He used ether anesthesia on the battlefield for the first time. Inventions of Russians who “went” to the West

#Pirogov #medicine #surgery

In Moscow, one of the main medical institutes bears the name of the great Russian surgeon Nikolai Pirogov. Every year on his birthday, a prize and medal are awarded in his name for achievements in the field of anatomy and surgery. In the house where Pirogov lived, a museum of the history of medicine has been opened.

On the occasion of the birthday of the outstanding anatomist and teacher, the editors of the Russian Education portal remembered why Pirogov owed such fame.

Nikolai Pirogov, with his dedicated and often disinterested work, turned surgery into a science, equipping doctors with a scientifically based method of surgical intervention. But first things first.

The beginning of the way

Nikolai Pirogov was born on November 25, 1810 in Moscow and was the youngest in a family of 6 children. The boy’s abilities were noticed by a doctor, professor at Moscow University Efrem Mukhin, and began to work with him individually.

Already at the age of 14 he entered the Faculty of Medicine Moscow University and was one of the first there in terms of academic performance. Then he went to Yuryev University in Tartu, where he worked in a surgical clinic for five years, brilliantly defended his doctoral dissertation and at the age of 26 became a professor of surgery.

He wrote his dissertation on the topic of ligation of the abdominal aorta. Before him, it was performed only once by the English surgeon Astley Cooper.

Pirogov studied in Berlin and then worked in Riga. He started with rhinoplasty. In Riga, he operated for the first time as a teacher.

Surgical anatomy

One of the most significant works of Nikolai Pirogov is “Surgical anatomy of arterial trunks and fascia” completed in Dorpat. Already in the title itself, gigantic layers are raised - surgical anatomy, a science that Pirogov created from his first, youthful labors.

Everything that the great surgeon discovered was not necessary for him in itself, but to indicate the best ways operations, first of all, “to find the right way to ligate this or that artery,” as he said. This is where the new science created by Pirogov begins - this is surgical anatomy.

A surgeon, as Pirogov explained, must deal with anatomy differently from an anatomist. Reflecting on the structure of the human body, the surgeon cannot for a moment lose sight of what the anatomist does not even think about - landmarks that will show him the way during the operation. Nikolai Pirogov provided a description of the operations with drawings of incredible accuracy.

In 1841, Pirogov was invited to the department of surgery at the Medical-Surgical Academy of St. Petersburg. Here the scientist worked for more than ten years and created the first surgical clinic in Russia. In it, he founded another branch of medicine - hospital surgery.

Nikolai Pirogov was appointed director of the Tool Plant, and he agreed. Now he came up with tools that any surgeon would use to perform the operation well and quickly.

Ether anesthesia

On October 16, 1846, the first test of ether anesthesia took place. And he quickly began to conquer the world. In Russia, the first operation under anesthesia was performed on February 7, 1847 by Pirogov’s friend at the professorial institute, Fyodor Inozemtsev. He headed the Department of Surgery at Moscow University.

Pirogov himself performed the operation using anesthesia a week later. Over the course of a year, 690 operations were performed under anesthesia in 13 cities of Russia, 300 of which were performed by Pirogov!

Soon he took part in military operations in the Caucasus. Here, for the first time in the history of medicine, he began to operate on the wounded with ether anesthesia. In total, the great surgeon performed about 10,000 operations under ether anesthesia.

The surgeon gave birth to a new medical discipline - topographic anatomy. Pirogov compiled the first anatomical atlas, which became an indispensable guide for surgeons.

Military field medicine and plaster

In 1853, the Crimean War began. Pirogov went to Sevastopol, where he operated on the wounded and used a plaster cast for the first time in the history of medicine. This innovation made it possible to speed up the healing process of fractures and saved the soldiers from curvature of their limbs.

One of Pirogov’s most important merits is the triage of the wounded: some underwent surgery directly in combat conditions, others were evacuated to the interior of the country after first aid was provided. On his initiative, sisters of mercy appeared in the Russian army. Pirogov laid the foundations of military field medicine.

After Sevastopol, the surgeon fell out of favor with Alexander II. For some time, Nikolai Pirogov settled on his estate “Vishnya” near Vinnitsa, where he organized a free hospital. He traveled from there only abroad, and also at the invitation of St. Petersburg University to give lectures. By this time he was already a member of several foreign academies.

In May 1881, the fiftieth anniversary was solemnly celebrated in Moscow and St. Petersburg scientific activity Pirogov. At this time, the scientist was already terminally ill, and in the summer of 1881 he died on his estate.

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 the introduction by me plaster cast into field surgery, mainly contributed to the spread of savings 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.

Getting rid of pain has been the dream of mankind since time immemorial. Attempts to stop the suffering of the patient were used in the ancient world. However, the methods by which the healers of those times tried to relieve pain were, by modern standards, absolutely wild and themselves caused pain to the patient. Stunning with a blow to the head with a heavy object, tight constriction of the limbs, squeezing of the carotid artery until complete loss of consciousness, bloodletting to the point of brain anemia and deep fainting - these absolutely brutal methods were actively used in order to lose pain sensitivity in the patient.

There were, however, other ways. Also in Ancient Egypt, Greece, Rome, India and China used decoctions of poisonous herbs (belladonna, henbane) and other drugs (alcohol until unconsciousness, opium) as painkillers. In any case, such “gentle” painless methods brought harm to the patient’s body, in addition to a semblance of pain relief.

History stores data on amputations of limbs in the cold, which were carried out by Napoleon's army surgeon Larrey. Right on the street, at 20-29 degrees below zero, he operated on the wounded, considering freezing to be sufficient pain relief (in any case, he had no other options anyway). The transition from one wounded person to another was carried out even without first washing hands - at that time no one thought about the obligatory nature of this moment. Larrey probably used the method of Aurelio Saverino, a doctor from Naples, who back in the 16th-17th century, 15 minutes before the start of the operation, rubbed snow on those parts of the patient’s body that were then subjected to intervention.

Of course, none of the listed methods provided the surgeons of those times with absolute and long-term pain relief. The operations had to be carried out incredibly quickly - from one and a half to 3 minutes, since a person can withstand unbearable pain for no longer than 5 minutes, otherwise a painful shock would occur, from which patients most often died. One can imagine that, for example, amputation took place under such conditions by literally cutting off a limb, and what the patient experienced at the same time can hardly be described in words... Such anesthesia did not yet allow performing abdominal operations.

Further inventions of pain relief

The surgery was in dire need of anesthesia. This could give most patients who needed surgery a chance of recovery, and doctors understood this well.

In the 16th century (1540), the famous Paracelsus made the first scientifically based description of diethyl ether as an anesthetic. However, after the death of the doctor, his developments were lost and forgotten for another 200 years.

In 1799, thanks to H. Devi, a variant of pain relief using nitrous oxide (“laughing gas”) was released, which caused euphoria in the patient and gave some analgesic effect. Devi used this technique on himself during the eruption of wisdom teeth. But since he was a chemist and physicist, and not a physician, his idea did not find support among doctors.

In 1841, Long performed the first tooth extraction using ether anesthesia, but did not immediately inform anyone about it. Subsequently, the main reason for his silence was the unsuccessful experience of H. Wells.

In 1845, Dr. Horace Wells, who had adopted Devi's method of pain relief by using laughing gas, decided to conduct a public experiment: extracting a patient's tooth using nitrous oxide. The doctors gathered in the hall were very skeptical, which is understandable: at that time no one completely believed in the absolute painlessness of operations. One of those who came for the experiment decided to become a “test subject,” but due to his cowardice, he began screaming even before the anesthesia was administered. When anesthesia was finally carried out, and the patient seemed to pass out, “laughing gas” spread throughout the room, and the experimental patient woke up from a sharp pain at the moment of tooth extraction. The audience laughed under the influence of the gas, the patient screamed in pain... The overall picture of what was happening was depressing. The experiment was a failure. The doctors present booed Wells, after which he gradually began to lose patients who did not trust the “charlatan” and, unable to bear the shame, committed suicide by inhaling chloroform and opening his femoral vein. But few people know that Wells’s student, Thomas Morton, who was later recognized as the discoverer of ether anesthesia, quietly and imperceptibly left the failed experiment.

T. Morton's contribution to the development of pain management

At that time, Thomas Morton, a prosthodontist, was experiencing difficulties regarding the lack of patients. People, for obvious reasons, were afraid to treat their teeth, much less remove them, preferring to endure rather than undergo a painful dental procedure.

Morton perfected the development of diethyl alcohol as a powerful pain reliever through multiple experiments on animals and his fellow dentists. Using this method, he removed their teeth. When he built an anesthesia machine that was most primitive by modern standards, the decision to conduct public anesthesia became final. Morton invited an experienced surgeon to assist him, assigning himself the role of an anesthesiologist.

On October 16, 1846, Thomas Morton successfully performed a public operation to remove a tumor on the jaw and a tooth under anesthesia. The experiment took place in complete silence, the patient slept peacefully and did not feel anything.

The news of this instantly spread throughout the world, diethyl ether was patented, as a result of which it is officially considered that Thomas Morton was the discoverer of anesthesia.

Less than six months later, in March 1847, the first operations under anesthesia were already performed in Russia.

N. I. Pirogov, his contribution to the development of anesthesiology

The contribution of the great Russian doctor and surgeon to medicine is difficult to describe, it is so great. He also made a significant contribution to the development of anesthesiology.

He combined his developments on general anesthesia in 1847 with data previously obtained as a result of experiments conducted by other doctors. Pirogov described not only the positive aspects of anesthesia, but was also the first to point out its disadvantages: the likelihood of severe complications, the need for precise knowledge in the field of anesthesiology.

It was in the works of Pirogov that the first data appeared on intravenous, rectal, endotracheal and spinal anesthesia, which is also used in modern anesthesiology.

By the way, the first surgeon in Russia to perform an operation under anesthesia was F.I. Inozemtsev, and not Pirogov, as is commonly believed. This happened in Riga on February 7, 1847. The operation using ether anesthesia was successful. But between Pirogov and Inozemtsev there were complex, strained relations, somewhat reminiscent of the rivalry between two specialists. Pirogov, after a successful operation performed by Inozemtsev, very quickly began to operate, using the same method of administering anesthesia. As a result, the number of operations he performed noticeably overlapped those performed by Inozemtsev, and thus Pirogov took the lead in numbers. On this basis, many sources name Pirogov as the first doctor to use anesthesia in Russia.

Development of anesthesiology

With the invention of anesthesia, a need arose for specialists in this field. During the operation, a doctor was needed who was responsible for the dose of anesthesia and monitoring the patient’s condition. The Englishman John Snow, who began his activity in this field in 1847, is officially recognized as the first anesthesiologist.

Over time, communities of anesthesiologists began to appear (the first in 1893). Science has developed rapidly, and purified oxygen has already begun to be used in anesthesiology.

1904 - intravenous anesthesia with hedonal was performed for the first time, which became the first step in the development of non-inhalation anesthesia. It became possible to perform complex abdominal operations.

The development of drugs did not stand still: many drugs for pain relief were created, many of which are still being improved.

In the second half of the 19th century, Claude Bernard and Greene discovered that anesthesia could be improved and intensified by pre-administering morphine to calm the patient and atropine to reduce salivation and prevent heart failure. A little later, antiallergic drugs were used in anesthesia before the operation. This is how premedication began to develop as a medicinal preparation for general anesthesia.

One drug (ether) constantly used for anesthesia no longer satisfied the needs of surgeons, so S.P. Fedorov and N.P. Kravkov proposed a mixed (combined) anesthesia. The use of hedonal turned off the patient's consciousness, chloroform quickly eliminated the phase of the patient's excited state.

Now in anesthesiology, too, a single drug cannot independently make anesthesia safe for the patient’s life. Therefore, modern anesthesia is multicomponent, where each drug performs its own necessary function.

Oddly enough, local anesthesia began to develop much later than the discovery of general anesthesia. In 1880, the idea of local anesthesia was expressed (V.K. Anrep), and in 1881 the first eye surgery was performed: ophthalmologist Keller came up with the idea of performing local anesthesia using the injection of cocaine.

The development of local anesthesia began to gain momentum quite quickly:

1889: infiltration anesthesia;
1892: conduction anesthesia (invented by A.I. Lukashevich together with M. Oberst);
1897: spinal anesthesia.

Of great importance was the still popular method of tight infiltration, the so-called case anesthesia, which was invented by A. I. Vishnevsky. Then this method was often used in military conditions and in emergency situations.

The development of anesthesiology in general does not stand still: new drugs are constantly being developed (for example, fentanyl, anexate, naloxone, etc.), ensuring safety for the patient and a minimum of side effects.

And you say: I slipped and fell. Closed fracture! Lost consciousness, woke up - a cast. (film “The Diamond Arm”)

Since ancient times, various materials have been used to maintain immobility in the fracture area and immobilize damaged bone fragments. The very fact that bones grow together much better if they are immobilized relative to each other was obvious even primitive people. The vast majority of fractures will heal without any need for surgery if the broken bone is properly aligned and immobilized. Obviously, in those ancient times, the standard method of treating fractures was immobilization (limitation of mobility). In those days, at the dawn of history, how could you fix a broken bone? According to extant text from the papyrus of Edwin Smith (1600 BC), hardening bandages were used, probably derived from the bandages used in embalming. Also while excavating tombs of the Fifth Dynasty (2494-2345 BC), Edwin Smith describes two sets of immobilization splints. It was a very long time before the first plaster cast appeared...
Detailed recommendations for the treatment of fractures are given in the “Hippocratic Collection”. The treatises “On Fractures” and “On Joints” provide techniques for realigning joints, eliminating deformities of the limbs during fractures, and, of course, methods of immobilization. Hardening dressings made from a mixture of wax and resin were used (by the way, the method was very popular not only in Greece), as well as splints made of “thick leather and lead.”
Later descriptions of methods for fixing broken limbs, in the 10th century AD. A talented surgeon from the Cordoba Caliphate (the territory of modern Spain) proposed using a mixture of clay, flour and egg white to create a dense fixing bandage. These were materials that, along with starch, were used everywhere until the beginning of the 19th century and technically underwent only minor changes. Another thing is interesting. Why wasn't plaster used for this? The history of the plaster cast, exactly as we know it today, dates back only 150 years. And gypsum was used as a building material back in the 3rd millennium BC. Has no one thought of using gypsum for immobilization in 5 thousand years? The thing is that to create a plaster cast you need not just plaster, but one from which excess moisture has been removed - alabaster. In the Middle Ages, the name “Parisian plaster” was assigned to it.

History of gypsum: from the first sculptures to Parisian plaster

Gypsum as a building material was used 5 thousand years ago, and was used everywhere in works of art and buildings of ancient civilizations. The Egyptians, for example, used it to decorate the tombs of the pharaohs in the pyramids. IN Ancient Greece gypsum was very widely used to create magnificent sculptures. In fact, the Greeks gave this natural material its name. “Gypros” in Greek means “boiling stone” (obviously due to its lightness and porous structure). It also became widespread in the works of the ancient Romans.
Historically, the most famous building material was also used by architects in the rest of Europe. Moreover, making stucco and sculpture is not the only use of gypsum. It was also used for the manufacture of decorative plaster for the treatment of wooden houses in cities. Huge interest in gypsum plaster arose due to a misfortune quite common in those days - fire, namely the Great Fire of London in 1666. Fires were not uncommon then, but then more than 13 thousand wooden buildings burned out. It turned out that those buildings that were covered with gypsum plaster were much more resistant to fire. Therefore, in France they began to actively use gypsum to protect buildings from fires. An important point: in France there is the largest deposit of gypsum stone - Montmartre. That’s why the name “Parisian plaster” stuck.

From plaster of Paris to the first plaster cast

If we talk about hardening materials used in the “pre-gypsum” era, then it is worth remembering the famous Ambroise Paré. The French surgeon impregnated the bandages with a composition based on egg whites, as he writes about in his ten-volume manual on surgery. It was the 16th century and firearms began to be actively used. Immobilizing bandages were used not only to treat fractures, but also to treat gunshot wounds. European surgeons then experimented with dextrin, starch, and wood glue. Napoleon Bonaparte's personal physician, Jean Dominique Larrey, used bandages soaked in a mixture of camphor alcohol, lead acetate and egg white. The method was not widespread due to its labor intensity.
But who was the first to think of using a plaster cast, that is, fabric impregnated with plaster, is unclear. Apparently, it was the Dutch doctor Antony Matthiessen who used it in 1851. He tried rubbing the dressing material with gypsum powder, which, after application, was moistened with a sponge and water. Moreover, at a meeting of the Belgian Society of Medical Sciences, it was sharply criticized: the surgeons did not like that the plaster stained the doctor’s clothes and quickly hardened. Matthiessen's headbands consisted of strips of coarse cotton fabric coated with a thin layer of Parisian plaster. This method of preparing a plaster cast was used until 1950.
It is worth saying that long before this there was evidence that gypsum was used for immobilization, but in a slightly different way. The leg was placed in a box filled with alabaster - a “dressing shell”. When the plaster set, the limb ended up with such a heavy blank. The downside was that it severely limited the patient's mobility. The next breakthrough in immobilization, as usual, was the war. In war, everything must be fast, practical and convenient for mass use. Who will deal with boxes of alabaster in war? It was our compatriot, Nikolai Ivanovich Pirogov, who first used a plaster cast in 1852 in one of the military hospitals.

The first ever use of a plaster cast

But why plaster? Gypsum is one of the most common minerals in earth's crust. It is calcium sulfate bound to two water molecules (CaSO4*2H2O). When heated to 100-180 degrees, gypsum begins to lose water. Depending on the temperature, you get either alabaster (120-180 degrees Celsius). This is the same Parisian plaster. At a temperature of 95-100 degrees, low-firing gypsum is obtained, called high-strength gypsum. The latter is precisely more preferable for sculptural compositions.

He was the first to use the familiar plaster cast. He, like other doctors, tried to use different materials to create a tight bandage: starch, colloidin (a mixture of birch tar, salicylic acid and colloid), gutta-percha (a polymer very similar to rubber). All of these products had a big disadvantage - they dried very slowly. Blood and pus soaked the bandage and it often broke. The method proposed by Matthiessen was also not perfect. Due to uneven saturation of the fabric with plaster, the bandage crumbled and was fragile.

Even in ancient times, there were attempts to use cement for immobilization, but the disadvantage was also the long curing time. Try sitting motionless for a whole day with a broken leg...

As N.I. wrote Pirogov in his “Sevastopol Letters and Memoirs” he saw the effect of gypsum on canvas in the studio of the famous sculptor of those days, N.A. Stepanov. The sculptor used thin strips of linen dipped in a liquid mixture of plaster of Paris to make the models. “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 leg. The success was remarkable. The bandage dried in a few minutes... The complex fracture healed without suppuration or any seizures.”
During the Crimean War, the method of using plaster casts was widely introduced into practice. The method for preparing a plaster cast according to Pirogov looked like this. The damaged limb was wrapped in cloth, and the bony protrusions were additionally covered. A plaster solution was prepared and strips of shirts or underpants were immersed in it (there is no time for fat in war). In general, everything was suitable for bandages.

If you have a plaster solution, you can turn anything into an immobilizing bandage (from the film “Gentlemen of Fortune”)

The plaster mixture was distributed over the tissue and applied along the limb. Then the longitudinal strips were strengthened with transverse strips. The result was a durable structure. After the war, Pirogov improved his method: a piece of fabric corresponding to the size of the damaged limb was cut out from rough canvas in advance and soaked in a plaster solution before use.

Matthiessen’s technique was popular abroad. The fabric was rubbed with dry plaster powder and placed on the patient's limb. The gypsum composition was stored separately in sealed containers. Subsequently, bandages sprinkled with the same composition were produced. But they were wetted after bandaging.

Pros and cons of a plaster cast

What are the advantages of a plaster-based fixation bandage? Convenience and speed of use. The plaster is hypoallergenic (I remember only one case of contact allergy). Very important point: the dressing “breathes” due to the porous structure of the mineral. A microclimate is created. This is a definite bonus, in contrast to modern polymer dressings, which also have a hydrophobic backing. Of the minuses: not always sufficient strength (although a lot depends on the manufacturing technique). Plaster crumbles and is very heavy. And for those who have suffered misfortune and had to contact a traumatologist, the question is often tormented: how to scratch under a cast? However, under a plaster cast it itches more often than under a polymer bandage: it dries out the skin (remember the hygroscopicity of plaster). Various wire devices are used. Anyone who has encountered this will understand. In a plastic bandage, on the contrary, everything “sinks.” The substrate is hydrophobic, that is, it does not absorb water. But what about the main bonus of polymer dressings - the ability to take a shower? Of course, the bandages created on a 3D printer do not have all these disadvantages. But so far such bandages are only in development.

Polymer and 3D printer as a means of immobilization

Will the plaster cast become a thing of the past?

Modern capabilities of a 3D printer in creating fixation bandages

Undoubtedly. But I think that this will not happen very soon. Fast growing modern technologies, new materials will still take their toll. The plaster cast still has a very important advantage. Very low price. And, although new polymer materials are appearing, the immobilizing bandage of which is much lighter and stronger (by the way, it is much more difficult to remove than a regular plaster bandage), fixing bandages of the “external skeleton” type (printed on a 3D printer), the history of the plaster bandage is not over yet.

Palamarchuk Vyacheslav

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The word "anesthesia" comes from a Greek word meaning "numbness", "numbness".

Anesthesia is necessary to block pain signals from the affected organs to the brain. Too powerful a signal can overstimulate one part of the brain, causing the rest to malfunction. As a result, cardiac or respiratory arrest may occur.

Anesthesia traces its history back to pain relief used during surgical operations in Assyria, Egypt, India, China and other countries. 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 the tincture or set on fire, resulting in the formation of vapors that put the sick to sleep. In addition, pain relief was caused by squeezing the vessels of the neck and limbs, releasing a large number of blood, giving the patient wine or alcohol, applying cold.

In the 12th 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 to hit the patient on the head.

At the beginning of the 19th century. English scientist G. Devi accidentally inhaled a large dose of nitrous oxide N 2 O. At the same time, he felt extreme excitement and intoxication, and 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 the amazing substance. Laughing gas had different effects: some jumped on tables and chairs, others talked incessantly, and others got into a fight.

In 1844, the American dentist H. Wells used the narcotic effect of nitrous oxide for pain relief. First, he asked his assistants to pull out his tooth, using this gas as an anesthetic. However, he did not feel any 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 performed abdominal surgery for the first time under full ether anesthesia. During the procedure, complete anesthesia was achieved, muscles were relaxed, and reflexes disappeared. The patient was plunged into deep sleep, losing sensation.

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 care on the battlefield.

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

On July 8, 1847, Pirogov left 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. Along the way, in 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 specifically operate in the presence of other wounded people in order to convince them of the analgesic effect of ethereal vapors. Thanks to the clear example, other wounded people also underwent anesthesia without fear. Arriving at the Samurt detachment, Pirogov performed 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 (in total, 690 of them were performed in Russia from February 1847 to February 1848).

On November 4, 1847, the Scottish doctor J. Simpson performed the first operation under chloroform euthanasia. The first operations under chloroform anesthesia in Russia were performed: December 8, 1847 by Lossievsky in Warsaw, December 9, 1847 by Paul in Moscow, December 27, 1847 in St. Petersburg at the Pirogov clinic.

Pirogov energetically introduced anesthesia into clinical practice. He continuously worked to improve the methods and techniques of anesthesia. Pirogov proposed a rectal method of anesthesia (injection 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. Based on 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 become widespread. However, Pirogov’s idea about the possibility of introducing a narcotic 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. They suggested injecting the sleeping pill hedonal directly into a vein.

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

In 1859, cocaine was discovered, an alkaloid from the leaves of the coca bush. Research has shown that it has pain-relieving properties. In 1884, the Russian doctor V.K. Anrep proposed using cocaine as an anesthetic, and in 1884 the Austrian Keller used cocaine anesthesia during eye surgeries. But unfortunately, with long-term use, cocaine was painfully addictive.

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, they began to develop various ways local anesthesia: infiltration, conduction and spinal anesthesia.

In the first half of the 20th century. Anesthesia, the science of pain relief, has become an independent branch of medicine. She prepares the patient for surgery, administers anesthesia and monitors during operations and in the postoperative period.

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

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

This text is an introductory fragment.