Who first proposed plaster casts for. When and who invented anesthesia? Koller's research in local anesthesia

18.10.2019 -

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 on a broken arm or leg, after initial examination a traumatologist and an x-ray, they will impose plaster cast. 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 is medical device- 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 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 conceal preparations for an attack. The country was not ready in the general, economic and social sense. Lacked modern weapons, modern fleet, railways(and it turned out to be critical!) leading to the theater of operations…

And also in Russian army not enough doctors. 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 are the shortcomings of the organization 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 pedantically describing everything that happened to him in the Crimea, Pirogov did not bother to leave to posterity accurate information on this score - 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 stories 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!

The creation and rather widespread use in medical practice of plaster casts for bone fractures is the most important achievement of surgery of the past century. It was N.I. Pirogov was the first in the world to create and put into practice a completely different bandage method, which was impregnated with liquid gypsum. However, it is impossible to say that Pirogov did not try to use gypsum before. Most famous scientists: these are Arab doctors, the Dutchman Hendrichs, the Russian surgeons K. Gibental and V. Basova, the Brussels surgeon Seten, the Frenchman Lafargue and others also tried to use a bandage, but it was a plaster solution, which in some cases was mixed with starch and blotting paper.

A striking example of this is the Basov method, which was proposed in 1842. A broken arm or leg of a person was placed in a special box, which was filled with alabaster solution; the box was then attached to the ceiling by means of a block. The patient was practically chained to his bed. In 1851, the Dutch physician Mathyssen began using a plaster cast. This scientist rubbed dry plaster on strips of material, wrapped them around the patient's leg, and then moistened with liquid.

To get the desired effect, Pirogov tried to use any raw material for dressing - starch, colloidin and even gutta-percha. However, each of these materials has its drawbacks. N.I. Pirogov decided to create his own plaster bandage, which is used in almost the same form today. The well-known surgeon was able to realize that gypsum is the best material after visiting the workshop of the sculptor N.A. Stepanova. There he first saw the effect of a plaster solution on a canvas. He immediately guessed that it could be used in surgery, and immediately applied bandages and strips of canvas, which were wetted with this solution, on a rather complex fracture of the lower leg. He had a wonderful effect before his eyes. The bandage dried up instantly: the oblique fracture, which also had a strong bloody smudge, healed even without suppuration. Then the scientist realized that this bandage could be widely used in military field practice.

First use of a plaster cast.

For the first time, Pirogov used a plaster cast in 1852 in a military hospital. Let's take a closer look at those times when a scientist under flying bullets tried to find a way to save the limbs of most of the wounded. During the first expedition to clear the Salt area from the invasion of enemies, a second one followed, also successful. At this time, there were quite terrible hand-to-hand fights. During the hostilities, bayonets, sabers and daggers were used. The positions of the army managed to hold high price. On the battlefield there were approximately three hundred killed and wounded soldiers of our troops, as well as officers.

Pirogov has already begun suffering in battle. He had to work for about twelve hours a day, while he even forgot to eat something. Ether anesthesia by the surgeon was widely used in combat situations. In the same period, the brilliant scientist managed to make another amazing discovery. In order to treat bone fractures, instead of lime bast, he began to use a fixed bandage made of starch. Pieces of canvas soaked in starch were applied layer after layer to a broken leg or arm. The starch began to solidify, and in a stationary state, the bone began to grow together over time. There was a fairly strong callus at the fracture site. Under the whistle of numerous bullets that flew over the tents of the infirmary, Nikolai Ivanovich realized what great benefit can be brought to the soldiers by a medical scientist.

And already at the beginning of 1854, the scientist Pirogov began to understand that it was quite possible to replace the rather convenient starch dressing with plaster. Gypsum, which is calcium sulphate, is a very fine powder that is extremely hygroscopic. If it is mixed with water in the required proportions, then it begins to harden in about 5-10 minutes. Prior to this scientist, gypsum began to be used by architects, builders, and also sculptors. In medicine, Pirogov widely used a plaster cast to fix and consolidate an injured limb.

Quite widely, plaster bandages began to be used during transportation and in the treatment of patients who had injured limbs. Not without a sense of pride for his nation, N.I. Pirogov recalls that "the benefit of anesthesia and this bandage in military field practice was investigated by our nation earlier than other nations." The rather wide application of the method of bone immobilization invented by him made it possible to carry out, as the creator himself claimed, "savings treatment." Even with fairly extensive damage to the bones, do not amputate the limbs, but save them. Competent treatment various fractures during the war was the key to saving the limbs and life of the patient.

Plaster cast today.

Based on the results of numerous observations, the plaster bandage has high therapeutic characteristics. Gypsum is a kind of protection of the wound from further contamination and infection, contributes to the destruction of microbes in it, and also allows air to penetrate to the wound. And the most important thing is that the necessary rest is created for broken limbs - an arm or a leg. A patient in a cast quite calmly endures even long-term transportation.

To date, a plaster cast is used both in traumatology and in surgical clinics in all parts of the world. Scientists today are trying to create different kinds such dressings, improve the composition of its components, devices that are designed for applying and removing plasters. Essentially, originally created by Pirogov, the method has not changed. The plaster cast has passed one of the most severe tests - it is the test of time.

So, today we have Saturday, April 1, 2017, and again in the studio with Dmitry Dibrov, star guests. The questions are the easiest at first, but with each task they become more difficult, and the amount of winnings grows, so let's play together, don't miss it. And we have a question - Which doctor was the first in the history of Russian medicine to use plaster?

A. Subbotin
B. Pirogov
C. Botkin
D. Sklifosovsky

The correct answer is B - PIROGOV

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

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Pirogov's plaster bandage is a time-tested method. The creation and rather widespread use in medical practice of plaster casts for bone fractures is the most important achievement of surgery of the past century. It was N.I. Pirogov was the first in the world to create and put into practice a completely different bandage method, which was impregnated with liquid gypsum. However, it is impossible to say that Pirogov did not try to use gypsum before. Most famous scientists: these are Arab doctors, the Dutchman Hendrichs, the Russian surgeons K. Gibental and V. Basova, the Brussels surgeon Seten, the Frenchman Lafargue and others also tried to use a bandage, but it was a plaster solution, which in some cases was mixed with starch and blotting paper.

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Background of the question

The thing is, I had a pretty decent hook when I was young. And the blow sometimes led to damage to his own hand. So in one of the troubles, I earned an impacted fracture of the right radius. In general, that's when I ran into a plaster cast.

To be honest, I don’t remember how long I carried this cast. But, nevertheless, I remember all the operations with the application of gypsum, as now. I did not just stop at the process of applying a plaster cast. The fact is that gypsum was applied for fractures even before Pirogov.

And now the answer

So, of all the surnames listed, Pirogov is the right one. But before him, the Russian doctor Basov used gypsum to fix broken limbs, but only in boxes. But in bandages convenient for transportation - this, of course, was the first Pirogov, and this was in 1852. And here is Pirogov himself.

And here are the first plaster bandages.

They put such a bandage on me. So what exactly is Pirogov's version, ...

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In our time, the merit of a scientist is measured in Nobel Prizes. Nikolai Ivanovich Pirogov passed away before its foundation. Otherwise, he would undoubtedly have become the record holder for the number of these awards. The famous surgeon was a pioneer in the use of anesthesia during operations. He came up with the idea to apply plaster for fractures; before that, doctors used a wooden splint. IN military history Pirogov entered as the founder of military field surgery. And as a teacher, Nikolai Ivanovich is known for having achieved the abolition of corporal punishment in Russian schools (this happened in 1864). But that's not all! Pirogov's most original invention is the Institute of Sisters of Mercy. It was thanks to him that the sick and wounded received the most healing medicine - female attention and care, and beautiful ladies found a launching pad for the triumphal procession of emancipation around the world.

How did such a nugget come about? As a result of a combination of what factors, such a versatile person was formed?

Future...

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Pirogov Nikolai Ivanovich (1810-1881) - Russian surgeon and anatomist, teacher, public figure, founder of military field surgery and anatomical and experimental direction in surgery, corresponding member of the St. Petersburg Academy of Sciences (1846).

The future great doctor was born on November 27, 1810 in Moscow. His father served as treasurer. In 1824 he graduated with honors from the boarding school of V.S. Kryazhev and became a student medical department Moscow University. A well-known Moscow doctor, professor of Moscow University Mukhin E. noticed the boy's abilities and began to work with him individually. After graduating from the university, N. Pirogov studied at a professorial institute in Derpt, defended his doctoral dissertation in 1832. He chose ligation of the abdominal aorta, which had been performed only once by the English surgeon Astley Cooper, as the subject of his dissertation. When Pirogov, after five years in Dorpat, went to Berlin to study, famous surgeons read his dissertation, hastily translated into ...

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The 19th century is considered to be the beginning new era in the development of surgery. This was largely facilitated by two outstanding discoveries: methods of anesthesia, asepsis and antisepsis. In a very short period of time, surgery has achieved such successes that it has not known in the entire previous centuries-old history.

The invention and widespread introduction into medical practice of a plaster cast for bone fractures is also one of the most important achievements of surgery in the last century. And we have the right to be proud that it is associated with the name of the brilliant Russian scientist N.I. Pirogov. It was he who was the first in the world to develop and put into practice a fundamentally new method of dressing impregnated with liquid plaster.

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 and other components to it. Gypsum, hardening poorly, did not create complete immobility of the bones, the care of the patient and especially its transportation became more complicated.

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 plaster, wrapped them around the injured limb, and only then wetted them with water using a sponge. However, this bandage was not strong enough, because while it was being applied, the dry cast fell off easily. And the main thing - reliable fixation of fragments could not be achieved.

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 most 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 plaster 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 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 ... I was convinced that this bandage could be of great use in field practice, and therefore I published a description of my method.

The scientist, surgeon and organizer Nikolai Ivanovich Pirogov glorified our Motherland with many outstanding discoveries that received worldwide recognition. He is rightly considered the father of Russian surgery, the founder of military field surgery.

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 immobilization of bones 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 the "traumatic epidemic", was the key not only to the preservation of the limb, but sometimes the life of the wounded.

A plaster bandage, as long-term observations show, has high medicinal properties. Gypsum protects the wound from further contamination and infection, promotes the death of microbes in it, and does not prevent air from penetrating. And most importantly, it creates sufficient rest for the injured arm or leg. And the victim calmly endures even long-term transportation.

Today, the plaster cast is used in surgical and trauma clinics around the world. Its types are becoming more diverse, the composition of its components, tools for applying and removing plaster are being improved. The essence of the method has not changed, having passed the most severe test - the test of time.