Pathological Physiology

PATHOLOGICAL PHYSIOLOGY, the science that studies the regularities and functions of a diseased organism, in contrast to normal physiology, which deals with the laws of life of a normal, healthy organism. This definition, however, is somewhat narrow, as it considers only the reactions of the organism to disease-causing stimuli while leaving in the shade the extremely important question of both the nature of the latter and the conditions of their disease-causing action. It is not enough to know, for example, how an organism reacts to the introduction of pathogenic bacteria and what changes are observed in it during an infectious disease on the part of various organs, but it is also important to have an idea of the nature of the pathogen itself, the conditions of fluctuation of its pathogenicity, the significance of causes predisposing to the disease, and, in particular, those socio-economic factors that contribute to the origin and development of diseases. Therefore, many pathologists are inclined not to identify pathological physiology with general pathology, the scope of which should include the development of all those problems that in their concrete form arise when studying any disease (for example, the usual problems of etiology, pathogenesis, classification and differentiation of diseases, constitution, etc.). In accordance with a narrower view of the tasks of pathological physiology, German manuals on pathological physiology, for example, treat the pathology of individual organs and systems, but do not contain such chapters as general nosology and general etiology of diseases (see, for example, the manuals of Krehl, Lüdtke, and Schleyer). In the USSR, until the last 4-5 years, general pathology existed in the above-mentioned broad sense of the word, and only now has this science been renamed pathological physiology in order to delimit it from the general part of pathological anatomy and to avoid some confusion of concepts associated with another name given to pathological physiology—experimental pathology, since a pathologoanatomist, insofar as he works in his field, turns to experiment, can also be called an experimental pathologist. Such a delimitation of concepts as in the West did not occur with us with the introduction of the new name, and our newest pathological physiology essentially continues to remain the same general pathology, only with some abbreviations in teaching programs for this subject to avoid parallelism with related disciplines. History of the development of pathological physiology. The beginnings of this science can, with some right, be discerned perhaps already in Galen, who resorted to experiments on animals in order to clarify certain questions of pathology; however, the methods used by Galen were so crude that, strictly speaking, they do not deserve the name of experiment. Only starting from the 17th century does the experiment become more serious and technically more perfect, gradually entering laboratory practice; a number of researchers set up experiments on animals in order to solve questions of pathology [I. F. Albertini, Lower, Baglivi, van Swieten, and especially the English surgeon John Hunter (1718-1783) on the question of blood changes in contagious diseases and the origin of pus]. Already from the 17th century, attempts also began to be made to treat the content of pathology in connection with physiology in special works (J. Varandaeus, "Physiologia et pathologia", Montpellier, 1620; J. Juncker, "Institutiones physiologicae et pathologicae", Halle, 1745; J. Schulze, "Pathologia generalis", Halle, 1747; D. Gaubius, "Institutiones pathologiae medicinalis", Leyden, 1758; A. Senft, "Elementa physiologiae pathologicae", v. I-III, Würzburg, 1774-78). The name "general pathology" is first found in F. de Francisco (Franc. de Francisco, 1618), and the most substantial work of this kind for its time, with which Virchow also reckoned, should be recognized as the book by Gaubius. Peter Frank (Frank, 1745-1821) brought comparative pathology to life, comparing the diseases of animals and humans. The real scientific development of pathological physiology began under the influence of the famous physiologist Müller (J. Müller, 1801-1858) and the works of the French physiologist Magendie (1783-1855). The latter directly intended to turn general pathology into pathological physiology. The most famous representative of pathological physiology in France was, again, the physiologist Claude Bernard with his famous experiment with the "sugar puncture", studies on the physiology and pathology of vascular nerves, and on the physical properties and pathological changes of body fluids. In Germany, Ludwig Traube (L. Traube, 1818-1876) became known in the same direction, striving to study the physical laws governing physiological and pathological phenomena. His works in this field are collected in "Gesammelte Beiträge zur Pathologie und Physiologie" (v. I-II, B., 1871). Traube was followed by Virchow's pupil Julius Cohnheim (1839-1884), subsequently a professor in Kiel and Breslau, who created the famous doctrine of the participation of white blood cells in inflammation, the embryonic theory of tumors, and much else. His classic lectures on general pathology enjoyed great popularity and have not lost their significance to this day. Another famous pathologist, Simon Samuel (Simon Samuel, 1839-1899), professor of pathological anatomy in Königsberg, zealously engaged in questions of inflammation from a pathological-physiological point of view, while the clinician Liebermeister (born in 1833) developed questions of thermopathology from the same point of view. Finally, mention should be made of the name of Fr. F. Recklinghausen, famous for his works on histophysiology, the author of an excellent monograph on the pathology of circulation and nutrition (1883). The connection between physiology and pathology existed, as indicated, long before Virchow. Immediately before Virchow and in his time, this connection deepened, became livelier, and moreover to a certain extent independently of him (Magendie, Claude Bernard), but Virchow still retains the great merit of a completely clear realization of the significance of pathological physiology in the cycle of medical sciences and the persistent propaganda of this science by word (a series of articles in "Archiv für pathologische Anatomie, Physiologie und klinische Medizin") and deed (for example, experiments on the question of embolism). In 1847, he came out definitively in favor of the fact that pathological physiology should replace general pathology. Furthermore, in § 2, vol. I of his special pathology (1854) he says: "It is not enough to know physiology to interpret pathological phenomena without further effort, much as the rationalist school tried to do. On the contrary, it is necessary by means of independent research, empirical observation, and experiment to rise to pathological physiology. Along with normal physiology, pathological physiology must therefore develop just as independently, similarly to how pathological anatomy independently grew alongside normal anatomy, not as some ingenious system, but as the slowly accumulating result of organized work." But expecting so much from pathological physiology, Virchow was nevertheless far from the thought of the desirability of opening special departments or organizing special institutes in this discipline. Even less disposed to this were Virchow's followers and successors, in which one cannot fail to perceive a certain one-sidedness of the purely pathological-anatomical bias of the scientific thought of German pathologists. Be that as it may, special departments and institutes in pathological physiology did not exist in Germany until recently, and only in 1919 was one opened in Cologne, to which Hering was invited from Vienna, and in addition, about 25 years ago, a privat-docentship in pathological physiology with an appropriate laboratory was organized at the Institute of Pathological Anatomy of the University of Berlin (headed by Prof. Bickel). By a questionnaire survey conducted shortly before the opening of the Cologne Pathophysiological Institute, an overwhelming majority of votes revealed the desirability of organizing institutions of this kind, but financial considerations prevent the implementation of this undertaking to this present time. Meanwhile, just as before, instead of pathological physiology, general pathology is taught in German universities as a general part of pathological anatomy, and it is taught precisely by representatives of the latter. Pathological physiology of individual organs and systems (organopathology) is handled by clinicians (especially, for example, Krehl). In other countries, matters shaped up differently. For example, in Austria-Hungary at one time general pathology was taught together with pharmacology, but already about 60 years ago it became separated and is read rather as pathological physiology under the name of general and experimental pathology. The same takes place in Italy. In France, too, completely separate from pathological anatomy, there exist: pathological physiology with a tendency to break down into several partial courses, experimental pathology (also pathological physiology, but with a bias more toward the methodology of experiment), and general pathology. In the Scandinavian countries, there are separate laboratories and departments of general pathology and special pathological anatomy, and general pathology is interpreted in various ways: with an immuno-biological, a biochemical, or a morphological bias. In Japan, there are pathological institutes with departments of general pathology and special pathological anatomy; general pathology is interpreted mainly from a morphological point of view. In the USA, the same order exists, but the interpretation of general pathology depends sharply on the individuality of the head. Finally, in England, the delimitation of pathological physiology from pathological anatomy and the clinic is not carried out at all. The development of Russian pathological physiology.

In Russia, the first independent department of general pathology with a physiological orientation was founded at Kazan University in 1874. V. V. Pashutin was elected as its professor. In 1878, an analogous department was founded at the Medical-Surgical Academy in St. Petersburg, and in 1880 at Moscow University. Since that time, all Russian universities have had special departments of general pathology with special institutes or at least laboratories and offices. Earlier, in the period of the 1860s and 1870s, teaching on this subject at the oldest Moscow University was limited to reading a brief supplementary course at the department of pathological anatomy, the program of which included: an exposition of the concept of "disease" with the provision of brief data on the etiology of diseases and an exposition, again in a concise form, of the doctrine of local circulatory disorders, regressive and progressive tissue metamorphoses, fever, and some organopathology. The teaching was conducted by: prosector at the department of pathological anatomy I. F. Klein (from 1866 to 1869) and professor of the same department A. I. Polunin. In 1878, regular docent of pathological anatomy A. B. Fokht was elected professor of the department of general pathology at the 1st Moscow State University, who in 1880 opened a course of theoretical lectures on general and experimental pathology to students of the 3rd and 4th semesters. An important event was the organization in Moscow in 1890 of the first Institute of General and Experimental Pathology in Russia attached to new clinical institutions. The latter was organized according to the plan of Prof. A. B. Fokht, with the participation of assistant A. I. Talyantsev. This institute has published a number of valuable works of a monographic nature (4 volumes of the Collection of Works of the Institute were published: 1896, 1897, 1899, and 1903), and a number of staff members received independent professorships (A. I. Talyantsev, V. K. Lindeman, V. V. Voronin, G. N. Sakharov, V. G. Korenchevsky, V. V. Vasilyevsky). At the Medical-Surgical (subsequently Military-Medical) Academy, the department of general pathology from 1879 to 1890 was held by the major Russian pathophysiologist V. V. Pashutin, who gave teaching a purely physiological direction and organized an excellent laboratory equipped mainly for the study of metabolism. The remaining Russian universities (with the exception, again, of Dorpat-Yuryev) regarding the organization of the department of pathological physiology (resp. general pathology) followed Moscow, but not to the same degree: for most of them, both old and new, until recently it would be more correct to speak of laboratories and offices rather than institutes of pathological physiology. The laboratory of pathological physiology of Kazan University functioned not so much as such in the broad sense of the word, but rather as an immunological-microbiological one. In Kharkov, in recent years, a new laboratory of pathological physiology has been organized, well adapted especially to biochemical research, and Saratov University, as a newer one, had the opportunity to equip its institute of pathological physiology in accordance with all the requirements of modern science. The department of the 2nd Moscow State University (A. B. Fokht, later A. A. Bogomolets) was at first extremely poorly provided for both in terms of premises and equipment, but later, in the 1920s, with the allocation of sufficient funds, it grew significantly, having received an orientation mainly toward research of a pathochemical nature. The laboratory of pathological physiology of Odessa University (Prof. V. V. Podvysotsky, V. V. Voronin, B. A. Shatsillo) is adapted mainly to pathohistological and pathochemical work. Finally, mention should be made of the pathophysiological laboratory (department of general pathology) of the State Institute of Experimental Medicine in Leningrad, which gained scientific fame thanks to the works of its heads S. M. Lukyanov, V. V. Podvysotsky, and E. S. London, and is adapted mainly for work of a biochemical nature. During its development in the USSR in the field of pathological physiology (resp. general pathology), a number of schools and trends emerged: the Moscow school, represented by the late Prof. Fokht and a number of his pupils (especially Prof. A. I. Talyantsev), cultivated with special devotion the so-called "big experiment," dwelling particularly on questions of blood and lymph circulation, and only in the last 17–20 years has this purely organopathological direction been replaced by the development of broader problems of both a general pathological and general biological nature (e.g., questions on the role of heredity in pathology, immunity, Abderhalden's enzymes, internal secretion). The Leningrad school, represented by Prof. V. V. Pashutin and his numerous pupils and successors, systematically for many years elaborated questions of starvation, metabolism, and thermopathology, applying original and at that time new research methodology. In particular, the doctrine of starvation by Pashutin's school was for the first time comprehensively elucidated and substantiated by a multitude of valuable experimental data. In later times, the laboratory developed mainly questions from the pathology of internal secretion and experimental oncology (Prof. V. Korenchevsky), and in recent years it has been occupied with studying the pathophysiology of the vascular system, lipid metabolism, and the function of the reticulo-endothelium (Prof. N. Anichkov). The Odessa, and partly Kiev schools, during the life of the late Prof. Podvysotsky, adhered in the development of problems of pathological physiology, resp. general pathology, mainly to the pathohistological direction; the Saratov (later 2nd Moscow) school focused almost entirely on questions of internal secretion with a bias toward pathochemistry (Prof. Bogomolets); finally, in Kazan, until the very last moment, the bias toward problems of immunity sharply dominated (Prof. Savchenko). The teaching of pathological physiology has always been conducted not quite identically, and sometimes even with significant deviations in different countries, in particular abroad and in our country (see above). Among foreign universities, the German university in Prague (Prof. A. Biedl) still deserves mention for the peculiarity of its teaching arrangement, where at the Institute of Experimental Pathology there is a hospital ward of 25 beds, apparently for the purpose of linking pathological physiology with the clinic. Such general pathological sections of the course as general etiology, on the contrary, are not lectured on at this department. In the USSR, the arrangement of teaching pathological physiology has undergone very significant changes over the past 10–12 years. Prior to this time, pathological physiology was lectured on in the form of general pathology with an emphasis on certain sections, depending on the scientific bias of the teacher, namely: in one university with an emphasis on organopathology (generally or a sub-department of it, e.g., circulatory pathology), in another on such largely morphological sections as the section on local tissue nutrition disorders, in a third on the doctrine of immunity, etc. Lectures were allocated 4 hours a week; practical exercises were not mandatory, and the latter had a different character in different places: sometimes pathohistological, then, as at Moscow University, experimental-pathophysiological, then immuno-bacteriological. At the 1st Moscow University and the Military-Medical Academy, the reading of the theoretical course was also accompanied by large experimental demonstrations, which in other universities was almost or entirely absent. Starting from 1920, the change in the system of teaching pathological physiology in the USSR began with the fact that the center of gravity was transferred from lectures to practical exercises, which gradually became mandatory and more organized, losing their accidental character and adapting more and more to the theoretical course. Active teaching methods are increasingly developed and perfected. At the same time, measures were taken to strictly eradicate parallelism in the teaching of related disciplines, in this case between the departments of pathological physiology and microbiology (chapter on immunity) on the one hand, and the same department and the department of pathological anatomy on the other (questions of a morphological order, like the section on local tissue nutrition disorders, pass to the department of pathological anatomy). There are no special scientific societies for pathological physiology in the USSR, and representatives of this discipline, together with pathanatomic-anatomists, are members of the societies of pathologists. The German society Deutsche Pathologische Gesellschaft consists almost entirely of pathanatomic-anatomists and debates questions mainly from the field of the latter discipline. The struggle of schools and trends in pathological physiology, as well as questions of ideology in general, are an inseparable part of the corresponding struggle in medicine as a whole (see Medicine).