, their publication ceased. After the civil war, from 1924, a new journal began to be published in Kharkiv-Dnepropetrovsk: 'Journal of Ear, Nose, and Throat Diseases' under the editorship of Prof. Kompaneyets. From 1924, the publication of the 'Monthly Journal' was resumed under the name 'Russian Otolaryngology' under the editorship of Prof. Levin and Lichkus in Leningrad, and from 1925 - a new edition of 'Russian Rhinolaryngootiatry' in Saratov under the editorship of Prof. Tsitovich. Thus, at present, three special journals are being published. A whole series of original works on professional diseases of the ear, nose, and throat have been published in the works of the Obukh Institute in Moscow, and the Leningrad and Kharkov Institutes of Professional Diseases.