The Society of Physicians at Kazan University celebrating its anniversary was founded in 1868, i.e., it is the oldest of all existing scientific societies in Kazan. Kazan. It would be difficult, even impossible, for me to give a complete, exhaustive picture of the Society's activities over the 60 years of its existence in this short essay. That is why I will limit myself to a brief sketch, in which I will outline only the main stages experienced by the Society.
Dear comrades! It is with a sense of involuntary embarrassment that I enter this chair on the glorious day of the 60th anniversary of the Kazan Society of Physicians, which for many decades has been serving the high goals of the development of medical science, the interests of physicians, and the medical profession in our region. I am embarrassed both by the great honor entrusted to me to speak at this meeting and by the somewhat unusual and difficult nature of the topic proposed, being aware in advance of the weakness of my attempt to present to you in due fullness and clarity the question of the physician's personality in medicine.
In the Pathological-Anatomical Institute of the Kazan University during the 60 years of its existence only two cases of p. r. p. have been found, of which one was in 1874, the other in 1908, for approximately 7,000 sections up to the present report. According to Govorov's (1914) famous statistics, based on the sectional material of a number of large cities in Europe. Among 211,520 autopsies, only 55 cases of p. p. p. were found, i.e. 0.026%.
Having at present a large number of observations on the variability of morphological characters of Obermeier's spirochaetes in cultures, we intend in the present report to point out a number of facts which seem to us to be of general interest. The following material was obtained by culturing a number of strains of spirochaetes of recurrent typhus for several years; it also includes observations obtained by artificial infection of humans with our cultures made for therapeutic purposes on paralytic patients (in the clinic of Prof. T.I. Yudin) and syphilitic patients (in the venereological department of the Institute for Advanced Medical Training in Kazan, Prof. M.S. Pilnov).
The personality of the physician at all times has undoubtedly had an enormous, sometimes powerful and even decisive influence on the course and outcome of a number of diseases. Even back then, when there was no talk of scientific medicine and therapy based on precise knowledge of anatomical changes and pathological-physiological processes in the human organism, which constitute the essence of a disease, the doctor's behavior alone, based on intuition and empiricism, often decided the fate of the patient.
Not so long ago, before our eyes, one might say, like a Deus ex machina, a slender, beautiful and seemingly solidly built in all its parts, the teachings of Volhard and Fahr grew up. But nothing is eternal under the moon, especially in medicine, where, as Wagner wrote, teachings are born only to disappear in five years, and so, in this thoroughly built building, mainly in its foundations, indeed, over time individual bricks began to fall out, and it began to loosen little by little. And the closer one looks into this doctrine and checks it against the practical side of the question and the life of the clinic, the more and more one becomes convinced that the whimsical life, even in its ordinary reveals-diseases, often does not want to fit into the Procrustean bed of schemes and hits us with surprises where everything seemed already finished, legalized, immutable, undeniable and established.
Among the postoperative complications that can threaten the life of the operated patient, postoperative bronchitis and bronchopneumonia developing from it are especially numerous and dangerous; the latter mostly have a severe course, often putting the very life of the patient at risk. Hence, it is natural that successful control of postoperative pulmonary complications is one of the next and practically important tasks of modern surgery. Therefore, it is not surprising that the surgical thought is constantly dealing with this issue, considering it both from the preventive and the therapeutic side.
With deep economic and even biological foundations, the struggle against motherhood has taken on truly colossal proportions for today's women. In all cultural countries there has been a progressive, year by year, growing decrease in the percentage of births, and at the same time, despite the decrease in mortality, a decrease in the annual population increase. Not to mention France, even in a country such as Sweden, which escaped the horrors of the imperialist war, and has generally been given the example of a socially healthy country, the birth rate fell from 26.3°/o in 1891 to 12.6°/o in 1926, or more than halved in 31/2 decades. Our homeland is no exception in this respect.
A one-sided anatomical approach to the evaluation of disease manifestations contributed to the fact that physicians focused all their attention on the diseased organ, forgetting about the personality as a whole. The last decade, enriched by advances in endocrinology, the doctrine of constitution, reflexology, has opened a new page in the understanding of the essence of human disease. A new direction in science about the relation between body and spirit is revealed. Especially gynecology, from the study of the female genital apparatus, becomes a science of woman in the broad sense of the word. We owe the development of scientific questions in gynecology in this latter direction mainly to Wahlthard and Liepmann.
Epidemics of raphania in Europe, and in Russia in particular, have been observed for a long time. The last epidemic of wicked bark in Western Europe was observed in 1879-80. (Tuezek), while in Russia these epidemics broke out from time to time even in the 20th century (1909-10) (Kolosov). The incessant rains and other climatic conditions of the summer of 1926 contributed to the increased growth of ergot. As a result, due to the uncultivation of the population and the lack of timely preventive measures, we had in 1926-27 an epidemic of ergotism, which invaded the Votsk and Ural regions and part of TR. It is very likely that the epidemic was not limited to these areas.
Cases of chronic poisoning by ergot in rye bread, which began in our area in the fall of 1926, continued in significant numbers in the spring of 1927. Usually this poisoning was expressed by cramps in the muscles of the arms and face, which persistently lasted for weeks and months, now weakening, now increasing, despite the termination, if we believe the patients, the abuse of rye bread.
After Mouflet, in 1634, had accurately described the scabies mite, and its role in the etiology of scabies gradually became generally recognized, many preparations and combinations of them were proposed for treating the disease. Leaving aside the enumeration and evaluation of each of them, we shall dwell in the present paper only on one method of treating scabies, proposed at one time by Comessati.
Practical surgery has already done a great deal to combat pain: anesthesia and local anesthesia have been introduced, and the whole sea of human suffering has thus been left far behind. But the questions of the essence of pain from the psychological point of view, of the construction and mechanics of apparatuses available in our organism for the perception of pain, and of the pathways conveying pain, still remain largely unresolved. In the studies made in this field there are many uncertainties, varieties, assumptions, and unsatisfactory answers to the most basic questions. This undoubtedly has the consequence that so far we are far from being able with the means at our disposal to stop or even only to reduce pains, especially where they, plunging man into severe suffering, are played out in connection with an unknown, or with a known, but unremovable root cause.
Considering together with the majority of authors that the phenomenon first described by d’Herellе with the greatest completeness and accuracy is essentially different from the phenomenon of Twort, we will further study the phenomenon of d’Herellе which he called bacteriophagy. The active agent causing this phenomenon, without predetermining its nature, we will call bacteriophage lysine.
Studying the thorax in children, the author found that its greatest growth occurs in the first year. The shape of the thorax changes markedly during this period, lengthening towards the end of the year. The heart grows slower, with the left heart growing faster than the right, and the ascending aorta especially increases.
To prove the influence of the autonomic system on the metabolism of protein-free nitrogen bodies, the authors performed a series of experiments on dogs and rabbits, using a chemical micromethod they examined "protein-free nitrogen" in blood or serum taken from v. hepatica before and after transection of the corresponding nerves of the autonomic system, as well as before and after excitation of the same nerves.
The author made a number of investigations by means of a puncture needle invented by him, and he managed to investigate amyloid liver in 10 cases by this method. In contrast to the view that a person suffering from amyloid sooner or later but always dies of it, W. was able to establish by repeated punctures that even the liver, which at the same time is overfilled with amyloid, can again be completely free from the latter.
In connection with the experiments of Camus and Gournay on dogs with atrophied genitals, in which after feeding with raw goitre these atrophied organs developed, and the sexual instinct, previously completely absent, arose, Lereboullet and Gournay give 4 of their most revealing observations on children 12 and 13 years old treated with the preparation thymus.
According to Goebel, measles is contagious even after a complete rash has developed, as evidenced by the fact that in the author's experiments, the blood of a measles patient taken on the second day of the rash, even after the addition of iatrene and 72 hours of holding in an ice cabinet, being injected into children who had no measles, still caused measles.
In connection with the suggestion of operative treatment of malignant anemia by removal of bone marrow from the tubular bones, the author performed experiments on dogs to find out how the blood picture changes when the bone marrow is completely and partially removed.
Based on the data obtained by Wasmeister and Küpferle in the roentgenization of experimentally infected tbc animals with bacilli and in the treatment of pulmonary tbc in humans, the authors performed roentgen therapy on 45 patients with lung tbc and obtained clinical cure in 20 cases.
The authors find that the accession of gastric ulcer to lung tbc significantly worsens the prognosis: under the influence of the ulcer, fibrotic tuberculosis may turn into ulcerous tuberculosis. In such cases, prompt intervention is indicated. When the cases are appropriate, it is possible to apply an artificial pneumothorax to prepare the patient for the operative radical treatment of the ulcer.
Hess and Meyers in 1919 noted yellow pigmentation of palms of hands and forearms and amber color of urine, with normal stool and white sclerae, as a result of increased consumption of carrots; this color disappeared with termination of carrot feeding; it is explained by the fact that the latter contains a special pigment - carotene, which, entering the animal body, gives the corresponding color to milk, fat, blood serum. Cairo also noted the yellow coloring of the skin of the face as a result of the consumption of carrots. Umber noted carotenemia in 15 diabetics who consumed carrots. These facts are considered by Pislav and Monceaux as an indication of a connection between carotenemia and metabolic disorders, namely reduced oxidation.
For the purpose of preventive vaccination against diphtheria, the authors in 130 cases administered Ramon's anatoxin through the nose by 3-4 drops in each nostril, in some patients 8 days in succession with 8-day intervals, and in others 3-4 days later until the Chick reaction had completely disappeared, and relatively identical figures were obtained as a result of either method of treatment: 3 weeks after the start of vaccination, only 50% of Chick'a reactions were negative, 40 days after the start-83%, the same 50 days later-95%.
According to H.W. Graf and Ramel, specific aortitis is the most frequent and usually only later, on average 20 years after infection, the manifestation of syphilis of internal organs. Meanwhile, the authors observed a 24-year-old syphilitic patient who developed specific mesaortitis and miliary gumma in the spleen already 11/2 years after infection, despite intensive, early treatment with neosalvarsan.
The author reports the use of x-rays in 353 patients with consumption. Of these, 247 (69.9%) became fully functional after 1 to 6 years.
The author points out that many fevers of consumption are due to retention of sputum, and narcotic drugs contribute to this retention. The so-called typus inversns fever is often a consequence of the evening administration of narcotic or hypnotic drugs.
Proceeding from the chemical affinity of chlorophyll with the coloring substance of blood and relying on the research of Neitzky and Abderhalden, the author made an attempt to study the effect of this substance experimentally and clinically.
According to observations of A.P. Belyaev, echinococcal fluid, filtered through Schamberlend's candle and preserved in sealed ampoules for a long time, at least 16 months, has the ability to give a positive reaction when injected intradermally in echinococcal patients, namely, when 0.3-0.5 of this fluid is injected into the skin, a blister appears at the injection site, surrounded by a reddened area and sometimes infiltrate.
For about a year Askanazy has been giving his hypertensive patients tablets of 0.5 calcium diuretin and 0.1 potassium rhodanide each, manufactured on his behalf by the Knoll factory. Totally he treated in this way 50 cases of hypertension, mostly of essential form (in 14 cases there was, however, secondary hypertension due to renal sclerosis).
The author believes that in chronically stagnant patients urea can be successfully taken for months at a time, giving an even, gradual dehydration. It is possible that this is joined by direct action on heart, especially affecting when urea is combined with foxglove, a clear slowing of pulse.
The author shares his observations on the treatment of these types of anemia by liver feeding and liver extract. The above method of treatment in pernicious anemia has given brilliant results both with American scientists (Minot and Murphy) and with Ral himself.
As is known, the sputum in this disease usually contains a very large number of different bacteria. I. W. Adelson from the sputum of 18 asthmatics managed to isolate 36 different microorganisms, of which str. brevis, pneumococcus and microc. catarrhalis occur with the greatest consistency.
In 4,600 percutaneous operations performed between 1911 and 1926, the author allowed patients to get up on the third day after surgery, and noticed that the number of postoperative embolisms and thromboses was three times less than in the period from 1905 to 1910, when he kept patients in bed for 1-2 weeks.
For the treatment of this disease is not enough one amputation of the gland with cleaning of axillary cavity, - it is necessary to remove the whole large pectoral muscle, and preferably the small one. Prophylactic use of x-rays is useful.
A new anaestheticum avertin or E 107 has recently become quite widespread in Germany. Chemically, this substance is a tribromide ethyl alcohol-CBr3CH2OH. It is a white, crystalline powder, melting between 79° and 80°, soluble in water at 272% at t° of 20° and 372% at t° of 40°. At higher temperatures avertine decomposes.
Based on experimental studies and literature data, the author considers narcylene to be the safest of all drugs in terms of shock. In this respect, narcylene anesthesia compares favorably with ether and chloroform anesthesia, which should be avoided in patients close to shock.
According to Grützer, trichloroisobutyl alcohol in combination with trimethylisanthine (nautisan) reduces the frequency of vomiting after anesthesia by half.
Based on the material of 200 cases, he recommends the following method of nonoperative treatment of hemorrhoids: on the eve of the day of the injection the patient's bowels are cleaned with laxatives and enema; 1/2 hour before the injection morphine with atropine is injected under the skin; then 50 cc of novocaine solution is injected into the rectum. 1/2% Novocaine solution; a Bier's jar is placed against the patient's anus, in the lap and elbow position, and suction is made until the nodes protrude. After that, 0.5 to 1 to 2 cc of absolute alcohol is injected into each node (necessarily for each node with a special needle), the nodes are repaired as quickly as possible with the fingers, and the patient is prescribed bed rest and liquid food, and on the 3rd day a laxative (magnesia or bitter water) is given.
This combination is not particularly rare: the author has observed five cases of this kind. In contrast to the rapid or sudden onset, transient myopia in diabetes mellitus, in arteriosclerotics myopia occurs slowly and has a growing character.
The author distinguishes two groups of cases here: 1) disorders due to local changes in the vessels of the eye or the conductive pathways-local retinal arteriosclerosis, preretinal hemorrhages, central artery or vein blockage, processes in the carotid artery and in the arteries of the conductive pathways; 2) disorders caused by arteriosclerosis mediately,-changes in the retina in general arteriosclerosis with high pressure, retinitis albuminurica in arteriosclerotic shriveled kidney, diabetes and diabetic complications of the eye due to arteriosclerosis, retinitis circinata, etc.
The author used vitreous suction in cases of ectogenous infection of the eye, threatening to develop into panophthalmitis, vitreous opacities depending on traumatic hemorrhages, hemorrhages in the vitreous body due to blood vessel disease, particularly in recurrent juvenile hemorrhages, in various kinds of choriocytes and in traumatic glaucoma.
Believing that one of the etiology of the glaucomatous process is a hyperfunction of the sympathetic, nerve, and knowing that ergotamine has the property to paralyze the end of the latter, the author began to use this agent in glaucoma or as tablets orally (2 tablets 3 times a day), or in combination with infections it under the conjunctiva, and got very encouraging results.
The author first of all recommends removal of grains by abrasion or extrusion in this disease, followed by massage of the conjunctival membrane, and cauterizing agents (cupri alumin. sticks, silver solutions) are indicated for more severe separation.
Having tested the method proposed by Stein, the author particularly recommends it for inducing labor at the end of pregnancy, particularly in cases where the pregnancy has been carried over 302 days. The method consists in giving the pregnant woman in the morning on an empty stomach 1 to 2 tablespoons of ol. ricini, with the appearance of intestinal peristalsis administered intramuscularly 0.5 fizormone and repeating this dose every hour until a total of 2 cc.
The author studied the effect of two drugs derived from the corpus luteum: one of them, systomenzine, is a lipoid of the corpus luteum and has hemostatic properties, especially in bleeding in the acute and subacute stages of inflammation of the appendages; the second drug, agomenzine, referred to the group of amines; it, conversely, causes blood flow to the uterus and increases its growth, and is useful in amenorrhea on the grounds of endocrine failure.
Hedon found that weak solutions of Na citrici (1.5-10%) prevent blood clotting, while concentrated solutions (30%) act to reverse clotting. Neuhof and Hirschfeld on 500 cases confirmed the anti-hemorrhagic properties of concentrated solutions of this substance. Renaud and Juge, using citrate injections in bleeding uterine cancer, had bleeding stop in all cases.
In severe asphyxia of newborns the author applied faradic current in the form of faradization of n. phrenici on the neck, and also by applying electrodes to both sides of the thorax. His experiments showed that faradic irritation is a correct, valid and, at the same time, gentle technique for achieving absolutely correct respiratory movements.
The author recommends striving in such cases to shorten and simplify the operation as much as possible, and therefore considers complete removal of blood from the abdominal cavity unnecessary. He considers incision and emptying of the tube and leaving it in place to be unsafe.
In persistent cases of posterior spastic parametritis, when all the usual conservative methods of treatment fail, the author recommends using the method of uterosacral ligament resection suggested by Warnekros.