Philippe Pinel - biography and interesting facts from life. Philippe Pinel - The father of modern psychiatry, Philippe Pinel first created for the mentally ill

Psychiatry is the science of mental illness, its treatment and prevention.

The first shelters for the mentally ill began to appear at Christian monasteries in Byzantium (IV century), Armenia and Georgia (IV-VI centuries), Islamic countries (IX century).

The reorganization of the maintenance and treatment of mentally ill people is related to the activity Philippe Pinel the founder of public and clinical psychiatry in France. During the revolution, he was appointed chief physician of the psychiatric institutions of Bicetre and Salpetriere in Paris. The possibility of progressive transformations carried out by F. Pinel was prepared by the entire course of social and political events. Pinel was the first to create human conditions for the mentally ill in a hospital, removed the chains from them, developed a system for their treatment, attracted them to work, and determined the main directions of the study of mental illnesses. For the first time in history, the mentally ill were restored to their human and civil rights, and mental institutions began to turn into medical hospitals.

F. Pinel's ideas were developed by an English psychiatrist John Conolly, who fought for the elimination of measures of mechanical restraint of patients in psychiatric hospitals.

In the Russian Empire, the first psychiatric institution was opened in Riga in 1776.

Sergey Sergeevich Korsakov(1854-1900), one of the founders of the nosological direction in psychiatry. Described for the first time a new disease - alcoholic polyneuritis with severe memory disorders

He was a supporter of non-embarrassment of the mentally ill, developed and introduced into practice a system of their bed keeping and supervision at home, paid great attention to the prevention of mental illness and the organization of psychiatric care. His "course in psychiatry" (1893) is considered a classic and has been reprinted many times.

21.6 Surgery (from the Greek. Chier - hand, ergon - action; literally "handicraft") is an ancient branch of medicine dealing with the treatment of diseases by means of manual techniques, surgical instruments and devices (surgical intervention).

In all likelihood, the oldest surgical techniques were aimed at stopping bleeding and healing wounds. This is evidenced by the data of paleopathology examining the fossil skeletons of ancient humans (fusion of bones, amputation of limbs, trepanation of skulls). The first written evidence of surgical operations is contained in the hieroglyphic texts of ancient Egypt (II-I millennium BC), the laws of Hammurabi (XVIII century BC), Indian samhits (first centuries AD). The development of surgery is devoted to the works of the "Hippocratic Collection", the works of prominent doctors of ancient Rome (Aulus Cornelius Celsus, Galen), the Byzantine Empire (Paul from Aegina), the medieval East (Abu l-Qasim al-Zahrawi, Ibn Sina).

21.6.1 the three-volume manual "Surgery" by Lavrenty Geister (Heister, Lorenz, 1683-1758), an outstanding German surgeon of the 18th century, one of the founders of scientific surgery in Germany. This work (Fig. 144) was translated into almost all European languages ​​(including Russian) and served as a guide for many generations of surgeons. Its first volume consists of five books: "On wounds", "On fractures", "On dislocations", "On tumors", "On ulcers." The second is devoted to surgical operations, the third to dressings. L. Geister described in detail the operation of the shin amputation, which at that time was most often performed in the field in the theater of operations. Her technique was developed so clearly that the entire operation lasted a matter of minutes. In the absence of anesthesia, this was of paramount importance for both the patient and the surgeon. Among the founders of French surgery is Jean Dominique Larrey (Larrey, Dominique Jean, 1766-1842). As a surgeon, he participated in the expedition of the French and navy to North America, was the chief surgeon of the French army in all of Napoleon's campaigns. Larrey was the founder of military field surgery in France. He was the first to create a mobile medical unit to transport the wounded from the battlefield and provide them with medical assistance. introduced a number of new operations, dressings and manipulations into the practice of "military field surgery."

EO Mukhin published his works “Description of surgical operations” (1807), “The first principles of bone-setting science” (1806) and “ Course of Anatomy "in eight parts (1818). He made a significant contribution to the development of Russian anatomical nomenclature. On his initiative, anatomical rooms were created at Moscow University and the Medical-Surgical Academy, teaching of anatomy on cadavers and the production of anatomical preparations from frozen corpses were introduced. ... 1832 NI Pirogov defended his doctoral dissertation "Is the ligation of the abdominal aorta for aneurysm of the groin area an easy and safe intervention?" ("Num vinetura aortae abdominalis in aneurysmate inguinali adhibita facile ac tutum sit remedium?"). Her conclusions are based on experimental physiological studies on dogs, rams, and calves. NI Pirogov has always closely combined clinical activity with anatomical and physiological research. That is why, during his scientific trip to Germany (1833-1835), he was surprised when he discovered that “neither Rust, nor Graefe, nor Dieffenbach knew anatomy” and often consulted anatomists. At the same time, he highly appreciated B. Langenbeck (see p. 289), in whose clinic he improved his knowledge of anatomy and surgery. On his return to Dorpat (already as a professor at the University of Dorpat), N.I. Pirogov wrote a number of major works on surgery. Chief among them is "Surgical Anatomy of Trunks and Fascia" (1837), awarded in 1840 with the Demidov Prize of the St. Petersburg Academy of Sciences - the highest award for scientific achievements in Russia at that time. This work marked the beginning of a new surgical approach to the study of anatomy. Thus, N.I. Pirogov was the founder of a new branch of anatomy - surgical (i.e., topographic in modern terminology) anatomy, which studies the mutual arrangement of tissues, organs and body parts. medical and surgical academy. The years of work at the academy (1841-1846) became the most fruitful period of his scientific and practical activity. At the insistence of N.I. Pirogov, a department was first organized at the academy. hospital i surgery (1841). Together with professors K.M.Ber and K-K-Seidlitz, he developed a project for the Institute of Practical Anatomy, which was created at the Academy in 1846. At the same time, heading both the department and the anatomical institute, N. I. Pirogov ran a large surgical clinic and consulted in several St. Petersburg hospitals. After a working day, he performed autopsies and prepared materials for atlases in the morgue of the Obukhov hospital, where he worked by candlelight in a stuffy, poorly ventilated basement. For 15 years of work in St. Petersburg, he performed almost 12 thousand autopsies.

21.6.2 The first doctor who paid attention to the analgesic effect of nitrous oxide was the American dentist Horace Wells (Wells, Horace, 1815-1848). In 1844, he asked his colleague John Riggs to remove his tooth under the influence of this gas. Operation was successfully completed. In 1846, the American dentist William Morton (Morton, William, 1819-1868), who experienced the sedative and analgesic effect of ether vapors, suggested that J. Warren check this time the effect of ether during the operation. Warren agreed and on October 16, 1846, for the first time, he successfully removed a tumor in the neck area under ether anesthesia given by Morton. W. Morton received from his teacher - chemist and physician Charles Jackson (Jackson, Charles, 1805-1880), who should rightfully share the priority of this discovery. Russia was one of the first countries where ether anesthesia was widely used. The scientific substantiation of the use of ether anesthesia was given by N.I.Pirogov. In experiments on animals, he conducted a wide experimental study of the properties of the ether with various methods of administration (inhalation, intravascular, rectal B, etc.) with subsequent clinical testing of individual methods (including on oneself). On February 14, 1847, he performed his first operation under ether anesthesia, removing a breast tumor in 2.5 minutes. In the summer of 1847, NI Pirogov was the first in the world to use ether anesthesia on a massive scale in the theater of military operations in Dagestan (during the siege of the village of Salta). The results of this grand experiment amazed

21.6.3 The first experiments on blood transfusion to animals began in 1638 (K. Potter), 10 years after the publication of labor. However, scientifically grounded blood transfusion became possible only after the creation of the doctrine of immunity (I.I. he was awarded the Nobel Prize. Later A. Decastello and A. Sturli (A. Decastello, A. Sturli, 1902) discovered another blood group, which, in their opinion, did not fit into Landsteiner's scheme. In 1907, the Czech physician Jan Jansky (Jansky, Jan, 1873-1921), who studied the effect of blood serum of mentally ill patients on the blood of experimental animals at the psychoneurological clinic of Charles University (Prague), described all possible variants of agglutination and confirmed the presence. four blood groups in humans and created their first complete classification, denoting Roman numerals from I to IV. Along with the digital, there is also an alphabetic nomenclature of blood groups, approved in 1928 by the League of Nations.

21.6.4 Pain The French surgeon Jules Emile Pean (Reap, Jules Emile, 1830-1898) made a great contribution to the development of the technique of operations on the organs of the abdominal cavity. He was one of the first to successfully carry out an oophorectomy (1864), developed a technique for removing ovarian cysts, and for the first time in the world removed a part of the stomach affected by a malignant tumor (1879). The outcome of the operation was fatal.

The first successful resection of the stomach (1881) was performed by the German surgeon Theodor Billroth (Billroth, Theodor, 1829-1894), the founder of gastrointestinal surgery. He developed various methods of gastric resection, named after him (Billroth-I and Billroth-P), for the first time performed resection of the esophagus (1892), larynx (1893), extensive excision of the tongue for cancer, etc. T .. Billroth wrote about a large the influence of N.I. Pirogov on his activities. (Their sympathies were mutual - it was to T. Billroth that N.I. Pirogov went to Vienna during his last illness.)

T. Kocher made a great contribution to the development of abdominal surgery, traumatology and military field surgery, to the development of antiseptic and aseptic problems.

In Russia, a whole era in the history of surgery is associated with the activities of Nikolai Vasilyevich Sklifosovsky (1836-1904). In 1863 he "defended his doctoral dissertation" On a blood peri-uterine tumor. "Developing abdominal surgery (of the gastrointestinal tract and genitourinary system), N. V. Sklifosovsky developed a number of operations, many of which bear his name. In traumatology, he proposed an original osteoplasty method of joining bones ("Russian castle", or Sklifosovsky castle).

Obstetrics (from the French accoucher - to help with childbirth) - teaching about pregnancy, childbirth and the postpartum period.

Gynecology (Latin Gynaecologia; from the Greek gyne (gynaikos) - woman and logos - teaching) - in a broad sense - the doctrine of a woman, in a narrow sense - about female diseases.

Both of these areas are the most ancient and were not separated until the 19th century - the doctrine of female diseases was an integral part of the doctrine of obstetrics.

The development of obstetrics as an independent clinical discipline began in France at the turn of the 17th -18th centuries. This was facilitated by the organization of obstetric clinics. The first obstetric clinic was opened in Paris (17th century) at the Hotel-Dieu hospital. The first school of French obstetrics was formed here, represented by François Morisot (1673-1709). F. Morisot - the founder of the first school of obstetrics in France. He is the author of a comprehensive manual on the diseases of pregnant women (1668), proposing several new obstetric operations and instruments.

Formation of obstetric education in the 50s of the 18th century in Russia was associated with the creation in Moscow and St. Petersburg of women’s schools, which trained "sworn attendants" (educated midwives, midwives). In the first years of study, foreigners initially taught: one doctor (professor of women’s business) and one doctor (obstetrician). The training was theoretical and ineffective. There were difficulties in recruiting female midwives, the enrollment was limited.

In 1784, Nester Maksimovich Maksimovich - Ambodik (1744 - 1812), the first Russian professor of midwifery art (1782), one of the founders of scientific obstetrics, pediatrics, and pharmacognosy in Russia, began teaching at the St. Petersburg school for women. After graduating from the St. Petersburg hospital school, he was sent to the medical faculty of the University of Strasbourg, where in 1775 he defended his doctoral dissertation on the topic: human liver.

In Russia, he organized the teaching of women’s business at a high level: he acquired obstetric instruments, accompanied lectures with demonstrations on a phantom and at the bedside of women in labor. A phantom of a female pelvis with a wooden child, straight and curved steel forceps with wooden handles, a silver catheter and other instruments were made according to his own models and drawings.

His major work "The Art of Poaching or the Science of Woman's Business" was the first Russian manual on obstetrics and pediatrics. N.M. Maksimovich-Ambodik first began teaching obstetrics in Russian. One of the first in Russia to use obstetric forceps.

The first model of obstetric forceps was developed in England in 1569 by the physician Guillaume Chamberlain (1540-1559) and improved by his eldest son Peter Chamberlain. However, this invention remained a secret of the Chamberlain dynasty for several generations.

In clinical practice, obstetric forceps began to enter in 1723. The Dutch anatomist and surgeon J. Palfyn (1650-1730) presented several samples of obstetric forceps of his own invention for testing at the Paris Academy of Sciences. Palphin's forceps were notable for their imperfect design: they consisted of two wide non-criss-crossing steel spoons on wooden handles, which were tied after being applied to the head. The first description of forceps appeared in

1724 in the second edition of the manual "Surgery" by L. Geister. Since that time, new modifications of obstetric forceps began to be created.

The French obstetrician André Levre (1703-1780) gave his long forceps a pelvic curvature, improved the lock, bent the ends of thin handles with a hook outward, established the indications and methods of using his model.

The forceps of the English obstetrician William Smeley were short and had the perfect lock that became typical of all subsequent English systems.

In Russia, obstetric forceps were first applied by the first professor of the Faculty of Medicine of Moscow University I.F. Erasmus, who in 1765 began teaching obstetrics at the Department of Anatomy, Surgery, and Woman's Art.

In 1790, the department of obstetric art at Moscow University was headed by Doctor of Medicine Wilhelm Mikhailovich Richter (1783-1822). VM Richter opened a three-bed obstetrics institute at the Clinical Institute of Moscow University, where clinical teaching of obstetrics was carried out.

The introduction of ether and chloroform (1847) anesthesia, the beginning of the prevention of childbirth fever, the development of the doctrine of antiseptics and asepsis opened up great opportunities for obstetric and gynecological practice.

In Russia, the first gynecological departments were opened in St. Petersburg and Moscow. The beginning of the surgical direction in Russian gynecology was laid by Aleksandr Aleksandrovich Kiter (1813-1879), a talented student of N.I. Pirogov. For 10 years, A.A. Kitter headed the Department of Obstetrics with the study of women's and children's diseases at the St. Petersburg Medical-Surgical Academy; he wrote the first Russian textbook on gynecology "A Guide to the Study of Women's Diseases" (1858) and performed the country's first successful transvaginal surgery to remove the uterus affected by cancer (1842).

A great contribution to the development of operative gynecology and operative obstetrics was made by A.A. Kiter's student Anton Yakovlevich Krassovsky (1821-1898). He was the first in Russia who performed successful operations of ovariotomy (oophorectomy) and removal of the uterus and constantly improved the technique of these surgical interventions, proposed an original classification of the forms of a narrow pelvis, clearly dividing the concepts of "anatomically narrow pelvis" and "clinically narrow pelvis", and developed indications for the imposition of obstetric forceps, limiting their unjustified use with a narrow pelvis.

Antiseptics (lat. Antiseptica; from the Greek. Anti - on the contrary, septicos - putrefactive, causing suppuration) - a set of measures aimed at destroying microorganisms in a wound, pathological focus or the body as a whole.

The empirical principles of antiseptics are associated with the name of the Hungarian obstetrician Ignaz Semmelweis (1818-1865), professor at the University of Budapest. Working at the clinic of Professor Klein, after long-term observations, Semmelweis established that the infectious principle that causes fever in childbirth is introduced by the contaminated hands of students who come to the maternity ward after anatomy of corpses. Having understood

the reason, he proposed a method of protection - washing hands with a solution of bleach. As a result, mortality in the maternity ward dropped to 1-3% (1847).

Pasteur's idea of ​​the role of microorganisms in the development of wound infection in surgery was first introduced by the English surgeon Joseph Lister (1827-1912) - the founder of antiseptics, professor, president of the Royal Society of London. Lister was the first to introduce chemical methods of dealing with wound infection. Having connected the suppuration of wounds with the ingress and development of bacteria in them, he gave a scientific explanation of surgical infection and for the first time developed a set of measures to combat it.

Lister's method is based on the use of 2-5% solutions of carbolic acid (water, oil, alcohol) and represents a harmonious system of antiseptics (destruction of microbes in the wound itself) with aseptic elements (treatment of objects in contact with the wound). The hands of surgeons were treated with a solution of carbolic acid, instruments, dressings and sutures were disinfected, and the surgical field was treated. Lister proposed an absorbable antiseptic catgut as a suture.

Lister attached particular importance to the fight against airborne infection. In the operating room, carbolic acid was sprayed with a nebulizer before the operation. After the operation, the wound was closed with an airtight bandage treated with carbolic acid and consisting of three layers. The first layer is silk, impregnated with carbolic acid in a resinous substance. Eight layers of gauze treated with carbolic acid with rosin and paraffin were applied over the silk. The top was covered with oilcloth and tied with a bandage soaked in carbolic acid.

Postoperative complications and mortality decreased several times. The teachings ushered in a new antiseptic era in surgery. He was elected an honorary member of European scientific societies and president of the Royal Society of London (1895-1900).

However, the carbolic bandage did not allow air to pass through, which led to extensive tissue necrosis. Vapors of carbolic acid caused poisoning of medical personnel and patients, washing the hand and the operating field led to skin irritation.

In the late 80s of the 19th century, the asepsis method was scientifically developed.

Asepsis (lat –aseptika; from the Greek a– - prefix of negation, and septicos – putrefactive, causing suppuration) is a system of measures aimed at preventing the ingress of microorganisms into the wound, tissues, organs and body cavities during surgery, dressings and other medical procedures.

The aseptic method is based on the action of physical factors and includes sterilization in boiling water or steam of instruments, dressings and sutures, a special system for washing the surgeon's hands, as well as a set of sanitary and hygienic and organizational measures in the surgical department. In order to ensure asepsis, they began to use radioactive radiation, ultraviolet rays, ultrasound, etc.

The founders of asepsis were German surgeons Ernst Bergman (1836), the founder of the surgical school and his student Kurt Schimmelbusch (1860-1895). The idea of ​​the method was inspired by the practice of R. Koch, who sterilized laboratory glassware with steam. In 1890, Bergmann and Schimmelbusch first reported on the method of asepsis at the 10th International Congress of Physicians in Berlin.

Asepsis and antiseptics

Asepsis is a set of methods and techniques of work aimed at preventing infection from entering the wound, into the patient's body, creating microbial, sterile conditions for all surgical work by using organizational measures, active disinfecting chemicals, as well as technical means and physical factors.

Antiseptics is a system of measures aimed at destroying microorganisms in a wound, a pathological focus, in organs and tissues, as well as in the patient's body as a whole, using active chemicals and biological factors, as well as mechanical and physical methods of exposure.

An obstetrician pioneered the fight for cleanliness in hospitals Semmelweiss... Trying to understand the causes of postpartum fever (sepsis), Semmelweis suggested that the infection is brought from the infectious and pathological departments of the hospital. Zemmelweis ordered the hospital staff to disinfect their hands by dipping them in a solution of bleach before manipulating pregnant women and women in labor. Thanks to this, mortality among women and newborns fell more than 7 times - from 18 to 2.5%.

Joseph Lister the largest English surgeon and scientist, the creator of surgical antiseptics. Considering that similar ideas of I.F.Semmelweis, expressed 20 years earlier, did not meet with understanding, it is precisely to Lister that modern antiseptics actually go back.

BERGMAN one of the largest surgeons of the 19th century, the founder of asepsis (developed methods of sterilization of surgical instruments, sutures and dressings). He worked in Dorpat, Würzburg and Berlin. The author of the classic. works on the surgery of the skull and brain. He made a great contribution to the development of military field surgery. He designed a number of surgeons. instruments, named. by his name.

SHIMMELBUSH German surgeon, one of the founders of asepsis. A student of E. Bergman. Proceedings on thrombus formation, plastic. surgery, etc. Described the type of mastopathy (disease Sh.). For the first time he performed a total rhinoplasty named after him. Proposed methods of sterilization surgeon. instruments and dressings, anesthesia mask. Fund. aseptic guide healing wounds

Dentistry.

Dentistry teaching about diseases of the oral cavity and maxillofacial area, methods of their diagnosis, treatment and prevention. As a clinical discipline, it has several directions: therapeutic dentistry, surgical dentistry, orthopedic dentistry, pediatric dentistry, etc.

Dentistry emerged as an independent area of ​​medicine only in the late 17th - early 18th centuries. To a large extent, this was facilitated by the activities of the French surgeon Pierre Fauchard, he described about 130 diseases of the teeth and diseases of the oral cavity, studied the causes of their occurrence and the characteristics of the course. On the basis of his research, he compiled one of the first classifications of dental diseases. He also made a significant contribution to dental prosthetics, defects in abnormal growth of teeth and jaws, and is rightfully considered the founder of orthodontics - a section of orthopedic dentistry.

In the first half of the 19th century. translated and original works on dentistry and maxillofacial surgery began to be published in Russian. Among them is the monograph K-F. von Gref"Rhinoplasty

In 1829 "Dentistry, or dental art" was published A. M. Soboleva, which was an encyclopedia of "the latest knowledge for that time in the field of dentistry (therapeutic and surgical dentistry, orthopedics and orthodontics, prevention of dental diseases). The second part of this book, entitled" Children's Hygiene "is devoted to preventive measures and recommendations for caring for children of different ages, aimed at strengthening the health of children in general and the dental-jaw system in particular.

In the first half of the 19th century. dentistry was carried out mainly by doctors who had the right to treat all diseases and perform all operations without exception. Specialization in the field of dentistry was rare. In the middle of the XIX century. significant changes have taken place in teaching dentistry. The widespread practice of training dentists through apprenticeship has been replaced by a system of education in special dental schools. The first "such school was opened in Baltimore (USA) in 1840. Later, dental schools arose in England, France, Russia, Switzerland, Germany. In Russia, a private dental school was opened in St. Petersburg by F. I. Vazhinsky. in order to obtain the title of dentist with the right to prescribe medications, graduates of this school had to pass special examinations at the Military Medical Academy or at the medical faculty of the university.

Since 1885 at the Faculty of Medicine of Moscow University, associate professor of odontology. In 1892, the first independent department of odontology in Russia was organized in St. Petersburg; its founder A.K ... Limberg began to give an independent course of lectures on odontology The development of Russian dentistry was largely facilitated by the activities of scientific and practical dental societies. “The first society of dentists in Russia (Vazhinsky), the society of dentists and doctors engaged in dentistry” (Alimberg).

Initially, he was preparing for the profession of a priest and only at the age of 30 he began to study medicine. In 1792, he entered the Parisian institution for the insane, Bicêtre, as a doctor, and here he acquired an unfading fame for securing permission from the revolutionary convention to remove the chains from the mentally ill.

This courageous act of humanity was crowned with brilliant success in the sense that fears that the insane, not chained, would turn out to be dangerous both for themselves and for those around them, were not justified. Soon, on the initiative of Pinel, patients from other institutions were also freed from their chains, and in general, since then, the principle of their humane maintenance began to spread throughout European homes for the insane, with the possible provision of freedom and living amenities to them. This achievement has become forever associated with the name of Philippe Pinel and brought him recognition in the world.

In addition to this feat, Pinel became famous as a scientist in the field of psychiatry. His treatise on mental illness (1801) is justly considered a classic work, and in general in France P. can be considered the founder of the scientific school of psychiatrists. In addition to psychiatry, Pinel also worked in the field of internal medicine and, in 1789, published an essay ("Nosographie philosophique"), which held the view that medicine should be developed by the same analytical method as natural sciences. This work went through 5 editions for 20 years, was translated into German and at one time played an important role in the development of rational medicine. For many years, Pinel was at the Paris Faculty of Medicine, the department of hygiene, and later internal diseases.

Matt Muigen, speaking of the process of transforming mental health care in Europe, notes that the influence of specialists, mainly psychiatrists, who fought for change, such as Pinel in France in the 19th century and Basaglia in Italy in the 20th century, apparently played a decisive role in it. century: 113. They proposed concepts for new models of humane and effective care that were revolutionary for their time, replacing unsatisfactory and inhuman traditional services: 113. Their real achievement was to get policymakers to support these concepts and convince colleagues to implement them, thereby opening up the possibility of real and lasting change: 113.

When writing this article, material was used from the Brockhaus and Efron Encyclopedic Dictionary (1890-1907).

Scientific works

Pinel Ph. Traité medo-philosophique sur l'aliénation mentale, ou la Manie. Paris: Richard, Caille et Ravier, an IX / 1800 ("Medico-philosophical treatise on mania").

Pinel Ph. Observations sur le régime moral qui est le plus propre à rétablir, dans certains cas, la raison égarée des maniaques // Gazzette de santé. 1789 ("Observations on the emotional appeal, which in some cases can restore the darkened mind of maniacs").

Pinel Ph. Recherches et observations sur le traitement des aliénés // Mémoires de la Société médicale de l'émulation. Section Médecine. 1798 ("Research and observation on the moral treatment of the mentally ill").

April 20 is an important date for the entire psychiatric community. On this day in 1745, Philippe Pinel was born in the south of France - a man whose name is associated with the beginning of a major reform in psychiatry. The reforms, which for the first time created the prerequisites for scientific clinical psychiatry and a humane attitude towards people with mental disabilities.

Who is Philip Pinel

"The era of Pinel" - this phrase became a symbol of the time when a suffering person was recognized in a mentally ill, and not a dangerous animal; when the chains were removed from the unfortunate prisoners of "insane asylums". And the "insane asylums" finally became not prisons, but clinics, where they treated (as best they could), and did not repress the sick in the most cruel ways. Patients became the object of attention of medicine and scientific psychiatric thought. All this is associated with the name of Philippe Pinel.

Pinel was a versatile educated man: he studied first at the seminary, then at the university in Toulouse, absorbed the philosophical trends of the Enlightenment. In 1778, the thirty-three-year-old Pinel came to Paris on foot and without money, but with hopes and ambitious plans. He did not foresee what role he would play in psychiatry at the end of the 18th century and the beginning of the 19th century ...

What were the mental hospitals before Pinel

But in order to assess the scale of Pinel's initiative, we first turn to the conditions in which the mentally ill were kept before the “Pinel era”. For example, Michel Foucault, a philosopher and historian of antipsychiatry, says:

“Large isolation wards are being created (and this is happening throughout Europe), which provide shelter not only to madmen, but also to a whole series of extremely dissimilar, at least in our opinion, individuals; they place poor disabled people, unhappy old people, beggars, convinced parasites, venereal patients, various libertines, those whom the family or royal power seek to protect from social punishment, wasteful fathers of the family, fugitive priests - in a word, all those who are in relation to the laws of reason, morality and society are showing signs of damage. It is for these reasons that the Government opens the General Hospital in Paris, Bicetre, Salpetriere; a little earlier this kind of prison from the former leper colony in Saint-Lazare was created by St. Vincent de Paul, and soon Charenton ... These institutions have no medical purpose ... "

These "shelters", where criminals, vagabonds, incurable syphilitics and the mentally ill were mixed, appear in historical descriptions with the same gloom and hopelessness. Stone walls and windows with bars, people lying on rotten straw, chained up, severely beaten by guards for any "offense". Hunger and cold, rats, screams and groans of people mad from torture, blocks and chains, gloomy stone casemates ... Naturally, no one here recognized the "insane" as sick and did not deal with the issues of their treatment. Moreover, as Yuri Kannabikh notes in his book The History of Psychiatry, the idle public loved to visit this hell and, for a reasonable fee, entertain themselves with the spectacle of suffering and madness, as if in a menagerie. Yes, Philippe Pinel had to start his business in such an environment ...

Asylum in London known as Bedlam

Liberating from shackles

Further, history and legend, facts and beautiful conjectures are inseparable. Assigned to the Bicetre casemate hospital in 1793, Pinel set about reform and began to free people with mental disorders from their chains. Rumors of such an innovation arouse the suspicions of the authorities, and the organizer of the revolutionary tribunals Georges Couton comes to Bicetre, suspecting that political enemies may be hiding among the "madmen". Couton was paralyzed, and his huge body was carried by two, leading him to the unfortunate chained in chains. The formidable paralytic tried to interrogate them, but apart from wild abuse and screams he achieved nothing. They carried him away, and he threw to Philip Pinel: "You yourself are probably mad if you are going to unchain these animals."

As soon as Couton left, Pinel released several dozen patients. Feral and embittered prisoners suddenly became quite quiet and grateful sick. There is, of course, in this story a shade of a beautiful legend, there are also doubts of historians that Couton visited Bicetre, however, the legendary in this story only accentuates the enormous significance (including symbolic) of Pinel's case, who fought for a human attitude towards the mentally ill, which is almost did not find wide understanding and recognition. In Salpetriere, a women's hospital, Pinel also began the release of prisoners, which was captured somewhat melodramatically by R. Fleury's famous painting “Pinel in the Salpetriere”. One way or another, but even the aura of the legend does not diminish, but emphasizes the full significance of his initiatives, the entire weight of a real and symbolic gesture indicating the beginning of a new psychiatry. After all, legends appear only when an event carries a special meaning.

R. Fleury. Pinel in the Salpetriere

Moral sadism - to replace the shackles

Of course, history is more complex, slower, and not as theatrical and beautiful as legends (even within the scientific community). Pinel did not come suddenly, like the messiah, to the dark earth. Historically, his reforms matured and matured for a long time. Even before the "Pinel era", there were humane approaches to those suffering from mental illness. Suffice it to recall the guesthouses at the Charenton and Sanly hospitals in France, opened by the Order of the Ioannites. Or the York Asylum in England, founded by Tuke, who belonged to the Quaker sect. In this hospital, there was a good attitude towards patients, and good food, care, a clean and pleasant environment. There were also rooms for studies and games of patients, gardens for walking. For many years, public and medical thought has discussed what made Pinel famous. Surprisingly, little was known about the York Asylum in the world. All local initiatives did not change the general state of affairs. The news of the reforms, of course, could only come from where there is a professorial department, from a large cultural center. The center of the European culture of that time was Paris, the presence of a department and a scientific community - these happy circumstances helped Pinel to influence the entire civilized world of that time, although not immediately. Not at all right away ...

By the way, critical historians of psychiatry draw attention to the fact that in the psychiatry of the Pinel era (and later), people with mental illness, freed from the iron shackles, were captured by the shackles of moral assessment and moral punishment. Rough pseudo-medical methods of "treatment" were now applied in a moral context. Michel Foucault writes:

“The shower no longer chilled, but punished - now it was necessary to use it not when the patient was“ hot ”, but if he had committed an offense; even in the middle of the 19th century, Loret will direct his sick ice souls to the head and at this moment will try to establish a dialogue with them, demanding to admit that their faith is just delirium. "

“In the new world of hospitals, in this punishing world of morality, madness has become mainly a fact of the human soul, its guilt and its freedom. (…) But this psychologization is only an external manifestation of a more secret and deeper process - the process by which madness is immersed in a system of moral values ​​and repression. It is enveloped in a punitive system, where a madman, when he is younger, approaches a child in his rights, and where madness with a sense of guilt instilled in him turns out to be initially associated with vice. ".

Michel Foucault argues that it was the "moral sadism" of the new type of clinic that created all the "psychology" of insanity we know of, with its secret mental nooks and crannies and torments. It seems that this is still an extremely one-sided statement, albeit based on the correct indication of the vicious connection between psychiatry and philistine moralism, which has no medical meaning. But moralism in psychiatry had to be fought in the 20th century as well.

The results of Pinel's work and the principles of psychiatry

Meanwhile, what was the essence of the case of Philippe Pinel, he left as a testament to future generations, who continued the humanization of psychiatry. I will briefly summarize his case, following mainly the instructions of the historian of psychiatry Yuri Kannabikh:

- The prison regime with shackles and chains is subject to decisive expulsion from hospital use. It is necessary to create a favorable environment for the treatment of psychosis.

- Measures of restraint for patients, for example, "violent", should be soft and always medically justified (only temporary tying to a bed, a straitjacket, in extreme cases an isolator are permissible).

- Understanding that the setting and psychological atmosphere of the clinic are critical in healing a suffering soul.

- The need for scientific activity in the clinic as a well-equipped institution, including keeping records of observation of the condition of patients, medical history. It is necessary to find out the causes of the disease, search for effective therapy.

- Psychiatry should be based on objective observation and natural science, avoiding metaphysics and dependence on vague philosophical hypotheses.

These are the first and necessary principles of clinical psychiatry. It is with this approach, as historians note, that for the first time a person with a mental illness appears in his true image, not distorted by humiliation, fear of beatings, anger and complete alienation from human communication and understanding. Unfortunately, history shows that the bright ideas of some run up against the prejudices and inertia of others, so that what was realized in the 18th century is far from being fully realized to this day ... The era of Pinel, of course, did not eliminate all the contradictions in the practice of keeping and treating the mentally ill. The fight against the still remaining measures of violent restraint of patients is associated with the name of John Connolly, but this is a different era and a different theme.

Pinel School

And one more thing: it is essential that Pinel was not a lone comet "in a circle of calculated stars", but created a school of psychiatrists, a scientific tradition. Among his students was the famous Jean-Etienne Dominique Eskirol, the result of which was the "Law on the Mentally Ill" in 1838. This is the first legislative act that takes into account the rights of the mentally ill and, in particular, requires a mandatory medical examination for placement in a psychiatric clinic.

Jean-Etienne Dominique Eskirol

Eskirol also headed the world's first department of psychiatry, which has since become a separate branch of medical science. If the systematics of diseases, created by his teacher Pinel, is still little developed and archaic, then Eskirol's systematics is a significant step forward. The increasing accumulation of accurate clinical observations and their analysis is the foundation of a new science. Following Eskirol, there are those who were his students and founders of psychopathology in the entire 19th century: Georges, Beyarget, Moreau, Morel ...

What we call modern psychiatry would hardly have been possible without the Pinel era, without his bold and humane reform of psychiatry at the turn of the 18th and 19th centuries, when the thought of such a reform not only to the philistine majority, but also to many doctors seemed insane, otherwise and just stupidity.

French psychiatrist. Initially, he was preparing for the profession of a priest and only in the thirtieth year of his life began to study medicine.

life and creation

In 1792 he was appointed physician of the Parisian institution for the insane Bicetre. In Bicetra, Pinel performed an act of humanity that became famous: he procured permission from the revolutionary Convention to remove the chains from the mentally ill.

Pinel gave patients freedom to move around the hospital grounds, replaced gloomy dungeons with sunny, well-ventilated rooms, and offered moral support and good advice as a necessary part of treatment.

Pinel's act of humanity was crowned with success: fears that the insane, not chained, would turn out to be dangerous both for themselves and for those around them, were not justified. The well-being of many people who were locked up for decades showed significant improvements in a short time, and these patients were released.

Soon, on the initiative of Pinel, patients of other institutions were also freed from chains (in particular, the Salpetriere, the Parisian hospital for women with mental disabilities), and the principle of their humane maintenance, with the provision of freedom and living amenities, became widespread in Europe. This achievement, firmly associated with the name of Philippe Pinel, brought him worldwide recognition.

Pinel also became widely known as the author of scientific works in the field of psychiatry. His treatise on mental illness (1801) is considered a classic; in France Pinel is the founder of the scientific school of psychiatrists. In addition to psychiatry, he also worked in the field of internal medicine and in 1797 published the essay "Nosographie philosophique", which argued that the method of research in the field of medicine should be analytical, as in the natural sciences. This work went through 6 editions for twenty years (in 1797, 1803, 1807, 1810, 1813 and 1818), was translated into German and played a major role in the development of rational medicine. For many years, Pinel held the Department of Hygiene at the Paris Faculty of Medicine, and later - of internal medicine.

Evaluations

Matt Muigen, speaking of the process of transforming mental health care in Europe, notes that in this process, obviously, the influence of specialists, mainly psychiatrists, who fought for change, such as Pinel in France in the 19th century and Basaglia in Italy in XX century. They proposed concepts for new models of humane and effective care that were revolutionary for their time, supplanting unsatisfactory and inhuman traditional services. Their real achievement was to get policymakers to support these concepts and convince colleagues to implement them, thereby opening up the possibility of real and lasting change.

According to Yu.S. Savenko, psychiatry took shape as a science and scientific practice only after Pinel's reform - after the removal of the sick chains and the elimination of the police rank as the head of the hospital. As noted by Yu. S. Savenko, these two principles (the principle of voluntariness and partial denationalization) remain relevant in psychiatry to this day; without their observance, the objectivity of diagnostics and expert opinions and the effectiveness of treatment are sharply reduced.

Scientific works

1. Pinel Ph. Traité medo-philosophique sur l'aliénation mentale, ou la Manie. Paris: Richard, Caille et Ravier, an IX / 1800 ("Medico-philosophical treatise on mania").
2. Pinel Ph. Observations sur le régime moral qui est le plus propre à rétablir, dans certains cas, la raison égarée des maniaques // Gazzette de santé. 1789 ("Observations on the emotional appeal, which in some cases can restore the darkened mind of maniacs").
3. Pinel Ph. Recherches et observations sur le traitement des aliénés // Mémoires de la Société médicale de l'émulation. Section Médecine. 1798 ("Research and observation on the moral treatment of the mentally ill").

Philippe Pinel (Pinnel) is a famous French psychiatrist and humanist.

Pinel was born in 1745 in Saint-André in d, Arleac in the family of a doctor. In his youth, Philip, having received his education at a Jesuit college, was preparing to be ordained a priest. He studied literature, linguistics and philosophy, but in 1767 decided to enter the university at the Faculty of Mathematics. Having successfully graduated from the university in 1970, Pinel works as a teacher, but he is fascinated by medicine, and he enters the medical faculty. After another 3 years, Philippe Pinel defended his doctoral dissertation at the University of Toulouse and is engaged in zoology at the University of Montpeigne.

In 1778 he moved to Paris, where he worked as an internal medicine doctor, earning private lessons in mathematics. During these years F. Pinel is fond of philosophy, visiting the salon of the widow Helvetius, writing articles and dissertations to order.

From 1784 to 1789 he created a newspaper about health, which is still being published. As editor-in-chief of the newspaper, Philip publishes his articles on psychiatry and hygiene in it. In 1787 he writes a work that is the premise of geopsychology. In it, Pinel points to the relationship between mental illness and the season, climate. And the work on analytical methods used in medicine, published in 1798, brought him wide fame.

In those years, Pinel worked as a psychiatrist in the private clinic of Dr. Belomme, it was there that he conceived the idea of ​​a humane attitude towards mentally ill people, when it was necessary to treat people not with violence, but with persuasion.

In 1793, Philippe Pinel was appointed chief physician of the famous Bisert Hospital, intended for the mentally ill and elderly disabled. This place had a bad reputation - here the sick were treated worse than criminals, they were kept in chains, in dark, damp rooms. Disgusting living conditions, hunger and disease - such was the reality of Bisert.

While working in this hospital, Philippe Pinel obtained permission from a revolutionary convention to remove the chains from mentally ill people. In 1798, the last patient of the Bisert hospital was released from chains. The conditions of detention of the insane have changed from prison to treatment.

Thanks to this initiative, the chains were removed from the patients of other clinics, and in Europe the idea of ​​a humane attitude towards the mentally ill, giving them some freedom and rights, as well as living amenities, spread.

Thanks to this act of humanity, Philippe Pinel became famous and recognized throughout the world. He is rightfully considered the founder of scientific, clinical psychiatry in France. The principles of attitudes towards mentally ill people laid down by F. Pinel - voluntariness and partial denationalization - are still used today.

Philippe Pinel is the author of many scientific papers on psychiatry. First of all, this is a treatise on mental illness, published in 1801, and articles on the maintenance of the mentally ill, for which Pinel was elected a member of the French Academy. For his attitude towards sick people, the scientific works in the field of medicine of Philippe Pinnel are rightfully considered an outstanding psychiatrist of the 18-19 centuries.