The term "pathology", made up of two Greek words, means "the science of disease." The discipline, which is currently designated by this term in most countries, has a number of other names: pathological anatomy, pathomorphology, morbid anatomy, anatomical pathology, histopathology, surgical pathology, etc. In domestic medicine, it is customary to call this discipline “pathological anatomy”. Pathological anatomy is a scientific and applied discipline that studies pathological processes and diseases through scientific, mainly microscopic study of changes that occur in cells and tissues.

A pathological process is understood as any disorder of structure and function, and a disease is a combination of one or more pathological processes leading to disruption of the normal state and functioning of the body.

In the history of the development of pathological anatomy, four periods are distinguished: anatomical (from antiquity to early XIX century), microscopic (from the first third of the 19th century to the 50s of the 20th century), ultramicroscopic (after the 50s of the 19th century); the modern fourth period of development of pathological anatomy can be characterized as the period of pathological anatomy of a living person.

The opportunity to study pathological changes in the organs of the human body appeared in the 15th-17th centuries. thanks to the emergence and development of scientific anatomy. The most significant role in creating a method of anatomical research, describing the structure of all the most important organs and their relative positions was played in the middle of the 16th century. works by A. Vesalius, G. Fallopius, R. Colombo and B. Eustachius.

Anatomical studies of the second half of the 16th and early 17th centuries. not only strengthened the position of anatomy, but also contributed to the emergence of interest in it among doctors. The philosopher F. Bacon and the anatomist W. Harvey had a significant influence on the development of anatomy during this period.

In 1676, T. Bonet made the first attempt, using significant material (3000 autopsies), to show the existence of a connection between the detected morphological changes and the clinical manifestations of the disease.

In the 17th century The richest anatomical museums appeared in Europe (Leiden), in which pathological anatomical preparations were widely represented.

The most important event in the history of pathological anatomy, which determined its separation into an independent science, was the publication in 1761 of the main work of J.B. Morgani “On the location and causes of diseases identified by the anatomist.”

At the turn of the 18th and 19th centuries. in France, J. Corvisart, R. Laennec, G. Dupuytren, K. Lobstein, J. Boillot, J. Cruvelier widely introduced pathological anatomy into clinical practice, and M. K. Bichat indicated the further path of its development - the study of damage at the tissue level . M.K.Bish's student F.Brousse created a doctrine that rejected the existence of diseases that do not have a material substrate. J. Cruvelier released in 1829-1835. The world's first color atlas on pathological anatomy.

In the middle of the 19th century. The greatest influence on the development of this branch of medicine was exerted by the works of K. Rokitansky, in which he not only presented changes in organs at various stages of the development of diseases, but also clarified the description of pathological changes in many diseases. In 1844, K. Rokitansky founded the Department of Pathological Anatomy at the University of Vienna and created the world's largest pathological anatomical museum. The name of K. Rokitansky is associated with the final separation of pathological anatomy into an independent scientific discipline and medical specialty. The turning point in the development of this discipline was the creation in 1855 of the theory of cellular pathology by R. Virchow.

In Russia, the first attempts to organize autopsy work date back to the 18th century. They are associated with the activities of prominent health care organizers - I. Fisher and P. Z. Kondoidi. These attempts did not produce tangible results due to the low level of development of Russian medicine and the state of medical education, although already at that time autopsies were carried out for control, diagnostic and research purposes.

The formation of pathological anatomy as a scientific discipline began only in the first quarter of the XIX V. and coincided with improvements in the teaching of normal anatomy in universities.

One of the first anatomists to draw students' attention to pathological changes in organs during dissection was E.O. Mukhin.

For the first time, the question of the need to include pathological anatomy among the compulsory teaching subjects at the medical faculty of Moscow University was raised in 1805 by M.Ya. Mudrov in a letter to the university trustee M.N. Muravyov. At the suggestion of Yu.H. Loder, the teaching of pathological anatomy in the form of a course at the department of normal anatomy was reflected in the university charter of 1835. In accordance with this charter, the teaching of an independent course of pathological anatomy was started in 1837 by prof. L.S. Sevruk at the Department of Normal Anatomy. Professors G.I. Sokolsky and A.I. Over began to use the latest pathoanatomical information in teaching therapeutic disciplines, and F.I. Inozemtsev and A.I. Pol - when lecturing on surgery courses.

In 1841, in connection with the creation of a new medical faculty in Kyiv, N.I. Pirogov raised the question of the need to open a department for teaching pathology at the University of St. Vladimir. In accordance with the charter of this university (1842), it was provided for the opening of the department of pathological anatomy and pathological physiology, which began to function in 1845. It was headed by N.I. Kozlov, a student of N.I. Pirogov.

On December 7, 1845, the “Additional Decree on the Medical Faculty of the Imperial Moscow University” was adopted, which provided for the creation of the department of pathological anatomy and pathological physiology. In 1846, Yu. Dietrich, an adjunct of the faculty therapeutic clinic, headed by A.I. Over, was appointed professor of this department. After the death of J. Dietrich, four adjuncts of therapeutic clinics of Moscow University took part in the competition to fill the vacant position - Samson von Gimmelyptern, N.S. Toporov, A.I. Polunin and K.Ya. Mlodzievsky. In May 1849, A.I. Polunin, an adjunct at the hospital therapeutic clinic of I.V. Varvinsky, was elected professor of the department of pathological anatomy and pathological physiology.

Modern medicine is characterized by a constant search for the most objective material criteria for diagnosis and knowledge of the essence of the disease. Among these criteria, morphological acquires exceptional importance as the most reliable.

Modern pathological anatomy widely uses the achievements of other medical and biological disciplines, summarizing the actual data of biochemical, morphological, genetic, pathophysiological and other studies in order to establish the patterns of operation of a particular organ and system in various diseases.

Thanks to the problems that pathological anatomy is currently solving, it occupies a special place among medical disciplines. On the one hand, pathological anatomy is a theory of medicine, which, by revealing the material substrate of the disease, directly serves clinical practice; on the other hand, it is clinical morphology for diagnosis, which provides the material substrate for the theory of medicine - general and specific human pathology (V.V. Serov, 1982).

By general pathology we mean the most general ones, i.e. the patterns of their occurrence, development and outcomes characteristic of all diseases. Having its roots in the particular manifestations of various diseases and based on these particulars, general pathology simultaneously synthesizes them and gives an idea of ​​the typical processes characteristic of a particular disease. The further progress of general pathology cannot be made dependent on the development of any one discipline or group of them, since general pathology represents the concentrated experience of all branches of medicine, assessed from a broad biological perspective.

Each of the modern medical and biomedical disciplines makes its contribution to the construction of the theory of medicine. Biochemistry, endocrinology and pharmacology reveal the subtle mechanisms of vital processes at the molecular level; in pathological studies, the laws of general pathology receive a morphological interpretation; pathological physiology gives their functional characteristics; microbiology and virology are the most important sources for the development of etiological and immunological aspects of general pathology; genetics reveals the secrets of the individuality of the body's reactions and the principles of their intracellular regulation; clinical medicine completes the formulation of the laws of general human pathology on the basis of its own rich experience and the final assessment of the experimental data obtained from the point of view of psychological, social and other factors.

The modern stage of development of medicine is characterized by the fact that disciplines that were previously predominantly or even exclusively experimental (genetics, immunology, biochemistry, endocrinology, pathological physiology, etc.) are becoming equally clinical.

The rapid development of clinical physiology, clinical morphology, clinical immunology, clinical biochemistry and pharmacology, medical genetics, fundamentally new methods of X-ray examination, endoscopy, echography, etc. has extremely enriched knowledge about the actual details and general patterns of the development of human diseases. The increasingly widespread use of non-invasive research methods (computed tomography, ultrasound diagnostics, endoscopic methods, etc.) makes it possible to visually determine the localization, size and even to a certain extent the nature of the pathological process, which essentially opens the way for the development of intravital pathological anatomy - clinical morphology, which is dedicated to course of private pathological anatomy.

The scope of application of morphological analysis in the clinic is constantly expanding due to the ever-increasing surgical activity and advances in medical technology, as well as due to the improvement of the methodological capabilities of morphology. The improvement of medical instruments has led to the fact that there are practically no areas of the human body that are inaccessible to a doctor. At the same time, endoscopy is of particular importance for improving clinical morphology, allowing the clinician to engage in a morphological study of the disease at the macroscopic (organ) level. Endoscopic examinations also serve the purpose of biopsy, with the help of which the pathologist obtains material for morphological examination and becomes a full participant in resolving issues of diagnosis, therapeutic or surgical tactics and prognosis of the disease. Using biopsy material, the pathologist also solves many theoretical issues of pathology. Therefore, the biopsy becomes the main object of research when solving practical and theoretical issues of pathological anatomy.

The methodological capabilities of modern morphology satisfy the pathologist's aspirations for ever-increasing accuracy of morphological analysis of disturbed vital processes and an increasingly complete and accurate functional assessment of structural changes. Modern methodological possibilities of morphology are enormous. They allow the study of pathological processes and diseases at the level of the organism, organ system, organ, tissue, cell, cellular organelle and macromolecule. These are macroscopic and light-optical (microscopic), electron-microscopic, cyto- and histochemical, immunohistochemical and autoradiographic methods. There is a tendency to integrate a number of traditional methods of morphological research, as a result of which electron microscopic histochemistry, electron microscopic immunocytochemistry, and electron microscopic autoradiography emerged, which significantly expanded the capabilities of the pathologist in diagnosing and understanding the essence of diseases.

Along with a qualitative assessment of the observed processes and phenomena, when using the latest methods of morphological analysis, there is the possibility of a quantitative assessment. Morphometry gave researchers the opportunity to use electronic technology and mathematics to judge the reliability of the results and the validity of the interpretation of the identified patterns.

Using modern research methods, a pathologist can detect not only morphological changes characteristic of a detailed picture of a particular disease, but also initial changes in diseases, the clinical manifestations of which are still absent due to the consistency of compensatory-adaptive processes (Sarkisov D.S., 1988). Consequently, the initial changes (preclinical period of the disease) are ahead of their early clinical manifestations (clinical period of the disease). Therefore, the main guideline in diagnosing the initial stages of the disease is the morphological changes in cells and tissues.

Pathological anatomy, having modern technical and methodological capabilities, is designed to solve problems of both clinical diagnostic and research nature.

Despite the fact that in last years In all countries, the number of autopsies is steadily decreasing; pathological examination remains one of the main methods scientific knowledge diseases. With its help, an examination of the correctness of diagnosis and treatment is carried out, and the causes of death are established. In this regard, an autopsy as the final stage of diagnosis is necessary not only for the clinician and pathologist, but also medical statistics and health care organizer. This method is the basis for scientific research, teaching fundamental and applied medical disciplines, and a school for doctors of any specialty. Analysis of autopsy results plays an important role in solving a number of major scientific and practical problems, for example, the problem of variability, or pathomorphosis, of diseases.

Objects studied by a pathologist can be divided into three groups: 1) cadaveric material, 2) substrates obtained from patients during their lifetime (organs, tissues and their parts, cells and their parts, secretion products, fluids) and 3) experimental material.

Corpse material. Traditionally, the organs and tissues of deceased corpses are the subject of study during pathological autopsies (autopsies, sections) of persons who died from diseases. Cases of death that did not occur from disease, but as a result of crimes, disasters, accidents or unclear causes, are examined by forensic doctors.

Cadaveric material is studied at the anatomical and histological levels. X-ray, microbiological and biochemical methods are less commonly used. The medical history and all available medical documentation are delivered to the pathology department along with the deceased. Before the autopsy, the pathologist is obliged to study all this, and then invite the attending physicians to the autopsy. Clinicians must verify those findings that confirm or refute their ideas about the processes and changes that occurred in the body during the patient’s lifetime. The pathologist records the results of the autopsy in the autopsy report, and indicates the cause of death of the patient in the death certificate, which is then issued to the relatives of the deceased.

Opening. The main purpose of an autopsy is to establish the final diagnosis and causes of death of the patient. The correctness or incorrectness of the clinical diagnosis and the effectiveness of treatment are also assessed. There are criteria for assessing discrepancies between clinical and pathological diagnoses, as well as a classification of the causes of discrepancies. Another goal of autopsy is the mutual enrichment of the scientific and practical experience of clinicians and pathologists. The significance of the sectional work of a pathologist is not only in monitoring the quality of diagnostic and treatment activities of clinicians (this control is complex and is carried out not only by pathologists), but also in the accumulation of statistical and scientific-practical data on diseases and pathological processes.

If sectional work is organized highly professionally and adequately equipped methodologically, then its implementation in full is very expensive. This was one of the reasons for the significant reduction in the number of hospital autopsies in a number of industries. developed countries. A trend towards a reduction in the number of autopsies has also emerged in Russia.

Material taken during the patient's lifetime. A much larger volume of a pathologist’s work is occupied by microscopic study of material obtained for diagnostic purposes during the patient’s lifetime. Most often, such material comes from operating clinicians: surgeons, gynecologists, urologists, otorhinolaryngologists, ophthalmologists, etc. The diagnostic role of the pathologist here is great, and his conclusion often determines the formulation of the clinical diagnosis.

Histological examination. Surgical and biopsy materials are subjected to this study. The pathologist is required to provide histological confirmation (clarification) of the diagnosis. In both cases, immediate fixation of the removed tissue is important. Even a short period of time keeping removed pieces or substrates in air, water or saline solution can lead to irreversible, artificially induced changes in the material that make it difficult or impossible to make a correct histological diagnosis.

Pieces of no more than 1 cm in diameter are cut out of the fixed material using a sharp razor, then they are placed in special cassettes and placed in machines for histological processing.

Histological sections 5-10 microns thick are glued onto glass slides, deparaffinized, stained in one way or another, and then placed in optically transparent media under a coverslip.

In urgent biopsies, often performed during major surgical interventions, in order to quickly obtain a histological diagnosis, the tissue is frozen and cut on a cryostat or freezing microtome. Frozen sections are usually thicker than paraffin sections, but they are useful for preliminary diagnosis. A cryostat and freezing microtome are used to preserve alcohol-soluble and some other tissue components that are important for diagnosis (for example, fat).

For routine diagnosis, universal histological staining of sections with hematoxylin and eosin is widely used. Tinctorial, i.e. The coloring properties of hematoxylin are realized in a slightly alkaline medium, and structures colored blue or dark blue with this dye are usually called basophilic. These include cell nuclei, lime salt deposits and bacterial colonies. Some types of mucus can produce mild basophilia. Eosin, on the contrary, at a pH less than 7 colors the so-called oxyphilic components pink-red or red. These include the cytoplasm of cells, fibers, red blood cells, protein masses and most types of mucus. Van Gieson picrofuchsin staining is very often used, electively, i.e. selectively, staining the collagen fibers of the connective tissue red, while other structures become yellow or greenish-yellow. There are also a variety of histological stains to identify specific tissue components or pathological substrates.

Cytological examination. It is carried out on smears made from the contents of hollow or tubular organs, as well as on impression preparations, punctures and aspirates (aspiration punctates, sucked out with a syringe). Smears are often made from material from swabs from the walls of organs, which makes it possible to capture cells that are in the process of natural or pathological desquamation (desquamation, exfoliation), for example, from the cervix. A more active intervention is scraping from the walls of organs. If the scraping material is abundant, it is processed using histological techniques. In particular, this is done with diagnostic endometrial scrapings. With scanty scrapings, the material is sent for cytological processing. Often, preparations are made from sputum, mucus, tissue trains and sediments in liquids. Precipitates can be obtained after centrifugation of suspensions.

Cytological material is usually fixed directly on a glass slide, often during staining. The most popular stains are: azure-eosin (its tincgorial properties are close to hematoxylin and eosin) or Bismarck-Brown according to Papanicolaou.

Immunohistochemical study. For some pathological conditions, especially tumors, it can be difficult and even impossible to determine the type of tissue or its origin (histogenesis) using histo- or cytological stains. Meanwhile, such verification is important for diagnosis and prognosis. Therefore, various additional methodological approaches are used. One of them is the immunohistochemical method. In this method, solutions with antibodies to the desired antigens are applied to histo- or cytological preparations: tumor, viral, microbial, autoantigens, etc. Antigens are not visible with conventional histological stains of tissues. Antibodies in serums carry a label: either a fluorochrome, i.e. a dye that glows in a dark field (in other words, gives fluorescence), or a dyeing enzyme. If the desired antigen is present in the tissues or cells being studied, then the resulting antigen-antibody complex plus a marker will accurately indicate its location, quantity, and will help study some of its properties.

Immunofluorescence is most often used when studying sections prepared in a cryostat or on a freezing microtome, as well as when studying cytological preparations. Sera with antibodies, so-called antisera, are used, most often conjugated with such a reliable fluorochrome as fluorescein isothiocyanate. The most popular is the indirect method, which allows the detection of antigens using a double reaction with antibodies.

The immunoperoxidase method is even more common. The antibodies of the dye serum do not carry a fluorochrome, but an enzyme - horseradish peroxidase, or less often another enzyme, for example, alkaline phosphatase. There are several variants of this method. The two most commonly used are the peroxidase-antiperoxidase method (PAP method) and the avidin-biotin complex method (ABC method).

With the PAP method, the chain of intermediate antibodies that bind the enzyme to the antigen is slightly longer than with the indirect immunofluorescence method. Enzymatic, i.e. The peroxidase antibody binds to the primary antibody already present on the antigen through another bridging antibody.

In the avidin-biotin method, the primary antibody located on the antigen and labeled with biotin binds to the PAP complex through an intermediate antibody labeled with avidin. Both proteins, avidin and biotin, dramatically increase the quality of the reaction, so the ABC method is considered more sensitive.

For immunohistochemical reactions, 2 types of antibodies are used: poly- and monoclonal. The former are obtained from antisera from immunized rabbits. Monoclonal antibodies are obtained in tissue culture or from ascitic fluid obtained from the abdominal cavity of laboratory animals. Monoclonal antibodies are absolutely specific for the antigen and do not cause cross-reactivity.

The popularity of the immunoperoxidase method is mainly due to its simplicity and accessibility. There are many commercial kits of sera to various tissue- or tumor-specific antigens, called markers. The benefits of using immunoperoxidase reactions are explained by their high sensitivity (compared to immunofluorescence, the PAP method is 1000 times more sensitive, and the ABC method is 10,000 times more sensitive), relative stability, and the possibility of using some reactions on dewaxed sections that have undergone both fixation and passage through alcohols.

Methods of molecular biology. In well-equipped pathology departments and research institutes, molecular biology methods are used for intravital diagnostics: flow cytometry and in situ hybridization techniques, i.e. in place, on a histological section. The first method is necessary for quantitative analysis DNA content in tumor cells. For this purpose, the piece of unfixed tissue under study is subjected to disaggregation with the help of enzymes, i.e. separation and crushing into individual cells. Then, in a special installation, a stream of a suspension of isolated cells 1 cell thick, surrounded by an enveloping liquid, passes through a reading laser beam.

Using in situ hybridization, the combination of genetic material (DNA fragments, genes) is achieved in vitro on the basis of complementarity, i.e. mutual correspondence, for example, of purine or pyrimidine bases in nucleic acids. This method is used mainly in three areas of pathology: to identify microbes or viruses found in tissues or fluids by genome; to study the genome in its congenital disorders; in the diagnosis of tumors, in particular, for the recognition of viral oncogenes. There are many modifications of the method.

Polymerase chain reaction (PCR) is very popular, which is carried out directly on histological sections. First, the DNA being tested is denatured, i.e. separating its two spiral threads and obtaining one of them in an isolated state. Then another foreign strand (usually RNA) labeled with a fluorochrome or PAP complex is layered. The molecular structure of this thread, i.e. the sequence of its bases is known. If there is complementarity with the test thread, then the staining reaction on the histological specimen is positive, and the structure of this thread becomes known.

Chromosome research. In many modern pathology departments and research institutes, chromosomal analysis is carried out, which makes it possible to determine deviations in the genetic apparatus (genome) of cells that are congenital or acquired.

This analysis is of particular importance when recognizing and studying tumors, various variants of which are accompanied by very specific marker rearrangements or chromosome aberrations. To do this, the tissue taken intravitally is cultured, i.e. grown on artificial media. This method of cultivation makes it possible, by reseeding and selecting cells, to obtain a culture of cells of the same tissue type and even one clone, i.e. line derived from a single stem cell.

The main stages of chromosomal analysis using the example of studying blood lymphocytes are as follows. Phytohemagglutinin is added to the culture of heparinized blood (heparin is an anticoagulant), stimulating T-lymphocytes to transform into blasts (less mature forms capable of mitosis and division). After 2-3 days of incubation, colchicine is added to the culture to delay mitosis at the metaphase stage in dividing lymphocytes. It is in the megaphase that the chromosomes seem to spread out, which is convenient for study. The cells are then transferred to a glass slide, fixed and stained, most often using the Giemsa method. As a result, light (uncolored) and dark (colored) bands are detected in each pair of chromosomes, which is why the method is called chromosome backing. The arrangement of bands in a normal karyotype (set of chromosomes) is highly specific for each pair of chromosomes, and banding diagrams (maps) are normally well known.

Chromosomal analysis is an economically expensive method and is therefore rarely used.

Electron microscopy. In the course of diagnostic studies on material taken during the patient’s lifetime, electron microscopy is often used: transmission (in a transmitted beam, similar to light-optical microscopy) and scanning (removing the surface relief). The first is used more often, especially for studying the details of cell structure in ultrathin sections of tissue, identifying microbes, viruses, deposits of immune complexes, etc. Ultrastructural research is very expensive, but is often used for diagnostic and scientific purposes.

Experimental material. When examining tissue taken during the life or after the death of a sick person, the pathologist observes changes at the time the tissue is removed. What happened before and could have happened after remains unknown. An experiment with a sufficient number of laboratory animals (white mice, white rats, guinea pigs, rabbits, dogs, monkeys, etc.) allows you to model and study diseases and pathological processes at any stage of their development.

The works of the French morphologists M. Bichat, J. Corvisart and J. Cruvelier, who created the world's first color atlas on pathological anatomy, were of great importance for the development of pathological anatomy. R. Bayle was the first author of a complete textbook on private pathological anatomy, translated into Russian in 1826 by the doctor A.I. Kostomarov. K. Rokitansky was the first to systematize the pathological processes of body systems in various diseases, and also became the author of the first manual on pathological anatomy.

In Russia, autopsies began to be performed for the first time in 1706, when medical hospital schools were organized by order of Peter I. But the clergy prevented autopsies from being carried out. Only after the opening of the medical faculty at Moscow University in 1755, autopsies began to be performed regularly.

The first department of pathological anatomy and pathological physiology in Russia was organized in 1849 at Moscow University by the famous therapist A.I. Polunin. He was the first to understand the need to compare the manifestations of the disease that existed during the patient’s life with the changes that were revealed during autopsies of corpses. A. I. Polunin is the founder of the clinical-anatomical direction, which became characteristic feature domestic medicine. The ideas of A. I. Polunin were continued and developed by his numerous students and followers. Among them is the founder of the Moscow School of Pathologists, the author of the first textbook on pathological anatomy in Russia, Prof. M. N. Nikiforov. The students of M. N. Nikiforov were academicians A. I. Abrikosov and I. V. Davydovsky. Developing the ideas laid down by A.I. Polunin and M.N. Nikiforov, A.I. Abrikosov created the principles of domestic pathological anatomy and made a great contribution to the development of many problems of general and specific pathology. I.V. Davydovsky proved the patterns of development of pathological processes and diseases; He carried out major research in the field of general pathology and wartime pathology. A student of M. N. Nikiforov was Professor M. A. Skvortsov, the recognized founder of pediatric pathological anatomy.

The successor to the ideas of the Moscow School of Pathologists was A. I. Abrikosov’s student, Academician A. I. Strukov. His name is associated with the development of pathomorphology of tuberculosis, rheumatic diseases, pathology of microcirculation, inflammation, as well as the introduction of new research methods into pathological anatomy - histochemistry, histoenzyme chemistry, electron microscopy, which gave it a functional focus. Modern stage The development of pathological anatomy is characterized by the emergence of molecular pathology, which studies diseases at the molecular level, ensuring intercellular relationships. This direction in our country is headed by Academician M. A. Paltsev.

In parallel with pathological anatomy, pathological physiology also developed. In 1849, the same professor A.I. Polunin became the founder of the department of pathological physiology at Moscow University. During this period, animal experimentation was already firmly established in the arsenal of scientific research methods. The foundation for the development of pathological physiology was the research of physiologists I. M. Sechenov, I. P. Pavlov, N. E. Vvedensky, and therapist S. P. Botkin.

In the creation of the departments of general and experimental pathology (pathological physiology) in Russia, great credit belongs to the outstanding physiologist, student of I.M. Sechenov - prof. V.V. Pashutin. His Scientific research were focused on the mechanisms of metabolic disorders, starvation and pathology of the endocrine system. A major contribution to the development of general pathology was made by domestic pathophysiologists Professors A. B. Fokht, A. A. Bogomolets, N. N. Anichkov, S. S. Khalatov, A. D. Speransky. N. N. Sirotinin, who developed various aspects of the problems of reactivity, aging, and pathology of the endocrine system. N. N. Anichkov and S. S. Khalatov created the first experimental model of atherosclerosis and did a lot to understand the mechanisms of its development.

Major foreign physiologists and morphologists - C. Bernard - made a great contribution to the development of pathology. V. Cannon. K. Rokitansky, R. Virchow, G. Selye. Thus, the famous physiologist of the 19th century C. Bernard is the founder of the experimental-physiological direction in pathology and the doctrine of the constancy of the internal environment of the body - homeostasis. The leading German pathologist R. Virchow is the founder of the doctrine of cellular pathology. The cellular theory of pathology has become a powerful stimulus for the study and systematization of cellular, and later subcellular, mechanisms of disease development. The research of G. Selye, who showed the important role of the neuroendocrine system in the formation of adaptive reactions and life disorders, became widely known and widespread. He is the founder of the doctrine of stress.

Lecture 1. Pathological anatomy

1. Objectives of pathological anatomy

4. Death and post-mortem changes, causes of death, thanatogenesis, clinical and biological death

5. Cadaveric changes, their differences from intravital pathological processes and significance for the diagnosis of the disease

1. Objectives of pathological anatomy

Pathological anatomy– the science of the occurrence and development of morphological changes in a sick body. It originated in an era when the study of painfully altered organs was carried out with the naked eye, i.e., using the same method used by anatomy, which studies the structure of a healthy organism.

Pathological anatomy is one of the most important disciplines in the system of veterinary education, in scientific and practical activities doctor She studies the structural, i.e., material basis of the disease. It relies on data general biology, biochemistry, anatomy, histology, physiology and other sciences that study general patterns life, metabolism, structure and functional functions of a healthy human and animal body in its interaction with the external environment.

Without knowing what morphological changes a disease causes in an animal’s body, it is impossible to have a correct understanding of its essence and mechanism of development, diagnosis and treatment.

The study of the structural basis of the disease is carried out in close connection with its clinical manifestations. Clinical and anatomical direction – distinguishing feature national pathological anatomy.

The study of the structural basis of the disease is carried out at different levels:

· the organismal level allows us to identify the disease of the entire organism in its manifestations, in the interrelation of all its organs and systems. From this level begins the study of a sick animal in clinics, a corpse in a dissection room or a cattle burial ground;

· the system level studies any system of organs and tissues (digestive system, etc.);

· the organ level allows you to determine changes in organs and tissues visible with the naked eye or under a microscope;

· tissue and cellular levels - these are the levels of studying altered tissues, cells and intercellular substance using a microscope;

· the subcellular level makes it possible to observe using an electron microscope changes in the ultrastructure of cells and intercellular substance, which in most cases were the first morphological manifestations of the disease;

· the molecular level of studying the disease is possible using complex research methods involving electron microscopy, cytochemistry, autoradiography, and immunohistochemistry.

Recognition of morphological changes at the organ and tissue levels is very difficult at the beginning of the disease, when these changes are insignificant. This is due to the fact that the disease began with changes in subcellular structures.

These levels of research make it possible to consider structural and functional disorders in their inextricable dialectical unity.

2. Objects of study and methods of pathological anatomy

Pathological anatomy deals with the study of structural disorders that arise at the very initial stages of the disease, during its development, up to the final and irreversible conditions or recovery. This is the morphogenesis of the disease.

Pathological anatomy studies deviations from the usual course of the disease, complications and outcomes of the disease, and necessarily reveals the causes, etiology, and pathogenesis.

Studying the etiology, pathogenesis, clinical picture, and morphology of the disease allows us to apply scientifically based measures for the treatment and prevention of the disease.

The results of observations in the clinic, studies of pathophysiology and pathological anatomy have shown that a healthy animal body has the ability to maintain a constant composition of the internal environment, a stable balance in response to external factors - homeostasis.

When an illness occurs, homeostasis is disrupted and life functions proceed differently than in healthy body, which is manifested by structural and functional disorders characteristic of each disease. Disease is the life of an organism in changed conditions of both the external and internal environment.

Pathological anatomy also studies changes in the body. Under the influence of drugs, they can be positive and negative, causing side effects. This is the pathology of therapy.

So, pathological anatomy covers a wide range of issues. She sets herself the task of giving a clear idea of ​​the material essence of the disease.

Pathological anatomy strives to use new, more subtle structural levels and the most complete functional assessment of the altered structure at equal levels of its organization.

Pathological anatomy obtains material about structural disorders in diseases through autopsy of corpses, surgical operations, biopsies and experiments. In addition, in veterinary practice, for diagnostic or scientific purposes, forced slaughter of animals is carried out at different stages of the disease, which makes it possible to study the development of pathological processes and diseases at various stages. A great opportunity for pathological examination of numerous carcasses and organs is presented in meat processing plants during the slaughter of animals.

In clinical and pathomorphological practice, biopsies are of particular importance, i.e. intravital removal of pieces of tissue and organs, carried out for scientific and diagnostic purposes.

Particularly important for elucidating the pathogenesis and morphogenesis of diseases is their reproduction in experiment. The experimental method makes it possible to create disease models for accurate and detailed study, as well as for testing the effectiveness of therapeutic and preventive drugs.

The possibilities of pathological anatomy have expanded significantly with the use of numerous histological, histochemical, autoradiographic, luminescent methods, etc.

Based on the objectives, pathological anatomy is placed in a special position: on the one hand, it is a theory of veterinary medicine, which, by revealing the material substrate of the disease, serves clinical practice; on the other hand, it is clinical morphology for establishing a diagnosis, serving the theory of veterinary medicine.

3. Short story development of pathological anatomy

The development of pathological anatomy as a science is inextricably linked with the dissection of human and animal corpses. According to literary sources in the 2nd century AD. e. The Roman physician Galen dissected the corpses of animals, studying their anatomy, physiology, and described some pathological and anatomical changes. In the Middle Ages, due to religious beliefs, autopsies of human corpses were prohibited, which somewhat halted the development of pathological anatomy as a science.

In the 16th century in a number of countries in Western Europe, doctors were again given the right to perform autopsies on human corpses. This circumstance contributed to the further improvement of knowledge in the field of anatomy and the accumulation of pathological and anatomical materials for various diseases.

In the middle of the 18th century. The book of the Italian doctor Morgagni “On the localization and causes of diseases identified by the anatomist” was published, where the scattered pathological and anatomical data of his predecessors were systematized and his own experience was generalized. The book describes changes in organs in various diseases, which facilitated their diagnosis and contributed to the promotion of the role of pathological and anatomical research in establishing a diagnosis.

In the first half of the 19th century. in pathology, the humoral direction dominated, whose supporters saw the essence of the disease in changes in the blood and juices of the body. It was believed that first there was a qualitative disturbance of the blood and juices, followed by the rejection of “pathogenic matter” in the organs. This teaching was based on fantastic ideas.

The development of optical technology, normal anatomy and histology created the prerequisites for the emergence and development of cell theory (Virchow R., 1958). The pathological changes observed in a particular disease, according to Virchow, are a simple sum of the diseased state of the cells themselves. This is the metaphysical nature of R. Virchow’s teaching, since the idea of ​​the integrity of the organism and its relationship with environment. However, Virchow's teaching served as an incentive for in-depth scientific study of diseases through pathological-anatomical, histological, clinical and experimental research.

In the second half of the 19th and early 20th centuries. In Germany, major pathologists Kip and Jost worked, authors of fundamental manuals on pathological anatomy. German pathologists conducted extensive research on equine infectious anemia, tuberculosis, foot and mouth disease, swine fever, etc.

The beginning of the development of domestic veterinary pathological anatomy dates back to the middle of the 19th century. The first veterinary pathologists were professors of the veterinary department of the St. Petersburg Medical-Surgical Academy I. I. Ravich and A. A. Raevsky.

Since the end of the 19th century, domestic pathanatomy has received its further development within the walls of the Kazan Veterinary Institute, where since 1899 the department was headed by Professor K. G. Bol. His pen belongs a large number of works on general and specific pathological anatomy.

The research conducted by domestic scientists is of great scientific and practical importance. A number of important studies have been carried out in the field of studying theoretical and practical issues of pathology of farm and commercial animals. These works made a valuable contribution to the development of veterinary science and animal husbandry.

4. Death and post-mortem changes

Death is the irreversible cessation of the vital functions of the body. This is the inevitable end of life, which occurs as a result of illness or violence.

The process of dying is called agony. Depending on the cause, the agony can be very brief or last up to several hours.

Distinguish clinical and biological death. Conventionally, the moment of clinical death is considered to be the cessation of cardiac activity. But after this, other organs and tissues with varying durations still retain vital activity: intestinal motility continues, gland secretion continues, and muscle excitability remains. After the cessation of all vital functions of the body, biological death occurs. Postmortem changes occur. Studying these changes is important for understanding the mechanism of death in various diseases.

For practical activities great importance have differences in morphological changes that occurred intravitally and postmortem. This helps to establish the correct diagnosis and is also important for forensic veterinary examination.

5. Cadaveric changes

· Cooling the corpse. Depending on the conditions, after various periods of time, the temperature of the corpse equalizes the temperature external environment. At 18–20°C, the corpse cools by one degree every hour.

· Rigor mortis. 2–4 hours (sometimes earlier) after clinical death, smooth and striated muscles contract somewhat and become dense. The process begins with the jaw muscles, then spreads to the neck, forelimbs, chest, belly and hind limbs. The greatest degree of rigor is observed after 24 hours and persists for 1–2 days. Then the rigor disappears in the same sequence as it appears. Rigor of the heart muscle occurs 1–2 hours after death.

The mechanism of rigor mortis has not yet been sufficiently studied. But the importance of two factors has been clearly established. During the post-mortem breakdown of glycogen, a large amount of lactic acid is formed, which changes the chemistry of muscle fiber and promotes rigor. The amount of adenosine triphosphoric acid decreases, and this causes the loss of elastic properties of the muscles.

· Cadaveric spots arise due to changes in the state of the blood and its redistribution after death. As a result of post-mortem contraction of the arteries, a significant amount of blood passes into the veins and accumulates in the cavities of the right ventricle and atria. Post-mortem blood clotting occurs, but sometimes it remains liquid (depending on the cause of death). In death from asphyxia, blood does not clot. There are two stages in the development of cadaveric spots.

The first stage is the formation of cadaveric hypostases, which occur 3–5 hours after death. The blood, due to gravity, moves to the underlying parts of the body and seeps through the vessels and capillaries. Spots are formed that are visible in the subcutaneous tissue after skin removal, during internal organs- upon opening.

The second stage is hypostatic imbibition (impregnation).

In this case, interstitial fluid and lymph penetrate into the vessels, thinning the blood and increasing hemolysis. The diluted blood again seeps out of the vessels, first onto the underside of the corpse, and then everywhere. The spots have indistinct outlines, and when cut, it is not blood that flows out, but sanguineous tissue fluid (different from hemorrhages).

· Cadaveric decomposition and rotting. In dead organs and tissues, autolytic processes develop, called decomposition and caused by the action of the dead organism’s own enzymes. Tissue disintegration (or melting) occurs. These processes develop most early and intensively in organs rich in proteolytic enzymes (stomach, pancreas, liver).

Decomposition is then joined by rotting of the corpse, caused by the action of microorganisms that are constantly present in the body during life, especially in the intestines.

Rotting occurs first in the digestive organs, but then spreads to the entire body. During the putrefactive process, various gases are formed, mainly hydrogen sulfide, and a very unpleasant odor occurs. Hydrogen sulfide reacts with hemoglobin to form iron sulfide. A dirty greenish color appears in the cadaveric spots. The soft tissues swell, soften and turn into a gray-green mass, often riddled with gas bubbles (cadaveric emphysema).

Putrefactive processes develop faster at higher temperatures and higher humidity of the environment.

From the book Obstetrics and Gynecology: Lecture Notes author A. A. Ilyin

Lecture No. 1. Anatomy and physiology of the female genital organs 1. Anatomy of the female genital organs A woman’s genital organs are usually divided into external and internal. The external genitalia are the pubis, labia majora and minora, clitoris, vestibule of the vagina, virgin

From the book History of Medicine: Lecture Notes by E. V. Bachilo

6. Pathological anatomy in Russia The development of pathological anatomy in Russia occurred directly in connection with clinics. Autopsies of dead bodies in hospitals were regularly carried out. Autopsies in Russia began to be carried out officially and regularly in the first half

From the book Pathological Anatomy: Lecture Notes author Marina Aleksandrovna Kolesnikova

LECTURE No. 1. Pathological anatomy Pathological anatomy studies the structural changes that occur in the patient’s body. It is divided into theoretical and practical. Structure of pathological anatomy: general part, specific pathological anatomy and clinical

From the book Dentistry: lecture notes author D. N. Orlov

1. Etiology, pathogenesis and pathological anatomy of osteomyelitis In 1880, Louis Pasteur isolated a microbe from the pus of a patient with osteomyelitis and called it staphylococcus. Subsequently, it was found that any microorganism can cause osteomyelitis, but its main

From the book History of Medicine by E. V. Bachilo

47. Pathological anatomy in Russia The development of pathological anatomy in Russia occurred directly in connection with clinics. Autopsies of dead bodies in hospitals were regularly carried out. Autopsies in Russia began to be carried out officially and regularly in the first half

From the book Dentistry author D. N. Orlov

36. Etiology, pathogenesis and pathological anatomy of osteomyelitis Any microorganism can cause osteomyelitis, but its main causative agent is Staphylococcus aureus. However, since the mid-70s. XX century the role of gram-negative bacteria has increased, in particular

From the book Blood Diseases by M. V. Drozdov

Pathological anatomy The morphological unit of lymphogranulomatosis is a polymorphic cellular granuloma. A number of cells take part in the formation of this type of granuloma, such as lymphoid, reticular, neutrophils, eosinophils, plasma cells

From the book Operative Surgery: Lecture Notes author I. B. Getman

LECTURE No. 5 Topographic anatomy and operative surgery of the head region The head region is of interest to specialists of various profiles: general surgeons, traumatologists, neurosurgeons, otolaryngologists, dentists, maxillofacial surgeons, cosmetologists,

From the book Psychiatry. Guide for doctors author Boris Dmitrievich Tsygankov

LECTURE No. 6 Topographic anatomy and operative surgery of the region

From the book Masturbation in Men and Women author Ludwig Yakovlevich Yakobzon

LECTURE No. 7 Operative surgery and topographic anatomy of the breast The upper border of the chest area runs along the upper edge of the manubrium of the sternum, clavicles, acromial processes of the scapula and further to the spinous process VII cervical vertebra; the lower limit means a line,

From the book Therapeutic Dentistry. Textbook author Evgeniy Vlasovich Borovsky

LECTURE No. 10 Topographic anatomy and operative surgery of the pelvic organs The “pelvis” in descriptive anatomy means that part of it that is called the small pelvis and is limited by the corresponding parts of the ilium, ischium, pubic bones, as well as the sacrum

From the author's book

LECTURE No. 11 Topographic anatomy and purulent surgery Purulent-septic diseases or complications are observed in approximately a third of the total surgical patients; no practicing physician can avoid encountering purulent diseases and their

From the author's book

ETIOLOGY, PATHOGENESIS, PATHOLOGICAL ANATOMY The etiopathogenesis of mental disorders in AIDS is associated with two factors: 1) general intoxication and increasing damage to brain neurons; 2) mental stress that develops after receiving news of the presence

From the author's book

Etiopathogenesis, pathological anatomy A single cause of anorexia nervosa and bulimia has not been established. Various factors are involved in the etiopathogenesis of the disease. An important role is played by personality predisposition (premorbid accentuations), family

From the author's book

11. PATHOLOGICAL ANATOMY 11.1. Possible pathological changes in men Pathological changes in the genital organs in men as a consequence of masturbation can be discussed insofar as inflammatory processes in the genitals caused by masturbation

From the author's book

6.4. PATHOLOGICAL ANATOMY OF DENTAL CARIES In the clinical course of caries, two stages are distinguished: the first is characterized by a change in color and, apparently, intact enamel surface, the second - by the formation of a tissue defect (carious cavity). The second stage was found to be quite complete

Pathological anatomy in the 20th century was influenced by the experimental-physiological direction. In contrast to the organolocalistic direction that dominated in the West, in Russia a nosological and functional direction has developed, considering the diseased organism as a whole.

The initiators of this direction were representatives of the Moscow school of pathologists - A. I. Abrikosov (1875-1955), M. A. Skvortsov (1876-1963), V. T. Talalaev (1886-1947), I. V. Davydovsky and others. The same school of pathologists began in 1927 to systematically compare clinical and pathological diagnoses and discuss them together with attending physicians at clinical and anatomical conferences. Subsequently, the conferences were legalized for all hospitals in the USSR; they increased the role of prosectory in diagnosis and stimulated the scientific development of hospital material, strengthening the clinical and anatomical direction.

Pathoanatomical schools, represented by N. N. Anichkov (1885-1964), S. S. Weil and others, carried out a systematic study of cardiovascular pathology, the reticuloendothelial system, infectious diseases using sectional material and by creating experimental models. The works of I. V. Davydovsky are devoted to the study of pathological changes in infectious diseases. V. T. Talalaev studied the histogenesis of rheumatic granuloma (Aschoff-Talalaev granuloma) and created the first clinical and anatomical classification of rheumatism. M.A. Skvortsov and D.D. Lokhov (1892-1958) laid the foundations for the pathological anatomy of childhood diseases.

A. V. Rusakov (1885-1953) et al. worked in the field of bone pathology. A. I. Abrikosov, V. G. Shtefko, A. I. Strukov, A. N. Chistovich and others made a significant contribution to the development of the pathological anatomy of tuberculosis. N. A. Kraevsky, together with the clinician X. X. Vlados, proposed a classification of leukemia. New chapters of pathology were developed - pathological anatomy of combat trauma and radiation sickness, and valuable research was carried out on regional pathology.

Abroad, L. Aschoff (Germany), based on the research of I. I. Mechnikov and V. K. Vysokovich, created the doctrine of the reticuloendothelial system, and was the first to describe an infectious granuloma in rheumatism, which received his name.

The central problem of general pathology, renamed pathological physiology in the USSR (1925), was the problem of reactivity. The ideas of I. I. Mechnikov were most developed in the school of A. A. Bogomolets (1881-1946), who created the doctrine of the role of connective tissue in the reactivity of the body, cytotoxins, aging and life extension. The latter has developed into a separate scientific discipline - gerontology and geriatrics (see).

The methods of angiostomy and organostomy created in the USSR by E. S. London (1868 - 1939) made it possible to study metabolism without disrupting neurohumoral regulation and laid the foundation for angiochemistry. The school of A.V. Reprev (1853-1930) investigated the role of endocrine and humoral factors in pathology. S. S. Khalatov (1884-1951), N. N. Anichkov and their students created the doctrine of the pathology of cholesterol metabolism. The school of A.D. Speransky (1888-1961) put forward a theory about the role of neurodystrophic processes in pathology. Representatives of the school of I. P. Pavlov (M. K. Petrova, P. S. Kupalov, A. O. Dolin, etc.) created a new section of pathophysiology - the pathophysiology of higher nervous activity, the doctrine of experimental neuroses. The problems of oxygen starvation, inflammation, fever, shock, and pathophysiology of the cardiovascular system were intensively developed. The pathogenic effect of environmental factors (electrical trauma, ionizing radiation, decreased and increased Atmosphere pressure and etc.).

The development of pathological physiology as an independent science dates back to the second half of the 19th century, when significant advances were made in the field of biology, chemistry and physiology, which made it possible to begin a systematic study of the mechanisms of the occurrence of pathological processes and diseases. The emergence of pathological physiology as an independent discipline was greatly facilitated by the use of physiological experimental methods for the study of pathological processes.

The work of I. P. Pavlov (1852-1936) and his school had a particularly great influence on the development of pathophysiology. Many issues of the pathophysiology of blood circulation, digestion, and especially higher nervous activity were developed by I. P. Pavlov and his students (A. D. Speransky, K. M. Bykov, L. A. Orbeli, etc.). I. P. Pavlov developed in pathophysiology the principles of integrity, nervism and verification in practice of the results obtained. The influence of the French physiologist Claude Bernard was also great, whose famous experiment - a “sugar injection” into the bottom of the fourth ventricle of the brain was the first experimental model of a human disease - diabetes mellitus.

In Russia, the development of pathological physiology (experimental pathology) is associated with the name of the great Russian physiologist. I. M. Sechenov and especially his student V. V. Pashutin, the founder of the first (independent department of general and experimental pathology at Kazan University (1814), as well as at the Military Medical Academy in St. Petersburg (1879). However, long before the organization independent departments of pathological physiology, the main elements of the doctrine of diseases (general pathology) were taught by clinicians or physiologists in the corresponding departments. During this period, pathology as a science containing a number of theoretical information about diseases was an introductory part to clinical disciplines, which is why it most often belonged to a single department pathology, therapy and clinics.The first teachers of the elements of general pathology in hospital and medical schools in the 18th century were such outstanding clinicians as A. M. Shumlyansky (1748-1795), who occupied the department of therapy, obstetrics and pathological anatomy at the Moscow Hospital School, M M. Terekhovsky (1740-1796), teacher of pharmacology, pathology and practical medicine at the Kronstadt Naval Hospital. At Moscow University, general pathology was taught by S. G. Zabelin (1735-1802), M. I. Barsuk-Moiseev (1768-1811). It is noteworthy that M.I. Barsuk-Moiseev was the first doctor of medicine at Moscow University; in 1794 he defended his dissertation on the topic “On Breathing.”

In the first half of the 19th century, a particularly large contribution to the teaching of general pathology was made by I. E. Dyadkovsky (1784-1841) and his student K. V. Lebedev (1802-1884), who taught a course in general pathology at Moscow University. K.V. Lebedev wrote a textbook on “General Anthropology” (1835), which was the first guide to general pathology in Russian. K.V. Lebedev, like his teacher I.E. Dyadkovsky, took a materialistic position in the analysis of the causes and essence of the disease. He emphasized the fundamental difference between human diseases (anthropology) and diseases of other living beings (zoopathology). But already during this period, Russian scientists clearly understood the importance of experimental research methods for studying the mechanisms of disease development. Thus, Professor of Moscow University A. M. Filomafitsky (1807-1849), head of the department of physiology and general pathology, for the first time in Russia carried out a number of purely pathophysiological experiments - removal of kidneys from animals, ligation of ureters, etc. He extensively developed the issues of blood transfusion, together with N.I. Pirogov, he studied the effect of narcotic drugs (chloroform, ether) on the animal body.

General pathology emerged as an independent discipline in 1863, but it was most often taught by pathologists. Thus, in Moscow, since 1863, a course in general pathology was taught by the famous pathologist A. I. Polunin (1820-1888). As a morphologist, he promoted experimental methods in pathology. In Kharkov the department of general pathology was headed by I. N. Obolensky, in Kyiv by N. A. Khrzhonshchevsky, in Kazan from 1867 to 1872 by M. F. Subbotin. The separation of general pathology into an independent discipline was of great importance for further development this important branch of medicine as an experimental science. Russian pathology of the second half of the 19th century is characterized by a transition from the morphological direction to the positions of experimental pathology, i.e. pathological physiology.

The increasingly widespread use of experimental research methods in pathology and the accumulation of experimentally obtained factual material have led to the need to separate the teaching of general pathology from morphology (pathological anatomy) and the creation of departments of experimental pathology (pathological physiology). The first department of general and experimental pathology in Russia was organized at Kazan University in 1874 by V. V. Pashutin, who transformed general pathology from a speculative science into an experimental one. As a student of I.M. Sechenov and S.P. Botkin, he developed the ideas of nervism in pathophysiology. V.V. Pashutin wrote the first original guide to pathological physiology, which has not lost its significance to this day. V.V. Pashutin's scientific interests were focused on the main problem of pathology - metabolic disorders. His work in the field of complete and partial fasting is especially valuable. He developed an original method for studying gas exchange and was the first to create a calorimeter to directly determine heat loss by the body of animals and humans. V.V. Pashutin for the first time in Russia began to study the activity of the endocrine glands (sex glands). The name of V.V. Pashutin is also notable for the fact that he is the creator of the first scientific school of pathophysiologists in Russia. His students developed the direction started by V.V. Pashutin in the study of the pathophysiology of metabolism. A number of his students later headed departments of general pathology at Russian universities: A. M. Albidkiy (Military Medical Academy in St. Petersburg), A. V. Reprev (Tomsk, Kharkov), N. G. Ushinsky (Warsaw, Odessa), etc. .

Simultaneously with the St. Petersburg one, the Moscow scientific school of pathophysiologists was created, coming from A. I. Polunin and his student A. B. Fokht (1848-1930). Characteristic feature this direction had close contact with the clinic. A. B. Fokht has carried out outstanding research on the pathology of the heart, edema, dropsy, inflammation of the pericardial sac, functional and anatomical changes in the heart during coronary artery embolism, circulatory disorders and cardiac activity during pulmonary embolism. Major representatives of the Moscow school of pathophysiologists also headed the departments of general pathology and pathological physiology at various universities: in Kiev (V. Lindeman), Moscow (G. P. Sakharov, A. I. Talyantsev), Minsk (F. A. Andreev), etc. .

A major role in the development of general pathology as an experimental science was played by V. V. Podvysotsky (1857-1913), who headed the department of general pathology in Kyiv from 1887. Such famous scientists as I. G. Savchenko, L. A. Tarasevich, D. K. Zabolotny, A. A. Bogomolets and others came from his school. V. V. Podvysotsky’s scientific interests were concentrated in the field of studying regeneration and the pathogenesis of neoplasms , immunity. He wrote the textbook “General and Experimental Pathology,” translated into all European and a number of Asian languages. At the end of the 19th and beginning of the 20th centuries, the textbook served as the main guide for the study of experimental pathology in Russia and abroad.

A special place in the history of pathophysiology is occupied by I. I. Mechnikov, whose work on inflammation, immunity, atrophy and self-poisoning of the body is classic. I. I. Mechnikov created a comparative pathological direction in the study of pathological processes. The phagocytic theory of inflammation, the doctrine of immunity and the infectious process are the basis of many studies carried out in these areas at the present time.

Pathological physiology as a scientific discipline received especially broad prospects for development after the Great October Socialist Revolution. From the very beginning, during the reform of medical education, pathological physiology began to be given great importance as a discipline playing an exceptional role in shaping the worldview of the Soviet doctor. In 1924, on the initiative of A. A. Bogomolets and S. S. Khalatov, the name “Department of Pathological Physiology” was officially adopted on an all-Union scale for the former departments of general pathology. Departments and research laboratories of pathological physiology were headed by prominent experimental scientists. The work of these departments received a strictly experimental direction. A number of large original schools of Soviet pathophysiologists arose: N. N. Anichkova (Leningrad), A. A. Bogomolets (Saratov, Moscow, Kiev), V. V. Voronina (Odessa, Tbilisi), N. N. Sirotinina (Kazan, Kiev ), I. R. Petrova (Leningrad), etc.

N. N. Anichkov (1885-1964) from 1919 to 1938 headed the department of pathological physiology of the Military Medical Academy. In 1946 he was elected the first president of the Academy of Medical Sciences. N. N. Anichkov with a large team of employees developed issues of diseases of cardio-vascular system, physiology and pathology of the reticuloendothelial system, pathogenesis of autoinfections, etc. The theory of infiltration origin of atherosclerosis is associated with the name of N. N. Anichkov. Such prominent pathophysiologists as I.R. Petrov, P.N. Veselkin, P.P. Goncharov and others came out of this school.

A large, fruitful school was created in Odessa and Tbilisi by the famous Russian scientist V.V. Voronin (1870-1960). His works were devoted to pathophysiology, microbiology and epidemiology, zoology, morphology and some problems of physics and mathematics. The main scientific interests of V.V. Voronin and his students were concentrated around the general pathology of inflammation, blood circulation, peripheral nervous system. In 1947-1948 V.V. Voronin published a two-volume textbook on pathological physiology, where the laws of mechanics, physics and mathematics were used to solve problems of the pathogenesis of diseases.

A. A. Bogomolets (1881-1946) had a great influence on the development of domestic pathophysiology. Bogomolets worked in Saratov, Moscow and Kiev and is the founder of the largest school of Soviet pathophysiologists. The central problem developed by the school of A. A. Bogomolets was the problem of reactivity . Much work was devoted to the study of connective tissue reactions in various pathological processes, issues of blood transfusion, endocrine pathology, cytotoxic stimulation of functions. Under the editorship of A. A. Bogomolets, the first multi-volume guide to pathological physiology was created (1940-1946). From the school of A. A. .Bogomolets such outstanding scientific pathophysiologists as N.N. Sirotinin, N.A. Fedorov, P.D. Gorizontov and others came out.

The most active continuer of the study of the problem of reactivity in pathology and physiology is currently N. N. Sirotinin and his school. The great merit of N. N. Sirotinin and his school is the development of questions about the comparative pathology of reactivity, allergies, immunity and the infectious process. N. N. Sirotinin has been systematically studying the issues of oxygen starvation and adaptation to hypoxia since 1929. Under the general editorship of N. N. Sirotinin in Lately a 4-volume manual on pathological physiology was created (1966).

I. R. Petrov (1893-1970) devoted his entire creative life to work at the Department of Pathophysiology of the Military Medical Academy. Together with his many students, he intensively and successfully developed the problems of oxygen starvation, the pathogenesis of traumatic shock, blood loss, blood transfusion, hypothermia and resuscitation, pathological regulation of blood circulation, etc.

A major role in the development of ideas about the importance of the nervous system in pathology was played by the research of A.D. Speransky (1888-1961), for example, his widely known work on nervous trophism, epilepsy, trace aftereffects in pathology, etc. Student of A.D. Speransky A. M. Chernukh fruitfully develops the problems of recovery and experimental therapy.