INTRODUCTION

Dear colleagues!

It is a joyful day today both in your life and in the life of the department. After you learnt the bases of anatomy, histology and some other disciplines, the clinical life begins. We are glad to greet you in the General Surgery Department and to share our experience and skills with you. We sincerely congratulate you on this day — the beginning of clinical disciplines studying.

The students work in the clinic and direct contact with patients, as well as the work in operating, dressing and other rooms of the surgical hospital, has features to which students should pay attention from the first day of study at the surgical clinic. Some of them are following:

The students for the first time come into professional contactwith patients, get acquainted with various diseases and psychology of a sick person. It is necessary to remember, that not every patient with readiness will agree to be an object of study, and in many cases patients reject that students carry out dressings or any other medical and surgical manipulations. This is connected with distrust to the quality of student’s knowledge and care of health. Therefore, it is very important that students, as soon as possible, acquire theoretical and practical skills, have a professional appearance and deserved the patient’s trust.

In each surgical clinic there are always some severily ill patients with various pathologies. Some patients are nervous, expecting for operation; others are already recovering from surgical intervention and demand, naturally, intensive therapy, rest, and care. Therefore, silent conversation gets special significance in surgical clinic, it is impossible to laugh, joke, and behave thoughtlessly, it is necessary to observe order while moving as groups of students through the corridors and chambers, from one to another floor. It is no less significant to know that training is being carried out at the same time with correct and sensitive approach to the patient;

Features of surgical methods of treatment and threat of woundsinfection demand to stick to specific actions, which directed to preserving sterility of dressing and instruments, surgeon’s and operation sister’s clothes, protection of postoperative wound against infection. At the operation block, dressing and manipulation rooms, special rules of behavior and certain habits, which students will gradually seize, have been developed. We shall acquaint you with them during lectures and practical classes, during the time of night duty in the clinic, during practical training, lessons in the circle of student’s scientific organization (SSO). Today it is important that you carry out all of these requirements, which are directed towards the protection of the patient against infection.

It is necessary to remember that a student should always have a tidy appearance, clean lab coat, medical mask, change of shoes.

Despite of achievements of surgery, surgical methods of treatment still now are aggressive and cause the negative emotions in people which are not used to that. Changing a dressing is mostly painful and surgical intervention is frequently accompanied by significant haemorrhage and suppuration. Experience testifies that during the first attendance of these work sites students feel bad, lose consciousness while observing surgical operations or manipulations. It is necessary to remember this, and at the first displays of feeling bad students should immediately inform the teacher.

HISTORY OF SURGERY DEVELOPMENT

Surgery is a section of medicine, which because of different social and economic periods developed extremely irregularly. After the period of prosperity in some ancient countries (2–4 thousand years BС) the period of its almost full degradation came in the middle ages when the church domination hindered sharply the development of medicine and surgery. At last, from ХІХ–ХХ century up to the present time, the period of most intensive and rapid surgery development has proceeded.

Information about surgery is received from archeological excavations of old burials, old manuscripts, papyruses and books, pictures on rocks, vases, antique sculptures and even from national eposes and legends, proverbs, sayings, etc. Early people struggled with the forces of nature, trusted in evil and kind spirits, and used elementary means of treatment. There is no doubt that the most ancient medical tools were used in case of traumatic damages (while hunting, at war) and in wound complications, in the case of bleeding during birth and other diseases.

Through the person’s importence to the forces of nature animalism and fetishism, shamanism and sorcery got wide spreading. All natural phenomena (fire, water, air, ground) and all illnesses of a person were connected with evil spirits (fever, shakes, swelling, etc.), which should be gotten rid of, expelled from the body of a patient or deceived (dance with noisy effects, masks, terrible clothes of shaman). Gradually people who had “contact” with these spirits singled out into separate castes of pagan priest and sorcerers.

Such “skilled craftsmen” were mostly concentrated in the temples, churches, imperial palaces, empirically accumulating experience for treating diseases and mixing this experience with demonisms and mysticism. So, gradually being separated, two qualitatively different directions were developed in medicine: temple medicine, which was more perfect and scientific, and folk medicine, which was primitive and developed empirically, without any claims for scientific character of knowledge.

“Surgery” (from Greek cheіr — hand, еrgon — action) means “hand action”. This name occurred in the ancient times and was also used for contraposition of surgery as a trade to internal medicine, which was not investigated enough yet, complex and mysterious science. People who had full training in temples or in special medical schools were engaged in internal medicine. Any person had an opportunity to be engaged in hand action, i. e. dressing of wounds, stop of external bleeding, setting of dislocations and treatment of fractures. More often this work was carried out by the uneducated barber, chiropodist or soldier-sorcerers, sorcerers.

For many thousands of years, people with diverse diseases, which had external attributes of illness — wounds, trophic ulcers, abscesses, inflammatory diseases of the eyes and external genitals, parasitic illnesses and tumours, visited such “surgeons”. Thus, the circle of pathological conditions in which the surgeons were engaged was very big, but the level of theoretical grounding of these doctors — very low.

Nevertheless, there was a quick decrease in culture, science and medicine, which was observed during the Middle Ages and that for 2–4 thousand years BC in many countries of the ancient world there was enough developed and well organized medicine and surgery.

Despite the elementary view about the world (recognition of the four elements — ground, water, air and fire), in ancient Egypt and Iran, Assyria and Babylon, India and China there were advanced grain husbandry, complex irrigational systems were buit, mathematics, mechanics and bronze, of which knifes and other medical tools were developed.

In these countries with a hot climate and a lot of skin and parasite diseases the priest of temple medicine gave a lot of attention to hygiene, body cult, water procedures and physical exercises. Bodies of the dead rather frequently were embalmed, therefore doctors of temple medicine had some conception of anatomy and human physiology, knew about the movement of the blood in vessels and distinguished the lighter “blood of the day” and darker, venous blood, which they named “blood of the night”.

For doctors and military doctors training, the special schools were created, and in Egypt — the “House of Life,” where young men studied nature, veterinary science and medicine. Among the doctors that were engaged in practice, some specialization was even observed, because someone became famous for experience in the treatment of eye and skin diseases, others — in the treatment of external genitals, others — in the treatment of mental diseases.

The most notable doctors specialized in internal diseases, which they treated with herbs, diet, physical exercises or councils. Surgeons were engaged in “hand action”, that is treated wounds and wound complications, bleedings, fractures and dislocations, superficially located purulent diseases and tumours. Thus, they differed from doctors of internal diseases, which developed the so-called “medicine of herbs” — surgeons gave more attention to practical habits and improvement of “knife medicine”. Thus, for the reduction of painful sensations doctors gave wine, opium, mandragora extract to their patients. While performing surgical interventions, they used bronze knifes and a big set of other surgical tools.

Nevertheless, understanding the extent of complexity and responsibility of surgical operations, rather severe laws were declared in some countries, which, undoubtedly, limited a wide development of surgery. The fullest idea of medicine and doctors of that time we received from the so-called code of laws of tsar Hammurapy from Babylon and the laws of Asbestos from Iran, where the questions of payment and compensations for the successful treatment, a certain degree of punishment for an unsuccessful operation and consequences of bad treatment were very precisely determined.

It is necessary to note, that only people who proved their qualification three times and successfully treated patients were admitted to medicine and surgical operations. After successful surgical treatment a “knife owner” was allowed to get payment or fee, which, depending on the patient’s social level and well-being, was paid in cows, sheep, money, ornaments from precious metals or as a mould of the organ which was successfully cured.

At the same time if the knife medicine was used in an unqualified way, and the surgical treatment was poorly done and had negative consequences, the doctor was judged and severely punished — one or both eyes were put out, a finger, wrist or whole hand were cut off.

Doctors had relatively honorable and very high social status in society, but Assyrian laws, nevertheless, specified that the doctor should search for any opportunity to improving his personal knowledge, to be polite, to keep medical secrets, to not afflict patients with unanswerable conjectures, and to speak only of probable things. Any modern doctor can use this wise advice.

Medicine and, particularly, surgery obtained the highest development in ancient China and India. Famous creations of Indian literature are the Ayurveda (“Book of Life”) where centuries-old experience of Indian doctors is generalized, which testifies that surgeons of ancient India treated wounds with success and almost sewed them tightly after the withdrawal of foreign objects, grounded plastic surgery (“Indian way”), with success carried out plastic of the nose, ears, lips. Some historians mark that they also perform abdominal intervention during intestinal obstruction and suturing the intestines.

No less than in India successes of medicine were observed in ancient China. Knife medicine was considered as the most responsible way of treatment which doctors used, who successfully treated patients with “knife incision” no less than three times. In China surgery was very highly appreciated and characterized as a “precious heaven gift and an eternal source of glory”. Chinese surgeons Huato, Ben-tsao used bamboo trunk for fixing fractures, studied anatomy on corpses, performed laparotomy and Cesarean section, used a wide range of medical plants and accupuncture.

Such sciences as “ pulse study”, “studies about the windows of a human body”, “study about the organism juices” (urine, blood, bile, etc.) were created in ancient China. Even in those old times, wise advice, which has not lost its actuality even today, were offered for young doctors. For example: “He who hid an illness from the doctor has deceived himself”, or “Do not treat only the head if the head is ill, or only the leg if the leg is ill”, or “The doctor should treat only that which is possible to cure, but if the disease cannot be cured — try to facilitate the sufferings of the patient”. Unfortunately, it is necessary to note that in some countries where medicine sometimes is a source of enrichment for the doctor, even the patient who does not need an operation, is prescribed treatment which costs a lot and also which is not useful to the patient, but only serves making the doctor wealthier.

Especially rich heritage is left by doctors of ancient Greece and Rome. In these advanced countries, books, collections, which are written by Hippocrates, Celsus, Galen, became a source of medical knowledge and influenced medicine for all peoples of Europe down through the Middle Ages.

Hippocrates (459–377 BC) is an outstanding doctor-physician, talented surgeon and tutor. He attentively collected anamnesis of his patients, in detail described the clinical symptoms of diseases, studied anatomy on corpses. Using various surgical means of treatment, he payed much attention to psychotherapy as well, suggesting physical exercises and natural treatment (sun, air, water). “Hippocrates’ Oath” gained the greatest fame, which young doctors give before beginning professional work.

The development of ancient Rome determined the medicine center transfer from Greece to Rome, though the Roman doctors were followers of Hippocrates. The most outstanding representatives of Roman medicine were Celsus (І century AD) and Galen (ІІ century AD). The works of Celsus and the treatises of Galen were the basic supervising guids for doctors of the West Europe down to ХV–XVІІІ century.

Celsus for the first time used ligature for vessels ligation in wounds with the purpose of bleeding stoppage, used lead tubes for draining wounds. In his works we find the first detailed description of the clinical course of the neglected cancer of the lower lip.

During the first period of his activity Galen was the gladiators’ doctor. He observed the course of processes which occurred in wounds, tried to suture wounds with silk, used bronze tubes for draining wounds. He considered that pus was an obligatory component of the healing process, confusing wound complications with the regeneration process (healing through pyesis). Studying anatomy and human physiology, he considered that the center of blood circulation is not the heart but the liver. He admired very much also the searching for medical herbs and manufacturing curative preparations and “miracle means of treatment”.

Despite the achievements of some representatives of the medical profession, it is necessary to emphasize that there were a few doctors, they treated mainly the palace people and high officials and they were inaccessible for the simple people. A known ancient Greek historian Gerodot described a custom that sick people were brought to crowded areas or markets and people, who were passing by, could give advice concerning treatment.

A lot of the surgical achievements were forgotten after the dawnfall of the Roman empire. Surgery confronted with a violent resistance on the part of church, attendants of a cult and religious fans who forbade autopsy, the performance of any operation connected with bleeding. Attempts of studying anatomy on corpses resulted in accusation of heresy and the scientist was threatened with the fire of inquisition. The domination of the church during the gloomy centuries of the Middle Ages put practically insuperable obstacles for the development of surgery, which became increasingly simpler to transform into craft.

But many daredevils and talented doctors continued to study and develop surgery, overcoming the backwardness of religious prejudices and gained certain successe. There are many outstanding doctors: an Arabian doctor Ibn Sina (Avicenna), who left over 100 scientific works about different questions of medicine and surgery; A. Visalus — a founder of normal anatomy; V. Harvey opened the laws of the blood circulation in a person: Ge De Sholiak, A. Pare′, Bruno De Longenburg, Paracelsus and other surgeons. The whole epoch in the history of surgery was created by M. I. Pyrogov who was not only a fine anatomist, brilliant surgeon, but also a talented scientist, innovator and statesman.

Almost till XVІІІ century progress of surgery was insignificant, that mostly connected with a poor social status of surgeons. An overturn took place in the XVІІІ century, when a surgeon Lafrangi from Milan for the first time was allowed to lecture in surgery at the medical faculty of Sorbona University (1719). In 1731 the French Surgical Academy was founded.

Thus, in spite of the fact that surgical actions belong to the most ancient habits of medical trade, surgeons for a long time did not find recognition in official medicine and even didn’t rank among doctors. It is necessary to note also that even when surgery was at last recognized as the official medical specialty, it could not be improved sufficiently until scientists of the whole world did not found a way to overcome three main obstacles:

Shock, which was frequently observed during an operationbecause of the lack of anesthetizing means.

Infections, which complicated all surgical interventions becauseof lack of aseptic and antiseptic means.

Bleeding and its consequences which doctors could not fightwith because of a still unsolved problem of isohemagglutination and there were no study of blood groups.

Further we shall be convinced that all these main obstacles in surgery development obtained scientific explanations only at the end of the XІX century and mainly in the XX century. Many questions of surgery have not been answered even today and demand studying. But the basic ways concerning the further development of surgery have been already determined and introduce into life actively.

Surgeons of Ukraine, following the well-known traditions of M. I. Pyrogov, B. A. Karavayev, S. M. Kolomnin, M. V. Sklifosovski, O. S. Yatsenko, V. F. Grube, A. G. Podrez and other outstanding surgeons, which worked in Ukraine, achieved great successes. Names of M. M. Volkovich, K. M. Sapezhko, M. P. Trinkler were known far outside of Ukraine. They united the best surgeons, directing their activity by practical application of surgical achievements. The schools of M. M. Volkovich, M. P. Trinkler, and K. M. Sapezhko were inseperably linked with advanced rural surgeons. This connection to a great extent was assisted by M. I. Pyrogov both by his works and by direct participation in creative activity of Ukrainian surgeons. “Pyrogov connected the university, academic surgery to the rural one”, — wrote V. A. Oppel. The close links of the academic surgery with the rural one was one of features of surgical schools in Kiev, Kharkov and Odessa in the first twentieth anniversary of the XX century. M. M. Volkovich, M. P. Trinkler and K. M. Sapezhko’s schools assisted in the association and improvement of the best forces of rural surgery.

Such outstanding Ukrainian surgeons as A. T. Bogayevsky, O. A. Yutsevich, V. G. Kozlovsky, Ya. V. Silberberg, L. I. Malinovsky, etc. were born in the depths of rural surgery. They together with other outstanding surgeons solved a number of major problems in surgery. The successful development of abdominal surgery is obliged to a great extent to A. T. Bogayevsky, M. P. Trinkler, O. A. Yutsevich, M. M. Volkovich, K. M. Sapezhko, V. G. Kozlovsky, L. I. Malinovsky, etc. Besides abdominal surgery, Ukrainian surgeons contributed much to orthopaedics. I. F. Sabaneyev, A. G. Podrez, M. M. Volkovich, K. F. Vegner and other surgeons suggested new osteoplastic operations, developed a functional method for treating bone fractures and other rational ways of treating pseudoarthrosis, contractures, and osteoarticulate tuberculosis. The operations of I. F. Sabaneyev were included into the arsenal of classical operations, and operative receptions and therapeutical ways of treating tuberculosis of the bones, suggested by A. G. Podrez, M. M. Volkovich, N. I. Kefer and other surgeons, have not lost its value even today.

Surgeons Ye. K. Istomin, O. O. Abrazhanov, Ya. O. Galperin, O. I. Meshchaninov, I. P. Sklyarov, I. D. Maslov, Ye. Yu. Kramarenko, V. L. Pokatilo, Ya. V. Silberberg, N. I. Kefer played a big role in the organization of surgical help to the population; also academic surgeons M. M. Volkovich, M. P. Trinkler, O. P. Krimov, I. V. Kudintsev, V. M. Shamov, O. V. Melnikov, etc. worked together with them. They were the initiators of convocation of the first congresses of surgeons.

At the first regional and republican congresses of surgeons (1923; 1927) in Odessa, Kharkov for the first time in the history of surgery the question of improvement of surgical service to rural population, about the struggle against traumatism, the organization of urgent help in acute peritonitis, the problems of cancer, tuberculosis and training of surgical staff were discussed. Other important problems, the solution of which had state importance, discussed at these congresses. The congresses not only summed up the results of work, fixed the achievements, but also elaborated the program of further activity of surgeons in the near future.

Surgeons of Ukraine always actively participated at work of health protection bodies, in the activity of surgical societies, popularized the medical knowledge. They were conductors of major state measures directed to the improvement of the public health care. The surgeons were the initiators of the creation of the efficient system of anticancer and antituberculosis services, precise organization of fast and urgent help in the republic. Prophylactic medical examination of the population, which is one of the basic part of medical prophylaxis, was offered.

Well-known surgical schools were created. V. M. Shamov, O. V. Melnikov, who worked in Ukraine almost 20 years, played a big role in the foundation of these schools. Their numerous followers created surgical schools too. The scientific development of the basic problems of haemotransfusion, introduction into the practice of the cadaveric haemotransfusion, solving importent problems of neurosurgery, abdominal surgery, endocrinology, tissue transplantation, malignant tumours, battlefield surgery belong to V. M. Shamov and his school. He has published more then 100 big works, some monographs and a lot of collections devoted to the most actual questions of theoretical and practical surgery. O. V. Melnikov is one of the founders of the Ukrainian schools of oncologists and gastric surgery. He had trained many followers, who are developing his ideas. He wrote more than 10 monographs and 130 works on problems of modern surgery.

It’s difficult to overestimate the role of O. P. Krimov, M. I. Sitenko, V. P. Filatov, N. I. Kefer, I. V. Kudintsev, Ya. O. Galperin, I. М. Ishchenko, M. M. Amosov, M. S. Kolomiychenko, O. I. Arutyunov, M. P. Novachenko, I. Ya. Deyneka, M. M. Milostanov, Z. Y. Geymanovich, O. O. Shalimov and many other Ukrainian surgeons in the development of surgery.

O. P. Krymov created his own school. He published over 130 works, including 10 monographs and a widely known surgery textbook. His work “The Studies of Hernias” is the most detailed research on this question in world literature. I. V. Kudintsev, the follower of L. V. Orlov, is one of the first organizers of urgent help at the acute surgical diseases. The development of important problems of abdominal surgery and urology belongs to him and his school.

Ya. O. Galperin, a follower of S. I. Spasokukotsky, created his school, suggested a lot of new ideas in surgery of oesophagus, stomach and others. I. М. Ishchenko, a follower of O. P. Krymov, one of the founders of the Ukrainian school of neurosurgeons, published over 100 works devoted to craniocerebral trauma, shock, bleeding, purulent infection, battlefield surgery, surgery of the stomach, spleen, bilious duct, development of the surgical science and the history of surgery. He is the organizer of many congresses and plenums of surgeons of Ukraine.

The development of the chest surgery initiated by Ukrainian surgeons (B. Yu. Frankenberg, Yu. Yu. Kramarenko, O. P. Krymov) gained in scope in 1948–1951.

A particulary successfull development chest surgery acquired in 1952, when the first chair of thoracic surgery headed by M. M. Amosov was founded at the Institute of Postgraduate Training in Kiev. M. M. Amosov elaborated the indications to surgical treatment of suppurative processes, tuberculosis damage, the technique of pneumonectomy and lobectomy, ways of anaesthesia during these operations. He achieved the lowest lethality after these operations. After the active participation of M. M. Amosov, many thoracic surgeons were prepared in Ukraine; departments of thoracic surgery were opened in all of regional centers.

Together with thoracic surgery, surgery of the heart and vessels has got wide development last years. In Ukraine, the majority of surgical interventions on the heart were performed by M. M. Amosov. Heart surgery was successfully developed: in Kiev by O. O. Shalimov, who was a prominent surgeon, talented scientist, innovator and organizer of the Institute of Clinical and Experimental Surgery, in Lvov — by M. V. Danylenko, in Donetsk — by V. K. Gusak, etc.

M. I. Sytenko is one of the founders of the Ukrainian school of orthopedists-traumatologists, a talented organizer of trauma service in our country. His works on the questions of orthopaedic aid and purely theoretic questions were always actual. He made a big contribution to the research of bone callous, the process of bone tissue regeneration, developed the technique of early treatment of diaphysar and epiphysar fractures in newborns with the application of spokes of his own design, the technique of treatment of radial bone fracture, developed the diagnosis of supracondilar fractures of the shoulder and methods of treatment, determined the indications to surgical treatment of bone fractures. M. I. Sytenko created a big school of followers.

M. P. Novachenko, the follower of M. I. Sytenko, published over 100 works, several monographs, elaborated the technique of original operations on the big joints, with osteomyelitis and bone tuberculosis, free bone plasty. In his activity the idea of M. I. Sytenko concerning the organization of orthopaedic-traumatologic care and preventive actions of traumatism got further development in Ukraine. M. I. Kolomiychenko published over 90 works devoted to surgery of the heart, pericardium, oesophagus, cardiospasmus, plasty, history of surgery, and organization of surgical aid in the republic.

A. I. Arutyunov promoted the development of neurosurgery and the organization of neurosurgical care in the country. He brought up a lot of followers — A. P. Romodanov, Yu. A. Zozulya. In the creation of the Ukrainian school of neurosurgeons, a significant role was played by Z. Y. Geymanovich, O. Y. Geymanovich.

O. O. Fedorovsky made an important contribution to the experimental surgery, treatment of burn traumas, and development of the haemotransfusion technique.

M. M. Milostanov put much work in the development of urgent medical service, battlefield surgery, treatment of wounds and the introduction of haemotransfusion to the practice. He wrote 80 works, among which a number of textbooks and manuals.

An important role belongs to I. T. Shevchenko, I. Ya. Deyneka and other surgeons in foundation of the oncologists school in Ukraine. I. Ya. Deyneka, the follower of O.V. Melnikov, published over 140 works and 4 monographs, and created a big school of specialists. His followers are at the head of chairs in many institutes.

A certain contribution in the history of surgery in Ukraine, in the history of domestic medicine was made by S. A. Verkhratsky. His works on the history of surgery in Ukraine have big scientific value.

K. T. Ovnatanyan, I. I. Kalchenko, G. G. Karavanov, A. Z. Tseytlin, A. A. Chayka and other surgeons of Ukraine have created schools of followers.

MODERN IDEAS OF SURGERY, SURGICAL DISEASES AND SURGICAL PROFESSION

A modern idea of surgery, certainly, considerably differs from the old notion about this profession. Surgery developed as an additional medical specialty before. During last 100 years it has undergone significant and profound changes, owing to which it can be considered one of the youngest branch of medical science, which is developing rather quickly.

If before only people who had different pathological processes, external features of diseases came to surgeons, today the concept of “general surgery” got narrower.

After the mastering anatomy and physiology, introduction of anaesthesia and methods of surgical infection prevention, surgery undergoes such a stormy period of development that a lot of specialties which were under the competence of surgery before became separated and independent. So, at the last decade, traumatology and orthopaedics, obstetrics and gynaecology, oncology, urology, eye diseases, anesthesiology, reanimatology, otorhinolaringology, etc. became independent scientific-practical disciplines.

In the big industrial centers of our country, as well as in other developed countries of the world, the process of further specialization of surgical aid is still going on. Taking into account the features of the organization of these services, the requirement for special equipment, surgery of the lungs and mediastinum, surgery of the heart and large vessels, surgery of the oesophagus and rectum and others are becoming more separated as independent disciplines. Specialization of surgical aid is the progressive phenomenon of modern medicine.

The concept of “surgical diseases” is continuously changing. After the established traditions, all illnesses or pathological conditions which for their normalization, certainly, demand correction with the help of a knife belong to “surgical” diseases. They are trauma and wounds, hernias and tumours of different localization, dead tissues and maldevelopment, acute-purulent inflammatory processes, etc.

At the same time there are a lot of diseases which can be treated either by the general physician or by the surgeon. They are stomach and duodenal ulcers, cholelithiasis, disease of the thyroid gland, bronchoectatic diseases, chronic purulent disease of the lungs, hereditary and acquired heart diseases, etc. The doctor should estimate the severity of the disease, prognosis in usage of this or that method of treatment, the presence of complications and threat to life or health of the patient. Such diseases are called “conditionally surgical” because under unfavourable conditions (bleeding, perforation of the ulcer, etc.) conservative treatment becomes unreasonable and the patients are further treated by the surgeon.

We shall also specify that with the development of surgery, medical knowledge, medical techniques many diseases previously regarded as therapeutic and were outside the competence of a surgeon, today are treated by surgical methods in specialized laboratories and institutes, ever more belong to the category of “surgical” pathology. In particular, this concerns such new parts of surgery as heart surgery, surgery of the large and small arterial vessels, tracheobronchial surgery, transplantation of the kidneys, etc.

The profession of a doctor-surgeon is difficult and labor-intensive, demands selflessness, physical, intellectual, and nervous effort The work of surgeon is extremely interesting and gives many joyful and happy moments to the doctor who operates on a severely ill patient, but it also brings much sorrow. Unfortunately, surgical intervention which is directed to the patient’s recovery does not always come to a successful end. Some patients have serious complications and sometimes with a lethal outcome which, certainly, upsets the surgeon who performed the operation. Each doctor takes seriously the failures of treatment, as he understands that some complications are possible to explain by the severity of the pathology or imperfection of science, whereas other unsuccessful cases, undoubtedly, are connected with insufficient knowledge of the surgeon, probably, with defects of patient preparation to the operation and mistakes in technique of its performing, that is insufficient professional qualification of the doctor.

The work of a surgeon is hard, intense, and sometimes even exhausting. And each student who is going to devote himself to this profession can understand this. It is necessary to study very long, persistently and steadily to achieve the true art of a surgeon. Without any exaggeration it is possible to say that a surgeon studies all his life long. Keeping in mind the P. O. Gertsen’s expression that “the best tool of a surgeon is his fingers”, it is necessary to remember always that a knife is a two-edged weapon, which can do not only good but much harm to a patient. The doctor-surgeon should constantly improve his knowledge, love his profession and patients, develop dexterity of fingers and hands, and study diligence, persistence and patience. What will the training of surgery be like at the medical university?

The teaching of surgery is carried out consistently in the departments of general surgery, faculty and hospital surgery, and internship. After receiving the profession of a doctor, further specialization and improvement are carried out in the departments of advanced medical studies (AMS) once every five years. Due to the wide development of surgical methods of treatment of diverse diseases, departments of the ІІ, ІІІ, ІV, V courses do not duplicate one another, but supplement and expand the knowledge of students.

After studying the basis of surgery at the department of general surgery, students of the ІІІ and ІV courses study classical symptomatology, treatment methods of some pathological conditions, and on the V course are acquainted with diveations from the classical course of diseases, with treatment methods of their complicated forms. Besides, on the V course, students are acquainted with the work of some specialized services — surgery of heart and large vessels, surgery of the lungs and mediastinum.

Despite the further ever particular surgical education, the continual search for new modern means of training, there are some questions which make the base for the whole process of training in school. The department of general surgery, where students learn the following sections of medicine, is engaged in these questions. What tasks bring the department’s attention?

Introduction to the speciality: to acquaint students with workof the surgical department and surgical service, elements of deontology and medical ethics.

To teach the students some professional knowledge, whichform the basis of medicine and surgery. These are such questions and sections of surgery, as aseptics and antiseptics, the basis of anaesthesia, bleeding and blood loss, haemotransfusion and blood substitutes, the basis of traumatology, diagnosis, prevention and treatment of surgical infection, the organization of an operation and caring for the patient in the pre- and postoperative periods, and a number of other problems.

To aspire that elements of clinical thinking, which collect overthe years and develop only due to long-term operational experience, form in students in the department of general surgery. It is necessary to always remember that it is not necessary to treat the disease which, at first sight, seems simple but the patient with his psychological features, complicated concomitant diseases and individual qualities. In spite of the fact that many questions concerning separate pathology is not a subject of the department of general surgery, students already now should think above the questions of operational risk, trauma and danger of an operation, get theoretical knowledge and practical habits which are directed on the correction of disturbances which arise in a patient. Let’s notice that all additional data which students will receive, reading not only textbooks, but also monographs, periodic literature, only expand their outlook, give confidence in work, assist in the formation of a future doctor.

Besides of professional knowledge and habits, students in thisdepartment may raise the general educational level, get acquainted with the history of world and home achievements, know the development and prospects of home surgery, truly estimate those advantages which are given by the public health services.

HISTORY OF THE GENERAL SURGERY DEPARTMENT

The clinic of general surgery contains 120 regular beds. All necessary conditions for qualitative training of students are created at the department. The department has its own lecture auditorium, sufficient number of educational rooms, acceptance chamber, scheduled and urgent operational rooms, wound-dressing rooms, radiological cabinets and clinical laboratory.

In the practical classes students get acquainted with these rooms in more details. It is necessary to emphasize that our department has very old and kind traditions, which today we try to support and augment.

The department was founded in 1903, first as a theoretical, then clinical base, and was situated in 4 rooms on the first floor of the main educational building of the Odessa Medical University. First it was called the “Department of Surgical Pathology and Therapy with Desmurgy and the Study of Dislocations and Fractures”.

For 5 years the department did not develop, and the heads were changing almost every year. The first head of the department was prof. Shchogolev Mykola Oleksandrovych; from 1904 till 1907 — private-senior lecturer I. F. Sabaneyev.

In 1907 the department was headed by prof. Konstantin Petrovich Serapin who transformed it from theoretical to clinical, and we rightfully consider him the founder of the clinic of general surgery. Without taking into consideration the break (in 1914–1918 he was called to military service), prof. K. P. Serapin headed the department and clinic till 1920. First the clinic was small with only 22 beds, located in a two-storied house of the city ambulance station of the infectious hospital. After the 3rd floor building in 1913 the bed fund started to increase gradually.

All the heads of the clinic brought something significantly new to development of surgical science. Professors I. Ye. Kornman, A. G. Sosnovsky, I. O. Bakkal, which headed the department after prof. K. P. Serapin, developed the methods of anaesthesia, applied new ways of antiseptics, put into practice haemotransfusion, treated traumatological patients, patients with purulent pathology, applied new surgical interventions.

The most active period of surgery development of our department occurred in 1950–1970, when the clinic was headed by the honored worker of science prof. I. Ya. Deyneka. During this period, employees of the clinic started to develop more intensively the question of stomach and intestine surgery, apply intervention on the organs of the mediastinum, and carry out the operations on the lungs and heart. Parasitic diseases, mostly human echinococcus, were intensively studied.

I. Ya. Deyneka’s numerous disciples prepared and successfully defended theses of candidate and doctor degree, introduced new methods of diagnosis and treatment of different diseases. Some of them work in other cities of our country now, many left to work in our medical university; they head the departments, work as senior lecturers and assistants (prof. A. I. Tregubenko, prof. A. O. Babur, prof. A. M. Torbynsky, associate professor T. V. Khomitska, V. V. Pirozhenko, etc.).

In 1960–1978 prof. K. D. Dvuzhilna became the head of the clinic. She paid much attention to the features of the course and treatment of wound infections, to the functional disturbances in diseases of the thyroid gland, to hormonal disturbances in duodenal ulcer, and to new antiseptic means, etc.

From 1978 till 1989 the department was headed by prof. L. Z. Drobkov. Under his supervision the staff of the clinic directed their efforts to study of most serious displays of surgical infection — peritonitis and surgical sepsis, on the estimation of immunobiological violations in patients with this pathology, the search for means of correction of intoxication syndrome and the improvement of consequences of surgical treatment of these conditions.

The departament of the general surgery was headed by professor B. I. Dmytriyev from 1989 to 2004. He provided a proper material support of surgical clinic; the educational-clinical base of faculty extended. The basic direction of scientific researches was devoted to problems of diagnosis, treatment, preventive maintenance of diseases of the liver, pancreas, endotoxicosis problem, diabetes.

In 2004 the General Surgery Departament and the surgical clinic were headed by professor V. V. Mishchenko. A basic direction of scientific-practical activities of clinic is diagnosis, preventive maintenance, treatment of acute surgical diseases of abdominal organs. 14 teachers work in the department today.

At the department the students can get elucidation of any unclear question and take the first steps in mastering the doctor profession. It is desirable that each student would regard the teacher not only as a teacher of discipline, but also as a mentor, senior comrade, friend.