GENERAL PATHOLOGY - pathological anatomy and pathological physiology

 

History of medicine

New time

MEDICAL AND BIOLOGICAL DIRECTION IN THE MEDICINE OF NEW TIME (1640-1918)

GENERAL PATHOLOGY (pathological anatomy and pathological physiology)

 

Pathological anatomy (from the Greek. Pathos — a disease) —the science that studies the structural bases of pathological processes — emerged from anatomy in the middle of the 18th century. Its development in the new history is conventionally divided into two periods: macroscopic (until the middle of the 19th century) and microscopic, associated with the use of a microscope.

 

MACROSCOPIC PERIOD

 

Francis Bacon (Bacon, Francis, 156I - 1626), an eminent English philosopher and statesman, who, not being a doctor, in many ways determined the paths for the further development of medicine, wrote about the need to study the anatomy of not only a healthy but also a sick body.

 

In the second half of the XVI century. in Rome, B. Eustachius first introduced in the Roman hospital a systematic autopsy of the dead and, thus, contributed to the formation of pathological anatomy. The beginning of pathological anatomy as a science was laid down by compatriot Eustachy - Italian anatomist and doctor Giovanni Battista Morgagni (Morgagni, Giovanni Battista, 1682-1771).

 

At the age of 19, he became a doctor of medicine, at the age of 24 he headed the department of anatomy of the University of Bologna, and five years later - the department of practical medicine at the University of Padua. Performing an autopsy of the deceased, J. B. Morgagni compared the changes he found to the affected organs with the symptoms of the diseases that he observed as a medical practitioner during the life of the patient. Summarizing the huge amount of material collected at that time — 700 autopsies and the labors of the successors, including his teacher — the professor of anatomy and surgery of the University of Bologna, Antonio Valsalva (Valsalva, Antonio Maria, 1666-1723), J. B. Morgagni published in 1761 The classic six-volume study “On the location and causes of diseases revealed by dissection” (“De sedibus et causis morborum per anatomen indagatis”) (Fig. 119).

 

J. B. Morgagni showed that each disease causes certain material changes in a particular organ and identified the organ as the place of localization of the disease process (organopathology). Thus, the concept of disease was connected to a specific material substrate, which dealt a powerful blow to metaphysical, vitalistic theories. Having brought together anatomy with clinical medicine, Morgann laid the foundation for the clinical-anatomical principle and created the first scientifically grounded classification of diseases. The recognition of the merits of JB Morgagni was the award of honorary diplomas to the academies of sciences of Berlin, Paris, London and St. Petersburg.

 

An important stage in the development of pathological anatomy is associated with the activities of the French anatomist, physiologist and physician Marie Francois Xavier Beat (Bichat, Marie Francois Xavier, 1771-1802). Developing the position of Morgagni, he showed for the first time that the vital activity of a separate organ is composed of the functions of various tissues that make up its structure, and that the pathological process affects not the whole organ, as Morgagni thought, but only its individual tissues (tissue pathology). Without using the microscopic technique, which at that time was still imperfect, Bit laid the foundations of the theory of tissues - histology (see p. 228).

 

The teaching of Bish was further developed in the writings of prominent representatives of the school of G.-N. Korvizar: R.T. Laenneka (see p. 266), Gaspard Laurent Beyle (Bayle, Gaspard Laurent, 1774–1816), F. Majandy (see 251) and other scientists.

 

MICROSCOPIC PERIOD

 

In the middle. XIX century. the development of pathology took place in the struggle of two directions; humoral (from the Latin. humor — moisture, liquid), rooted in the philosophies of the ancient East and ancient Greece, and appeared later, solidary (from the Latin. solidus - dense, solid), the first ideas about which were developed by Erasistratos and Asclepiad (see pp. 109 and 120).

 

The leading representative of the humoral direction was a Viennese pathologist, a Czech by nationality Karl Ro-Kitansky (Rokitansky, Karl, 1804–78), a member of the Vienna and Paris Academies of Sciences. In 1844, he created the first in Europe Department of Pathological Anatomy. His three-volume "Manual of Pathological Anatomy" ("Handbuch der speciellen pathologi-schen Anatomie". 1842-1846), compiled on the basis of more than 20,000 autopsies made using macro- and microscopic methods of research, survived three editions and was translated into English and Russian. Rokytansky considered the main cause of the painful changes to be a violation of the composition of body fluids (juices) - dis-krazy (the term of ancient Greek doctors). At the same time, he considered the local pathological process as a manifestation of a common disease. Understanding the disease as a general reaction of the organism was a positive side of its concept.

 

In the middle of the XIX century. Rokitansky's humoral pathology came into sharp contradiction with new factual data. The use of the microscope brought natural science to the level of the cell structure and dramatically expanded the possibilities of morphological analysis in normal and pathological conditions. The principles of the morphological method in pathology were laid by Rudolf Virchow (Virchow, Rudolf, 1821-1902) —German doctor, pathologist and public figure (Fig. 120).

 

Having adopted the theory of cell structure (1839), R. Virchow first applied it to the study of the diseased organism and created the theory of cellular (cell) pathology, which is described in his article “Cellular pathology as a teaching based on physiological and pathological histology” ( Die Cellular-pathologie ..., 1858).

According to Virkhov, the life of the whole organism is the sum of the lives of autonomous cellular territories; the material substrate of the disease is the cell (i.e., the dense part of the body, hence the term “joint” pathology); All pathology is cell pathology: "... all our pathological information must be reduced to changes in the elementary parts of tissues, in cells."

 

Some provisions of the cellular theory of pathology based on mechanistic materialism contradicted the theory of the integrity of the organism. They were criticized (I. M. Sechenov, N. I. Pirogov and others) during the lifetime of the author. But in general, the theory of cellular pathology was a step forward compared with the theories of tissue pathology of Bish and the humoral pathology of Rokitansky. She quickly gained universal acceptance and had a positive impact on the subsequent development of medicine. R. Virkhov was elected an honorary member of scientific societies and academies of almost all countries of the world.

Rudolf Virkhov made a great contribution to the development of pathological anatomy as a science. Using the method of microscopy, he first described and studied the pathological anatomy of inflammation, leukocytosis, embolism, thrombosis, phlebitis, leukemia, kidney amyloidosis, fatty degeneration, the lupus tuberculosis nature, neuroglia cells. Virkhov created the terminology and classification of the main pathological conditions. In 1847, he founded the scientific journal Archives of Pathological Anatomy, Physiology and Clinical Medicine, nowadays published under the name Virkhov Archives (Virkhov Archiv). P. Virkhov is also the author of numerous works on general biology, anthropology, ethnography and archeology.

 

The cellular theory of pathology, which at one time played a progressive role in the development of science, was replaced by a functional Direction based on the theory of neurohumoral and hormonal regulation. However, the role of the cell in the pathological process was not crossed out: the cell and its ultrastructures are considered as integral components of the whole organism.

In Russia, the onset of pathological anatomy and forensic autopsies were laid in 1722, hen the "Regulations" of Peter I about hospitals. It prescribed compulsory necropsy on a violent death. In 1835, “Us by hospital ”was introduced obya full autopsy of all the dying in hospitals. The first patolo chair Anatomy of Russia was created given in 1849 in Moscow University network It was headed by Alexei Ivano.

Polunin (1820-1888) —the basis the first in Russia pathoanatomical anatomical school of thought. Great contribution to development of pathological anatomy in Russia made M. N. Nikiforov (1858-1915) —the author of one of the feathers country textbooks on pathologists anatomy repeatedly reissued given; N.I. Pirogov, who from 1840 he led the course of autopsy in Medico-Surgical Academy;

M.M. Rudnev (1823–1878) —the founder of the Petersburg school of pathologists and others.

 

In the middle of the 19th century, an experimental direction was formed in Russian pathology (later called “pathological physiology”). For the first time, a course of general and experimental pathology in Russia was given at the Moscow University by the famous pathologist A. I. Polunin.

The birth of pathological physiology as a science is connected with the activity of Viktor Vasilyevich Pashutin (1845-1901) - the founder of the first national school of pathophysiology (Fig. 121). In 1874, he organized the department of general and experimental pathology at Kazan University, and in 1879 he headed the department of general and experimental pathology at the Military Medical Academy in St. Petersburg.

As a student of I. M. Sechenov and S. P. Botkin, V. V. Pashutin introduced the ideas of nervism into the general pathology. He is the author of basic research on metabolism (the study of vitamin deficiency) and gas exchange (the study of hypoxia), digestion and the activity of the endocrine glands. V. V. Pashutin for the first time defined pathological physiology as the “philosophy of medicine”. His two-volume manual "Lectures on general pathology (pathological physiology)" (1878, 1891) for a long time remained the main textbook on pathological physiology.

 

In the late XIX - early XX century. a great contribution to the development of pathological physiology was made by I. I. Mechnikov (see p. 248), G. P. Sakharov, A. A. Bogomolets.

 

 

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