The word "anesthesia" comes from the Greek word meaning "stupor", "numbness".

Anesthesia is necessary to block pain signals from the affected organs to the brain. Too strong a signal can overexcite one part of the brain so much that the work of the rest will go wrong. As a result, cardiac or respiratory arrest may occur.

Narcosis traces its history back to anesthesia used in surgical operations in Assyria, Egypt, India, China and other countries of the Ancient World. The first painkillers were made from plants and used in the form of infusions, decoctions and "sleepy sponges" soaked in the juice of henbane, hemp, opium, and hemlock. The sponge was soaked in tincture or set on fire, resulting in the formation of vapors that lulled the sick. In addition, anesthesia was caused by squeezing the vessels of the neck and limbs, releasing a large amount of blood, giving the patient wine or alcohol, applying cold.

In the XII century. at the University of Bologna, about 150 prescriptions for painkillers were collected. Around 1200, R. Lull discovered ether, the painkillers of which were described in 1540 by Paracelsus.

Despite these studies, during operations, in order to cause loss of consciousness, a wooden mallet was often used, with which the patient was beaten on the head.

At the beginning of the XIX century. the English scientist G. Devi accidentally inhaled a large dose of nitrous oxide N 2 O. At the same time, he felt extremely excited and intoxicated, he danced like a madman. Having learned about the properties of "laughing gas", respectable ladies and gentlemen began to come to Devi's laboratory to breathe in an amazing substance. Laughing gas acted in different ways: some jumped on tables and chairs, others spoke incessantly, others got into a fight.

In 1844, the American dentist X. Wells used the narcotic effect of nitrous oxide for pain relief. He first asked his assistants to extract a tooth from him using this gas as an anesthetic. However, he did not feel pain at all. Later, he tried this anesthesia on his patients, but the public demonstration of tooth extraction ended in failure: the patient screamed loudly either from pain, or at the sight of medical instruments. Failure and ridicule drove the pioneering dentist to suicide.

On October 16, 1846, N. I. Pirogov for the first time performed an abdominal surgical operation under full ether anesthesia. During it, complete anesthesia was carried out, muscles were relaxed, reflexes disappeared. The patient was immersed in a deep sleep, having lost sensitivity.

On February 14, 1847, N. I. Pirogov performed the first operation under ether anesthesia in the 2nd military land hospital.

Having tested etherization (ether anesthesia) on healthy people, again on himself, and having the material after 50 operations under ether anesthesia (using it in hospital and private practice), Pirogov decided to use ether anesthesia directly when providing surgical assistance on the battlefield.

In the same year, Pirogov performed intracheal anesthesia - the introduction of an anesthetic directly into the windpipe.

July 8, 1847 Pirogov leaves for the Caucasus, where there was a war with the highlanders, in order to test the effect of ether anesthesia as an anesthetic on a large scale. On the way to Pyatigorsk and Temir-Khan-Shura, Pirogov introduced doctors to the methods of etherization and performed a number of operations under anesthesia. In Ogly, where there was no separate room for operations, Pirogov began to operate on purpose in the presence of other wounded, in order to convince them of the analgesic effect of ether vapors. Thanks to a clear example, other wounded were also fearlessly subjected to anesthesia. Arriving at the Samurt detachment, Pirogov conducted about 100 operations in a primitive "infirmary". Thus, Pirogov was the first in the world to use ether anesthesia on the battlefield. During the year, Pirogov performed about 300 operations under ether anesthesia (a total of 690 were performed in Russia from February 1847 to February 1848).

On November 4, 1847, the Scottish physician J. Simpson performed the first operation under chloroform sedation. The first operations under chloroform anesthesia in Russia were carried out: on December 8, 1847, Lossievsky in Warsaw; on December 9, 1847, Paul in Moscow; on December 27, 1847, in St. Petersburg at the Pirogov clinic.

Pirogov vigorously introduced anesthesia into clinical practice. He continuously worked on improving the methods and techniques of anesthesia. Pirogov proposed a rectal method of anesthesia (introduction of ether into the rectum). For this, the great surgeon designed a special apparatus and improved the design of existing inhalation devices.

While studying ether anesthesia, Pirogov also injected ether into the carotid and femoral arteries, into the internal jugular vein, femoral and portal veins. On the basis of experimental data, Pirogov came to the conclusion that when liquid ether is injected into a vein, instant death occurs.

The method of intravenous anesthesia with pure ether has not gained popularity. However, the idea of ​​Pirogov about the possibility of introducing a drug directly into the blood was put into practice by Russian scientists N. P. Kravkov and S. P. Fedorov, who at the beginning of the 20th century. suggested to inject the hypnotic hedonal directly into the vein.

Along with general anesthesia, local anesthesia developed. To do this, they used rubbing various substances, squeezing the nerve trunks, etc.

In 1859, cocaine, an alkaloid from the leaves of the coca bush, was discovered. Studies have shown that it has analgesic properties. In 1884, the Russian doctor V.K. Anrep proposed the use of cocaine as an anesthetic, and in 1884 the Austrian Keller used cocaine anesthesia for eye operations. But unfortunately, long-term use of cocaine caused painful addiction.

A new stage in local anesthesia began with the advent of novocaine, created on the basis of cocaine, but not addictive. With the introduction of novocaine solutions into practice, various methods of local anesthesia began to develop: infiltration, conduction and spinal anesthesia.

In the first half of the XX century. anesthesia, the science of pain relief, has become an independent branch of medicine. She is engaged in preparing the patient for surgery, conducting anesthesia and monitoring during surgery and in the postoperative period.

During anesthesia, the patient's condition is monitored using electroencephalography and monitoring of the pulse and blood pressure. An important stage is the exit from anesthesia, since reflexes in patients are restored gradually and complications are possible.

The use of anesthesia made it possible to carry out operations on the heart, lungs, brain and spinal cord, which were previously impossible due to a powerful pain shock. Therefore, the anesthesiologist is no less important than the surgeon.

This text is an introductory piece.

"Divine art to destroy pain" for a long time was beyond the control of man. For centuries, patients have been forced to patiently endure torment, and healers have not been able to end their suffering. In the 19th century, science was finally able to conquer pain.

Modern surgery uses for and A who first invented anesthesia? You will learn about this in the process of reading the article.

Anesthesia techniques in antiquity

Who invented anesthesia and why? Since the birth of medical science, doctors have been trying to solve an important problem: how to make surgical procedures as painless as possible for patients? With severe injuries, people died not only from the consequences of the injury, but also from the experienced pain shock. The surgeon had no more than 5 minutes to perform the operations, otherwise the pain became unbearable. The Aesculapius of antiquity were armed with various means.

In ancient Egypt, crocodile fat or alligator skin powder was used as an anesthetic. One of the ancient Egyptian manuscripts, dated 1500 BC, describes the analgesic properties of the opium poppy.

In ancient India, doctors used substances based on Indian hemp to obtain painkillers. Chinese physician Hua Tuo, who lived in the 2nd century BC. AD, offered patients to drink wine with the addition of marijuana before the operation.

Anesthesia methods in the Middle Ages

Who invented anesthesia? In the Middle Ages, the miraculous effect was attributed to the root of the mandrake. This plant from the nightshade family contains potent psychoactive alkaloids. Drugs with the addition of an extract from the mandrake had a narcotic effect on a person, clouded the mind, dulled the pain. However, the wrong dosage could lead to death, and frequent use caused drug addiction. The analgesic properties of mandrake for the first time in the 1st century AD. described by the ancient Greek philosopher Dioscorides. He gave them the name "anesthesia" - "without feeling."

In 1540, Paracelsus proposed the use of diethyl ether for pain relief. He repeatedly tried the substance in practice - the results looked encouraging. Other doctors did not support the innovation, and after the death of the inventor, this method was forgotten.

To turn off a person's consciousness for the most complex manipulations, surgeons used a wooden hammer. The patient was struck on the head, and he temporarily fell into unconsciousness. The method was crude and inefficient.

The most common method of medieval anesthesiology was ligatura fortis, i.e., infringement of nerve endings. The measure allowed to slightly reduce pain. One of the apologists for this practice was Ambroise Pare, the court physician of the French monarchs.

Cooling and hypnosis as methods of pain relief

At the turn of the 16th and 17th centuries, the Neapolitan physician Aurelio Saverina reduced the sensitivity of operated organs with the help of cooling. The diseased part of the body was rubbed with snow, thus being subjected to a slight frost. Patients experienced less pain. This method has been described in the literature, but few people have resorted to it.

About anesthesia with the help of cold was remembered during the Napoleonic invasion of Russia. In the winter of 1812, the French surgeon Larrey carried out mass amputations of frostbitten limbs right on the street at a temperature of -20 ... -29 ° C.

In the 19th century, during the mesmerization craze, attempts were made to hypnotize patients before surgery. BUT when and who invented anesthesia? We will talk about this further.

Chemical experiments of the XVIII-XIX centuries

With the development of scientific knowledge, scientists began to gradually approach the solution of a complex problem. At the beginning of the 19th century, the English naturalist H. Davy established on the basis of personal experience that the inhalation of nitrous oxide vapors dulls the sensation of pain in a person. M. Faraday found that a similar effect is caused by a pair of sulfuric ether. Their discoveries have not found practical application.

In the mid 40s. XIX century dentist G. Wells from the USA became the first person in the world who underwent surgical manipulation while under the influence of an anesthetic - nitrous oxide or "laughing gas". Wells had a tooth removed, but he felt no pain. Wells was inspired by a successful experience and began to promote a new method. However, a repeated public demonstration of the action of a chemical anesthetic ended in failure. Wells failed to win the laurels of the discoverer of anesthesia.

The invention of ether anesthesia

W. Morton, who practiced in the field of dentistry, became interested in the study of the analgesic effect. He carried out a series of successful experiments on himself and on October 16, 1846, he immersed the first patient in a state of anesthesia. An operation was performed to painlessly remove the tumor on the neck. The event received a wide response. Morton patented his innovation. He is officially considered the inventor of anesthesia and the first anesthesiologist in the history of medicine.

In medical circles, the idea of ​​ether anesthesia was picked up. Operations with its use were made by doctors in France, Great Britain, Germany.

Who invented anesthesia in Russia? The first Russian doctor who dared to test the advanced method on his patients was Fedor Ivanovich Inozemtsev. In 1847, he performed several complex abdominal operations on patients immersed in it. Therefore, he is the discoverer of anesthesia in Russia.

The contribution of N. I. Pirogov to the world anesthesiology and traumatology

Other Russian doctors followed in the footsteps of Inozemtsev, including Nikolai Ivanovich Pirogov. He not only operated on patients, but also studied the effect of ethereal gas, tried different ways of introducing it into the body. Pirogov summarized and published his observations. He was the first to describe the techniques of endotracheal, intravenous, spinal and rectal anesthesia. His contribution to the development of modern anesthesiology is invaluable.

Pirogov is the one. For the first time in Russia, he began to fix injured limbs with a plaster cast. The physician tested his method on wounded soldiers during the Crimean War. However, Pirogov cannot be considered the discoverer of this method. Gypsum as a fixing material was used long before him (Arab doctors, the Dutch Hendrichs and Mathyssen, the Frenchman Lafargue, the Russians Gibental and Basov). Pirogov only improved plaster fixation, made it light and mobile.

Discovery of chloroform anesthesia

In the early 30s. Chloroform was discovered in the 19th century.

A new type of anesthesia using chloroform was officially presented to the medical community on November 10, 1847. Its inventor, the Scottish obstetrician D. Simpson, actively introduced anesthesia for women in labor to facilitate the process of childbirth. There is a legend that the first girl who was born painlessly was given the name Anasthesia. Simpson is rightfully considered the founder of obstetric anesthesiology.

Chloroform anesthesia was much more convenient and profitable than ether anesthesia. He quickly plunged a person into sleep, had a deeper effect. He did not need additional equipment, it was enough to inhale the vapors with gauze soaked in chloroform.

Cocaine - local anesthetic of South American Indians

The ancestors of local anesthesia are considered to be the South American Indians. They have been practicing cocaine as an anesthetic since ancient times. This plant alkaloid was extracted from the leaves of the local shrub Erythroxylon coca.

The Indians considered the plant a gift from the gods. Coca was planted in special fields. Young leaves were carefully cut off from the bush and dried. If necessary, the dried leaves were chewed and saliva was poured over the damaged area. It lost sensitivity, and traditional healers proceeded to the operation.

Koller's research in local anesthesia

The need to provide anesthesia in a limited area was especially acute for dentists. Extraction of teeth and other interventions in dental tissues caused unbearable pain in patients. Who Invented Local Anesthesia? In the 19th century, in parallel with the experiments on general anesthesia, the search for an effective method for limited (local) anesthesia was carried out. In 1894, a hollow needle was invented. To stop toothache, dentists used morphine and cocaine.

Vasily Konstantinovich Anrep, a professor from St. Petersburg, wrote about the properties of coca derivatives to reduce sensitivity in tissues. His works were studied in detail by the Austrian ophthalmologist Karl Koller. The young doctor decided to use cocaine as an anesthetic for eye surgery. The experiments were successful. Patients remained conscious and did not feel pain. In 1884, Koller informed the Viennese medical community of his achievements. Thus, the results of the experiments of the Austrian doctor are the first officially confirmed examples of local anesthesia.

The history of the development of endotrachial anesthesia

In modern anesthesiology, endotracheal anesthesia, also called intubation or combined anesthesia, is most often practiced. This is the safest type of anesthesia for a person. Its use allows you to control the patient's condition, to carry out complex abdominal operations.

Who invented endotrochial anesthesia? The first documented case of the use of a breathing tube for medical purposes is associated with the name of Paracelsus. An outstanding doctor of the Middle Ages inserted a tube into the trachea of ​​a dying person and thereby saved his life.

André Vesalius, a professor of medicine from Padua, conducted experiments on animals in the 16th century by inserting breathing tubes into their tracheas.

The occasional use of breathing tubes during operations provided the basis for further developments in the field of anesthesiology. In the early 70s of the XIX century, the German surgeon Trendelenburg made a breathing tube equipped with a cuff.

The use of muscle relaxants in intubation anesthesia

The mass use of intubation anesthesia began in 1942, when Canadians Harold Griffith and Enid Johnson used muscle relaxants during surgery - drugs that relax muscles. They injected the patient with the alkaloid tubocurarine (intokostrin), obtained from the well-known poison of the South American curare Indians. The innovation facilitated the implementation of intubation measures and made operations safer. Canadians are considered to be the innovators of endotracheal anesthesia.

Now you know who invented general and local anesthesia. Modern anesthesiology does not stand still. Traditional methods are successfully applied, the latest medical developments are being introduced. Anesthesia is a complex, multicomponent process on which the health and life of the patient depends.

This year marks the 200th anniversary of the birth of Nikolai Ivanovich Pirogov - his name is inscribed in golden letters in the history of world medicine. The current government approached the celebration of this event very responsibly.

So, back in early May, President Viktor Yanukovych instructed the government to form an Organizing Committee to prepare for the celebration of the anniversary. In particular, he will organize a set of works to improve the Pirogov National Museum-Estate, hold thematic conferences and round tables in medical universities and scientific medical institutions, as well as ensure the publication of Pirogov's scientific works in Ukrainian and foreign languages. This will once again remind Ukrainian citizens of who Mykola Ivanovich was and what contribution he made to medicine.

Honest Aesculapius

Much was said and written about Pirogov during his lifetime. For example, the writer Nikolai Nekrasov in the Sovremennik magazine called him "a man marked by the stamp of a genius, who at the same time combines the highest development of the best properties of human nature." And the Russian scientist Ivan Pavlov wrote about the great surgeon: “With the clear eyes of a man of genius, at the very first time, at the first touch of his specialty - surgery, he discovered the natural science foundations of this science - in a short time he became the creator of his field."

Indeed, for the powerful and unusually inquisitive mind of Pirogov, there were no limits and boundaries in the field of knowledge. His searches and discoveries in the field of surgery and anatomy, his brilliant operations and the unusual gift of teaching, his most valuable scientific works became the property of not only Russia, Ukraine, but the whole of Europe, having a huge impact on the further development of all medicine.

Nikolai Ivanovich was born in 1810 in Moscow. The grandson of a serf, he recognized the need early. His father served as treasurer, major of the food depot, was a commission agent of the 9th class. Ivan Ivanovich Pirogov had fourteen children, most of them died in infancy. Of the six survivors, Nikolai was the youngest.

In 1815, a collection of cartoons "A gift to children in memory of 1812" was published in Russia, which were distributed free of charge. Each caricature was explained by verses. According to these cartoons, Nikolai learned to read and write. But he was helped to get a good education by a family friend - a well-known Moscow doctor, professor of Moscow University E. Mukhin, who noticed the boy's abilities and began to work with him individually.

At the age of 17, Pirogov, having graduated from the medical faculty of Moscow University, received a medical degree, and five years later he defended his doctoral dissertation. The young scientist began to work in the city of Dorpat in Estonia. Then he moved to Berlin with the intention of learning everything new that the most prominent representatives of German medicine could give him.

But there he was soon severely disappointed. Medical science in Germany, in particular surgery, was divorced from its foundations - anatomy and physiology. Although from the first steps in science, Nikolai Pirogov realized that "there is no medicine without surgery, and there is no surgery without anatomy." That is why he returns to Dorpat, especially since they promised him the title of professor of surgery and asked him to head the corresponding department at the University of Dorpat.

The young professor very quickly got used to the new place - during the day he lectured, and in the evenings he worked enthusiastically. During this period, Nikolai Ivanovich created the publication "Annals of the Derpt Surgical Clinic". It was a medical confession of a young surgeon: he gave a harsh assessment of his own medical activities, described individual pathologies.

The “Annals” of Nikolai Pirogov outraged the entire medical community: the young surgeon broke the tradition that had existed among doctors for centuries - not to take out the garbage from the house.

Never and under no circumstances before him did the mistakes of doctors, which led to the complication of the disease, become the subject of wide discussion. So it's safe to say that Pirogov introduced honesty into medicine. In 1837-1839 he published two volumes of the Annals. The scientist Ivan Pavlov called these publications a feat, and the Russian neurosurgeon Nikolai Burdenko - an example of a sensitive conscience and a truthful soul.

"Sister, anesthesia!"

At the university where Pirogov taught, there was a fund designed for business trips of scientists. With his help, Nikolai Ivanovich decided to seek funds for a trip to Paris to inspect French hospitals. And at the age of 28 he succeeds - having received funds from the university, he went to the capital of France.

The second trip abroad, like the first, clearly showed him that medicine, and, in particular, surgery, in the most culturally developed countries of Western Europe remains at a very low scientific level. It turned out that even at the beginning of his scientific career, Nikolai Pirogov was head and shoulders above famous foreign surgeons. Returning from Paris in frustrated feelings, Nikolai Ivanovich works a lot and fruitfully in a surgical clinic and anatomical theater.

When summer came and lectures at the university ended, the professor set about organizing a mobile surgical clinic. Messages were sent to the cities where he intended to go, and there they began to look forward to the arrival of the Aesculapius. In the first city he performed fifty operations, in the second sixty. Such annual summer trips supplemented the scientific and pedagogical work of the autumn and winter months at Dorpat University, and also brought popularity to the young surgeon.

Soon his fame spread throughout Europe. And when he came to the famous Parisian professor Velpo to learn from him, he replied that he himself needed to learn from Pirogov. But Nikolai Ivanovich at that time was not even thirty.

The speed with which the great surgeon operated was legendary. For example, he did a lithotomy (extraction of stones) in two minutes. Each of his operations gathered a lot of spectators who, with watches in their hands, followed its duration. It was said that while the observers were pulling watches out of their pockets in order to mark the time, the operator was already throwing out the extracted stones. If we take into account that at that time there was still no anesthesia, it becomes clear why the young surgeon achieved this saving speed.

By the way, it was Pirogov who was one of the first to operate under anesthesia. This happened on February 14, 1847. Convinced of the effectiveness of operations under anesthesia, Nikolai Ivanovich performed 300 such operations during the year and analyzed each one at the same time. He was the first to develop the so-called "savings treatment", invented and applied a starch, and then a plaster bandage for complex fractures.

Concerned about accuracy in studying the structure of organs, Pirogov invented "ice anatomy" and published an Atlas of cuts and sections of frozen bodies of the dead, providing it with a thousand drawings. At the same time, he headed the department, studied at the Anatomical Institute he created, treated patients in the clinic, operated, designed and manufactured medical instruments, fought cholera, wrote books, articles, and performed eleven thousand autopsies! Indeed, not a single medical institution could keep up with him - he alone worked for everyone.

Doctor, teacher, social worker

However, his innovations were not immediately accepted. So, when Pirogov demanded that Russian surgeons operate in white boiled coats, because their ordinary clothes could carry dangerous microbes, his colleagues hid him in a lunatic asylum. However, he was released three days later without finding any mental disorder.

In 1854 the Crimean War began. Pirogov was at that time in the besieged Sevastopol, thanks to this, many wounded were saved on the battlefields, and order was established in local hospitals. Nikolai Ivanovich introduced medical sorting of the wounded at dressing stations, together with the squads of nurses he created, he achieved the creation of prefabricated front-line hospitals, developed a surgical conveyor, and, finally, developed a gentle evacuation system for the wounded with hot food and a warm overnight stay. “There is no soldier near Sevastopol (we are not talking about officers), there is no soldier or sailor who would not bless the name of Pirogov,” Sovremennik wrote in those days.

But, being at the top of his fame, the great anatomist and surgeon suddenly decided to end his medical career and retire. This act plunged the whole of progressive Russia into amazement. Some believed that Pirogov could no longer endure the inertia and routine at the Medico-Surgical Academy, of which he was a professor, others said that he decided to treat a sick society. Both of them were right in a way. But only Pirogov knew the truth.

Being engaged in medicine and being, according to Pavlov's definition, a rare example of a teacher and doctor, Nikolai Ivanovich now and then faced the consequences of the shortcomings and vices of educating young people. Rightly believing that upbringing decides the fate of a person, he sought to put into practice his thoughts on upbringing and the reform of education in Russia.

He had many ardent supporters, especially after appearing in the press with the article "Questions of Life." He always believed that the title of a doctor obliges to be a public figure, and he was never aloof from the pressing issues of life.

Therefore, when in 1856 Pirogov was offered the position of trustee of the Odessa educational district in the department of public education, he, full of hopes and ideas, immediately set to work ardently. Since that time, the life and work of this brilliant man has become inextricably linked with Ukraine.

Lost a bad habit

The new trustee impressed everyone with his extraordinary capacity for work, ease of handling and democracy. He managed to turn the administrative position of an official into a creative laboratory of scientific and pedagogical activity.

Having then taken the post of trustee of the Kyiv educational district, Pirogov was carried away by the creation of free Sunday schools, which appealed not only to the poor class, but also to student teachers. In 1859, the first Sunday school was opened in Kyiv on Podil, which was a great success. Forgetting about everything in the name of the cause, the new trustee broke many established orders and traditions, behind which stood the powers that be. As a result, he had to retire. According to Leskov, “darkness gathered to see Pirogov off, he really was a beloved person, with whom it was painful and hard for people to part.”

Pirogov settled in Vyshnia near Vinnitsa, on his wife's estate, but he did not even think of resting.

The famous surgeon did not change his accustomed rapid pace of life: he still received free of charge patients who flocked to him from all over Russia, and still performed many successful operations. He resettled the operated patients in huts, monitored their condition, and supplied them with medicines. I have been abroad three times. At the age of 67, during the Russian-Turkish war, he was at the front for six months as a consultant on medical support for the army. After that, the book “The Beginnings of General Military Field Surgery” appeared, which at that time had no equal in scientific value.

Knowing so much about bad habits and their impact on health, Nikolai Pirogov, however, was a passionate smoker, because of this, already at a very advanced age, he discovered cancer in himself. An incurable disease took the life of the famous surgeon on November 23, 1881. In memory of the great scientist, the first All-Russian Congresses of Doctors were called Pirogov.

Interestingly, shortly before his death, the great scientist made another discovery - he proposed a completely new way of embalming the dead. To this day, the body of the famous surgeon embalmed in this way is kept in the church of the village of Cherry. And on the territory of the estate today there is a museum of a brilliant doctor and an ascetic of science.

Prepared by Maria Borisova,
according to materials:

One of the most important inventions of a brilliant Russian doctor, who was the first to use anesthesia on the battlefield and brought nurses into the army
Imagine an ordinary emergency room - say, somewhere in Moscow. Imagine that you are there not for personal need, that is, not with an injury that distracts you from any extraneous observations, but as a bystander. But - with the ability to look into any office. And now, passing along the corridor, you notice a door with the inscription "Plaster". What about her? Behind it is a classic medical office, the appearance of which differs only in the low square bathtub in one of the corners.

Yes, yes, this is the very place where a plaster cast will be applied to a broken arm or leg, after an initial examination by a traumatologist and an x-ray. What for? So that the bones grow together as they should, and not as horrible. And so that the skin can still breathe. And so as not to disturb a broken limb with a careless movement. And ... What is there to ask! After all, everyone knows: once something is broken, it is necessary to apply plaster.

But this “everyone knows” is at most 160 years old. Because for the first time a plaster cast as a means of treatment was used in 1852 by the great Russian doctor, surgeon Nikolai Pirogov. Before him, no one in the world had done this. Well, after it, it turns out, anyone can do it, anywhere. But the “Pirogovskaya” plaster cast is just the priority that no one in the world disputes. Simply because it is impossible to dispute the obvious: the fact that gypsum as a medical device is one of the purely Russian inventions.

Portrait of Nikolai Pirogov by artist Ilya Repin, 1881.

War as an engine of progress

By the beginning of the Crimean War, Russia was largely unprepared. No, not in the sense that she did not know about the impending attack, like the USSR in June 1941. In those distant times, the habit of saying “I’m going to attack you” was still in use, and intelligence and counterintelligence were not yet so developed as to carefully hide the preparation for an attack. The country was not ready in the general, economic and social sense. There was a lack of modern, modern, railways (and this turned out to be critical!), Leading to the theater of war ...

And there were not enough doctors in the Russian army. By the beginning of the Crimean War, the organization of the medical service in the army was in accordance with the guidelines written a quarter of a century before. According to his requirements, after the outbreak of hostilities, the troops should have had more than 2,000 doctors, almost 3,500 paramedics and 350 paramedic students. In reality, there was not enough of anyone: neither doctors (a tenth part), nor paramedics (twentieth part), and there were no students at all.

It would seem that not such a significant shortage. But nevertheless, as the military researcher Ivan Bliokh wrote, “at the beginning of the siege of Sevastopol, one doctor accounted for three hundred wounded people.” To change this ratio, according to the historian Nikolai Gubbenet, more than a thousand doctors were recruited during the Crimean War, including foreigners and students who received a diploma but did not complete their studies. And almost 4,000 paramedics and their students, half of whom failed during the fighting.

In such a situation, and taking into account, alas, the rear organized disorder characteristic of the Russian army of that time, the number of wounded who were permanently disabled should have reached at least a quarter. But just as the resilience of the defenders of Sevastopol amazed the allies preparing for a quick victory, so the efforts of the doctors unexpectedly gave a much better result. The result, which had several explanations, but one name - Pirogov. After all, it was he who introduced immobilizing plaster bandages into the practice of military field surgery.

What did it give the army? First of all, the ability to return to service many of those wounded who, a few years earlier, would have simply lost an arm or leg as a result of amputation. After all, before Pirogov, this process was arranged very simply. If a person with a broken bullet or a fragment of an arm or leg got on the table of surgeons, he was most often expected to be amputated. Soldiers - by the decision of doctors, officers - by the results of negotiations with doctors. Otherwise, the wounded still most likely would not have returned to duty. After all, unfixed bones grew together at random, and the person remained a cripple.

From workshop to operating room

As Nikolai Pirogov himself wrote, "war is a traumatic epidemic." And as for any epidemic, for the war there had to be some kind of vaccine, figuratively speaking. She - in part, because not all wounds are exhausted by broken bones - and gypsum became.

As is often the case with ingenious inventions, Dr. Pirogov came up with the idea of ​​​​making his immobilizing bandage literally from what lies under his feet. Or rather, under the arms. Since the final decision to use gypsum for dressing, moistened with water and fixed with a bandage, came to him in ... the sculptor's workshop.

In 1852, Nikolai Pirogov, as he himself recalled a decade and a half later, watched the work of the sculptor Nikolai Stepanov. “For the first time I saw ... the effect of a plaster solution on the canvas,” the doctor wrote. - I guessed that it could be used in surgery, and immediately put bandages and strips of canvas soaked in this solution on a complex fracture of the lower leg. The success was wonderful. The bandage dried up in a few minutes: an oblique fracture with a strong blood stain and perforation of the skin ... healed without suppuration and without any seizures. I am convinced that this bandage can find great application in field practice. As, in fact, it happened.

But the discovery of Dr. Pirogov was the result of not only an accidental insight. Nikolai Ivanovich struggled over the problem of a reliable fixing bandage for more than a year. By 1852, behind Pirogov's back, there was already experience in using linden popular prints and a starch dressing. The latter was something very similar to a plaster cast. Pieces of canvas soaked in a starch solution were applied layer by layer to a broken limb - just like in the papier-mâché technique. The process was quite long, the starch did not solidify immediately, and the bandage turned out to be bulky, heavy and not waterproof. In addition, it did not allow air to pass through well, which negatively affected the wound if the fracture was open.

By the same time, ideas using plaster were already known. For example, in 1843, a thirty-year-old doctor, Vasily Basov, proposed fixing a broken leg or arm with alabaster, poured into a large box - a “dressing projectile”. Then this box on blocks was lifted to the ceiling and fixed in this position - almost in the same way as today, if necessary, cast limbs are fixed. But the weight was, of course, prohibitive, and breathability - no.

And in 1851, the Dutch military doctor Antonius Mathijsen put into practice his method of fixing broken bones with the help of bandages rubbed with plaster, which were applied to the fracture site and moistened with water right there. He wrote about this innovation in February 1852 in the Belgian medical journal Reportorium. So the idea in the full sense of the word was in the air. But only Pirogov was able to fully appreciate it and find the most convenient way of plastering. And not just anywhere, but in the war.

"Precautionary allowance" in Pirogov's way

Let's return to the besieged Sevastopol, during the Crimean War. The surgeon Nikolai Pirogov, already famous by that time, arrived at it on October 24, 1854, in the midst of events. It was on this day that the infamous Inkerman battle took place, which ended in a major failure for the Russian troops. And here the shortcomings of the organization of medical care in the troops showed themselves to the fullest.

Painting "The 20th Infantry Regiment at the Battle of Inkerman" by artist David Rowlands. Source: wikipedia.org

In a letter to his wife Alexandra on November 24, 1854, Pirogov wrote: “Yes, on October 24, the matter was not unexpected: it was foreseen, intended and not taken care of. 10 and even 11,000 were out of action, 6,000 were too wounded, and absolutely nothing was prepared for these wounded; like dogs, they were thrown on the ground, on the bunks, for whole weeks they were not bandaged and not even fed. The British were reproached after Alma for having done nothing in favor of the wounded enemy; we ourselves did nothing on October 24th. Arriving in Sevastopol on November 12, therefore, 18 days after the case, I found too 2000 wounded, crowded together, lying on dirty mattresses, mixed up, and for a whole 10 days, almost from morning to evening, I had to operate on those who were supposed to be operated on immediately after battles."

It was in this environment that the talents of Dr. Pirogov manifested themselves in full. Firstly, it was he who was credited with introducing the sorting system for the wounded into practice: “I was the first to introduce sorting of the wounded at Sevastopol dressing stations and thereby destroyed the chaos that prevailed there,” the great surgeon himself wrote about this. According to Pirogov, each wounded person had to be assigned to one of five types. The first is the hopeless and mortally wounded, who no longer need doctors, but comforters: nurses or priests. The second - seriously and dangerously wounded, requiring urgent assistance. The third is the seriously wounded, "who also require urgent, but more protective benefits." The fourth is "the wounded, for whom immediate surgical assistance is necessary only to make transportation possible." And finally, the fifth - "lightly wounded, or those in whom the first benefit is limited to applying a light dressing or removing a superficially sitting bullet."

And secondly, it was here, in Sevastopol, that Nikolai Ivanovich began to widely use the plaster cast he had just invented. How much importance he attached to this innovation may be judged by a simple fact. It was under him that Pirogov singled out a special type of wounded - requiring "precautionary benefits".

How widely the plaster cast was used in Sevastopol and, in general, in the Crimean War, can only be judged by indirect evidence. Alas, even Pirogov, who meticulously described everything that happened to him in the Crimea, did not bother to leave to his descendants accurate information on this matter - mostly value judgments. Shortly before his death, in 1879, Pirogov wrote: “The plaster cast was first introduced by me into military hospital practice in 1852, and into military field practice in 1854, finally ... took its toll and became a necessary accessory of field surgical practice. I allow myself to think that my introduction of a plaster cast in field surgery, mainly contributed to the spread of savings treatment in field practice.

Here it is, that very “savings treatment”, it is also a “precautionary allowance”! It was for him that they used in Sevastopol, as Nikolai Pirogov called it, "a stuck-on alabaster (gypsum) bandage." And the frequency of its use directly depended on how many wounded the doctor tried to save from amputation - which means how many soldiers needed to put plaster on gunshot fractures of the arms and legs. And apparently they numbered in the hundreds. “We suddenly had up to six hundred wounded in one night, and we did too seventy amputations within twelve hours. These are repeated incessantly in various sizes,” Pirogov wrote to his wife on April 22, 1855. And according to eyewitnesses, the use of Pirogov's "stuck bandage" made it possible to reduce the number of amputations by several times. It turns out that only on that nightmarish day, about which the surgeon told his wife, gypsum was applied to two or three hundred wounded!

Nikolay Pirogov in Simferopol. The artist is not known.

Do you know that...

The invention and widespread introduction into medical practice of a plaster cast for bone fractures is one of the most important achievements of surgery in the last century. And it was N.I. Pirogov was the first in the world to develop and put into practice a fundamentally new method of dressing impregnated with liquid gypsum.

It cannot be said that before Pirogov there were no attempts to use gypsum. Known are the works of Arab doctors, the Dutchman Hendrichs, Russian surgeons K. Gibental and V. Basov, a surgeon from Brussels Seten, a Frenchman Lafargue and others. However, they did not use a bandage, but a solution of gypsum, sometimes mixing it with starch, adding blotting paper to it.

An example of this is the Basov method proposed in 1842. The broken arm or leg of the patient was placed in a special box filled with alabaster solution; the box was then attached to the ceiling through a block. The victim was essentially bedridden.

In 1851, the Dutch doctor Mathyssen had already begun to use a plaster cast. He rubbed strips of cloth with dry gypsum, wrapped them around the injured limb, and only then wetted them with water.

To achieve this, Pirogov tries to use various raw materials for dressings - starch, gutta-percha, colloidin. Convinced of the shortcomings of these materials, N.I. Pirogov proposed his own plaster cast, which is used almost unchanged at the present time.

The fact that gypsum is just the best material, the great surgeon made sure after visiting the workshop of the then-famous sculptor N.A. Stepanov, where "... for the first time I saw ... the effect of a gypsum solution on the canvas. I guessed," writes N.I. Pirogov, "that it can be used in surgery, and immediately applied bandages and strips of canvas soaked with this solution , on a complex fracture of the lower leg. The success was remarkable. The bandage dried up in a few minutes: an oblique fracture with a strong blood streak and perforation of the skin ... healed without suppuration ... I was convinced that this bandage could find great application in military field practice, and therefore published a description of my method.

For the first time, Pirogov used a plaster cast in 1852 in a military hospital, and in 1854 - in the field, during the defense of Sevastopol. The wide distribution of the method of bone immobilization created by him made it possible to carry out, as he said, "saving treatment": even with extensive bone injuries, not to amputate, but to save the limbs of many hundreds of wounded.

The correct treatment of fractures, especially gunshot ones, during the war, which N.I. Pirogov figuratively called "traumatic epidemic", was the key not only to the preservation of the limb, but sometimes the life of the wounded.

Portrait of N.I. Pirogov by artist L. Lamm