From Big Medical Encyclopedia

CELLULAR PATHOLOGY (Latin cellula the small room, here — a cell; pathology) — the direction in pathology considering a cell as material substrate of a disease, and a disease as a certain sum of defeats of a set of separate cells.

Attempts to explain observable a wedge, displays of diseases the corresponding structural changes were undertaken still in the ancient time and in the Middle Ages. This question developed J. Morganji on the basis of solid actual material in the classical work «About Location and the Reasons of the Diseases Opened Posredstvokhm Sections» (1761), in Krom urged to look for persistently a structural basis of functional disturbances in order that it is deeper to understand essence of a disease and more successfully to treat her. Though at the time of J. Morganyi there was already a microscope, and M. Malpigi опуб^ exulted by then the classical researches in the field of normal histology, J. Blinking did not use a microscope and section material investigated only with the naked eye. Most likely, J. Morganyi did not attach due significance to a microscope as the cellular theory as the philosophy of a structure of living matter was not formulated yet. A wedge, displays of diseases compared only with changes of a form, the sizes, consistences, colors of bodies and some other macroscopic signs.

R. Virkhov one of the first understood huge value for pathology of the cellular theory and in it his main historical merit before medicine consists. Having created cellular pathology by means of microscopic examination, he took the following step to disclosure of localization patol. changes already not only in this or that body, but also in the cellular elements making it. It sharply increased the accuracy of the structural analysis patol. processes. Thus, R. Virkhov should be considered the founder of a so-called microscopic stage of development of pathological anatomy (see), and to consider the cellular pathology created by it as addition patol. anatomy patol. histology.

C. the item was logical continuation and development of the cellular theory (see), edges by the time of emergence of C. the item was the most popular in biology. C. with the item universality of the cellular doctrine, its value for biology emphasized, physiology, pathology and applied medicine.

Original positions of cellular pathology were stated by R. Virkhov in the article «Cellular Pathology» (1855) and a kntsga «Cellular pathology as the doctrine based on physiological and pathological histology» (1858). R. Virkhov wrote that he made «attempt to present in a bigger order, than it happened hitherto, view on cellular property of all vital manifestations physiological and pathological, animal and vegetable that... to bring the next home unity of life in all organic and at the same time to oppose the thinnest mechanics and chemistry of a cell to so unilateral indications of roughly mechanical and chemical direction».1 One of fundamental provisions C. the item is the fact that «the section really is the last morphological element of all live bodies... We have no right to look for the real life activity out of it... Each animal is the sum of vital units from which everyone separately taken necessary for life contains all. Character and unity of life shall look for not in this or that body of the higher organism, for example, in a brain of the person but only in volume the certain, constantly repeating device which we notice in each separate element: in a cell; from this it is visible that any live body of a little considerable volume represents the device, similar public where the set of separate existence is put into dependence from each other, but so..., that each of them has the special activity and if it also receives motivation to this activity from other parts, but it makes the work by own forces».

Throughout all the life R. Virkhov developed and specified bases of C. the item, remaining the convinced propagandist of a look that a cell — an elementary base unit of life both in normal, and in patol. conditions that cell — «place» and «essence» of various processes. R. Virkhov considered that the doctor shall «think microscopically», but at a bed of the patient «the doctor successfully to work, needs first of all knowledge of regulatory ways. What interests the doctor, is not a cell at all, but always their sum».

General arranging biol. the principle, according to R. Virkhov, is the cell, inside a cut of substance work under laws of physics and chemistry. At the same time physical and chemical laws are not broken by a disease; they are only shown differently, than in a healthy organism.

R. Virkhov considered that the cell is the first and major element of life; being the most general and most constant form of living matter, it bears in itself «full character of life». «A cell which eats... digests... moves, allocates — yes, it is a being... active, active being; and it is not a mystification, but pure realism». R. Virkhov knew about atomistic representations, from the point of view of to-rykh living matter and cells were considered as a certain composition. However he strongly objected against to reduce life to «any dispersion of molecules» since the last, in his opinion, shall have a certain communication. Each vital composition, according to R. Virkhov, has the previous generation (maternal live composition), and it is impossible to create this composition artificially, just as to present that it arose accidentally.

The principle «local» in C. the item is the leader. «There are no other diseases, except local,» — R. Virkhov's thesis so categorically sounds. Sometimes it softens this principle with the instruction that representation about local, as well as about essence of a disease, is not necessarily purely anatomic: «... there are new tasks, from set of anatomic, especially etiological data to try to define by reasonings the place of a disease». In these cases R. Virkhov suggested not to stop in reasonings on what can be opened by an anatomic knife, and focus attention on the functional phenomena opened by clinic.

In positions of the founder Ts. the item centuries-old fight of the universalistichesky and locale-stichesky principles in understanding of essence of a disease (see), and also understanding by R. Virkhov of borders morfol was reflected. method of a research, at that time still very imperfect, far from modern. In a crust, time the antithesis between morphological and physiological is overcome both with actual, and from the methodological party. Formulation of the question about localization patol. processes (see Localization of disease processes), without being on the substance of new, was of great importance for development of medical specialties. R. Virkhov said that «any doctor cannot correctly think about disease process if he is not able to specify to it the place in a body».

R. Virkhov considered a cell the only structure live that poured out in theoretically important, but methodologically false situation about «personification» of a cell, i.e. it was considered as an organism or an individual. The cell «bears», according to R. Virkhov, not only «full character of life», she is an original individual. The whole organism is an only «seeming», «fabulous» unity (1898). «What represents an organism in general the same and is a cell in small even more». There is no other unity, except unity of fine particles and the whole life arising from them which, however, at all not unity».

In the subsequent works R. Virkhov considered necessary to soften with reservations nek-ry of the unambiguous judgments. So, describing essential distinctions between live elements and inorganic matters, pointing out divisibility of cells, their ability to breed, he drew a conclusion that cells keep «the identity only the known time». From here also a bit different characteristic R. Virkhovom of autonomy of cells follows. Recognizing the known independence of a cell, R. Virkhov wanted to emphasize only ability of cells to satisfy the requirements «to a certain extent». Even more softened, as a matter of fact disproving the principle of cellular identity, look other provisions of R. Virkhov: «... it would be false to think if we wanted to consider a human body as the simple unit of disconnected vital units. On the contrary, we know that thanks to the reasonable device these diverse units are united in unity, higher and fuller on the value. On the top there are nervous elements in which the major animals and human functions, and also blood — this big assembly point of a metabolism gather». In the light of these provisions of the statement of R. Virkhov about an organism as about doubtful identity and doubtful unity, its comparisons of an organism with «cellular federation», or just with «the sum of separate lives» seem a contradiction.

Though R. Virkhov did not see radical contradictions between humoral and solidary representations and even agreed with need to nominate nervous system «to the highest place», having subordinated to it «more or less all functions of a body», nevertheless it nevertheless inclined to a thought that it is possible to gain the correct impression about life of the higher organism (sick or healthy) in all its «multidistinction», only considering activity of «separate parts». «If to resort to big comparisons — R. Virkhov wrote — that a difficult organism can rather be compared to society, than to something single, it is rather with the state, than with the citizen». Owing to eclecticism of the views it could not overcome a contradiction between a cell as «indivisible» biological «atom» and the whole organism as an original individual.

R. Virkhov with special persistence noted that the cell is constructed by the principle of the «constantly repeating device» which is not subject to further decomposition on a part that searches of «any dispersion of molecules» should be rejected unconditionally. Phenomena of life mean the definiteness of molecular composition providing a reproduction. Otherwise it should allow a possibility of spontaneous generation (i.e. spontaneous formation of live structures from lifeless substance), to-ruyu R. Virkhov considered impossible. So the formula «omnis cellula e cellula» (any cell from a cell) which is not shaken in the principle and in a crust, time was born. All attempts of histologists, embryologists, pathologists to revive the principle of spontaneous generation of cells from a tsistoblastoma (according to T. Shvanna), from intercellular substance (according to the doctrine of school of Gravitts), from yolk spherules, from protein, from blood plasma (according to M. D. Lavdovsky and N. P. Tishut-kin, S. A. Usov, O. B. Lepeshin-skaya, etc.) were insolvent as well as the ideological basis of these views — to connect an origin of cells with «living material». R. Virkhov's formula does not serve as a brake to more profound cytologic, cytochemical, and also to the electronic microscopic examinations setting a task comprehensively to study life of a cell at molecular level. In the course of such research there was other formula offered by Frey and Vissling (Frei, Wissling) — «omnis structura e structura» (any structure from structure) which is in details reflecting stereotypic changes of ultrastructures of cytoplasm of a cell.

Being essentially new and progressive for the time, C. met by the item not only approval, but also objections, up to its complete negation. Throughout the whole century of C. found the item, lost the defenders. Among them there was a number of the scientists simplifying and vulgarizing original positions of C. the item, creating from them a target for attacks of those who apprehended C. the item without analysis of all scientific depth of system of R. Virkhov, without its historical premises. Were such, e.g., Gekkel's attempt (E. N of Haeckel) to create on the basis of C. the item «cellular psychology», or the theory of «cellular soul», attempts of other scientists to attribute to cells of difficult organisms of function of the whole organisms (the cell «is protected», «fights», the cell, e.g. nervous, «is strongly angry», the cell «is aggressive», napr, in tumors, etc.). These analogies drawn between a separate cell and a metaphyte at once made unpopular «cellular physiology» of Fervorn. They were the cause of I. I. Mechnikov's charge (it was talked of his phagocytal theory) of vitalism.

After issue of the first edition of the book of R. Virkhov of criticism fell upon her author, accusing him of «cellular vitalism», of ignoring of nervous activity as major factor, through means to-rogo «organic life activity» both in normal, and in patol is carried out. conditions. Critics considered R. Virkhov's attempt to reduce a problem of life, a disease, unity, identity, irritability to a cellular problem as reflection of far-fetched physiophilosophical representations of the past.

Especially sharply against C. the item expressed Rikker (G. Ricker, 1924) who was completely denying its original positions. According to Rikker, all described in C. the item processes — not a fruit of observations, but the abstract data based on false judgments. Accusing R. Virkhov of «removal of physical processes of logical concepts», Rikker saw in R. Virkhov's theory something close to animistic and teleologic representations. He considered that everything made R. Virkhov in the plan morfol. unsurpassed interest has justifications of the system, but what locates by it philosophically, did only harm. This criticism was not free from exaggerations, besides Rikker proceeded from essentially incorrect installations, according to the Crimea the scientist shall keep separate carefully from biological, i.e. the general, concepts (their Rikker called physiophilosophical and metaphysical) and to operate with only purely scientific facts, to establish their causal relationships and the relations, without concerning «imaginary elements of life», i.e. cells. The pathologist and the physiologist, according to Rikker, shall study not life, and only processes in the Live organism. Attempts to transform pathology in biol were a historical merit of R. Virkhov just. to a vauk to get into essence patol. processes as special form of life activity. Life can be shown only in certain structures and forms. One of the major such structures is also the cell.

Critic Ts. the item from outside do not tear - stov the most fierce. Actually a nervosism (see) was an antithesis of C. the item though the most popular theory of neuron, i.e. a primacy of a nervous cell, apparently, had to soften this antithesis. C. the item did not exclude at all reflex theories as out of the cellular principle connecting nervous and other cells of an organism in a whole, functions of the last are impracticable. Lack of C. the item, from positions of a nervosism, consisted first of all in underestimation of the principle of integration and coordination of all functions of a complete organism and in obvious underestimation of a role of a nervous system. Underestimation of a role of a nervous system led R. Virkhov to opposition of the general and local, to a primacy local, to cellular identity, to «cellular territories».

Denial by R. Virkhov «the general sredotocheniye, a cut could be clearly recognized as the general and starting point of various kinds of activity of an organism», undoubtedly, was directed against a unilateral oligarchical nervosism of 18 century and the first half of 19 century. «I fight — R. Virkhov in 1880 — with the pathological theories connecting a disease with any only system of a body and considering all others as objects of influence of this system wrote... It is unfair to believe that the nerve center by means of nerve fibrils is able to find special action on each slightest part of the nervous district».

R. Virkhov had a metaphysical idea of integrity of an organism. It did not open relationship of parts whole and whole with the environment that brought closer it to I. Müller's representations. Nervous system completes both internal integration of functions of an organism, and its unity with the environment. The unity of an organism exists not only «in egg and in consciousness» as R. Virkhov wrote, and it not «the abstraction based on false interpretation of identity of the higher mature organisms», and the objective reality disclosed in works I. M. Sechenova and I. P. Pavlov.

C. the item gave a reason for R. Virkhov's charge of animism, a teleologiz-ma, vitalism (see), an anthropomorphism (see) and a primitive physiophilosophical ontologizm. A. I. Polunin called C. item «unilateral pathology». E. V. Pelikan spoke about «a fragile hypothesis», about «guess», about return to «medical romanticism», vitalism. F. I. Inozemtsev called C. the item «neudobnoponyatny» (from a position of a nervosism).

R. Virkhov himself called himself a vitalist, right there adding that it «not the spiritualist». At the same time he was afraid that the cell was not regarded as «biological mysticism» as her life does not come down only to chemical and physical processes. To it the principle of «the vital force» sickened, but the impossibility of the data of the vital phenomena only to physical and chemical laws forced it to operate with this concept. It is obvious that this in itself is not the sufficient basis for R. Virkhov's charge of vitalism. Rejecting vitalism as the philosophical direction, calling the doctrine about «the vital force» superstition, R. Virkhov concluded that «the nature is not obliged by the emergence and existence to any foreign forces or the creator, and than more precisely we study substance, especially we recognize it automatic». Eclecticism of philosophical representations of the founder Ts. the item, generally positivistic, did not allow it to draw the correct conclusion on life as to qualitatively special form of motion of matter.

The modern biology and theoretical medicine adopted a number of provisions C. the item, having eliminated the metaphysical parties in the doctrine about a cell, considerably having expanded and having scientifically rationalized a problem of a cell in physiology and pathology. In modern medicine huge significance is attached to comprehensive study of a cell along with the most important theoretical problems of medicine (regeneration, tumors, an inflammation, immunity, etc.). E.g., the problem of a cancer cell, vegetative mutation, alien information, a genome of a cell, its nukleoproteidny exchange, a problem of growth and development stand in the center of attention of modern oncology (see the Carcinogenesis, tumors). «Each type of a tumor — R. Virkhov wrote — in essence matches the known typical formations of a body». In other words, studying of tumors also should be conducted from this point of view the general laws of organic development. Problems of hereditary diseases (see), teratologies (see), questions of a histochemistry (see), enzymologies (see), exocrine and endocrine secretion (see), in particular neurosecretions (see), etc. cannot scientifically be developed without carrying out researches at the cellular level. C. the item was not simply morfol. theory. And the creator on an extent of all life called it for studying morfol. the phenomena, considering their obvious communication with a functional state. R. Virkhov urged to study «emergence of a state», and not just «the existing state». Thanks to it pathology and patol. anatomy become biol. sciences.

During lifetime of R. Virkhov his postulate that the cell is an elementary base unit of all live bodies and that we have no right to look for the real life out of it, began to be called in question. So, the famous Russian

pathologist S. M. Lukyanov at the end of 19 century raised a question already absolutely differently: Whether «There is a cell the only elementary form in which life is shown? There was a time when the cell was proclaimed as the last structural element when it was considered as the last live — sharing — indivisible. Now the similar point of view begins to fluctuate strongly. We know that the cell is difficult whole. Some parts of this whole possess undoubtedly some kind of autonomy which is shown both concerning food, and concerning reproduction, and concerning the movement. The cell lives not as one continuous whole; she, like a metaphyte, lives not the uniform, but integrated life in the numerous and diverse parts... everything declines us to an assumption that outside a cell life does not terminate and that biology, coming from the cell, does not come to the end with the cellular theory..., it is very probable that each cell represents, in turn, strictly coordinate system of live even more elementary educations». This anticipation received confirmation in the middle of 20 century when by means of a submicroscopy (see) in cells the complex system of organellas, each of was open to-rykh plays a part in operation of the intracellular conveyor creating this or that function. The same properties live, as a cell are inherent in organellas: they have ability to continuous self-updating, are damaged under the influence of adverse environmental factors, recover the structure after elimination of the last, can proliferate etc. All this gives serious reasons to consider that the cell, certainly, is the main base unit of an organism. Electronic microscopic examinations showed that at various diseases there are peculiar changes of nuclear and cytoplasmatic organellas; it allowed to speak already about ult-rastrukturny pathology. The accuracy rate of comparison of functional disturbances to structural changes, typical for this disease, even more raised.

Ultramicroscopic period of development patol. anatomy is essentially direct continuation and further development of the main idea of R. Virkhov about cellular pathology, only realizuyekhmy at thinner structural level. Where did not see morfol earlier. changes and on the basis of it spoke about purely functional changes which are not followed structural yet, today accurately distinguish the thinnest disturbances of a structure of nuclear and cytoplasmatic organellas. Thus, the circle of so-called functional diseases is more and more narrowed. Gradually the material basis of life activity of an organism in the form of a continuous row all of the increasing structures appears in all completeness: molecules, subunits of organellas, organellas, cells, fabrics, bodies, systems. On this basis the principle of unity of structure and function is normal also of pathology, to-ry was rather theoretical earlier, than almost notable, gains lines of reality more and more.

In a crust, time studying of structural bases of diseases of the person at all levels — at the level of an organism, body, fabric, a cell, intracellular structures is the rule. Lack of data on structural changes on any one of these levels deprives of the researcher of an opportunity to gain an integral impression about a disease, does it fragmentary (or the most general, or, on the contrary, extremely narrow).

The considerable success in studying of pathology at the level of a cell achieved in the second half of 20 century was of great importance for further deepening of ideas of mechanisms of development of diseases of the person, disclosure of mechanisms of interaction of pathogenic factors with subcellular structures, developments of effective etiological and pathogenetic methods of treatment. C. found the item the continuation and further development in the new big field of modern biology and medicine — in molecular (subcellular) pathology, within a cut many issues of virology, oncology, an immunopathology, genetics, pathology of cardiovascular system, etc. are resolved. At the same time close attention of researchers to the thinnest intracellular mechanisms strengthens those shady sides of C. the item, on to-rye still R. Virkhov's contemporaries specified. They saw the main danger of the increasing immersion in depths of a cell in inevitable easing of attention to an organism as to a whole. Only two years later after issue of «Cellular pathology», i.e. at the very beginning of the victorious procession of the new doctrine, I. M. Sechenov wrote that «cellular pathology which cornerstone physiological independence of a section or, at least, its hegemony over the environment is — as the principle is false. The doctrine it is no more as an extreme step of development of the anatomic direction in pathology». Much later D. D. Pletnev paid attention that at undoubted scientific merits the biggest lack of medicine is the pushing off on a background of anthropology (see) and substitution by its organopathology. In a crust, time it is a pushing off can become even more considerable since the organism as whole is covered from a look of the researcher not only with an organopathology, but also ultrastructural pathology. As the earliest changes at the same time note disturbances of the membrane device of the corresponding type of cells. It, however, does not give yet the grounds to consider that at last the prime cause of this or that disease is found out and it is possible to register the moment of its emergence. To conclusions of this sort, on a basis to-rykh all new, so-called membrane concepts of the mechanism of development of diseases of the person move forward, it is necessary to belong with care. There is no confidence that change of membranes of cells is not preceded by any earlier disturbances, in particular in regulatory systems of an organism and that, therefore, these intracellular changes represent not primary link in a picture patol today. process, and only consistently joined in it later certain time after the valid beginning of development of this disease. It is necessary to consider also that thin intracellular changes, as a rule, are not a proximate cause of emergence of symptoms of a disease, they are integrated on the basis of neurohumoral bonds in system of a complete organism and depending on efficiency of compensatory and adaptive reactions of the last or are implemented in corresponding a wedge. a picture, or remain for a long time or even forever stopped within this or that body of so-called almost healthy person.

Justice of criticism of cellular pathology and its direct continuation — modern molecular pathology consists that attempts to disclose essence of a kliniko-anatomic picture of this or that disease by studying of changes of the thinnest structures of a cell without assessment of these changes from this point of view of work of an organism as a whole in a crust, time remain so unreliable, as well as in the past. No interest of researches in the field of genetics (see) and immunology (see), exclusive prospects of studying of many other problems of modern cytology (see) shall not be distracted from simultaneous profound development of problems of a nervosism (see) and clarifications of patterns of regulation of life activity of an organism in the changing conditions of the environment. Only on the basis of synthesis of these two directions it is possible to overcome private character of original positions of C. the item also to rise before consideration of patterns of a current patol. process from the point of view of the general pathology of the person.

The gap which is observed in a crust, time between rapid advance of a research thought in the mysteries of work of a cell and considerable slower course of knowledge of activity of an organism as complete system is explained not by a simple inattention of researchers to the last. If studying of mechanisms of functioning of a separate cell represents great difficulties, then the analysis of almost infinite set of bonds between cells, fabrics, bodies and systems, integration to-rykh gives new quality — an organism as an integrated whole, represents the task incommensurably more difficult. For the successful solution of various problems a wedge, medicine it is necessary to consider local, local changes from positions of an organism as whole. From this point of view it is also necessary to estimate both various historical aspects of cellular pathology, and a role of her direct successor — molecular pathology in further progress of theoretical and applied medicine.

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