Pathophysiology

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Pathophysiology

 

a medical discipline that studies compensatory reactions, adaptive reactions, and the patterns of origin and development of pathological processes in the sick organism. The method of pathophysiology is animal experimentation, or experimental pathology, combined with clinical observation. The main concerns or subdivisions of pathophysiology are the general study of disease; general etiology, or the study of causes and conditions of origin of disease; and general pathogenesis, or the study of adaptation, compensation, restoration of impaired functions, and mechanisms of development of pathological processes. Pathophysiology also focuses on the study of such typical pathological processes as inflammation, fever, starvation, malignant growth, disturbances of the peripheral blood circulation, metabolic disturbances, and hypoxia. Other concerns are artificial induction and simulation of pathological processes and study of general patterns of impairment and restoration of function in organs and functional systems, for example, the nervous, cardiovascular, and respiratory systems.

In the USSR, Czechoslovakia, Bulgaria, Rumania, Yugoslavia, and a few other countries, pathophysiology is an independent scientific discipline. Elsewhere, for example, in France, Italy, Great Britain, and the USA, it is either called general or experimental pathology or is regarded as a branch of pathological anatomy or of corresponding clinical disciplines.

Pathophysiology originated as a result of the use of the experimental method in the 19th century in studying pathological processes. Early, influential experimenters were F. Magendie, A. M. Filomafitskii, and C. Bernard. In the second half of the 19th century, the morphological approach became dominant, and pathophysiology did not develop independently. The founder of pathophysiology as an independent scientific discipline and subject of teaching in Russia was V. V. Pashutin, who created the first Russian school of pathophysiological thought; his followers included P. M. Al’bitskii, A. V. Reprev, E. A. Kartashevskii, N. G. Ushinskii, and P. P. Avrorov. The school studied metabolism, heat exchange, and gas exchange in different forms of starvation and other experimentally induced pathological conditions; it also worked on such problems as hypoxia and internal secretion.

The Moscow school of pathophysiologists, which was founded by A. B. Fokht, arose independently. It emphasized the clinical and experimental approach and the comprehensive study of disease by experimental physiological and experimental morphological methods, as well as by clinical methods. Fokht and his students were primarily concerned with the adaptive and compensatory reactions of the body and the role of neural and humoral regulation in morbid conditions of the cardiovascular, lymphatic, and urogenital systems. Among Fokht’s students were A. I. Tal’iantsev, F. F. Venulet, V. K. Lindeman, V. G. Korenchevskii, F. A. Andreev, D. D. Pletnev, and G. P. Sakharov. Fokht and Tal’iantsev, among others, worked out original methods of simulating various cardiac diseases. Lindeman, who worked in E. Metchnikoff’s laboratory, was able to experimentally induce cytotoxic nephritis. Korenchevskii became one of the pioneers in gerontology. In 1905, Sakharov described serum anaphylaxis in guinea pigs.

The school of pathologists created by V. V. Podvysotskii in universities in Kiev and Odessa and at the Institute of Experimental Medicine in St. Petersburg, which included I. G. Savchenko, L. A. Tarasevich, and A. A. Bogomolets, researched oncology, regeneration of glandular tissue, endocrinology, and immunity and other aspects of infectious pathology. A. A. Bogomolets and his students, including N. N. Sirotinin, E. A. Tatarinov, and R. E. Kavetskii, developed Metchnikoff’s teaching on cytotoxins and on the role of connective tissue in the body’s reactivity and made a major contribution to problems of blood transfusion, aging, and endocrine regulation.

The experimentally induced simulation of atherosclerosis that was devised in 1912 by S. S. Khalatov and subsequently improved by N. N. Anichkov stimulated extensive research. In 1919, E. S. London proposed the method of angiostomy—the artificial formation of an orifice in a blood vessel; in 1935 he developed a similar method for making openings in organs. These methods enabled scientists in the USSR and foreign countries to study many aspects of the physiology and pathology of carbohydrate, protein, cholesterol, and water and salt metabolism. The pathophysiology of diabetes mellitus and diseases of lipid and fat metabolism was elucidated by S. M. Leites and his students.

A standard methodology based on dialectical materialism and a close relationship between experimental research and the demands of clinical medicine are characteristic of the development of pathophysiology in the USSR. I. P. Pavlov’s school, which included A. G. Ivanov-Smolenskii and M. K. Petrova, developed simulations of neuroses and founded the field of the pathophysiology of higher nervous activity. S. M. Pavlenko and A. D. Speranskii and his students V. S. Galkin, S. I. Frankshtein, and A. M. Chernukh investigated the role of the nervous system in pathogenesis and the recovery process. The work of Sirotinin and his students on the comparative physiology and pathology of reactivity in poisonings, allergies, and infections drew attention to the problem of the evolution of different kinds of reactivity. The correlation of neural and humoral elements in the altered reactivity that is associated with allergies was studied by A. D. Ado and many others. Inflammation has been studied in light of V. V. Voronin’s and D. E. Al’pern’s theory of reactivity. The mechanism by which fevers develop was thoroughly investigated by P. N. Veselkin.

The clinical and experimental studies of several scientists, including V. V. Parin, F. Z. Meerson, and N. N. Gorev, shed light on several mechanisms of the pathogenesis and compensatory processes in cardiovascular pathology. Outstanding successes were achieved in experimental studies on blood transfusion and on the pathogenesis and treatment of shock, hypoxia, and radiation lesions by I. R. Petrov, P. D. Gorizontov, N. N. Fedorov, and I. A. Piontkovskii. The science of resuscitation was addressed by F. A. Andreev, S. S. Briukhonenko, S. I. Chechulin, and V. A. Negovskii, among others.

Modern pathophysiology incorporates a tendency to join with other disciplines. Experimental therapy is used as a means of both studying pathogenesis and developing new modes of treatment. Many major issues in modern pathology cannot be studied without comprehensive research on permeability of biological membranes and microcirculatory patterns. These issues include inflammation; tissue and organ transplantation; circulatory disturbances in the brain, heart, and kidneys; and compensation for circulatory disturbance in heart disease, including heart disease that has been surgically corrected. The research is carried out in conjunction with specialists in other branches of biology and medicine. Cytological methods in pathophysiology led to the formation of a new branch—cellular pathophysiology. Soviet and American scientists are researching the effects of space factors on organisms.

In the USSR the centers of research in pathophysiology are the Institute of General Pathology and Pathophysiology of the Academy of Medical Sciences of the USSR and the laboratories of research institutes and departments of pathophysiology that are attached to medical and veterinary schools. Institutes of pathophysiology also exist in Bratislava, Czechoslovakia, and Skopje, Yugoslavia. The All-Union Society of Pathophysiologists was organized in 1950. The First All-Union Conference of Pathophysiologists and the First All-Union Congress of Pathophysiologists were held in 1950 and 1970, respectively. Issues in pathophysiology are discussed in the journal Patologicheskaia fiziologiia i eksperimental’naia terapiia, which has been published since 1957. Beginning in 1869, the subject was taught in departments of general pathology; but by now these have been renamed departments of pathophysiology, and they are found in all medical institutes and many institutes (departments) for the advanced training of physicians. Similar departments have been organized in several socialist countries.

REFERENCES

Pashutin, V. V. Kurs obshchei i eksperimental’noi patologii (patologicheskoi fiziologii), vols. 1–2. St. Petersburg, 1885–1902.
Sakharov, G. P. Metodologiia patologii, 2nd ed. Moscow, 1935.
Rukovodstvo po patologicheskoi fiziologii, vols. 1–3. Edited by A. A. Bogomolets. Kiev, 1940–47.
Voronin, V. V. Rukovodstvo patologicheskoi fiziologii, parts 1–2. Tbilisi, 1947–48.
Speranskii, A. D. Izbr. trudy. Moscow, 1955.
Bogomolets, A. A. Izbr. trudy, vols. 1–3. Kiev, 1956–58.
Patologicheskaia fiziologiia. Edited by A. D. Ado and I. R. Petrov. Moscow, 1957.
Al’pern, D. E. Patologicheskaia fiziologiia, 5th ed. Moscow, 1960.
Shilinis, Iu. A. “Patologicheskaia fiziologiia.” In Istoriia meditsiny SSSR. Edited by B. D. Petrov. Moscow, 1964. Pages 154–202. (Bibliography.)
Mnogotomnoe rukovodstvo po patologicheskoi fiziologii, vols. 1–4. Edited by N. N. Sirotinin. Moscow, 1966.
Ado, A. D. “Razvitie teorii meditsiny v trudakh sovetskikh patofiziologov.” Patologicheskaia fiziologiia i eksperimental’naia terapiia. 1967, no. 5, pp. 10–18.
Gorizontov, P. D. “Patologicheskaia fiziologiia.” In 50 let sovetskogo zdravookhraneniia, 1917–1967. Moscow, 1967. Pages 277–84.

I. A. PIONTKOVSKII and IU. A. SHILINIS

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