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Haematologist who introduced the concept of disseminated intravascular coagulation
Zinovy Solomonovich Barkagan is internationally recognised for his pioneering research on snake bites and blood coagulation. He wrote about 20 monographs—including Poisonous Snakes and their Venoms (with P P Perfilev 1967), Salicylates: Modern Views on their Pharmacodynamics and Clinical Use (1975), Laboratory Methods in Investigation of the System of Haemostasis (1980), Haemorrhagic Diseases and Syndromes (1988, 2nd ed)—and chapters in Russian manuals on haematology (2004, 3rd ed), oncology (2001), and the antiphospholipid syndrome (2003), as well as coauthoring several hundred papers.
Zinovy Barkagan was born in Odessa in 1925 into a teaching family. Later on his father graduated from the local medical school and became a professor at Odessa Medical Institute. At the turn of the 20th century Odessa was a cosmopolitan city on the Black Sea in the south of Russia, the birth place of many outstanding Soviet poets and writers, including Isaac Babel, Konstantin Paustovsky, Eduard Bagritsky, Valentin Kataev, Ilja Ilf, and Yevgeny Petrov. Barkagan explained this phenomenon with his “formula of genius”—everyone in Odessa ate a lot of fish and shrimps. Barkagan himself hesitated in his choice between literature and medicine. He combined his medical studies during the second world war at Alma-Ata in Kazakhstan with evening classes at the journalism faculty of the literary institute evacuated from Moscow. He learnt that O Henry was awarded a prize for the shortest story consisting of just two sentences: “A newly married couple was smoking near the open petrol tank of a car. Both deceased were 25 years old.” And, according to Chekhov, “to write is to cross out.” Barkagan followed this rule in his own writing and in editing his colleagues' papers.
After graduating from Odessa Medical Institute, Barkagan worked at the clinic of internal medicine headed by Professor Mikhail Yasinovsky. In 1950 he defended his kandidatskaya dissertation (the Russian equivalent of a PhD thesis) on vascular reactivity in the cold in arterial hypertension and other internal diseases. Owing to an anti-Semitic campaign in the last years of Stalin's life, Barkagan was forced to leave Odessa for Stalinabad (now Dushanbe, Tajikistan), where he worked as a local medical institute as assistant professor and eventually as acting chair of hospital therapy. There he came across numerous deaths from snake bites and the bites of black widow spiders (Latrodectus tredecimguttatus). The only treatment was to apply a rubber tourniquet, which often resulted in amputation of the hand or leg and seldom saved lives. Barkagan suggested sucking out the venom by mouth. Nowadays this method of treating snake bites is given in all manuals of emergency medicine. To prove the safety of this method Barkagan performed experiments on himself, holding the venom of the Levantine viper (Vipera lebetina) and the carpet viper (Echis carinatus) in his mouth before and after having damaged the mucosa. His doctorskaya dissertation (a second thesis required for professorship in Russia), defended in 1964, was dedicated to diagnosing treating venom poisoning from snakes and arthropods in Middle Asia. Barkagan considered changes in blood coagulation (hypercoagulation) to be the key point of venom poisoning. He admitted that he first came across this idea from reading Zahira-i Kharazmshahi (The Treasure of the Shah of Khoresm) by Abu Ibrahim Jurjani (1045-1137). Barkagan also participated in expeditions to eradicate smallpox in the Pamir mountains of Tajikistan and in nearby Afghanistan.
In 1956 Barkagan moved to a newly established medical institute in Barnaul (capital of the Altai region in western Siberia), where he was the propaedeutic (preclinical) chair of internal medicine till 1997. He worked in Barnaul for half a century until his death. During this time his research and clinical activity was focused on the diagnosis, pathogenesis, and treatment of impairments in haemostasis. He organised the first laboratory to diagnose and treat impairments of haemostasis, and for many years it was the only one in the eastern part of the former Soviet Union, later becoming the Siberian Centre for Haemophilia and the Altai Haematological Centre.
Barkagan suggested treating disseminated intravascular coagulation (first described by Maria Machabeli, a Soviet haematologist, as the thrombohaemorrhagic syndrome) with massive transfusion of serum (plasma) instead of whole blood. This saved the lives of millions of people who would have otherwise died from severe haemorrhages.
He also emphasised the role of disseminated intravascular coagulation in sepsis. He viewed sepsis as an infection that results in the formation of microthrombi and requires huge doses of antibiotics and serum transfusion or plasmapheresis.
The efficacy of treating the crush syndrome with plasmapheresis, frozen serum, and heparin was demonstrated during the earthquake in Armenia in 1989. It helped to avoid amputation and achieved a tenfold decrease in acute renal failure and death.
Barkagan and his colleagues also contributed to the diagnosis and treatment of arthropathies in haemophilia. They described a secondary rheumatoid syndrome in haemophilia (known as the Barkagan-Egorova syndrome) and developed an original method of rehabilitation after haemophilic haemorrhages using external fixation techniques.
Two decades ago Barkagan started his fight against habitual miscarriages. Up to 80% of affected women have the antiphospholipid syndrome. Plasmapheresis and heparin during the whole pregnancy successfully allow carriage to term in all such cases. Women from many countries, including the United States and Sweden, came to Barnaul to give birth, but now this treatment is routine.
Barkagan was an honoured science worker of the Russian Federation (1982), a state prize laureate of the USSR (1987), a corresponding member of the Russian Academy of Medical Sciences (1993), a director of the the Altai branch of the Haematological Scientific Centre of the Russian Academy of Medical Sciences, doctor honoris causa of the University of Minnesota (USA), and an honorary citizen of Barnaul.
He founded a haematological school. Thirty two of his pupils defended doctorskaya and 82 kandidatskaya dissertations. His lifestyle contradicted conventional dogmas. He was a chainsmoker, neglected sports, worked at night, and did not eat much. Until his last days he preserved a childlike capacity for amazement. Shortly before his death he was presented with an aquarium. “Do you know how these small red worms [food for fish] save themselves from being eaten?” he asked his colleagues the next day. “I watched them the whole evening. They from a dense sphere and a fish cannot pull out a single worm! This is a collective mind and a collective method of defence!” He was delighted by this “discovery.” In one of his interviews he said that his research had been poorly funded, adding that this was no excuse for inertia: “As you know, poverty makes the mind more sophisticated, whereas excessive wealth results in stupefaction.”
His wife, Ida Mikhailovna (née Proector), a paediatrician, predeceased him in 1995. He leaves two twin sisters, a son and a daughter (both medical doctors), and four grandchildren. His memory will be commemorated in Barnaul by a plaque at the house where he lived and a bust in the campus of Altai Medical University, and it is expected that the local authorities will name a street in his honour.
Zinovy Solomonovich Barkagan, haematologist, professor emeritus of Altai State Medical University, Barnaul (b 1925, q Odessa 1946; MD), died from a heart attack on 27 December 2006.