The concept of disease in society. Health and disease

"I often recall an episode from my early childhood. Then I was three years old, and I lived with my parents in the Murmansk region. I was walking somewhere with my mother, someone else and, suddenly, I wondered how I got into this world .It was as if some kind of sunbeam flashed in my head, but I did not receive an answer. (p. 64)

Ab ovo

"From the point of view of Darwinian and neo-Darwinian views, the best sign of today's survival is the invention of nuclear, hydrogen and other increasingly sophisticated methods of warfare. Thus, the Darwinist scheme rushes towards the absurdity. That is why I do not like Darwin, along with Catholics, Muslims and other murderers of the human race."

The first thing that captivates the style chosen by the author is an attempt to most sincerely state his positions, to integrate them with the positions of other world famous scientists, not trusting any templates. This, however, is only the beginning of the book's merits. The power of logic, unexpected and sparkling conclusions, good scientific romance - will give food for thought to any scientist and practitioner who is simultaneously interested in philosophy, psychology, sociology, jurisprudence, and other social and human sciences.

Consciousness

Through the efforts of many philosophers, psychologists and other scientists, the concept of "consciousness" has been greatly vulgarized and blurred. The author's view of consciousness is original, worthy of respect for the attempt to resurrect and concretize this concept. On the other hand, it should be noted that consciousness cannot but be the key concept of the topic of social diseases. Just as a biological disease narrows the consciousness of a person, makes him think about his illnesses, so social diseases narrow, rebuild people's consciousness, limit spiritual life, self-realization. Any patient is primarily fixed on the negative. And after Olkov's book, one can even make a broad generalization: fixation on the negative - is a necessary and sufficient sign of a person's illness.

Ol, soul and psyche

"War, all kinds of other conflicts, various forms public, psychosomatic, somatic diseases, etc. - also a method of natural selection. "(p. 150)

This quote obviously represents a very, very interesting point. The author (accidentally or deliberately) put objectively related phenomena in one row:
1. Somatic diseases (diseases of the body)
2. Psychosomatic diseases (diseases of the body + soul)
3. Public diseases
4. All kinds of conflicts
5. War
In our opinion, the systematic nature of this scheme, proof of the adequacy of its use when considering a wide range of problems, can become a hypothesis of serious scientific work. It is obvious that both conflicts and war can be need regarded as diseases. According to the Soviet Encyclopedic Dictionary, "A disease is a violation of the normal functioning of an organism due to functional and (and) morphological changes." This definition does not even need to change anything in order to extend it to points 3, 4 and 5. It is enough to imagine society, humanity as a notorious organism. It should be noted that conflicts and war cannot be a variant of social diseases. Social diseases cover SOCIETY, a kind of large virtual team. Conflicts cover two or more groups that differ on a number of issues. War also involves two or more factions. The discrepancies in the latter case are so great that each side allows the physical destruction of the enemy. That is, there is no desire to have anything in common with the enemy, even life.
In this scheme, extreme positions (somatic illnesses and war) are the most lethal, i.e. capable of causing death: What has been said does not mean at all that people do not die as a result of conflicts (domestic fights, for example), psychosomatic diseases (ulcers, diabetes, neurosis), social diseases (criminalization of society, addiction, etc.). But still, during hostilities, serious illnesses - death occurs as a more logical consequence. We can say that death is the essence, an inevitable companion of these processes.
The scheme is convenient for considering the dynamics of many political processes. It is obvious that the neighboring elements of the circuit are most closely connected with each other, they excite each other, slow down. And, if the "organism" has a weak immune system, inflammation is transmitted to neighboring levels. And in the presence of complications, aggravating circumstances - all 5 levels can "flare up".
We will try to illustrate what was said on the example of the history of our country at the beginning of the century:

• The science of that time was not able to give a more or less suitable interpretation of the ongoing (psychological-)political processes, as a result of which great importance acquired non-scientific interpretations;
• Culture and art did not increase, but lowered the immunity of the nation;
• Over a short period of time, a large number of "infections" spread: Bolshevism, the Black Hundreds, Zionism, etc., together which society could not overcome;
• "Rotten head";
• and etc.

"The goal of scientific knowledge is not just a passive adaptation to the environment and inner world, but an attempt to organize it, to learn to control the environment. "(p. 59)

Public health and disease

Thus, Olkov proposes to evaluate all diseases equally from a moral point of view: cancer, AIDS, (suicide) murder. In the meantime, there is one subtle point that the author has overlooked. As he aptly points out, ordinary illnesses do not carry even the slightest moral prestige. But they and not condemned society. People with the flu are not obstructed. If you follow the logic of the author, referring to (suicide) murders as common illnesses, we will be forced to recognize (suicide) murder as a variant of the norm, the normal existence of people. For what could be more normal for a modern person than get sick?! Yes, and the core of our population is hypochondriacs, disease people. It is for this psychological type By the way, the majority of modern politicians, primarily regional ones, rely on it.

In our opinion, it would be too straightforward to interpret illegal behavior solely as a social disease. If only because such a view will never take root among the masses. For the layman, illness is normal; crime is bad; and together they do not come together!

"God forbid I go crazy - it's better to have a staff and a scrip"
The disease of the disease is different. And some diseases are completely unprestigious. First of all, it concerns mental disorders. With the exception of neuroses, all the rest mental disorders absolutely "not quoted". "Schizophrenic", "Paranoid", "Oligophrenic", etc. labels are very persistent, effective. To voluntarily turn to a psychiatrist is a shame; a person who has visited a psychiatrist usually encounters problems in communication, prejudice. A piece of "fame" of psychiatrists went to psychologists. Half of the blame lies with psychiatrists, who are mostly convinced of the incurability of mental illness to the end, therefore non-propaganda possibilities of his science. Nevertheless, very, very many mental disorders are correctable. Most of the psychological problems with which they come to see a psychologist are also correctable.
It is obvious that the universal recognition of the curability of mental disorders, their equality with ordinary diseases will give a greater effect than the usual statement of a sick society. Usually a person does not even allow himself to think that he has a sick soul, he is afraid to imagine himself at a consultation with a psychologist or psychiatrist. If a person with a cold does not want to go to see a doctor, he self-medicates (with varying degrees of success). A person with an upset psyche does not even seek to engage in self-help. At best, he is limited to taking alcohol and other drugs, which, as a rule, is not helping himself. Thus, if the effect of the traumatic factor is not stopped by rational means, it remains to rely on the last bastion of mental health - psychological defense mechanisms. When she can’t stand it either, a rapid development of the disorder begins, with an unpredictable outcome. Most often, clients come to psychiatrists and psychologists in this acute phase, when it is no longer enough to get rid of the action of one or several traumatic factors. Mental disorder quickly and decisively acquires a systemic character. The earlier a person turns to a psychologist or a psychiatrist (uses methods of psycho-correction on his own), the easier it is to overcome the problem. It may seem paradoxical, but without a "fashion" for mental disorders, it is not possible to talk about the spiritual health of society.

Public health and disease indicators

Prevention and treatment

social diseases

human diseases, the occurrence and spread of which to a certain extent depend on the influence of adverse conditions of the socio-economic system. To S. b. include: tuberculosis, venereal diseases, alcoholism, drug addiction, rickets, beriberi, and other diseases of malnutrition, some occupational diseases. S.'s distribution. contribute to the conditions that give rise to class antagonism and exploitation of the working people. The elimination of exploitation and social inequality is a necessary prerequisite for the successful fight against S. b. At the same time, socio-economic conditions have a direct or indirect influence on the emergence and development of many other human diseases; it is also impossible to underestimate the role of the biological characteristics of the pathogen or the human body, and with the so-called. S. b. Therefore, since the 1960s and 70s term "S. b." finds more and more limited use.

Big soviet encyclopedia. - M.: Soviet Encyclopedia. 1969-1978 .

See what "Social diseases" is in other dictionaries:

SOCIAL ILLNESSES- SOCIAL ILLNESSES. Under S. b. they understand, no, the distribution of krykh is due to social. economic the structure of society. To S.'s group. carry first of all tbc, veins. b none, especially syphilis, alcoholism; this also includes drug addiction, rheumatism and ... ...

social diseases - common name diseases arising from predominantly social causes (such as poverty, homelessness, neglect of children, migration, war, racial, ethnic and religious conflicts, occupational hazards, accessibility ... ...

A disease is a process that occurs as a result of exposure to an organism of a harmful (extreme) stimulus of the external or internal environment, characterized by a decrease in the adaptability of a living organism to the external environment while ... ... Wikipedia

Social human rights- this is a set of constitutional rights of a person (or only citizens of a particular state), giving him the opportunity to claim to receive material or other benefits from the state under certain conditions. To social rights guaranteeing ... ... Big Law Dictionary

Diseases are social- a non-special name for social processes that can lead to distress, mental disorders and behavioral disorders in the masses of the population. For example, the spread of archaic ideas, racial prejudices, the stratification of society according to ... ... Encyclopedic Dictionary of Psychology and Pedagogy

GOST R 22.0.04-95: Safety in emergency situations. Biological and social emergencies. Terms and Definitions- Terminology GOST R 22.0.04 95: Safety in emergency situations. Biological and social emergencies. Terms and definitions original document: 3.3.8 animal safety: A condition in which, through compliance with legal regulations, ... ... Dictionary-reference book of terms of normative and technical documentation

INTERNAL ILLNESSES- INTERNAL DISEASES, one of the largest branches of theoretical and practical medicine, a scientific discipline that has as its task the study of disease recognition internal organs in their various clinical forms, causes of origin ... ... Big Medical Encyclopedia

The law "On providing workers in case of illness" is a law of the Russian Empire adopted on June 23, 1912. The law provided for workers to receive payments in case of temporary disability and obliged entrepreneurs to organize for ... ... Wikipedia

MENTAL ILLNESS- MENTAL ILLNESS, such a state of a person, in which the regularity of his behavior is disturbed due to the fact that his emotional mood or thinking ceases to be a reflection of reality. Crazy, features are a product of… … Big Medical Encyclopedia

- (from Latin Venus, the genitive Veneris Venus, the ancient Romans had the goddess of love) a group of infectious diseases transmitted mainly through sexual contact, Syphilis, Gonorrhea, Chancre soft and Lymphogranulomatosis inguinal. The term "B. b. "... ... Great Soviet Encyclopedia

Books

• Russian Intelligentsia and Questions of Public Hygiene, E. I. Lotova. Russian Society for the Protection of Public Health. Creation. Main features; Issues of epidemiology; Improvement of populated areas; Nutrition issues; Hygiene of upbringing and education; Hygiene and...

Infectious diseases in humans- These are diseases caused by pathogens and transmitted from an infected person (or animal) to a healthy one.

The main routes of transmission of infection and the impact on them

• airborne transmission (influenza, colds, chicken pox, whooping cough, tuberculosis, diphtheria, measles, rubella, etc.) - for prevention, masks are used, airing, preventing the accumulation a large number people in the room;
• alimentary (food) transmission route (all intestinal infections, salmonellosis, dysentery, viral hepatitis A) - an important role is played by personal hygiene, washing hands, food, the absence of flies in the premises;
• sexual (contact) transmission (viral hepatitis B, C, HIV AIDS, genital herpes, syphilis, gonorrhea, papillomatosis) - important point the prevention of such infections is the absence of promiscuity with frequent changes of partners and the use of condoms;
• blood route of transmission (most often viral hepatitis B, HIV AIDS) - in this case, sterile surgical instruments will help prevent infectious diseases, avoiding tattoos (especially at home), that is, all efforts are aimed at preventing violations of the integrity of the skin and mucous membranes.

Prevention of infectious diseases

Like any other disease, infectious diseases are easier to prevent than to treat later. For this, the prevention of infectious diseases is used, which helps to prevent the development of an infectious process.

Allocate public and individual prevention. Individual prevention includes: vaccinations, hardening, outdoor walks, sports, proper nutrition, observance of the rules of personal hygiene, rejection of bad habits, life and rest, environmental protection . The public one includes a system of measures to protect the health of collectives: creation of healthy and safe working and living conditions at work, at the workplace .

In order to prevent, limit the spread and eliminate infectious diseases, immunoprophylaxis by conducting preventive vaccinations. This type of prevention of infectious diseases is directly related to the creation in the human body of immunity (immunity) to a specific infection through immunization and is called specific immunoprophylaxis of infectious diseases. There are two main types of immunoprophylaxis:

• active immunization (vaccination) - after the introduction of a vaccine (pathogen antigen or live weakened microorganisms) into the human body, specific antibodies are formed, which, even when infected, prevent the development of an infectious disease. Currently, active immunization is being carried out against such infectious diseases: tetanus, whooping cough, diphtheria, viral hepatitis B, poliomyelitis, measles, rubella, epidparotitis ("mumps"), tuberculosis.
• passive immunization - ready-made antibodies to a specific infection are introduced into the body, which is used for emergency prevention of infectious diseases (emergency prophylaxis of tetanus).

Importance of immunoprophylaxis

It must be remembered that what more people vaccinated, the higher herd immunity and barrier to infectious diseases. The infection can be defeated if the entire population is vaccinated.

Whatever the method of prevention, its use will help prevent the disease, which is especially important for incurable infections such as HIV AIDS, rabies and viral hepatitis.

It can be argued that the primary and main process in the development of each disease is damage, destruction, disorganization of the structures and functions of the diseased organism. All reactive, protective, compensatory, adaptive processes are always secondary, developing after damage by one or another pathogenic effect on the body.

It should be emphasized that in the process of development of any disease, adaptive and compensatory processes themselves become harmful to the patient and seriously affect his condition. Examples include the secretion of urea by the gastric mucosa and skin (sweat glands) in uremia, severe fevers, and other conditions.

Hans Selye called the syndrome he described "stress" (tension) adaptation disease, or adaptation disease. By this, he emphasized that the overstrain of the body's adaptive systems during illness is in itself harmful to the body and can worsen the course of the latter. The disease of adaptation also indicates that attempts to see in any disease only elements of the adaptation of a diseased organism to existence in environment untenable and cannot be taken seriously.

Thus, the essence of the disease cannot be reduced only to adaptation, although adaptive, compensatory processes are involved in

Part I. GENERAL NOSOLOGY

the life of a sick organism and are essential for the life of healthy living beings in all its manifestations.

An example of a simplified interpretation of the essence of the disease in terms of molecular pathology is the concept of Leinus Pauling about "sick molecules". In fact, there are no sick molecules, but there are diseases in which molecules of a composition and properties unusual for a healthy organism appear. In the broad sense of the word, all diseases are molecular, but the laws of molecular processes are mediated in animals in the biological, and biological processes in humans are and in social plan.

For a person, as a social being, the most important and obligatory link in maintaining health and the development of a disease is the mediation of biological (physiological) processes by social factors. A significant influence on these processes is exerted by the labor activity of a person, which distinguishes him from animals.

The most important role of social factors in the development of pathological processes becomes apparent when studying the effect of any pathogenic causes on the human body. In essence, all of them act on the human body indirectly through the social processes surrounding it.

Indeed, the influence of social factors on the occurrence of epidemic processes (for example, nosocomial, water supply, military, hunger epidemics) is well known. There are many professions that socially mediate the possibility of the occurrence of various diseases, the prevention of which requires special protection measures and working conditions for workers. Wars are a severe form of social mediation of mass death and morbidity of people. The effect on the human body of physical and chemical pathogenic factors (heat, cold, electricity, poisonous substances, etc.), with rare exceptions (lightning, poisoning with poisonous mushrooms, freezing of a motionless person in the cold, etc.), is also mediated by social factors - clothing, housing, electrical appliances and etc. At the same time, a number of sources of ionizing radiation, electricity, etc., can cause severe

damage, created by human labor. The resulting pathological processes are also socially mediated.

It is important to emphasize that disease- it is a qualitatively new life process, in which, although the functions inherent in a healthy organism are preserved, new changes appear. For example, at healthy person the number of newly formed cells in the body is strictly equal to the number of deaths (as a result of the completed life cycle) cells. In patients with tumors, a clone of cells appears with a high potential for reproduction, but normally functioning cellular systems are also preserved. At the level of the whole organism, a new quality is a decrease in adaptability and ability to work.

Summarizing all of the above, we can give the following definition of the disease: disease- this is a complex general reaction of the body to the damaging effect of environmental factors, it is a qualitatively new life process, accompanied by structural, metabolic and functional changes of a destructive and adaptive nature in organs and tissues, leading to a decrease in the body's adaptability to continuously changing environmental conditions and disability.

1.1.3. Disease criteria

An important criterion for disease is patient complaints(malaise, pain, various functional disorders, etc.), which, however, do not always objectively reflect the state of the body. In some cases, people with increased suspiciousness and superficially, but quite widely aware of the individual symptoms of a particular disease and the causes that cause them, can misinform the doctor by telling him about their ailments and linking them to the specifics of the profession (for example, working with sources of radioactive radiation ) or a certain place of residence (for example, in zones, in their opinion, of ecological trouble, etc.). Students of medical universities, starting to study clinical disciplines and getting acquainted with the symptoms of individual diseases, often “project” them onto themselves, comparing what is written on the pages of textbooks with their own

natural state of health (“third-year illness”).

The defining criterion of the disease is the results of an objective examination of the patient with the involvement of a wide range of laboratory and instrumental research methods that allow to identify certain deviations from the norm and establish characteristic symptoms(signs) of disease.

The most important criteria of the disease are, as already mentioned, a decrease in adaptability and disability. To detect a decrease in the adaptive capabilities of the body, the so-called functional tests when an organism (organ, system of organs) is artificially placed in conditions in which it is forced to show an increased ability to function. As an example, a sample with a sugar load at diabetes, various functional loads to detect ECG abnormalities, etc.

1.1.4. General principles
disease classification

There are many classifications of diseases based on various principles. Diseases are divided according to the causes that cause them, for example, hereditary, infectious diseases, injuries, radiation sickness, etc. According to another principle, diseases are classified according to their pathogenesis, for example, metabolic diseases, allergic diseases, shock, etc. The organ principle for classifying diseases, for example, diseases of the heart, lungs, kidneys, liver, etc., is very popular. An important place in the classification of diseases is occupied by age principles. Distinguish diseases of newborns (micropediatrics), childhood diseases (pediatrics), diseases of senile age (geriatrics). Women's diseases (gynecology) are a special section of medicine.

1.1.5. pathological reaction.
pathological process,
pathological condition

Pathological reaction - a short-term, unusual reaction of the body to any effect. For example, a short-term increase

schenie blood pressure under the influence of negative emotions.

Pathological reactions include allergic reactions, inadequate psycho-emotional and behavioral reactions, pathological reflexes (reflexes Rossolimo, Babinsko- go, etc.).

A pathological process is a combination (complex) of pathological and protective-adaptive reactions in damaged tissues, organs or an organism, manifested in the form of morphological, metabolic and functional disorders.

Permanent combinations or combinations of various pathological processes and individual pathological reactions of cells and tissues formed and fixed in the process of evolution are called typical pathological processes. These include inflammation, fever, hypoxia, edema, tumor growth, etc.

The pathological process underlies the disease, but is not it. The differences between the pathological process and the disease are as follows:

1. The disease always has one main etiological cause (a specific producing factor), the pathological process is always polyetiological. For example, inflammation (a pathological process) can be caused by the action of various mechanical, chemical, physical and biological factors, and malaria cannot occur without the action of malarial plasmodium.

2. The same pathological process can cause different pictures of the disease depending on the location, in other words, the location of the pathological process determines the clinic of the disease (pneumonia - pneumonia, inflammation of the meninges - meningitis, inflammation of the heart muscle - myocarditis, etc. ).

3. The disease is usually a combination of several pathological processes. So, for example, with croupous pneumonia, there is a combination (in interconnection) of such pathological processes as inflammation, fever, hypoxia, acidosis, etc.

4. The pathological process may not be accompanied by a decrease in the body's adaptability and disability (warts, lipoma, atheroma, etc.).

Part I. GENERAL NOSOLOGY

A pathological state is a slowly (sluggishly) ongoing pathological process. May occur as a result of a previously transferred disease (for example, cicatricial narrowing of the esophagus after a burn injury; false joints; condition after kidney resection, limb amputation, etc.) or as a result of intrauterine development disorders (clubfoot, flat feet, defect upper lip and hard palate etc.). This is, as it were, the result of a completed process, as a result of which the structure of the organ has steadfastly changed, atypical substitutions have arisen in a certain tissue or part of the body. In some cases, the pathological condition can again turn into a pathological process (disease). For example, a pigmented area of ​​the skin ( birthmark) under the influence of a number of mechanical, chemical and physical (radiation) factors can transform into a malignant tumor melanosarcoma.

1.2. GENERAL ETIOLOGY

The term "etiology" (from the Greek aitia - cause, logos - teaching) was introduced by the ancient Greek materialist philosopher Democritus. In ancient times, this word denoted the doctrine of diseases in general (Galen). In the modern sense, etiology is the study of the causes and conditions for the occurrence and development of diseases.

1.2.1. Causes of diseases

Despite the fact that from ancient times to the present day, the question of why a person fell ill was one of the main ones in medicine, unfortunately, and at present, the etiology remains, according to I.P. Pavlov, "the weakest department of medicine." Meanwhile, it is obvious that without identifying the cause of the disease, it is impossible to determine the correct way of its prevention and treatment.

serious scientific development etiology began only at the end of the 19th century, thanks to the rapid development of biology and medicine in general and microbiology in particular. The starting stimulus for this was R. Virchow's "Cellular Pathology", which substantiated the material nature of functional disorders arising from diseases and prompted researchers to search for specific material causes of these disorders.

The revolutionary breakthrough in microbiology, associated with the discovery of a number of microorganisms - the causative agents of human infectious diseases (P. Ehrlich, R. Koch, L. Pasteur, etc.), dealt a crushing blow to the age-old idealistic ideas about the causes and essence of diseases, approving the materialistic principles of determinism . In the future, more and more new causes of diseases began to come to light. At the same time, for a long time it was believed that the presence of a cause (a disease-causing factor) was equivalent to the presence of a disease, while the body was assigned the role of a passive object under the action of this factor. This period in the development of the doctrine of etiology is designated as the period of mechanical determinism. Soon, however, it became obvious that the presence of a pathogenic factor does not always lead to the onset of a disease. It has been proven that the state of the body (reactivity, gender, age, constitution, individual anatomical and physiological characteristics, heredity), various social conditions (unsanitary living conditions, malnutrition, difficult working conditions, bad habits etc.) and many other factors that either contribute to or, on the contrary, prevent the onset of the disease.

Thus, two diametrically opposed views arose in the interpretation of the problems of etiology: monocausalism and conditionalism. Representatives of monocausalism argued that only its main (i.e. one) cause (monos - one, causa - cause) is of decisive importance in the occurrence of a disease, and all other factors do not play a significant role.

Supporters of the opposite point of view believed that the disease is caused by a complex of conditions, all of them are equal (equipotential) and it is not possible to single out any one (main) cause of the disease. This direction was called conditionalism (conditio - condition). The ancestor of conditionalism was the German physiologist and philosopher Max Verworn (1863-1921), who argued that "the concept of cause is a mystical concept" to be expelled from the exact sciences. The concept of conditionalism in etiology turned out to be very stable; to one degree or another, it was adhered to by the largest domestic pathologists V.A. Oppel, S.S. Khalatov, N.N. Anichkov, I.V. Davydovsky and others.

Chapter 1 / GENERAL DOCTRINE OF DISEASE

From modern positions, both points of view cannot be considered correct: mono-causalism, quite rightly highlighting the main cause of the disease, completely denies the role of the conditions in which it occurs; Conditionalism, on the contrary, denies the leading role of the main (main) cause of the disease, completely equating it to other conditions, thereby making it impossible to study the specific factors of diseases and conduct etiotropic therapy. The correct position on this issue is to consider the causes and conditions for the occurrence of diseases. in their dialectical unity, i.e. in constant and close interaction of both while maintaining the specific role of each of them [Sarkisov D.S., Paltsev M.A., Khitrov N.K., 1997].

Modern views about causality in pathology follow from three main provisions of materialistic dialectics: 1. All phenomena in nature have their own cause; there are no causeless phenomena; the cause is material, it exists outside and independently of us. 2. The reason interacts with the organism and, changing it, changes itself. 3. The reason gives the process a new quality, i.e. among the many factors affecting the body, it is she who gives the pathological process a new quality.

The disease is caused by a complex of factors, but they are far from equivalent. Should highlight main etiological factor(producing, specific) is the factor in the absence of which the disease cannot develop under any circumstances. For example, lobar pneumonia occurs not only under the influence of human infection with pneumococcus. Colds, fatigue, negative emotions, malnutrition, etc. also contribute to the disease. It is easy to understand, however, that without infection with pneumococcus, all these factors cannot cause lobar pneumonia. Therefore, pneumococcus should be considered the cause of this disease, its main etiological factor.

However, sometimes it is difficult to identify the cause of the disease (some tumors, mental illnesses). It has been established, for example, that a stomach ulcer develops both from irregular and malnutrition, and from the state of neurosis, dysfunctions of the autonomic nervous system, endocrine disorders. These and many other observations gave rise to the presentation

about the polyetiology of the disease. This position is incorrect. It arose as a result of the lack of our knowledge about the causes of certain diseases and their variants.

As mentioned, each disease has its own cause, peculiar only to it. With the accumulation of knowledge about the causes of all types and subtypes of diseases, their prevention and treatment will improve. Many diseases, as their true causes are known, break up into new subspecies, each of which has its own separate cause. For example, before there was a disease "bleeding" (hemorrhagic diathesis). As the causes of the individual manifestations of this disease were established, new completely independent forms of the disease were revealed, characterized by bleeding (scurvy, hemophilia, hemorrhagic purpura, etc.). Similarly, neuro-arthritic diathesis (gout, rheumatism, non-infectious polyarthritis, etc.) broke up into independent diseases with their own causes.

The reasons(main etiological factors) of diseases are divided into external and internal. To external reasons include mechanical, physical, chemical, biological and social factors, to internal - a violation in the genotype. The disease can also be caused by a deficiency in the environment or in the body of substances (factors) necessary to ensure normal life (avitaminosis, starvation, immunodeficiency states, etc.).

It should be noted that the presence of the main etiological factor and even its impact on the body does not always lead to the onset of the disease. This is facilitated or, on the contrary, hindered by a whole range of conditions.

1.2.2. Conditions for the emergence and development of diseases

Factors that influence the occurrence and development of diseases are called the conditions for the occurrence of the disease. AT Unlike causative factor conditions are not necessary for the development of the disease. In the presence of a causative factor, the disease can develop without the participation of some conditions for its occurrence. For example, lobar pneumonia caused by highly virulent pneumococcus can develop

Part I. GENERAL NOSOLOGY

Curl and without colds, without weakening the diet and other conditions. There are conditions that predispose to the disease or contribute to its development, preventing the occurrence of the disease and its development. Conditions that promote or hinder the development of diseases can be internal and external.

The internal conditions that contribute to the development of the disease include a hereditary predisposition to the disease, a pathological constitution (diathesis), early childhood or old age.

External conditions that contribute to the development of diseases include malnutrition, overwork, neurotic conditions, previous illnesses, and poor patient care.

The internal conditions that prevent the development of diseases include hereditary, racial and constitutional factors, for example, the species immunity of a person to some infectious diseases animals. A person does not suffer from the plague of dogs and cats, pneumonia of cattle and many other infectious diseases of animals. People with sickle cell anemia do not get malaria.

The external conditions that prevent the development of diseases include good and rational nutrition, proper organization of the working day, physical education, and in case of illness, good patient care.

The establishment of the main (producing, specific) etiological factor, the identification of conditions that predispose to the disease or contribute to its development, and the conditions that prevent the onset of the disease and its development are absolutely necessary for the development of effective measures for preventing diseases, reducing morbidity and improving the population.

1.3. GENERAL PATHOGENESIS

1.3.1. Definition of the concept of "pathogenesis"

Pathogenesis(from Greek pathos - suffering 1, genesis - origin) - section of pathological

1 According to Aristotle, pathos also means damage. Chapter 1 / GENERAL DOCTRINE OF DISEASE

3 Item No. 532

physiology, studying the mechanisms of development of diseases. The study of the most general patterns of occurrence, development, course and outcome of diseases is the content of the general doctrine of pathogenesis. It is based on generalized data on the study of certain types of diseases and their groups (private pathology and clinical disciplines), as well as on the results of experimental reproduction (modeling) of diseases or individual signs in humans and animals. At the same time, a sequence of changes in the body is established for each disease, cause-and-effect relationships between various structural, metabolic and functional changes are revealed. In other words, the study of pathogenesis is reduced to the study of the so-called pathogenetic factors of the disease, i.e. those changes in the body that occur in response to the action of the main etiological factor and in the future play the role of a cause in the development of the disease.

Thus, if the study of etiology makes it possible to answer the question: “Why did the disease arise?”, Then the end result of the study of pathogenesis should be the answer to the question: “How does it develop?”

The main (specific) etiological factor acts as a trigger for the development of the disease. The pathogenesis of the disease begins with some primary damage (R. Virkhov) or “destructive process” (I.M. Sechenov), “breakage” (I.P. Pavlov) of cells in one or another part of the body (first-order pathogenetic factor) . In some cases, the initial damage may be gross, clearly visible to the naked eye (injuries, burns, wounds, etc.). In other cases, damage is invisible without the use of special methods for their detection (damage at the molecular level). There are various transitions between these extreme cases. The products of tissue damage become sources of new damage in the course of the development of the disease, i.e. pathogenetic factors of the second, third, fourth, ... order. In some cases, such as lead poisoning, mercury poisoning, or chronic infections, the etiological factor as a trigger remains for as long as there is poison or infection in the body.

1.3.2. Protective-compensatory
processes

An important manifestation of each disease is reactive changes in cells, organs and systems, which occur, however, always secondary, in response to damage caused by pathogenic causes. These include processes such as inflammation, fever, edema, etc.

These reactive changes in the body are referred to as protective-compensatory processes, or a “physiological measure” of protection (I.P. Pavlov), as “pathological (or emergency) regulation of function” (V.V. Podvysotsky, N.N. Anichkov), "healing powers of the body" (I.I. Mechnikov). In the course of the development of the disease, the processes of damage and recovery are in close interaction, and, as I.P. Pavlov, it is often difficult to separate one from the other.

These processes develop and proceed on various levels, starting with the molecular and ending with the whole organism of a sick person. At the onset of the disease, protective and compensatory processes develop at the molecular and cellular levels. If the effect of pathogenic causes is weakly expressed and short-lived, the disease may not develop. This happens in cases of ingestion of not very virulent microbes, poisons in small doses, with low doses of ionizing radiation, minor injuries, etc. Significant damage causes stronger responses from the organs and their regulatory systems.

1.3.3. The main link and "vicious
circle" in the pathogenesis of diseases

In the development of diseases and pathological processes, it is extremely important to determine the main

main link in the chain of disturbances arising in the body - change in the body(one of the pathogenetic factors), determining the development of other stages of the disease. Elimination of the main link of pathogenesis leads to the recovery of the body. Without establishing the main link of pathogenesis, it is impossible to carry out pathogenetic therapy- a set of measures aimed at interrupting the chain of causal relationships between various structural, metabolic and functional disorders that occur in the body due to the influence of the main etiological factor by eliminating the main link in pathogenesis. For example, stenosis of the left atrioventricular opening serves as the main link in the chain of many subsequent disorders: expansion of the left atrium, stagnation of blood in the small circle, dysfunction of the right ventricle, and then stagnation in big circle circulation, oxygen starvation circulatory type, shortness of breath, etc. The elimination of this link by mitral commissurotomy eliminates all these violations.

A violation of the function of an organ or system that has arisen during the development of a pathological process often itself becomes a factor (cause) that causes this violation, in other words, cause-and-effect relationships change places. This situation in medicine is called a "vicious circle". For example, a sharp deterioration in oxygen transport during blood loss leads to heart failure, which further impairs oxygen transport. There is a "vicious circle" (Scheme 1).

It is important to note that in many cases of the formation of vicious circles, the essence of this process is to disrupt the negative feedback, transform it into a positive feedback, which becomes the basis for the aggravation of the pathological process [Sarkisov D.S.,

blood loss

(weight reduction

circulating blood)

"Vicious circle" with blood loss