Anamnesis

ANAMNESIS (from Greek anamnesis - recollection), represents the medical biography of a patient, set forth according to periods of life. From the anamnesis, it is possible to establish how the patient's organism reacted to all those external living conditions and hazards that existed in their past. The anamnesis consists of the statements of the patient themselves, their relatives, and those around them. The value of the anamnesis is subjective and varies depending on the individuality of the person being questioned. The physician must conduct the anamnesis actively, i.e., having allowed the patient to state their main complaints, thereafter conducting the questioning themselves using some sort of scheme. A distinction is made between the remote and the immediate anamnesis. The former has the task of clarifying who is before us, where and when they were born, of what nationality, how they were fed and developed, and the conditions of the locality where the patient lived and lives. Next, it is necessary to become acquainted with the housing conditions of the patient at their place of residence, as well as the setting and conditions of work (lighting, ventilation, heating, humidity, crowding, etc.). When inquiring about diet, it is necessary to take into account the time and place of meals, what the intervals between meals are, how often the patient eats, and how much time is spent on eating. It is important to clarify what kind of food predominates (meat, dairy-vegetable, etc.), in what form it is taken (home cooking, canteen, dry rations), what the patient drinks, when, and how much. Working conditions are detailed, since they are also part of the external conditions acting upon the organism. It is also necessary to ask about rest, both daily and more prolonged, and its rational use. Touching upon a woman's sexual life, it is necessary to find out the time of onset of menstruation, their character, duration, regularity, and painful sensations. Furthermore, sexual life itself, the attitude toward it, contraceptive measures, abortions, miscarriages, and leukorrhea are important; it is important to clarify the number of pregnancies, their course, complications, childbirth, the postpartum period, the period of lactation, the period of the fading of sexual life—the climacteric, the time of its beginning or end, and the painful phenomena that accompanied it. In men, it is necessary to ascertain whether the patient engaged in masturbation, what their sexual life is like, and any abuses. In sequential order, family life must be revealed (relationships, environment, children, etc.). It is important to find out whether the patient smokes, how much, and when they started smoking; the same data are important in relation to alcoholic beverages and other narcotics. Then, attention in the anamnesis is fixed on diseases suffered by the patient; one finds out what illnesses this patient has suffered, how often they occurred, how they proceeded, and what the individual features of their course were in the given patient. Among diseases, syphilis, tuberculosis, malaria, typhus, etc., must be especially noted. Taking into account the thoughtlessness and secrecy of some patients, one must find out about these diseases through indirect questions (about Wassermann, Bordet-Gengou, and von Pirquet reactions, urine analyses, miscarriages, sweats, etc.). Heredity plays a major role in the anamnesis, and therefore the patient must be carefully questioned about the living conditions, health, and causes of death of both close and remote relatives. Special attention must be paid to the general constitution of relatives, alcoholism, nervous and mental diseases, syphilis, tuberculosis, neoplasms, and metabolic anomalies. The immediate anamnesis answers questions under what conditions and with what symptoms the present illness developed before seeking medical help, what the main complaints were, how the major organs functioned, and what the treatment was. Here it is necessary to clarify the temperature reaction of the organism, the patient's general well-being, sleep, its character and duration; headaches, their character, time of onset, intensity, localization; dizziness, the causes eliciting it, and fainting. Complaints of pain occupy a large place in the anamnesis, and therefore it is necessary to note the character of the pains, their radiation, localization, persistence, and time of appearance (syphilitic night pains, pains in duodenal ulcer, etc.). Loss of appetite, perversion of taste, sensations after eating, nausea, vomiting, bloating, and constipation are also frequent complaints of the patient. Shortness of breath, palpitations, and the time of their appearance (rest, work, lying down), voice, cough, etc., are also clarified. Then the immediate anamnesis is focused on the system of diseased organs with complaints about which the patient came, and here various specialists have their own in-depth anamnesis for each specialty (ophthalmologists, otologists, neurologists, urologists, etc.), which allows them to become more closely acquainted with the subjective manifestations of the diseased or suffering organs and systems.

A. Gerke. Occupational anamnesis. The understanding of health and disease states as a relationship between the organism and the environment requires a careful accounting of all conditions of the working environment and occupational labor. Their correct evaluation can be obtained only as a result of a special familiarization with the working conditions, with the application in necessary cases of appropriate laboratory and hygienic methods. However, for the general practitioner and even for the usual type of therapeutic and therapeutic-prophylactic institutions, this is far from always feasible, and therefore the subjective statements of the patient or the examined subject in general (during mass examinations of occupational groups, in the process of health screening, etc.) collected by the occupational anamnesis acquire great importance. The occupational anamnesis is also necessary because it makes it possible to take into account a number of essential circumstances that even the most careful study of the working environment associated with the work of the person being questioned cannot reveal. The factors revealed by the occupational anamnesis and having serious significance for clarifying the occupational etiology of the disease, for assessing the degree of sensitivity and resistance of a given organism in relation to individual occupational hazards, and for formulating a prognosis regarding the future health state of a given person and the possibility for them to continue working in this profession, include: 1) the age at which the person questioned first began to engage in occupational activity, 2) total length of service, 3) special length of service in the given profession, 4) age of starting work in the given profession, 5) interruptions in occupational activity, 6) subsidiary work besides the main profession, 7) preceding professions, and 8) work performed during periods of temporary interruptions of work in this specialty. A detailed familiarization with all the features of occupational length of service makes it possible to establish much that would otherwise completely escape the gaze of even the most experienced clinician. Thus, for example, according to data from the Leningrad Institute of Occupational Diseases, of pneumatic hammer riveters, only 21% worked in one profession, 29% worked in two professions, and 50% of all those questioned worked in three or more. Out of an average employment duration of 24.3 years, the main profession accounted for only 13.6 years or slightly more than half. Among "subsidiary," "accidental," or often even entirely overlooked main professions, work associated with serious occupational hazards can easily remain unnoticed. Thus, according to the work of the named institute, among all male workers who passed through it, 6.9% had dealt with lead in the past, with their average "lead" service equal to 4.4 years or almost 25% of their total employment duration. The clarification of facts of this kind is of enormous importance both in the study of entire occupational groups and in the investigation and treatment of individual individuals. Subjective statements of the person questioned about the working environment and their occupational hazards in the past and present, which are of particular importance in the absence of simultaneously collected data by a special sanitary examination of production processes and the workplace, should be collected approximately according to the following scheme: 1) labor process and labor regime (duration and intensity of work, distribution of working time, body position, strain of individual organs, etc.); 2) hazards associated with the processed material, applied substances, tools, and machines (contact with poisons, dust emission, noise, etc.); and 3) sanitary condition of the premises (cubic capacity, lighting, heating, ventilation, etc.). At the same time, special attention is paid to ensuring that the person questioned does not so much characterize the given profession in general or the entire workshop as a whole, but rather emphasizes the conditions specially characterizing their personal work. Since the person questioned can far from always correctly note and evaluate specific occupational hazards, they should be made to carefully set out the entire production process and all labor movements in order to make the necessary conclusions themselves or draw up a working hypothesis for subsequent verification of the direct working environment. Collecting the occupational anamnesis, the physician must clarify the opinion of the person questioned about the connection between one or another harmful moment or the conditions of occupational labor in general with the individual complaints of the patient or the functional changes noted by them. Without a careful occupational anamnesis, it is impossible to compile a single case history in an inpatient medical institution, a single questionnaire form in an outpatient clinic or dispensary, or a single form during mass medical examinations. The occupational anamnesis passes without sharp boundaries into the social anamnesis, encompassing such questions as the amount of wages, distance from the workplace to housing, diet regime, etc.

S. Kaplun. Social anamnesis, the elucidation of factors of a social character that influenced the state of health of the organism in the past. Gathering clinical information about a disease at the patient's bedside, illuminating it with data on the state of their health in the past, the attending physician strives to clarify the etiology and conditions that caused the onset of the disease; only the possession of this knowledge leads them to an accurate diagnosis of the disease and hence to rational therapy. In this process of special investigation of the human personality, the physician, along with clinical material, inevitably has to investigate also those aspects of the patient's situation that have social significance (i.e., exert an influence on the personality as a unit of the social environment). First and foremost, this includes information on the social status of the patient, insofar as the latter determines the general and economic situation, the living conditions of existence: very often the factors that destroy human health are rooted right here; further, the history of working life and the passage of stages of occupational labor, with a characterization of its environment, reveal, sometimes in the distant past, the source of later disease; in connection with these moments, the vital sanitary and social environment and setting surrounding the patient are restored before the investigator, the entire process of fulfillment and non-fulfillment of their social needs in the past, exposing the conditions and factors that could cause pathological phenomena in their organism or favor their development; finally, the investigator also has to keep in mind those aspects of the patient's anamnesis that are associated with social heredity passing from ancestors to descendants. All these moments, established in the order of the social anamnesis of an individual patient, are of the most essential importance for the characterization and diagnosis of their morbid condition, the causes and conditions of the origin of the latter, as well as for the prescription of correct and rational therapy. If, further, we turn from the individual to the collective, the social organism, then in this direction as well, grounds for formulating a social anamnesis can be outlined. Just as the internist approaches the examination of the individual organism, in the exact same way the state of a collective mass or population group can be the subject of investigation. First of all, this includes materials on social anamnesis under dispensary methods of organizing medical care, where doctors and their auxiliary personnel—investigating nurses—gather and examine all data characterizing the way of life and social environment of entire population groups, individual professions, and so on. Further, valuable material consists of data on morbidity and attendance at medical institutions, the processing of which can be used as mass material for the social anamnesis of large groups of the population. And finally, this also includes materials from sanitary examinations and the processing of relevant data by sanitary physicians. Properly executed sanitary and hygienic studies are one of the most widely used methods of mass social anamnesis, including both general sanitary-statistical study and local sanitary examinations. The sanitary-statistical method includes: a) determination of population morbidity (infectious, social, occupational), b) determination of the natural movement of the population (general mortality, age-specific mortality, infant mortality, birth rate, natural increase), c) determination of physical development (childhood ages, students, adolescents, draft age, workers), d) determination of the activity of medical and prophylactic institutions for the protection of public health and the population's utilization of them. Such, in broad outlines, is the scope of a general sanitary-statistical study. Alongside it, a local examination characterizes the environment and socio-economic milieu of the population, its life, and everyday conditions (housing, nutrition, labor conditions, etc.). Possessingamnestic information for the past period in terms of sanitary-statistical material and in relation to the sanitary environment and social milieu is of high value for every modern sanitary-diagnostic examination of the population, giving the examination a historical and dynamic illumination. For gathering social anamnesis, both specially processed registration forms and records in medical institutions serve, as well as special sanitary journals used according to types developed by the People's Commissariat of Health and other organizations. For gathering mass social anamnesis, various programs of sanitary-statistical surveys are used. Valuable material for the social anamnesis of various population groups of the USSR is also provided by the works of the former Zemstvo sanitary organization. This also includes a rather large literature of monographic descriptions compiled by district and sanitary physicians for individual localities of rural Russia, as well as more or less systematic studies of the natural movement of morbidity and physical development of the population, performed by sanitary physicians and provincial sanitary bureaus in many provinces. Lit.: Zhbankov D., Bibliographic Index to Zemstvo Medical Literature (1870-1890), Moscow, 1890; by the same author, Bibliographic Index to General Medical Literature for 1890-1905, Moscow, 1907; Kurkin P., Sanitary Statistical Work in 14 Provinces on Statistics of Natural Movement and General Morbidity (Handbook on Public Health and Medical-Everyday Issues, published by the Society of Russian Physicians in Memory of N. I. Pirogov, p. 89, Moscow, 1910); by the same author, Zemstvo Sanitary Statistics, An Attempt at a Systematic Bibliography (4 provinces), 1908;

Journal of the Society of Russian Physicians in Memory of N. I. Pirogov

Obshchestvenny Vrach

Department of Reviews and Abstracts, 1900-1917; Yakovenko E., Medical Statistics, Moscow-Petrograd, 1925; Proceedings of the Commissions on Examining the Sanitary Consequences of the War of 1914-1920, ed. by M. M. Gran, P. I. Kurkin, and P. A. Kuvshinnikov, iss. 1, Moscow-Petrograd, 1923.