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Of Internal Diseases






The Russian and Soviet clinicists Mudrov, Zakharyin, Botkin, Ostroumov, Obraztsov, Strazhesko, Konchalovsky, Lang and many others made an important contribution to the development of the diagnosis and general therapy of internal diseases.

The founder of the Russian therapeutic school, Matvey Mudrov (1776-1831), assumed that disease is a result of exposure of man to un­favourable effects of the environment. Accordingly he was the first to in­terrogate the patient in order to substantiate the anamnestic method. He developed a planned clinical examination, and recording case histories. Mudrov was the first in Russia to organize practical clinical studies for students, he organized special laboratories and a museum. In the field of general therapy he followed the principle of individual approach and claimed that the patient should be treated rather than his disease. He also emphasized the great importance of hygiene.

Grigory Zakharyin (1829-1897) worked out in detail the anamnestic method of diagnosis which helped establish individual diagnosis (in addi­tion to the physical examination of the patient) in the presence of not only morphological but also functional changes in various organs. An outstan­ding French clinicist Huchard wrote: " Zakharyin's school used observa­tion, accurate anamnesis, and knowledge of aetiology, which where raised to the level of an art". Zakharyin worked at the diagnosis of tuberculosis and its classification, he described zones of hypersensitivity of the skin in diseases of internal organs. According to Zakharyin, the therapy of disease should include hygienic procedures, climate therapy, dietary treatment, and medicamentous treatment. His contribution to symptomatic therapy is very great; he proposed treatment with koumiss (fermented mare's milk) and mineral water.

Sergei Botkin (1832-1889) founded the physiological school in medicine and pioneered in experimental pharmacology, therapy, and Pathology in Russia. Botkin considered that a clinical experiment is a tool



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Chapter 2. History of Diagnosis



 


for opening the mechanism of disease development. He widely introduced the physiological and instrumental study in clinical practice. Guided by Sechenov's ideas, Botkin worked out the theory of disease development, in which the first role was given to the nervous system. This enabled him and his pupils to show the role of the nerve centres in regulation of haemopoiesis and body temperature. In the field of diagnosis, Botkin established the difference between hypertrophy and dilatation of the heart, discovered the postsystolic murmur in stenosis of the left venous orifice (which was later described as a protodiastolic murmur), described the listening points for diastolic murmur in aortic valve incompetence, was the first to diagnose thrombosis of the portal vein. Botkin pointed out for the first time the infectious aetiology of catarrhal jaundice (which was later given his name); he gave a detailed description of the disease known as Wolhynian (five-day) fever, and discovered the role of tissue destruction in the pathogenesis of fever.

Botkin believed that the main task of practical medicine is disease prevention. He was a social worker and was the first to organize out­patient and then hospital treatment free of charge. He is justly considered to be the founder of military field therapy.

Aleksey Ostroumov (1844-1906) actively fought for the connection of theory with practical medicine. He emphasized the importance of physics, chemistry and biology for the development of clinical medicine. Physiological studies by Ostroumov proved the important role the central nervous system plays in man. They were aimed at solving problems of clinical medicine. He worked out the main principles of the theory of reflex disorders in various organs due to affection of the nervous system. Ostroumov believed that variations in the course of one disease depend on the special properties of an individual macroorganism and its nervous system. He emphasized the importance of the relationships between man and the environment, and the role of hereditary factors in the pathogenesis of diseases. Ostroumov worked out in detail the clinic of early tuberculosis, balneo- and physiotherapy, indications and contraindications to sanatorium and health resort therapy in tuberculosis and nervous diseases. In Ostroumov's opinion, individual therapy, envigorating and symp­tomatic treatment should be combined with specific treatment of patients.

Vasily Obraztsov (1849—1920) was among the founders of the Soviet therapeutic school. He developed and improved methods for clinical study of patients. He devised and substantiated the method of deep sliding palpa­tion of the stomach and the intestine, and palpation of other organs. He was the first to propose direct percussion of the thoracic and abdominal organs, direct auscultation of the heart to differentiate between the gallop rhythm and the third heart sound. Together with Strazhesko, Obraztsov


gave a complete account of the clinic of thrombosis of the coronary arteries and proved the possibility of intravital diagnosis of thrombosis. He also classified enteritis as an independent clinical form.

Nikolai Strazhesko (1876-1952) was the disciple and successor of Obraztsov. He continued developing methods to study internal organs. He substantiated the principles of examination of the alimentary organs, which he described in his book " Fundamentals of Physical Diagnosis of Diseases of the Abdominal Cavity", which has remained a valuable manual for the therapist of today. His studies of the cardiovascular system enabled him to work out the teaching of functional circulatory insufficien­cy, to classify (together with Vasilenko) circulatory insufficiency, to describe various symptoms in diseases of cardiovascular system (e.g. a pistol-shot sound in complete heart block). Strazhesko described rheumatism as an infectious-allergic disease of the streptococcal aetiology, revealed special features of rheumatism and connections between rheumatism, sepsis, and endocarditis; he described the relation between cardiac asthma and angina pectoris.

Maksim Konchalovsky (1875-1942) demonstrated the importance of the syndrome approach to diagnosis of diseases and worked out the infectious-allergic theory of rheumatism; he described its clinical forms and course, and also determined indications and contraindications to blood transfusion in the clinic of internal diseases. Konchalovsky described the clinic of late chlorosis, the " tourniquet" sign in thrombocytopenia, and developed the teaching of the haemopoietic function of the stomach. Konchalovsky struggled for the union between therapy and broad pro­phylactic measures, for therapy of premorbid conditions; he developed methods for functional diagnosis, and worked at problems of employment prognostication.

Georgy Lang (1875-1948) was the first to define essential hypertension as an independent disease caused by disordered cortical and subcortical regulation; he classified diseases of the circulatory system and was the first to propose the term " myocardial dystrophy".

Lang founded a new " functional" trend in haematology which treats some diseases of the blood system in connection with disorders in the cir­culatory and haemolytic systems. He proposed a classification of liver diseases. Lang and his pupils developed methods for functional diagnosis °f cardiovascular diseases and diseases of the liver. He was the first to pro-Pose treatment of fibrillation with quinidine.

The Soviet clinicists Zimnitsky, Pletnev, Zelenin, Yanovsky, Kurlov, Shklyar, Chernorutsky, Vovsi, Myasnikov, Molchanov and many others made an important contribution to the development of internal medicine, diagnosis of diseases in particular. Many other outstanding Soviet scien-



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tists and clinicists, talented teachers continue the traditions of the Russian and Soviet medicine and work to solve many important problems of inter­nal pathology.


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