In what year did Pirogov invent anesthesia? History of the plaster cast

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

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

An example of this is the Basov method, proposed in 1842. The patient's broken arm or leg 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 Matthiessen already began using a plaster cast. He rubbed strips of cloth with dry plaster, wrapped them around the injured limb, and only then moistened them with water.

To achieve this, Pirogov is trying 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 still used almost unchanged today.

The great surgeon became convinced that gypsum is the best material 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 canvas. I guessed,” writes N.I. Pirogov, “that it could be used in surgery, and immediately applied bandages and strips of canvas soaked in this solution , for a complex fracture of the tibia. The success was remarkable. The bandage dried out in a few minutes: an oblique fracture with severe bleeding 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."

Pirogov first used a plaster cast in 1852 in a military hospital, and in 1854 in the field, during the defense of Sevastopol. The widespread use of the bone immobilization method he created made it possible to carry out, as he called, “saving treatment”: even with extensive bone damage, not to amputate, but to save the limbs of many hundreds of wounded people.

Proper treatment of fractures, especially gunshot fractures, during the war, which N.I. Pirogov figuratively called it a “traumatic epidemic,” which was the key to not only preserving a limb, but sometimes even the life of the wounded.

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

The phrase “I woke up - a cast” perfectly illustrates the medical practice of Nikolai Pirogov. In 1850, this great surgeon began to operate on the wounded with ether anesthesia in the field for the first time in the history of medicine. In total, Pirogov performed about 10,000 operations under ether anesthesia. He was the first in Russian medicine to use gypsum to treat fractures.

Inventions of Russians who “went” to the West. Pirogov's ether anesthesia.

And although the first ether anesthesia in Russia was performed by Fyodor Ivanovich Inozemtsev (1802-1869) on February 7, 1846, the role of N.I. Pirogov in the development of surgical anesthesia in Russia is so enormous that any discussion of priority, and especially the opposition of these two outstanding doctors lose all meaning.

It should be emphasized that N.I. Pirogov, first of all, tested the features of the clinical course of anesthesia on himself and his assistants, and only after that began to use ether anesthesia in the clinic on patients.

On February 14, 1847, he performed his first operation under ether anesthesia in the 2nd Military Land Hospital, on February 16 he operated under ether anesthesia in the Obukhov Hospital, on February 27 in the Peter and Paul Hospital (St. Petersburg). Almost immediately he publishes his impressions of the operations performed, on the basis of which he comes to the conclusion that ether anesthesia can “even completely transform surgery.”

American medical historians, distorting the truth, have repeatedly emphasized and continue to emphasize today that “America taught Europe the ABCs of anesthesia.” However, irrefutable historical facts indicate something else. At the dawn of the development of anesthesia, both America and Europe studied with the great Russian surgeon N.I. Pirogov. It is no coincidence that V. Robinson, in his book “Victory over Pain” (1946), wrote about N.I. Pirogov: “Many pioneers of pain management were mediocrities. By accident of location, chance information, or other fortuitous circumstances, they had a hand in this discovery. Their quarrels and petty envy left an unpleasant mark on science. But there are also figures of a larger scale who participated in this discovery, and among them, Pirogov should most likely be considered the most important as a person and as a scientist.”

One of the most important inventions of the 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 find yourself there not for personal reasons, that is, not with an injury that distracts you from any extraneous observations, but as a random passerby. But - with the opportunity to look into any office. And so, walking along the corridor, you notice a door with the inscription “Gypsum”. And what's behind it? Behind it is a classic medical office, the appearance of which differs only from the low square bathtub in one of the corners.

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

But this “everyone knows” is at most 160 years old. Because the first time a plaster cast was used as a means of treatment was in 1852 by the great Russian doctor, surgeon Nikolai Pirogov. No one in the world had done anything like this before. Well, after it, it turns out, anyone can do it, anywhere. But the “Pirogov” plaster cast is precisely that priority that is not disputed by anyone in the world. Simply because it is impossible to dispute the obvious: the fact that gypsum as a medical remedy is one of the purely Russian inventions.

Portrait of Nikolai Pirogov by artist Ilya Repin, 1881.

War as an engine of progress

Back to top Crimean War Russia turned out to be unprepared in many ways. No, not in the sense that she did not know about the coming 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 conceal preparations for an attack. The country was not ready in the general, economic and social sense. There wasn't enough modern, modern, railways(and this turned out to be critical!) leading to the theater of military operations...

There were also not enough doctors in the Russian army. By the beginning of the Crimean War, the organization of medical service in the army was in accordance with the manual written a quarter of a century earlier. 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 no one enough: neither doctors (a tenth part), nor paramedics (a twentieth part), and their students were not there at all.

It would seem that there is not such a significant shortage. But nevertheless, as military researcher Ivan Bliokh wrote, “at the beginning of the siege of Sevastopol, there was one doctor for every three hundred wounded people.” To change this ratio, according to historian Nikolai Gübbenet, during the Crimean War more than a thousand doctors were recruited into service, 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 were disabled during the fighting.

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

What did this give the army? First of all, it is an opportunity to return to duty 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 came to the surgeons table with an arm or leg broken by a bullet or shrapnel, he most often faced amputation. For soldiers - according to the decision of doctors, for officers - based on the results of negotiations with doctors. Otherwise, the wounded man would still most likely not return to duty. After all, the unfixed bones grew together haphazardly, and the person remained crippled.

From the workshop to the operating room

As Nikolai Pirogov himself wrote, “war is a traumatic epidemic.” And like any epidemic, a war had to find its own, figuratively speaking, vaccine. This - partly because not all wounds are limited to broken bones - was plaster.

As often happens with brilliant inventions, Dr. Pirogov came up with the idea of ​​making his immobilizing bandage literally from what was lying under his feet. Or rather, at hand. Because the final decision to use plaster of Paris, moistened with water and fixed with a bandage, for the 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 sculptor Nikolai Stepanov work. “For the first time I saw... the effect of a gypsum solution on a canvas,” the doctor wrote. “I guessed that it could be used in surgery, and immediately applied bandages and strips of canvas soaked in this solution to a complex fracture of the tibia. The success was remarkable. The bandage dried in a few minutes: an oblique fracture with strong bleeding and perforation of the skin... healed without suppuration and without any seizures. I was convinced that this bandage could find great application in military field practice.” Which is exactly what happened.

But Dr. Pirogov’s discovery was not only the result of an accidental insight. Nikolai Ivanovich struggled with the problem of a reliable fixation bandage for many years. By 1852, Pirogov already had experience in using linden splints and starch dressings. The latter was something very similar to a plaster cast. Pieces of canvas soaked in a starch solution were placed layer by layer on the broken limb - just like in the papier-mâché technique. This process was quite long, the starch did not harden immediately, and the dressing 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 gypsum were already known. For example, in 1843, 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 was raised on blocks to the ceiling and secured in this position - almost the same way today, if necessary, plastered limbs are secured. But the weight was, of course, prohibitive, and there was no breathability.

And in 1851, the Dutch military doctor Antonius Mathijsen introduced into practice his own method of fixing broken bones using 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 war.

“Safety benefit” in Pirogov style

Let's return to besieged Sevastopol, during the Crimean War. The already famous surgeon Nikolai Pirogov arrived at it on October 24, 1854, at the very height of the events. It was on this day that the infamous Battle of Inkerman 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 Twentieth 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, October 24 was not unexpected: it was foreseen, planned 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; They left them like dogs on the ground, on bunks; for whole weeks they were not bandaged or even fed. The British were reproached after Alma for not doing anything 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 10 whole days, almost from morning to evening, I had to operate on those who should have had the operation immediately after battles."

It was in this environment that Dr. Pirogov’s talents fully manifested themselves. Firstly, it was to him that he was credited with introducing into practice the system of sorting the wounded: “I was the first to introduce the sorting of the wounded at the 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 classified into one of five types. The first is the hopeless and mortally wounded, who no longer need doctors, but comforters: nurses or priests. The second is seriously and dangerously wounded, requiring immediate assistance. The third is the seriously wounded, “who also require immediate, but more protective benefits.” The fourth is "the wounded for whom immediate surgical care is necessary only to make possible transportation." And, finally, the fifth - “slightly wounded, or those for whom the first benefit is limited to applying a light bandage or removing a superficially seated bullet.”

And secondly, it was here, in Sevastopol, that Nikolai Ivanovich began to widely use the plaster cast he had just invented. How much great importance he gave this innovation, can be judged by a simple fact. It was for him that Pirogov identified a special type of wounded - those requiring “safety benefits.”

How widely the plaster cast was used in Sevastopol and, in general, in the Crimean War can be judged only by indirect evidence. Alas, even Pirogov, who meticulously described everything that happened to him in 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: “I first introduced the plaster cast into military hospital practice in 1852, and into military field practice in 1854, finally... took its toll and became a necessary accessory to field surgical practice. I allow myself to think that my introduction of a plaster cast into field surgery mainly contributed to the spread of cost-saving treatment in field practice.”

Here it is, that very “saving treatment”, it is also a “preventive benefit”! It was for this purpose that what Nikolai Pirogov called “a molded alabaster (plaster) bandage” was used in Sevastopol. And the frequency of its use directly depended on how many wounded the doctor tried to protect from amputation - which means how many soldiers needed to have plaster applied to gunshot fractures of their arms and legs. And apparently they numbered in the hundreds. “We suddenly had up to six hundred wounded in one night, and we performed too many seventy amputations in 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 “stick-on bandage” made it possible to reduce the number of amputations several times. It turns out that only on that terrible day that the surgeon told his wife about, plaster was applied to two or three hundred wounded people!

Nikolai Pirogov in Simferopol. The artist is unknown.

Great, brilliant, famous - about the doctor Nikolai Pirogov descendants speak in a superlative sense. He really managed to make discoveries that were ahead of his time and became the founder of military field surgery in Russia. AiF.ru recalls the biography of a famous physician.

Aesculapius games

Nikolai Pirogov was born on November 25, 1810 into the patriarchal family of a treasury official. The boy was the 13th child of his parents. And his path to medicine began already in childhood with his first meeting with a famous Moscow doctor at that time Efrem Osipovich Mukhin.

In 1820, when little Kolya was only 10 years old, one of his older brothers became seriously ill with rheumatism. One doctor replaced another at the patient’s bedside, but there was no result. After an unsuccessful visit to the fifth doctor, the neighbors advised the Pirogovs to invite Professor Mukhin, a celebrity at the time. Nikolai’s father doubted whether such a doctor would accept the invitation of a poor man? But Mukhin agreed - he was always interested in severe cases that were difficult to treat.

- Well, young man, what happened to you? — he carefully examined the patient, listened to complaints, and began treatment. And after several sessions, relief came. “And you, sir, would make a good doctor,” said Mukhin, addressing 10-year-old Kolya as if he were an adult. “I understood this from the way you looked after your brother.”

Afterwards, Mukhin often visited the Pirogovs’ house. Nikolai liked the doctor’s manners and behavior so much that he regularly played “Mukhin” with his family - he “listened” to them with his pipe many times, coughed and imitated Mukhin’s voice while prescribing medicine.

As a result, when the young man graduated from school, at the family council they again remembered the famous doctor’s prediction - and decided to send Pirogov Jr. to medical school. However, there was a problem - the boy was barely 14 years old. It’s too early - they won’t accept... And then Mukhin came to the rescue again. He personally addressed the rector himself, telling him: “I feel in my gut, Your Excellency, that the boy will be a good one.”

...And there was a point

Nikolai Pirogov graduated from the university in 1828. Moreover, his student years were during difficult years, when various medical experiments and experiments, as well as the preparation of various anatomical preparations, were prohibited as an “ungodly” matter. After graduating from university, he went to the city of Dorpat to prepare for a professorship and practice anatomy and surgery under the guidance of a respected mentor Ivan Moyer. Moreover, in 1832, at the age of 22, he had already defended his dissertation “Is ligation of the abdominal aorta for an aneurysm of the groin area an easily feasible and safe intervention?”, which completely changed the idea of ​​procedures of this kind and refuted a number of statements by eminent foreign doctors.

Pirogov did not want to sit in one place - as a result, he managed to work in Dorpat and visit Germany, everywhere improving as a doctor, gaining experience and conducting experiments.

Each discovery and statement of the young physician was scientifically and factually supported by many different experiments and studies. For example, while preparing his work on ligation of the Achilles tendon as a means of orthopedic treatment, he made no less than 80 experiments in this industry! Based on his empirical findings, he was able to come up with an excellent treatment option.

In 1841, Pirogov became the head of the hospital surgery clinic, where he was able to improve his skills and knowledge, and also received a fairly wide field for research. In 1847, the doctor went as a military field surgeon to the Caucasus in the active army. His work there opened a new page in the history of Russian medicine.

Russian anesthesiologist

Literally a year before going to war, the surgeon learned about the use of ether as anesthesia. He closely followed all modern discoveries in the field of health and read such magazines and newspapers as “Northern Bee”, “Friend of Health”, “St. Petersburg Vedomosti”. And it was from them that he learned about the successful demonstration of the use of ether as an anesthesia William Morton.

Initially, the doctor was skeptical and negative towards this kind of pain relief and attempted to find his own option. However, the successful experiment of a foreign colleague forced him to reconsider his views. Pirogov begins research and becomes convinced that all his doubts were unfounded, and ether anesthesia is “a tool that can instantly transform the entire surgery.”

In the field, the doctor began to actively use anesthesia, which significantly improved recovery rates - now patients did not suffer from pain and did not die from shock. The monograph published by the famous surgeon indicated his recommendations for the use of such anesthesia. He believed that it was first necessary to test the patient's "susceptibility" to the drug, because Each body's reaction is individual.

The war in which the doctor took part made it possible to reconsider the principle of providing first aid according to the degree of urgency. “I was the first to introduce triage of the wounded at the Sevastopol dressing stations and thereby destroyed the chaos that reigned there,” the surgeon himself wrote. According to his opinion, it was necessary to divide the soldiers arriving from the front line according to the degree of urgency of providing medical care: the most severe ones forward, those with minor wounds - to wait. In addition, it was at his instigation that sisters of mercy appeared in Russia - they helped nurse the sick, did the necessary dressings and washings.

Pirogov triangle

Nikolai Pirogov is responsible for many medical discoveries. A number of anatomical formations are named after him - Pirogov’s triangle, Pirogov’s ring, etc. Some operations are also named in his honor.

In addition, the outstanding Russian doctor created a new section of anatomy - topographical study of organs. Previously, it was almost impossible to study the location of organs inside using dummies and created models. Anatomical autopsies also did not provide a complete picture. Pirogov proposed a series of experiments that allowed him to significantly correct the overall picture and gave doctors a more complete vision of what is happening inside the human body. The result was a 4-volume book that brought the Russian doctor worldwide fame.

Nikolai Pirogov also took care of the students, believing that there is no better experience than practical one. Therefore, he tried to create such conditions so that every surgical student could participate in various experiments and surgical interventions.

...The name of Nikolai Pirogov is now well known not only to medical students. Pirogov congresses and readings are held in his honor, and even a medical society named after Pirogov was created. Also, many hospitals, several streets, embankments and even an asteroid are named after him.