What is the clinical significance of the incubation period?

Dromology: The course of the disease from a clinical point of view

Diseases have always been described primarily as clinical pictures, whereby the fully developed state of the disease is brought into focus and remains in the imagination and memory. On the other hand, the point of view of the course of the disease, the course of the disease, is hardly brought to bear with the same impressiveness and awareness.


"Course aspect" is of great importance
Thus, under the "principles of medicine" (6), the "progression" aspect as such is neglected in that it is mentioned in scattered places and only very casually. And nowhere else have I found a coherent representation of the time factor in disease processes. In the literature, once the eye is focused on it, a whole series of formulations for the point of view of the course of the disease stands out, which, however, consistently lack the specific conciseness that is indispensable for a term; The frequently used expression "disease development" should be mentioned here. The fact that the simple designation "course" is not felt to be sufficient to raise awareness of the clinical issue clearly enough is demonstrated by pleonastic word combinations such as "temporal course", "course of the disease" or even "temporal course of the disease", and finally also "course dynamics "and" Chronodynamik "visible. Almost as curiosities, the following should be mentioned: "Patterns of illness over time", "cinematic sequence of the disease process" and "metachronic course". - If one looks for "progressive" terms in English or in French and other Romance languages, one encounters the same conceptual pallor.
For the point of view of the temporal course of the disease processes and the teaching to be developed from it, the term Dromo-Logie is now proposed here. In terms of its linguistic components, this term is by no means foreign to the medical practitioner; Derived from the Greek word "drómos" (run), the medical terms "prodrome" and "syndrome" represent two fixed clinical terms that share the characteristic of the temporal classification of symptoms in the disease process.
This new term with the derived adjective "dromological" (to which the "dromogram" is added) is characterized by the required conciseness and specificity and provides an equally handy and smooth technical term for everyday medical language, such as pathology, etiology, histological, Hemograms have been around for a long time. The term should also be helpful for international scientific and clinical-practical exchange.
Dromology is by no means an abstract theoretical term, but is an eminently important medical way of thinking and viewing and has its own "clinical dimension" (3), which includes aetiology, pathogenesis, pathology, symptomatology, diagnostics, therapy and prognostics in a comprehensive way.
Dromology must not be equated with statistical methods for recording the course of the disease in individual patients or groups of patients. - Dromology is primarily medical action on the individual patient.


An old principle
At the same time, dromology does not bring anything substantially new; it has always been practiced in scientifically oriented medicine. A vivid example of this is provided by the fever curve, which over time has developed beyond the registration of body temperature and pulse rate to a progress image, a dromogram with a horizontal axis and a vertical axis of findings for a wide variety of clinical parameters.
In addition to "longitudinal sections", "cross-sectional" documentations are also a dromological structure, according to the good old "Status praesens", and the prognosis also proves to be a dromological aspect. The confirmation of the diagnosis "ex juvantibus" (remediis) uses a corresponding time scheme, and the therapeutic riddle question "propter or post" also has a dromological character (1).
An important dromological aspect for medical and medical action is the choice of the right moment. - For the Greeks, the right moment for action, the kairos, was an essential philosophical concern that was understood as an event spanning all areas of life. But the special medical-clinical significance of the kairos, the recognition and grasping of the right moment, cannot be overestimated, especially since this can also be eventful.


Examples of use
The physiology and pathology of pregnancy is presented as a diverse dromological example. The pathology of tuberculosis, like that of syphilis, was dominated by dromological description in its classical times. Infectious diseases in the narrower sense with their typical appearance and disappearance of symptoms also prove to be another important area of ​​the dromological perspective. Finally, the dromological structures of phase and relapse, exacerbation, episode and relapse, chronicity, relic and defect, which are important in psychiatry, should be mentioned.
After the Second World War, the long-term damage after typhus encephalitis in some cases raised considerable health care problems, as these damage often only became clinically manifest after years - usually with initially very unspecific symptoms - and then could hardly be recognized as such by the treating physicians. It is true that at this point in time the "military service damage" itself could no longer be addressed therapeutically as it was during the very short acute phase of the illness. On the other hand, however, the later the more likely the risk of incorrect assessments increased, since the clinical picture as such no longer appeared in the clinical field of vision of the subsequent generation of doctors - also a dromological process, but at the same time an aspect of medical history! (4, 2).
The diabetic polyneuropathy arising from diabetes mellitus is a neurological clinical picture that has only been fully in the focus of doctors for a few years with its pathogenetic connections, in which early treatment and thus early detection are crucial so that the otherwise almost inevitable desolate end states are prevented (5). - A highly topical dromological case!
In conclusion: once the attention has been drawn to the time factor, you will consider dromology more consciously in your medical considerations and actions and - once the term has found its way into technical terminology - you will use it to make yourself briefly and concisely understandable can.


literature
1. Brandt T, Dichgans J, Diener HC (eds): Therapy and course of neurological diseases. Verlag Kohlhammer, Stuttgart Berlin 1988 (spontaneous development as therapeutic criterion).
2. Delius L, Fahrenberg J: Psychovegetative Syndromes. Georg Thieme Publishing House. Stuttgart 1966 (Page 227: Typhus late damage)
3. Groß Rudolf: On the clinical dimension of medicine - contributions to some fundamentals and basic questions. In the series: Interdisciplina, ed. by Paul Lüth. Hippokrates Verlag, Stuttgart 1976
4. Kluge E (neurologist): Neurotic bad posture or failure after typhus? About the displeasure with the "neurosis" (description "on the basis of a medical history... What happened to a person"). Editor: The medical expert 1963, pages 198-200
5. Mehnert Hellmut, Standl Eberhard: Handbook for diabetics, 5th edition. TRIAS Thieme Hippocrates Enke. Stuttgart 1991
6. Rothschuh Karl E: Principles of Medicine - a guide through medicine. Urban & Schwarzenberg, Munich – Berlin 1965


How this article is cited:
Dt Ärztebl 1996; 93: A-1257-1258
[Issue 19]


Author's address:
Dr. med. Gottfried Odenwald
Neurologist
Felsenstrasse 31/3
89518 Heidenheim, Germany