therapy(redirected from hemofiltration therapy)
Also found in: Dictionary, Thesaurus, Medical, Legal.
(in Russian, terapiia). (1) Medical treatment by conservative methods. Among the types of therapy are treatment by medicines (pharmacotherapy), including chemotherapy, antibiotic therapy, and hormone therapy; serotherapy and vaccinotherapy; and treatment with ionizing radiation (radiotherapy). Other methods of treatment are achieved by means of climate, exercise, therapeutic muds, mineral waters, massage, electricity, and other physical factors; these methods include sanatorium and health resort treatment, physical therapy, and exercise therapy. Still other types of therapy are dietotherapy and cryotherapy, or the therapeutic use of cold.
(2) Internal medicine, the clinical discipline dealing with internal diseases—their causes, development, diagnosis, nonradical treatment, and prevention. Diseases of internal organs and of blood circulation, respiration, digestion, metabolism, the blood, connective tissues, and endocrine glands are included among internal diseases.
The history of therapy before the 19th century is part of the history of medicine as a whole. For several millennia the practice of medicine was limited to therapy (medicine), surgery, and obstetrics. During the Middle Ages the physician, or internist, was a man with medical training, in contrast to the surgeon, who was generally a barber. The great physicians of ancient Greece and Rome, the Orient, and Europe during the Renaissance founded major systems, schools, and trends of therapy. Hippocrates advocated observation at the patient’s bedside as a professional method of examination, stressed the importance of the environment and mode of life as factors responsible for health and disease, and established the individual approach to treatment. Galen systematized the medical knowledge of the classical period and proved that anatomy and physiology constitute the scientific basis of diagnosis and treatment. Avicenna compiled a medical encyclopedia, and Paracelsus, an advocate of experimentation, used chemical elements and compounds and mineral waters for therapeutic purposes, developed the concept of drug dosage, and laid the foundation of iatrochemistry.
Empirical medicine achieved a high level of development in the 17th century in the work of T. Sydenham, who rejected dogmatic systems of medicine in favor of practical medicine based on the Hippocratic principle of observation. Sydenham developed the concept of phases of disease and described the symptoms of many diseases. The principle of observation at the patient’s bedside was advocated by H. Boerhaave, C. Hufeland, S. G. Zybelin, G. I. Sokol’skii, and many other physicians during the period from the second half of the 17th to the first half of the 19th century.
Between the 16th and 19th centuries, the foundations were laid for the development of therapy as a scientific discipline. In the 16th and 17th centuries, A. Vesalius founded the scientific study of anatomy, and W. Harvey discovered the circulation of the blood. Advances in pathological anatomy, which helped establish the site and substratum of diseases, were made by the physicians G. B. Morgagni, M. Bichat, K. Rokitansky, R. Virchow, and A. I. Polunin. In the 18th and 19th centuries, methods of medical examination were developed by M. Ia. Mudrov and G. A. Zakhar’in. Percussion was introduced by L. Auenbrugger and J. N. Corvisart des Marets, and auscultation by R. Laénnec and J. Skoda. Experimental research was furthered by F. Magendie and J. P. Müller.
In the mid-19th century, the experimental and clinical work of a number of physicians also contributed to the development of therapy as a scientific discipline. They included L. Traube (Germany), A. Trousseau (France), R. Bright and T. Addison (Great Britain), and R. Oppolzer (Austria). The focus on bacteria in medicine between 1870 and 1890, initiated by the work of L. Pasteur and R. Koch, resulted in the discovery of the causative agents of many infectious diseases, but at the same time exaggerated the role played by bacteria in the origin of disease.
A functional trend in therapy emerged in opposition to the anatomic and localistic approach of the adherents of cellular pathology. This trend was established by C. Bernard; I. M. Sechenov; S. P. Botkin, the founder of scientific therapy in Russia; I. P. Pavlov; A. A. Ostroumov; the English physician J. Mackenzie, the founder of clinical cardiology; the German internist G. von Bergmann; and many other physiologists and clinicians. The functional trend sought to correct the prevalent underestimation of the role of the body itself in pathogenesis and the process of recovery. Followers of the functional trend recognized the body as a functional entity and regarded the neural and endocrine regulatory mechanisms as responsible for this unity. Disease was viewed as the body’s reaction to injurious environmental factors, and organ and systemic dysfunction as responsible for the course and outcome of disease. Both clinical observation and experimentation were regarded as essential components of scientific research.
A physiological trend in therapy was developed by E. O. Mukhin and I. E. Diad’kovskii. This trend determined the approach of Botkin’s school to clinical pathology and became characteristic of Russian therapy as a whole. Beginning with the work of S. G. Zybelin and his followers, the Moscow University professors F. G. Politkovskii and M. Ia. Mudrov, the Russian approach to therapy focused on preventive medicine and the clinical method and criticized speculative medical systems. G. A. Zakhar’in’s clinical method gained worldwide recognition.
Advances in physics and technology and the related development of physiology at the turn of the 20th century resulted in new methods of medical examination with instruments and improved the ability of physicians to diagnose disease; of particular importance were the discovery of X rays and the rapid development of roentgen diagnosis. Electrocardiography was introduced by the Dutch physiologist W. Einthoven (1903), and the acoustic method of determining blood pressure was developed by the Italian physician S. Riva-Rocci (1896) and the Russian physician N. S. Korotkov (1905). The work of P.-C.-E. Potain and L. Vaquez (France), F. Kraus and K. F. Wenckebach (Austria), T. Lewis (Great Britain), G. Pardee (USA), and M. V. Ianovskii and V. F. Zelenin (Russia) led to new methods of diagnosis.
Advances in chemistry during the same period resulted in the development of new drugs and of new methods of diagnosis by means of laboratory analysis of the blood, urine, and stomach contents. Progress in microbiology and immunology led to the use of vaccines and serums for the prevention and treatment of disease. The method of serodiagnosis was developed by the French internist G. F. I. Widal, who used it with typhoid patients (1896).
Clinical medicine underwent differentiation in the 19th century owing to the rapid accumulation of medical knowledge, and therapy became divided into a number of independent disciplines. Dermatology was developed in the first half of the 19th century by R. Willan (England), J. Alibert (France), and F. von Hebra (Austria). Neuropathology was founded by J. M. Charcot (1860) and A. Ia. Kozhevnikov (1869). Phthisiatry developed somewhat later, as did the method of determining the clinical picture of infectious diseases. The field of therapy was defined by the term “internal diseases,” although many clinicians emphasized the difficulty of making clear-cut distinctions between internal and external diseases.
A number of outstanding foreign internists of the late 19th and early 20th centuries founded major schools and contributed to progress in the diagnosis and treatment of internal diseases. They included A. Huchard (France), E. Leiden, B. Naunyn, and M. Romberg (Germany), and W. Osier and J. B. Herrick (USA). Russian and Soviet internists also made important contributions to the development of diagnostic methods; these contributions included V. P. Obraztsov’s method of deep sliding palpitation, M. I. Arinkin’s puncture of the sternum to study bone marrow (1927), and S. S. Zimnitskii’s renal function test. Among the founders of the Soviet school of internal medicine were M. P. Konchalovskii, who studied the stages of diseases, premorbid states, the pathology of digestive organs and blood, and rheumatism. G. F. Lang, the first to study hypertension (1922–48), proposed a classification of circulatory diseases (1935) that became the basis for their further study in the USSR. D. D. Pletnev developed clinical and experimental methods in cardiology and became widely known for his research on arrhythmia and angina pectoris. N. D. Strazhesko and V. P. Obraztsov provided the first classical description of myocardial infarction (1909), advanced a theory of the streptococcal origin of rheumatism (1934), and described a number of symptoms of diseases of the circulatory and digestive organs.
Modern therapy deals with changes in the nature of pathology, the continuing differentiation of the clinical disciplines, the increasing use of laboratory and instrumental methods of diagnosis, and the application of drug therapy. In the economically developed countries, infectious diseases have been displaced as the leading form of pathology by cardiovascular diseases, which now present the main threat to human health and life. Extensive research is being devoted to studying cardiovascular diseases and devising effective measures of dealing with them.
The field of internal medicine has undergone differentiation, and at the same time, related fields have become increasingly integrated, for example, surgery, urology, physiology, and experimental pathology and therapy. During the second half of the 20th century these developments resulted in the emergence of cardiology, gastroenterology, and nephrology as independent medical fields. Consequently, the training of physicians and the integration of research in internal medicine are becoming increasingly complex.
The steady expansion of medical examination by means of laboratory and instrumental methods is accompanied by research on machine diagnosis; the problem of the physician’s medical outlook and approach is especially important. The development of sulfanilamides, antibiotics, hormonal preparations, cytostatics, psychotropic drugs, and vaccines and serums has placed the internist on a level with the surgeon and his scalpel. These drugs are generally effective, but they may result in complications or drug diseases. Consequently, there is a need for the careful study of new drugs, of maximum safe doses, and of possible side effects. The developing area of clinical pharmacology deals with these problems.
Therapy in the USSR reflects the principles of the Soviet public health system and the foundation of Soviet medicine—the theory of higher nervous activity. These factors determine the preventive and functional approach followed in Soviet medical research and practice.
Therapy (therapeutics) is the main clinical discipline taught in the subdepartments of internal medicine at all the higher medical educational institutions in the USSR from the third to sixth years of study. Internists receive additional specialized training during a “seventh-year” internship in the departments of internal medicine of major hospitals. Further training is provided during clinical residencies, through graduate studies, in subdepartments of institutions for the advanced training of physicians, and in local medical institutions.
Research centers for internal medicine include such specialized institutes as the A. L. Miasnikov Institute of Cardiology, the Institute of Rheumatism, and the Institute of Gastroenterology (Moscow), the Institute of Pulmonology (Leningrad), the N. D. Strazhesko Institute of Clinical Medicine (Kiev), and institutes of rheumatism in Belgrade, Prague, and London. Research in internal medicine is also conducted at the National Heart, Lung, and Blood Institute in Bethesda, Md. (USA), at a cardiology center in Berlin, and in many other centers. In addition, studies in internal medicine are carried out in specialized clinics and in departments of internal medicine at medical schools.
As of 1974, more than 30,000 physicians were members of the All-Union Society of Internists (founded 1922). Russian congresses of internists were held from 1909 through 1924; the first congress was held in Kiev, and the seventh in Moscow. Beginning with the eighth congress, held in Leningrad in 1925, these were all-Union congresses; the Seventeenth All-Union Congress of Internists was held in Moscow in 1974. International congresses of internists deal with general aspects of internal medicine (since 1950) and with specialized fields, for example, rheumatology (since 1926), gastroenterology (since 1935), and nephrology (since 1960).
Specialized Soviet journals in the field include Terapevticheskii arkhiv (Archives of Internal Medicine, since 1923) and Klinicheskaia meditsina (Clinical Medicine, since 1920). Among foreign journals are Archives of internal Medicine (Chicago, since 1908), Advances in Internal Medicine (London-New York, since 1942), Ergebnisse der inneren Medizin und Kinderheilkunde (Berlin, since 1908), Journal of the Japanese Society of Internal Medicine (Tokyo, since 1913), and Excerpta Medica, Sect. 6: Internal Medicine (Amsterdam, since 1947).
REFERENCESZakhar’in, G. A. Klinicheskie lektskii i izbr. stat’i, 2nd ed. Moscow, 1910.
Pletnev, D. D. Russkie terapevticheskie shkoly. Moscow-Petrograd, 1923.
Meier-Steineg, T., and K. Sudhoff. Istoriia meditsiny. Moscow . (Translated from German.)
Osler, W. Rukovodstvo po vnutrennei meditsine. Leningrad, 1928. (Translated from English.)
Bergmann, G. von. Funktsional’naiapatologiia. Moscow-Leningrad, 1936. (Translated from German.)
Uchebnik vnutrennikh boleznei, vols. 1–2. Edited by G. F. Lang. [Leningrad] 1938–41.
Mudrov, M. Ia. Izbr. proizvedeniia. Moscow, 1949.
Botkin, S. P. Kurs kliniki vnutrennikh boleznei i klinicheskie lektsii, vols. 1–2. Moscow, 1950.
Ostroumov, A. A. Izbr. trudy. Moscow, 1950.
Borodulin, F. R. S. P. Botkin i nevrogennaia teoriia meditsiny, 2nd ed. Moscow, 1953.
Tareev, E. M. Vnutrennie bolezni, 3rd ed. Moscow, 1957.
Lushnikov, A. G. Klinika vnutrennikh boleznei v Rossii pervoi poloviny XIX veka. Moscow, 1959.
Lushnikov, A. G. Klinika vnutrennikh boleznei v Rossii. Moscow, 1962.
Lushnikov, A. G. Klinika vnutrennikh boleznei v SSSR. Moscow, 1972.
Mnogotomnoe rukovodstvo po vnutrennim bolezniam, vol. 10. Edited by A. L. Miasnikov. Moscow, 1963.
Gukasian, A. G. Evoliutsiia otechestvennoi terapevticheskoi mysli. (Po materialiam s”ezdov i konferentsii terapevtov.) Moscow, 1973.
Saintignon, H. Laënnec, sa vie et son oeuvre. Paris, 1904.
Spezielle Pathologie und Therapie innerer Krankheiten, vols. 1–11. Edited by F. Kraus and T. Brugsch. Berlin-Vienna, 1919–27.
N. M. PREOBRAZHENSKII