Domestic researchers who significantly contributed in the study of digestive system diseases: images in art. Vasyl Parmenovich Obraztsov

Abstract

Vasyl Parmenovich Obraztsov (1849 — 1920) was an outstanding therapist, Professor of Medicine, and innovator in the field of techniques for diagnosing diseases of the cardiovascular and digestive systems. The research interests of V. P. Obraztsov were mainly focused on studying the most important issues in general and specific gastroenterology and cardiology. At the same time, he aimed to invent reliable techniques for the physical diagnosis of diseases of the abdominal organs and heart.
 Palpation of the abdominal organs, invented and introduced into clinical practice by V. P. Obraztsov, is based on four principles. During deep breathing, especially when the patient is lying down, the abdominal press occasionally relaxes. During the exhalation phase, the researcher tries to reach deep into the abdominal cavity with a palpating hand and press an organ that needs to be felt against the posterior abdominal wall. The first principle of the research technique that V. P. Obraztsov came up with is deep palpation. It is usually possible to palpate any organ in the abdomen when the fingertips of the palpating hand slide off the edge of the organ being examined. The palpable part of the gastrointestinal tract is pressed against the posterior abdominal wall with a strong downward movement of the hand that is perpendicular to the organ’s long axis. When the fingers slip from the organ, the localization of the organ, as well as its consistency, shape, width, and mobility, can be determined; at the same time, the patient may report unpleasant or painful sensations. Sliding palpation is the second principle of the research technique by V. P. Obraztsov. According to topographic anatomy, each organ in the abdominal cavity has its own normal localization. Now, X‑rays confirm this, but V. P. Obraztsov had to do experiments to develop a typical topography of certain segments of the digestive tract in the abdominal cavity of a healthy person and find typical projections of internal organs on the anterior wall of the abdomen. Further studies by his students proved the correctness of his description of the topography of the abdominal organs. Of course, both V. P. Obraztsov and his students repeatedly emphasized the possibility of individual differences or physiological variants in the localization of the digestive tract organs in patients. Topographic palpation has become the third guiding principle of the research technique developed by V. P. Obraztsov. V. P. Obraztsov suggested that a study of the organs in the abdomen be done in a certain sequence. First, the sigmoid colon is examined, then the cecum, the terminal segment of the small intestine, the appendix, the stomach, with an attempt to palpate its small and large curvatures, and the pylorus. After that, the palpation of the transverse colon and the ascending and descending sections of the large intestine starts. The examination is completed by determining the localization, consistency, shape, mobility, and other features of the parenchymal organs — the liver, spleen, and kidneys. Thus, systematic palpation is the fourth principle of the examination of the abdominal organs.
 V. P. Obraztsov made a significant contribution to the history of cardiology. Systematic cardiac auscultation with a stethoscope and directly with the ear let him describe some features of the tone I, report the presence of a normal tone III, and point out the relatively frequent detection of bifurcation and splitting of heart tones. A series of works by V. P. Obraztsov on the study of the gallop rhythm is of particular importance for cardiology.
 In 1950, on the centenary of his birth, the government of the Ukrainian SSR decided to publish his «Selected Works», build a monument, and assign his name to the Department of Internal Diseases No. 1 of the Kyiv Medical Institute. By the same date, the country’s medical journals had published his students’ memoirs, as well as articles and essays about his life path.