On December 18, 1927 in Kazan, at a solemn meeting of the Council of the Institute with the participation of representatives of universities and public organizations, chaired by the People's Commissar of Health of the RSFSR, Professor N.A. Semashko, marked 30 years of scientific and pedagogical and medical and social activities of the Institute Director and Head of therapeutic clinic, Professor Roman Albertovich Luria.
One extremely interesting and important symptom of this moment is the discrepancy (a kind of "scissors") between the demands of the population and the means we have for meeting these demands. This divergence can be observed in all areas of construction, both economic and cultural. We can also observe this symptom in the field of health care. Looking back on the road covered, we can state certain successes by the 10th anniversary of October, but we can't help noticing how far we have fallen from satisfying the needs of the population. As far as cultural work in general and health care in particular is concerned, the French proverb: "L'appetit vient en mangeant" is more justified than anywhere else.
One year ago in the January issue of "Kazan Medical Journal" was published my report, made on November 1, 1926 to the Scientific Assembly of Physicians of the State Institute for Advanced Training of Physicians under the title: "A new method of so called "rejuvenation" of organisms". I based my work on the doctrine of "natural cellular poisons", which I had been developing for many years. According to this doctrine, dissimilation products are natural and unavoidable poisons for those cells and tissues from which they were formed. This is explained by the fact that each organ, each tissue has its own specific protein. The specificity of the latter can be easily proved by immuno-biological reactions: precipitation, complement binding, anaphylaxis, etc. At the same time, the more complex the function of the cell, the more complicated is the physicochemical structure of its protein, and the more complex are the products of vital activity and metabolism that arise here.
When we begin to evaluate any therapeutic agent, we need first of all to study its direct effect on physiological or pathological processes in the organism, organs and tissues. In radiotherapy this assessment was earlier complicated by the fact that we did not yet have sufficient biological data, on the basis of which we could speak about the direct action of X-rays on organs and their functions. Only recently separate experimenters resorted to the technique of tissue cultures in the explant to solve this question.
The works of Zondek, Kraus, Loeb, Laew and Rosen revealed a great role of mineral substances in the living organism. Such substances include mainly Na, K and Ca ions. It was only natural to think to make a series of observations to find out how ultraviolet light affects the electrolyte composition of the body. The most convenient substrate for such observations is the blood, reflecting on itself the particular changes of the latter.
The usual examination of the gastric contents after a test breakfast, and not only after its single extraction, but even with the more perfect fractional method, gives a total picture of the motility and secretory activity of the stomach, from which it is difficult to distinguish the influence of each of these factors separately. The curves obtained by the fractional method of investigation are not "secretion curves", but only "acidity curves" (Katsch and Kalk), the course of which depends on the intensity of secretion, on the speed of emptying the stomach, on the course of the intake of duodeni contents, on swallowing saliva.
Polyuria and associated polydipsia are known to be the main, and often the only, symptoms of diabetes insipidus. The amount of urine excreted may reach enormous figures - 43 liters in the case of Trousseau. Specific gravity is at a very low level, reaching 1001 and below. Together with this disturbance of water exchange, the exchange of sodium chloride is usually disturbed, and these two processes, in fact, characterize diabetes insipidus. Regarding the origin, systematics, and pathogenesis of these basic symptoms there is a large literature, but even on the main questions there are still fundamental discrepancies.
The problem of treatment of diarrhea, in spite of classical works on this question by Ad. Schmidta, Noorden, etc., cannot be considered to be completely solved until now. Dietotherapy, which here with good reason occupies the first place, is intended first of all for treatment of diarrhea of enterogenic character; and meanwhile clinical experience teaches us that diarrhea is often the result not only of disease of the intestine itself, but also of disease of the whole organ system, or even of the whole organism - a disease in which diarrhea is only an external expression of those deep changes which occur in the organism. Naturally, in such cases, diet therapy alone cannot lead to the goal and ensure treatment success. Obviously, new ways of treating such forms of diarrhea are needed, ways that follow from the modern understanding of these forms of diarrhea as an expression of the disease of the whole organism.
Among echinococcal diseases of internal organs, lung echinococcus, although a relatively infrequent disease, still ranks second in frequency after liver echinococcus. According to Alexinsky, in 1950 cases of echinococcus the latter was found in the liver in 53%, and in the lungs - in 6.3%; according to Frey and Madelung, % of echinococcus in lungs is 11.9, according to Neisser - from 7.4 to 10.6, according to Frangenheim-7; among 22 cases of Palygauay echinococcus in lungs was found once. In our clinic Echinococcus of the lung was found only twice out of 20 cases of echinococcus of internal organs.
Echinococcal disease has been a program topic at the regional meetings of Russian surgeons in recent years (I North Caucasian and Transcaucasian meetings of 1925). The school of Prof. N.I. Napalkov revived the interest to this disease by a number of extremely interesting works of experimental and clinical nature, and we owe to this school rich achievements in the recognition of human echinococcosis and its pathology.
According to Wenglowski, esophageal ruptures usually occur quite unexpectedly, in the midst of complete health, due to some external influence, or for no apparent reason at all. But so far we do not have a classification covering all possible cases of traumatic esophageal injuries, probably due to a very limited number of published cases. This report is based on a case of esophageal gas rupture, which is of considerable interest both because of its rarity and because of the setting in which the injury occurred.
In our observations of autohemotherapy we tried to note both general reaction of the organism (temperature) and local and focal reaction. We measured temperature accurately only in hospitalized patients. Usually the t° reaction did not exceed 37.2°-37.6°, and only in two cases we had an increase in t° to 38.2° after blood injection. After the first two injections, patients often complained of mild malaise, cognition and slight headache, which disappeared the next day. As for the local reaction, only in one patient after the fifth blood injection we could note the next day pain in the elbow joint of the left arm when bending and unbending, slight swelling and redness around the vena mediana, which disappeared after 3 days.
The method of intravital staining first applied by Goldmann made it possible to detect a whole group of cells with the ability of intracellular accumulation of electro-negative colloids. Further study of these cells, as we know, led to the creation of the doctrine of the so-called reticulo-endothelial system. During the last years numerous researches have studied not only the morphology of this system but also proved its great functional importance for the course of biological processes in the organism.
Considering it necessary to ascertain hitherto unknown norms, taking into account the influence of national, social and geographical factors, for the city of Kazan, we decided to collect data on the weight and height of Kazan's infants. Until now we have had no such material at our disposal, and only now, thanks to the development of consultations for children, are we able to obtain these data.
In the first years of my activity in Kazan as an otolaryngologist, I used a 20% solution of hydrochloric cocaine for surface anesthesia, but, noticing frequent cases of poisoning, I replaced it with a 10% solution. However, even when smearing with this solution, we also observed symptoms of poisoning quite often, although the percentage of cases of the latter and its degree were much less than with the 20% solution. This indicates that cocaine poisoning depends not only on the predisposition, but also on the concentration of the solution. Wishing to be completely free from the unpleasant consequences of superficial cocaine anesthesia during operations in the nose, nasopharynx and larynx, I replaced cocaine solutions with strong solutions of novocaine. It turned out, however, that while subcutaneous injections of 1/2% novocaine give good anaesthesia during operations on the maxillary cavity, on the mastoid process, etc., with surface anaesthesia even with the strongest solutions of this substance I did not get good results, and the patients felt severe pain during all manipulations in the above mentioned organs, so I had to return to strong solutions of cocaine.
The growth of legal cases against physicians and, in particular, the apparent futility of the vast majority of charges (81.4%) caused natural unease in the medical community. It was feared that any dissatisfaction with a doctor, any case of failed treatment, prolonged course of illness, death of a patient and other failures and misfortunes natural in the medical profession, might serve as a pretext for legal action against the doctor. The ease and accessibility of prosecution in the hands of people with little understanding of the art of medicine and the limited possibilities of medical science, while at the same time overestimating their rights in relation to the doctor, threatened to put the work of doctors in extremely difficult conditions.
Sleep is one of the most interesting problems of biology. The periodic change of sleep and wakefulness in all living creatures of the Earth, including plants, sleep of individual organs, adaptation of the biological rhythm to the cosmic rhythm (change of day and night) - these are the most difficult topics, which have been the subject of serious discussions more than once. In May and June of last year, the question of sleep, normal and pathological, was on the agenda of the international meeting of the Society of Neuropathologists in Paris.
Prof. Gurvich and his students have recently published a number of works on a specific stimulus for cell division, which they called "mitogenetic rays". In these works, it is proved that stimulus to cell division acts also when cells do not have any direct contact with the place from which the stimulus comes.
By passing fluid through an isolated adrenal gland using the Kravkoz method, we found that arecoline (1:4,000-1:50,000), a typical vagotropic poison, vigorously constricts the adrenal vessels and increases the secretion of adrenaline-like bodies. If the decreased outflow is compensated by an increase in pressure, the concentration of adrenaline-like bodies in the outflowing fluid is also increased.
On the basis of clinical observations on the action of urea and the effect of liver extracts on diuresis, Rohasek finds that the diuretic properties of urea depend on the functions of the liver. The very production of urea and the supply of it to the body have as their main source the liver. Insufficient production of it causes disorders in excretion of water and salts, breaks physical and chemical equilibrium and on this basis causes edema and ascites.
The author cautions against taking seriously, when examining with x-rays, pictures sometimes very similar to those of lung caves. These include: transverse cuts of normal bronchi, random combinations of normal, striation with its enhancement, some pictures on the border of rib cartilages with bone, connective tissue pulls, drainage effusions, irregularly developed pulmonary emphysema.
Analyzing caverns clinic on the sanatorium material (100 cases of cavernous tbc), the author concludes that it is necessary to distinguish early caverns from terminal ones, because the course and prognosis of both are completely different. Fresh early caverns are almost always unilateral, late caverns tend to spread metastatically to the other side and are mostly multiple.
The author confirmed by his experiments that constitutional resistance or susceptibility to infectious diseases stands in connection with the organs of internal secretion. In the Tuberculosis Institute it was found that guinea pigs and rabbits have a difference in endocrine formulas, which difference corresponds to the difference in the natural immunity of these animals against different infections. For final proof, an attempt was made to approximate the endocrine formula of a rabbit to that of a guinea pig to see if its natural immunity would change.
For tbc diseases of the urinary organs at New-York Hospital there has been a special department for more than a year, where a urologist and tbc specialists work together. Severe cystitis is best treated with internal and local application of methylene blue. General treatment requires, above all, complete rest, fresh air, and good nutrition.
The author is an opponent of the doctrine of demineralization of the organism by consumption. Numerous studies at the Bologna Med. It has been proved by numerous studies in the Bologna Medical Institute that mineral losses are not at all necessary in this disease, even in the acute stage of its development, and when they occur, they are caused not by the specific action of tbc poison itself, but by secondary phenomena like fever, digestive disorders, assimilation, etc., which are also found in other disease processes.
The author studied the comparative value of the Pirquet and Mantoux reactions clinically in 171 children under 2 years of age and found that the former is rarely positive in infants even in clinically clearly manifested cases of tbc, while the Mantoux reaction is much more sensitive and more likely to detect tbc infection in young children.
The author treated tuberculosis in various forms with triphalus. This drug, which is an organic preparation of gold, was injected into the veins, starting at 0.01 pro dosi, twice a week. Successful results were obtained sometimes in very severe cases. The most suitable for such treatment were productive forms with fresh fine nodular dissemination and productive, little progressive, confluent forms with moderate fever and a tendency to drainage.
According to the author, foxglove has a favorable effect on the administration of the stomach, kidneys, pancreas, etc. due to the toning of the vagus nerve system; especially sharply affected by its use are increased secretion of the stomach and pancreas and increased motive power of the stomach and intestines.
The author notes that after the use of tetraiodophenolphthalein the liver and kidneys become more visible in X-rays, because iodine, after administration per os or through the duodenal probe, by portal circulation enters the liver before it appears in the general circulation, and before the discharge into the gall bladder. The best conditions for hepatography occur 2 hours after duodenal probe administration and 6 hours after per os ingestion.
The author treated 70 cases of gastric and duodenal ulcers with subcutaneous injections of pepsin (Megske 1% or Kahlbaum 2-5%), and often observed a good effect in the sense of lowering acidity and complete disappearance of all disorders.
The author cites cases of inflammation of all three membranes of the heart in human trichinosis. The author was also able to establish the presence of myocarditis in trichinosis, which is a consequence of penetration of young trichines into the heart muscle.
Regarding the report of Prof. Ral'ya about liver therapy, the author points out that as early as 1918, he published a work where, based on many years of experience, he notes the magical effect of using liver and liver extract in hemeralopia and scorbutus.
That the whipworm (trichocephalus dispar) can be a very dangerous guest of the human intestine is shown by the case reported by Dr. P. Bonem. A 54 year old woman was admitted to the Stuttgart City Hospital in June 1927 for diagnosis, who at the end of winter had an apparently unexplained anemia. Besides the usual signs of the latter, the examination revealed numerous hemorrhages in the skin, and in the feces many eggs of the whipworm and stringworm.
The method described by the author gives an impression of simplicity and ease. By using it, the highest and lowest blood pressures, along with the heartbeat, venous pulse, heart tones, etc., are recorded completely automatically.
The author cites a number of data in favor of his theory of the action of X-rays, explaining the effect of illumination by the influence of decay products (neurohormones). The most urgent problems of modern radiobiology are: 1) the general biomechanism of the rays' action, 2) their general effect on the organism, and 3) the "irritant" effect.
The author suggests using a combination of scopolamine and hyoscine, from which he has observed a good effect both protective and therapeutic. The dose is equal to 0.5 mgr.
To solve this question, the author illuminated an isolated lymphatic gland in the fossa poplitea simultaneously with a normal one on the other side. Histological examination resulted in very intense changes only in the non-isolated gland.
The author draws the attention of practical doctors to the results of treatment of gastric and duodenal ulcers (more than 100 own observations) with X-rays. 10-14 days after application of one series of illumination (4 times a week in small doses) independent pains disappear (without preliminary reaction), appetite quickly appears, bleeding stops (several hours after the first illumination), and spastic constipation, which are companions of stomach and duodenal ulcers, disappears. As for the pains of pressure and hyperacidity, they remain for a while, but subsequently also disappear.
The authors used for their experiments pathogenic filamentous fungi and amoebas. After illumination for 10-10 1/2 minutes the fungi were destroyed, the amoebae turned out to be radiotolerant: 45 minutes of illumination caused only a delay in their movements.
According to E. I. Kazakevich among other therapeutic methods used in bronchial asthma, mercury-quartz irradiation deserves great attention in many cases. At the same time presence of vegetative nervous system hypertonia in this disease is one of the main points in indications for application of this method.
B. Shimshelevich found that diathermy should be used in all cases of decreased gastric secretion, including achylia. On the contrary, diathermy treatment is contraindicated in cases of increased secretion.
Based on 403 operations with treatment of the operating field with 5% alcoholic solution of picric acid, the author considers the latter to be quite reliable means for disinfection of the operating field (4% of suppuration). Due to its strong skin tanning properties, picric acid solution can replace iodine tincture.
The author successfully applied ultraviolet rays to a patient suffering from pruritus on the basis of diabetes, while diet and insulin without light therapy did not give the patient any relief. In another case, a patient with diabetic mycosis, improvement was achieved only after local illumination of the affected parts: epithelialization of erosions, disappearance of inflammatory hyperemia, excruciating itching, etc.
On the basis of 110 operations performed for goiter, the author concludes that the more toxic goiter is, the more often local anesthesia should be used for its operation, avoiding ether anesthesia if possible.
The author cites 2 cases of death of patients who had undergone prior radiotherapy after strumulectomy. Eidelsberg noted that the operation to remove the goiter is extremely difficult after the previous radiotherapy due to the abundance of adhesions and irrigation of the gland with the surrounding tissues.
The author reviews 1,546 cases of operations performed under spinal anesthesia at the Hospital Surgical Clinic of Tiflis University. The average duration of analgesia in these cases was 1 hour 25 minutes. The age of the patients varied from 15 to 80 years. Operations under spinal anesthesia were performed for diseases localized below the navel, which made up 18.5% of the clinic material.
Comparing, based on a number of observations, the effect of various pharmacological agents proposed against postoperative urinary retention (magnesium sulfate, urotropine, pilocarpine), the author gives a strong preference among them to pilocarpine (injected subcutaneously in an amount of 1 cc of 1% solution).
The author reports that the Eiselsberg Clinic had 25 cases of tetanus over a period of 20 years, a very small number compared to the large number of patients with traumatic injuries admitted. The disease manifested itself in two forms - the lightning one, which always killed the patient, and the protracted one, which often ended in recovery.
Based on the material of 100 cases the author gives preference to cholecystoduodenotomy or cholecystogastrostomy over cholecystectomy in inflammatory diseases of the gallbladder. After a suture is placed, the infection usually subsides, bile passes freely into the intestine, cholecystitis no longer recurs, and there is no ascending cholangitis. The mortality rate after these operations is lower than after cholecystectomy.
The author exposes the v. saphenam at its inflow into the v. femoralis, dissects it, and introduces a ureteral catheter into its distal end (the author managed to pass, in nonthrombosed vessels with a large lumen, below the knee joint to the lower third of the shin); then through this catheter is introduced, using a 10-20 gm syringe, 20% saline or glucose solution, and the catheter is carefully extracted at this time.