Philip R. Liebson
Rush University, Chicago, Illinois, United States (Spring 2013)
Within the years 1905-1913, three figures associated with the Imperial Military Medical Academy in St. Petersburg presented papers that provided the stepping-stones for the study of two major conditions leading to cardiovascular disease–hypertension and atherosclerosis. They created the seeds of a revolution that outlasted the more famous revolution of 1917. The three figures were Nikolai Korotkov, AI Ignatowski, and Nikolai N. Anichkov.
|Nikolai Korotkov (1874-1920)|
Nikolai Korotkov (1874-1920) graduated with distinction in medicine from Moscow University in 1898.
He became a surgeon and joined the Military Medical Academy in 1903. Temporarily on leave with the Red Cross in 1904-1905 in Manchuria during the Russo-Japanese War, he returned to the Academy to complete his doctoral thesis based on case reports of vascular surgery during the War. In 1905, almost as an aside, he presented the technique of blood pressure measurement to which his name was given, in 281 words:
The cuff of Riva-Rocci is placed on the middle third of the upper arm; the pressure within the cuff is quickly raised up to complete cessation of the circulation of circulation below the cuff. Then, letting the mercury of the manometer fall one listens to the artery just below the cuff with a children’s stethoscope. At first no sounds are heard. With the falling of the mercury in the manometer down to a certain height, the first short tones appear; their appearance indicates the passage of part of the pulse wave under the cuff. It follows that the manometric figure at which the first tone appears corresponds to the maximal pressure. With the further fall of the mercury in the manometer one hears the systolic compression murmurs, which pass again into tones (second). Finally, all sounds disappear. The time of cessation of sounds indicates the free passage of the pulse wave; in other words at the moment of the disappearance of the sounds the minimal blood pressure within the artery predominates over the pressure in the cuff. It follows that the manometric figures at this time correspond to the minimal blood pressure.1
Korotkov performed animal experiments to demonstrate that the sounds came from the brachial artery, and not from the heart. For many years there was controversy as to whether the 4th sound (decrease of the systolic sound), or the 5th (complete cessation), should be taken as diastolic pressure. This argument, however, is not relevant to the present topic. Very shortly after his paper, the technique was verified by MV Yanovsky and initially it was known as the Korotkov-Yanovsky method. Korotkov died at a young age, 46, of pulmonary tuberculosis.
Our other two figures, Ignatowski and Antichkov, dealt with the role of diet in initiating atherosclerosis. Of AI Ignatowski we know very little aside from his presentation at the Imperial Military Academy in 1908. This address demonstrated the first association of cholesterol-rich food, specifically milk, meat and eggs, with atherosclerotic lesion in rabbits.2 The term atherosclerosis had been introduced only four years before by Felix Marchand, who suggested that atherosclerosis was mostly responsible for arterial obstruction.
Of Nikolai Anitchkov (1885-1964) we know a great deal more. His father was Vice Minister of Education in the Russian Empire. He entered the Imperial Military medical Academy and graduated in 1909. Anitchkov expanded on Ignatowski’s observations to demonstrate that cholesterol was responsible for atherosclerotic lesions in the rabbit arteries.2,3 What is more, he associated the degree of atheromatous involvement with the amount of cholesterol uptake. His investigations were reported in 1913.4 Anitchkov went on to undertake considerable investigation into histopathology. His name has been given to a degenerating myocyte. He developed an experimental model for atherosclerosis. Working in Aschoff’s laboratory in Freiburg, he recognized Anitchkov myocytes in the vicinity of the Aschoff bodies in rheumatic myocarditis. These myocytes are considered pathognomonic for rheumatic myocarditis. They are also called “caterpillar cells.”
|Nikolai Anitchkov (1885-1964)|
Anitchkov was also the first to describe the foam cell, the lipid-laden macrophage in atherosclerotic lesions, which he called the “cholesterinesterphagozyten.”
From Freiburg, he corresponded regularly to colleagues at the Military Medical Academy. In describing a plan for research in atherosclerosis he wrote the following:
Regarding atherosclerosis in humans…To determine the influence of infection, we will have to study the aortas of children and young people who died of acute infections, and, at the same time, of these young people who died of non-infective diseases. This topic is very large and…very worthy, especially in view of our previous experimental data.3,5
Was Antichkov hinting at the possibility of an infective cause of atherogenesis, aside from cholesterol? Perhaps to facilitate the process? We know consider atherogenesis and inflammatory process and there have been some studies to associate viruses with these lesions.
Anitchkov went on to great recognition for his work and from 1939-1946 was in charge of the Military Medical Academy’s pathologic anatomy department (except for 1942-1945 when the academy was closed because of the siege of Leningrad and the staff evacuated to Samarkand).
He died in 1964 of a myocardial infarction.
- Korotkov N. To the question of methods of determining the blood pressure. Reports of the Imperial Military Academy 1905;11: 365-367
- Gowda RM, Sardana NK, Khan IA. Firsts in cardiology: Milestones and vital discoveries. Int J Cardiol 2006;111: 457-460.
- Konstantinov NN, Mejevoi N, Anitchkov NM. Nikolai N. Anitchkov and his theory of atherosclerosis. Tex Heart J 2006;33:417-423.
- Classics in arteriosclerosis research.: Anitschkow N, Chalatow S. On experimental cholesterin steatosis and its significance in in the origin of some pathologic processes. Zentrbl Allg Pathol Anat 1913;24:1-9. See Arteriosclerosis 1983;3: 178-182.
- Sarkisov DS, Pozharisskii KM, Anitchkov NM. NN Anitchkov (1885-1964). Moscow. Meditsina Press 1989.
PHILIP LIEBSON, MD, graduated from Columbia University and the State University of New York Downstate Medical Center. He received his cardiology training at Bellevue Hospital, New York and the New York Hospital Cornell Medical Center, where he also served as faculty for several years. A professor of medicine and preventive medicine, he has been on the faculty of Rush Medical College and Rush University Medical Center since 1972 and holds the McMullan-Eybel Chair of Excellence in Clinical Cardiology.