Who first proposed the use of plaster bandages. Pirogov and a plaster cast - passions in the history of medicine — livejournal

18.10.2019 -

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.

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

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

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

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

GYPSUM TECHNOLOGY- a series of sequential manipulations and techniques associated with the use of gypsum in medicinal purposes. The ability of moistened gypsum to take the given shape during hardening is used in surgery, traumatology and dentistry for fixation and immobilization. bone fragments, as well as to obtain models of dentition, jaws and face masks. G. t. is used in the treatment of various diseases and injuries of the limbs and spine. For this purpose, various plaster bandages, corsets and cribs are used.

Story

Treatment of fractures by fixation of fragments with the help of various hardening agents has been carried out for a long time. So, even Arab doctors used clay to treat fractures. in Europe by the middle of the 19th century. hardening mixtures have been used camphor alcohol, lead water and whipped protein (D. Larrey, 1825), starch with gypsum [Lafarque (Lafarque), 1838]; starch, dextrin, wood glue were also used.

One of the first successful attempts to use gypsum for this purpose belongs to the Russian surgeon Karl Gibenthal (1811). He doused the injured limb with a solution of gypsum, first on one side, and then, lifting it up, on the other, and thus received. cast of two halves; then, without taking casts, he attached them to the limb with bandages. Later, Cloquet (J. Cloquet, 1816) suggested placing the limb in a bag of gypsum, which was then moistened with water, and V. A. Basov (1843) in a special box filled with alabaster.

Essentially, all of these methods did not use plaster casts, but plaster molds.

For the first time, dressings made of fabric, previously rubbed with dry plaster, began to be used for the treatment of fractures by the Dutch surgeon Mathysen (A. Mathysen, 1851). After applying a continuous bandage, it was moistened with a sponge. Later, Van de Loo (J. Van de Loo, 1853) improved this method by suggesting that the cloth rubbed with plaster should be moistened with water before bandaging. The Royal Academy of Medicine of Belgium recognized Mathijsen and Van de Loo as the authors of the plaster cast.

However, the invention of a plaster bandage - the prototype of the modern one, its widespread use for the treatment of patients with bone fractures belongs to N.I. Pirogov, who described it in a special brochure and book "Ghirurgische Hospitalklinik" in 1851-1852. The book published by Pirogov “Must-on alabaster gypsum bandage in the treatment of simple and complex fractures and for the transport of the wounded on the battlefield ”(1854) is a work summarizing the previous information about the methodology, indications and technique for using a plaster cast. Pirogov believed that with the Mathijsen method, alabaster impregnates the canvas unevenly, does not hold tightly, easily breaks and crumbles. Pirogov's method was as follows: the limb was wrapped in rags, additional rags were placed on the bone protrusions; dry gypsum was poured into water and a solution was prepared; shirt sleeves, underpants or stockings were folded into 2-4 layers and lowered into solution, then stretched “on the fly”, smeared with hands on both sides of each strip. Stripes (longets) were applied to the injured limb and strengthened with transverse strips, superimposed so that one half covered the other. Thus, Pirogov, who first proposed the imposition of plaster bandages impregnated with liquid plaster, is the creator of both circular and longet plaster bandages. The propagandist and defender of the plaster cast was Professor of Derpt University Yu. K. Shimanovsky, who published in 1857 the monograph military surgery". Adelman and Shimanovsky proposed an unlined plaster cast (1854).

Over time, the technique of making plaster bandages has been improved. In modern conditions, factory-packed plaster bandages of certain sizes are mainly used (length - 3 m, width - 10, 15, 20 cm), less often - such bandages are made by hand.

Indications and contraindications

Indications. A plaster bandage is widely used for peacetime and wartime injuries and in the treatment of various diseases of the musculoskeletal system, when immobilization of the limb, trunk, neck, head is necessary (see Immobilization).

Contraindications: circulatory disorders due to ligation of large vessels, limb gangrene, anaerobic infection; purulent streaks, phlegmon. The imposition of G. p. is also inappropriate for persons old age with severe somatic disorders.

Equipment and tools

Plastering is usually carried out in specially designated rooms (gypsum room, dressing room). They are equipped with special equipment (tables for material preparation and plastering, pelvis, back and leg holders, a frame for hanging the patient when applying a corset bandage with a loop for traction, etc.), tools, basins for wetting bandages. To apply and remove a plaster cast, you must have the following tools (Fig. 1): scissors of various designs - straight, angled, button-shaped; gypsum expanders; forceps for bending the edge of the bandage; saws - semicircular, sheet, round.

Basic rules for applying plaster bandages

The patient is given a position, with Krom free access to the damaged part of the body is easily achieved. Bone protrusions and parts of the body at the edge of the bandage are covered with cotton wool to avoid bedsores. When casting, it is necessary to comply with the requirement for a certain arrangement of personnel: the surgeon holds the limb in the correct position, and the assistant or plaster technician applies a bandage. It is necessary to strictly observe the rules of bandaging. The first tours of the bandage, covering the area intended for gypsum, are not applied tightly, the subsequent ones are more dense; the bandage is led spirally with moderate tension, applying each subsequent move to 1/3-1/2 of the surface of the previous one; the bandage is constantly smoothed to avoid the formation of constrictions, kinks and depressions. To ensure a uniform fit of the bandage to the body, after applying the third layer, modeling of the bandage is started, compressing the bandage according to the contours of the body. The bandage should have a uniform number of plaster layers (6-12), be somewhat thicker in places subject to fracture (in the area of the joint, at fracture sites); as a rule, it should capture two adjacent joints.

After applying a bandage, the limb must be elevated to reduce swelling; for this, metal tires, pillows, a functional bed are used. Beds for patients with hip bandages and corsets should be equipped with shields. A properly applied plaster cast should not cause pain, tingling or numbness; for control, fingers and toes should be left uncasted. Cyanosis and swelling of the fingers indicate a violation venous outflow, their pallor and coldness - about the cessation of arterial circulation, lack of movement - about paresis or paralysis of the nerve. When these symptoms appear, the bandage is urgently cut along the entire length, and the edges are folded to the sides. If blood circulation is restored, the bandage is fixed with a circular plaster bandage, otherwise it must be removed and replaced with a new one. If local pain occurs, more often in the area of \u200b\u200bbone protrusions, a “window” should be made in this place to avoid the formation of bedsores. At long-term use Plaster casts may cause muscle atrophy and limited movement in the joints. In these cases, it is recommended after removing the bandage exercise therapy and massage.

Types of plaster casts

The main types of plaster casts: 1) circular, circular, deaf (unlined and lining); 2) fenestrated; 3) bridge; 4) milestone; 5) open (longet, tire); 6) combined (with twist, articulated); 7) corsets; 8) cribs.

A circular bandage (Fig. 2) is a deaf plaster bandage applied directly to the body (unlined) or to the body, previously covered with cotton-gauze bandages or knitted stockings (lining). Lining plaster bandage is used after orthopedic operations and for patients with diseases of the joints (bone tuberculosis).

The fenestrated plaster cast (Fig. 3) is also a circular bandage with a "window" cut over the wound; it is advisable if it is necessary to examine the wound, dressings.

For the same purposes, a bridge bandage is also used (Fig. 4), when it is necessary to leave at least 2/3 of the circumference of the limb open in any area. It consists of two sleeves fastened together by one or more plastered "bridges".

A staged plaster cast is used to eliminate contractures and deformities. A circular bandage is applied with a slight possible elimination of the deformity, and after 7-10 days it is cut into 1/2 circles in the deformity area and the position of the limb is corrected again; a wooden or cork spacer is inserted into the resulting space and the correction achieved is fixed with a circular plaster bandage. The next stage plaster casts are made in 7-10 days.

An open splint cast (Fig. 5) is usually applied to the posterior surface of the limb. It can be made according to a previously taken measurement from plaster bandages or splints, or rolled out bandages directly on the patient's body. You can turn a circular bandage into a splint plaster bandage by cutting out 1/3 of its front part.

A plaster bandage with a twist is used to eliminate persistent contractures. It consists of two sleeves connected by rope loops. By rotating the twist wand, they stretch the cord and bring together the points of its attachment.

A hinged plaster cast is used to treat bone fractures, if necessary, to combine the fixation of the damaged area with partial preservation of the function of the nearby joint. It consists of two sleeves interconnected by metal tires with hinges. The axis of the hinge must coincide with the axis of the joint.

Corset is a circular plaster bandage applied to the trunk and pelvic girdle in diseases of the spine. A special type of removable plaster cast used to immobilize the spine is a plaster bed.

The method of applying plaster bandages

Plaster bandages on the pelvic girdle and thigh. Unlined longet-circular Whitman-Turner hip bandage is used for a fracture of the femoral neck. Produce traction along the length, the leg is retracted outward and rotated inward. Wide splints are placed around the body at the level of the nipples and at the level of the navel, the other two are placed on the pelvis and thigh, and the bandage is fixed on the body and in the area of the hip joint with a plaster bandage, followed by plastering of the entire limb. A few days later, a stirrup is put in plaster for walking (Fig. 6). Due to the successful results surgical treatment this type of injury, the Whitman-Turner bandage is used extremely rarely.

The hip circular plaster bandage is applied after orthopedic operations on hip joint and fracture of the diaphysis of the femur. It can be with a corset (semi-corset), belt, with or without a foot; the level of overlap depends on the nature of the disease and injury. A padded hip bandage with an additional “trouser leg” on the other leg and a wooden spacer (Fig. 7) is indicated after hip surgery, for example, after open reduction of a congenital hip dislocation. Plaster bandage of Lorentz (Fig. 8) is applied after bloodless reduction of congenital dislocation of the hips. Hip dressings are applied on a Holi-type orthopedic table (Fig. 9).

Plaster casts on the lower limb. For diseases knee joint(tuberculosis, infectious arthritis, osteomyelitis, arthropathy) and in some cases of damage to the knee joint and bones of the lower leg, as well as after orthopedic operations on the lower leg (bone grafting, osteotomy, muscle tendon transplantation) are applied different kind plaster casts depending on the nature, location and extent of the disease and damage. They can be up to the ischial fold, up to the upper third of the thigh, with and without a foot, circular and splint.

At various diseases and fractures of the bones of the foot and ankle joint, various types of plaster bandages are used, applied up to the knee joint. 1. Plaster boot - a circular plaster cast with an additional splint in 5-6 layers on the sole (Fig. 10). In the treatment of congenital clubfoot, when a boot is applied, the bandage should go from the fifth finger through the rear of the foot to the first finger and then to the sole. By tightening the bandage, the deformation is reduced. With valgus deformity of the foot, a boot is also applied, but the bandage is carried out in the opposite direction. 2. Splint bandage of various depths. When applying her patient, it is more convenient to lay on the stomach, bend the knee at a right angle; the doctor holds the foot in the desired position. 3. Longet bandage: measure the lower leg (from the internal condyle of the tibia along inside through the calcaneal region of the sole and further along the outer side of the lower leg to the head of the fibula) and roll out on the table a splint of appropriate sizes in 4-6 layers; another longuet, equal to the length feet attached to it. The plaster cast is applied from the outside through the foot, then along the inner surface. To avoid swelling, the splint is fixed with a soft bandage, and after 8-10 days with a t-gypsum bandage, while you can put a heel or a stirrup for walking.

Plaster cast on the upper limb. The imposition of plaster casts on the upper limb due to anatomical and topographic features is associated with a greater possibility of compression of blood vessels and nerves compared to the lower limb. Therefore fixation upper limb in most cases, it is carried out with a plaster splint. Its size is different. So, for example, after repositioning the dislocation of the shoulder, a rear dorsal plaster splint is applied (from a healthy scapula to the metacarpophalangeal joint of the diseased arm).

Plaster bandage for dislocation of the acromial end of the clavicle - a shoulder strap, consisting of an annular plaster belt, by means of which the forearm with the elbow joint bent at a right angle, is fixed along the anterior and anterior-lateral surface of the chest, and a half ring thrown over the damaged shoulder girdle in the form of a shoulder strap attached to a plaster belt in a state of tension (Fig. 11).

After surgery for shoulder joint and in some cases, after a fracture of the diaphysis of the humerus, a thoracobrachial plaster bandage is applied, consisting of a corset, a plaster bandage on the arm and a wooden spacer between them (Fig. 12).

Immobilization of the elbow joint after open reduction of intra- and periarticular fractures, after operations on tendons, vessels and nerves, is carried out with a posterior plaster splint (from the metacarpophalangeal joint to the upper third of the shoulder). In case of fracture of both bones of the forearm, two splints can be used: the first is applied to the extensor surface from the metacarpophalangeal joint to the upper third of the shoulder, the second - along the flexor surface from the middle of the palm to the elbow joint. After reposition of the fracture of the bones of the forearm in a typical place, a deep dorsal gypsum splint is applied (from the metacarpophalangeal joint to the upper third of the forearm) and narrow - along the palmar surface. Children are recommended to use only splint plaster bandages, because circular ones often lead to ischemic contractures. Adults sometimes have to apply circular plaster casts. In this case, as a rule, bend the arm in elbow joint at a right angle and set the forearm in a position intermediate between pronation and supination; according to indications, the angle in the elbow joint can be acute or obtuse. The bandages are rolled out circularly, starting from the hand, and lead in the proximal direction; on the hand, the bandage should pass through the first interdigital space, with the first finger remaining free. The hand is set in the position of slight extension - 160° and ulnar deviation - 170° (Fig. 13). A circular plaster bandage from the metacarpophalangeal joint to the upper third of the forearm is indicated for fractures of the bones of the hand.

Plaster bandages for the treatment of diseases of the spine. To unload and fix the spine in case of its fractures, inflammatory and degenerative lesions, congenital defects and curvature, various plaster corsets are applied, which differ from each other depending on the area of the lesion, stage and nature of the disease. So, with damage to the lower cervical and thoracic vertebrae up to the level of Th 10, a corset with a head holder is shown; in case of damage to Th 10-12 - a corset with shoulders, fix if necessary lumbar- corset without shoulders (Fig. 14). The corset is applied with the patient standing in a wooden frame or on the Engelmann apparatus (Fig. 15). Traction behind the head is carried out with a Glisson loop or gauze strips until the patient can touch the floor with his heels, the pelvis is fixed with a belt. The corset can also be applied when the patient is lying down (more often after surgical interventions) on the orthopedic table. In case of compression fractures of the lower thoracic and lumbar vertebrae with simultaneous reduction, the corset is applied between two tables that have different heights; in staged reclination according to Kaplan, a plaster corset is applied in the position of suspension by the lower back.

To apply a corset, wide plaster bandages are used, which are carried out mainly in circular or spiral passages. Tight coverage of bone points of support (scallops of the iliac bones, pubic area, costal arches, occiput) contributes to unloading the severity of the corset. To do this, modeling begins after the first round of bandaging. Headrest - a circular plaster bandage covering the chin, neck, back of the head, shoulder girdle and upper part chest, indicated for lesions of the upper three cervical vertebrae. After surgery for congenital muscular torticollis, a plaster cast is applied with a certain setting: tilting the head to the healthy side, turning the face and chin to the diseased side (Fig. 16).

For scoliosis, various corsets were used. Sayre's corset, applied in an extended position, eliminates the deformity only temporarily. The removable Goffa detorsion corset aims to correct both the lateral displacement of the body and the rotation of the body relative to the pelvis with an elongated spine. In connection with the application surgical intervention Sayre and Goffa corsets are rarely used.

Abbott (E. G, Abbott), who recommended applying a very tight corset that compresses chest. After the plaster had hardened, a “window” was cut out on the back of the concave side of the curvature; with each breath, the ribs of the compressed convex side pushed the spine to the concave side, i.e., towards the cut out “window”, which provided a slow correction. The Abbott corset is sometimes used as one of the stages in the correction of spinal deformity.

Risser's corset (Fig. 17) consists of two halves connected by a hinge; the upper half is a short corset with a collar, the lower half is a wide belt with a trouser leg on the thigh from the side of the bulge of the curvature; between the walls of the corset along the concave side of the curvature, a screw device such as a jack is strengthened, with the help of which the patient is gradually tilted towards the convexity of the curvature, thereby correcting the main curvature. The Risser brace is used for preoperative deformity correction.

A plaster bed is used for diseases and injuries of the spine; it is designed for long periods. An example is Lorenz's bed (Fig. 18): the patient is placed on his stomach, his legs are stretched out and slightly parted, his back is covered with a piece of gauze; bandages are rolled out on the patient and well modeled; splints or gauze layers soaked in gypsum slurry can be used. After manufacturing, the bed is removed, cut, dried for several days, after which the patient can use it.

Plaster technique in dentistry

Gypsum in dentistry is used for taking casts (impressions), obtaining models of the dentition and jaws (Fig. 19-20), as well as face masks. It is used to make rigid headbands (gypsum helmets) that fix equipment for extraoral traction during orthodontic treatment, in case of jaw trauma and splinting devices. AT therapeutic dentistry plaster can be used as temporary fillings. In addition, gypsum is part of some masses for casting and soldering dentures, as well as a molding material for the polymerization of plastic in the manufacture of removable and non-removable dentures.

Removal of casts from the dentition and jaws begins with the selection of a standard spoon in the presence of teeth or the manufacture of an individual spoon for a toothless jaw. 100 ml of water is poured into a rubber cup and 3-4 g of sodium chloride are added to accelerate the hardening of gypsum, then gypsum is poured into the water in small portions so that the gypsum hill is above the water level; excess water is drained and the gypsum is stirred to the consistency of thick sour cream. The resulting mass is placed in a spoon, injected into the mouth and pressed on the spoon so that the plaster mass covers the entire prosthetic field. The edges of the cast are processed in such a way that their thickness does not exceed 3-4 mm; excess plaster is removed. After the gypsum has hardened (which is determined by the fragility of the gypsum residues in the rubber cup), the cast in the mouth is cut into separate fragments. Incisions are made from the vestibular surface: vertical along the existing teeth and horizontal - on the chewing surface in the area of the dentition defect. Plaster fragments are removed from the oral cavity, cleaned of crumbs, placed in a spoon and glued in a spoon with hot wax. To cast the model, the spoon with the impression is placed for 10 minutes. into water so that the impression is better separated from the model, after which liquid gypsum is poured into it, and after hardening, the model is opened by separating the impression gypsum from the model.

Removing a plaster cast from edentulous jaws is extremely rare. Gypsum in these cases is replaced by more advanced impression materials - silicone and thermoplastic masses (see Impression materials).

When removing the mask, the patient is given horizontal position. The face, especially its hairy areas, is lubricated with vaseline oil; rubber or paper tubes are inserted into the nasal passages for breathing, the borders of the cast on the face are covered with cotton rolls. The entire face is covered with an even layer of gypsum approx. 10 mm. After the plaster has hardened, the cast can be easily removed. The mask is cast after the cast has been placed for 10 minutes. in water. To cast the mask, liquid gypsum is required; in order to avoid the formation of air bubbles, it must be evenly distributed over the surface of the cast and shaken frequently by hand or with a vibrator. The hardened model with the impression is placed in boiling water for 5 minutes, after which the impression plaster is chipped off the model with a plaster knife.

For the manufacture of a rigid plaster head bandage, a scarf of several layers of gauze or nylon is applied to the patient's head, and a plaster bandage is applied around the head, metal rods are placed between the layers to fix the equipment. The plaster bandage should capture the frontal and occipital tubercles. A nylon or gauze handkerchief makes it easy to remove and put on a plaster cast, which improves the gig. conditions for tissues under a rigid plaster cast.

Plaster technique in military field surgery

Gypsum equipment in military field surgery (VPH) is used to lay down. and transport and to lay down. immobilization. The priority of introducing a plaster cast into the arsenal of means of the VPH belongs to N. I. Pirogov. The effectiveness and advantage of plaster casts in comparison with other means of immobilization in the war were proved by him during the Crimean campaign (1854-1856) and in the theater of operations in Bulgaria (1877-1878). As E. I. Smirnov pointed out, the widespread use of plaster bandages for the treatment of the wounded in military field conditions ensured the progress of the domestic military-industrial complex and played a great role in the future, especially during the Great Patriotic War. In combat conditions, plaster bandages provide reliable transport immobilization of the injured limb, facilitate and improve the care of the wounded, create opportunities for further evacuation of most of the victims in the coming days after surgical treatment; the hygroscopicity of the dressing contributes to a good outflow of the wound discharge and creates favorable conditions for wound cleansing and repair processes. However, when using plaster casts, secondary displacement of fragments and the formation of contractures and muscle atrophy are possible.

In military field conditions, longet, circular and longet-circular plaster bandages are used. Indications: to lay down. immobilization for open gunshot and closed fractures of the bones of the limb, damage to the main vessels and nerves, as well as for extensive damage to soft tissues, superficial burns, frostbite of the limbs. The imposition of a blind plaster bandage is contraindicated in case of developing anaerobic infection (or suspicion of it), insufficiently carefully performed surgical treatment of the wound, in early dates after operations on the main vessels (due to the possibility of developing gangrene of the limb), in the presence of unopened purulent streaks and phlegmon, extensive frostbite or extensive deep burns of the limb.

The use of plaster casts in the conditions of modern warfare is possible in institutions that provide qualified and specialized assistance.

In SMEs, gypsum technique can be used Ch. arr. in order to strengthen the transport tire for immobilization lower extremities(the imposition of three plaster rings) and the imposition of longet bandages. In exceptional cases, with a favorable medical and tactical situation, blind plaster bandages can be used.

In the working conditions of honey. services of GO plaster bandages can be applied in hospital bases (see).

Equipment: a field orthopedic table, an improved ZUG apparatus (Behler type), plaster in hermetically packed boxes or bags, ready-made non-shedding plaster bandages in cellophane packaging, tools for cutting and removing plaster bandages.

When working in military field conditions, it is necessary to ensure the imposition of a large number of plaster bandages in a short time. For this purpose, in specialized surgical hospitals and profiled surgical hospitals, a plaster room and a room for drying superimposed plaster bandages (room, tent) located near the operating room and dressing room are deployed. The marking of the circular plaster cast facilitates the organization of observation of the wounded and triage during the evacuation stages; it is usually done in a visible spot on a wet dressing. The date of injury, surgical treatment, plaster cast is indicated, and a schematic drawing of bone fragments and wound contours is also applied. During the first days after the application of a plaster cast, monitoring of the condition of the wounded and the limb is required. Changes in normal color, temperature, sensitivity and active mobility of the parts of the limb (fingers) open for inspection indicate certain shortcomings in the technique of applying a plaster cast, which must be immediately eliminated.

Bibliography: Bazilevskaya 3. V. Plaster technique, Saratov, 1948, bibliography; Bom G. S. and Chernavsky V. A. Plaster bandage in orthopedics and traumatology, M., 1966, bibliogr.; Vishnevsky A. A. and Shraiber M. I. Military field surgery, M., 1975; K a p l a n A. V. Closed damage bones and joints, M., 1967, bibliogr.; KutushevF. X. id r. The doctrine of bandages, L., 1974; P e with l I am to I. P. and Drozdov A. S. Fixing dressings in traumatology and orthopedics, Minsk, 1972, bibliogr.; Pirogov N. I. Nalep-naya alabaster bandage in the treatment of simple and complex fractures and for the transport of the wounded on the battlefield, St. Petersburg, 1854; H e h 1 R. Der Gipsverband, Ther. Umsch., Bd 29, S. 428, 1972.

H. A. Gradyushko; A. B. Rusakov (military), V. D. Shorin (stomist).

And you say: slipped, fell. Closed fracture! Lost consciousness, woke up - plaster. (film "Diamond Hand")

Since ancient times, various materials have been used to immobilize damaged bone fragments in order to maintain immobility in the fracture area. The very fact that bones grow together much better if they are immobilized relative to each other was obvious even to primitive people. The vast majority of fractures will heal without any need for surgery if the broken bone is properly aligned and fixed (immobilized). Obviously, in that ancient time, immobilization (limitation of mobility) was the standard method of treating fractures. And how in those days, at the dawn of history, you can fix a broken bone? According to an extant text from the papyrus of Edwin Smith (1600 BC), hardening bandages were used, probably derived from bandages used in embalming. Also in the excavation of the tombs of the Fifth Dynasty (2494-2345 BC), Edwin Smith describes two sets of immobilization splints. Before the advent of the first plaster cast was very far ...
Detailed recommendations for the treatment of fractures are given in the Hippocratic Collection. The treatises “On Fractures” and “On Joints” give the technique of repositioning the joints, eliminating limb deformities in fractures, and, of course, immobilization methods. 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 tires made of "thick leather and lead."
Later descriptions of methods for fixing broken limbs, in the 10th century AD A talented surgeon from the Caliphate of Cordoba (the territory of modern Spain) suggested using a mixture of clay, flour and egg white to create a tight 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 was plaster not used for this? The history of the plaster cast as we know it today is only 150 years old. And gypsum as a building material was used as early as the 3rd millennium BC. Has no one thought to use plaster for immobilization for 5 thousand years? The thing is that to create a plaster cast, you need not just gypsum, but one from which excess moisture has been removed - alabaster. In the Middle Ages, the name "Parisian plaster" was assigned to it.

History of plaster: 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, buildings of ancient civilizations. The Egyptians, for example, used it to decorate the tombs of the pharaohs in the pyramids. AT Ancient Greece plaster was widely used to create magnificent sculptures. In fact, the Greeks gave the name to this natural material. “Gypros” in Greek means “boiling stone” (obviously, due to its lightness and porous structure). It was also widely used in the works of the ancient Romans.
Historically, the most famous building material was used by the architects of the rest of Europe. Moreover, the manufacture of stucco and sculpture is not the only use of gypsum. It was also used for the manufacture of decorative plaster for processing wooden houses in cities. A huge interest in gypsum plaster arose because of the misfortune that was 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. Therefore, the name "Paris plaster" was fixed.

From Parisian plaster 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 Pare. The French surgeon impregnated the bandages with an egg white composition, as he writes in his ten-volume manual on surgery. It was the 16th century and firearms began to be actively used. Immobilizing dressings were used not only for the treatment of fractures, but also for the treatment of gunshot wounds,. European surgeons then experimented with dextrin, starch, wood glue. Napoleon Bonaparte's personal physician, Jean Dominique Larrey, used dressings soaked in camphor alcohol, lead acetate and egg white. The method, due to the complexity, was not massive.
But who first guessed to use a plaster cast, that is, a fabric soaked in plaster, is unclear. Apparently, it was a Dutch doctor - Anthony Mathyssen, who applied it in 1851. He tried rubbing the dressing with plaster powder, which, after being applied, was moistened with a sponge and water. Moreover, at a meeting of the Belgian Society of Medical Sciences, he was sharply criticized: the surgeons did not like the fact that the plaster stains the doctor's clothes and quickly hardens. Matissen's dressings were strips of coarse cotton fabric with applied thin layer Parisian plaster. This method of making a plaster cast was used until 1950.
It is worth saying that long before that there is 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 projectile". When the gypsum set, such a heavy blank was obtained on the limb. The downside was that it severely limited the patient's mobility. The next breakthrough in immobilization, as usual, was the war. In war, everything should be fast, practical and convenient for mass use. Who in the war will deal with boxes of alabaster? It was our compatriot, Nikolai Ivanovich Pirogov, who first applied a plaster cast in 1852 in one of the military hospitals.

The first ever use of a plaster cast

But why is it gypsum? Gypsum is one of the most common minerals in the 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, either alabaster (120-180 degrees Celsius) is obtained. This is the same Parisian plaster. At a temperature of 95-100 degrees, low-fired gypsum is obtained, called high-strength gypsum. The latter is just more preferable for sculptural compositions.

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

For immobilization in ancient times, there were attempts to use cement, but it was also a minus long time curing. Try sitting still with a broken leg all day...

As N.I. Pirogov in his "Sevastopol Letters and Memoirs" he saw the action of plaster on canvas at the workshop of the famous sculptor N.A. Stepanov in those days. The sculptor used thin linen strips soaked in a liquid mixture of Parisian plaster to make models. “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 ... The complex fracture healed without suppuration and any seizures.
During the Crimean War, the method of using plaster casts was widely put into practice. The technique for preparing a plaster cast according to Pirogov looked like this. The injured limb was wrapped in a cloth, and the bone protrusions were additionally wrapped around. A gypsum solution was being prepared and strips from shirts or underpants were immersed in it (in war there is no time for fat). In general, everything was suitable for bandages.

In the presence of a plaster solution, you can turn anything into an immobilizing bandage (from the movie "Gentlemen of Fortune")

The gypsum gruel was distributed over the tissue and applied along the limb. Then the longitudinal stripes were reinforced with transverse stripes. It turned out to be a solid construction. Already after the war, Pirogov improved his method: a piece of tissue was cut out of coarse canvas in advance, corresponding to the size of the injured limb and soaked in a plaster solution before use.

Abroad, the Matissen technique was popular. The fabric was rubbed with dry gypsum powder and applied to the patient's limb. The gypsum composition was stored separately in sealed containers. In the future, bandages sprinkled with the same composition were produced. But they wetted them after bandaging.

Pros and cons of a plaster cast

What are the advantages of a gypsum-based fixing bandage? Convenience and speed of application. The gypsum is hypoallergenic (only one case of contact allergy is remembered). A very important point: the bandage "breathes" due to the porous structure of the mineral. A microclimate is created. This is a definite bonus, unlike modern polymer dressings, which also have a hydrophobic substrate. Of the minuses: not always sufficient strength (although a lot depends on the manufacturing technique). Gypsum crumbles and is very heavy. And for those who have been affected by misfortune and had to turn to a traumatologist, the question is often tormented: how to scratch under a cast? Nevertheless, under a plaster cast, it itches more often than under a polymer one: it dries out the skin (recall the hygroscopicity of gypsum). Various devices made of wires are used. Who faced, he will understand. In a bandage made of plastic, on the contrary, everything “fades”. 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, here all these disadvantages are devoid of bandages created on a 3D printer. 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 the creation of fixation dressings

Undoubtedly. But I don't think it will be very soon. Rapidly developing modern technologies, new materials will still take their toll. The plaster bandage still has a very important advantage. Highly low price. And although there are new polymer materials, an immobilizing bandage of which is much lighter and stronger (by the way, it is much more difficult to remove this 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

If you find a typo in the text, please let me know. Highlight a piece of text and click Ctrl+Enter.

Do you know that...

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

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

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

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

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

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

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 her - classic medical office, whose appearance differs only in a low square bath in one of the corners.

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

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

Portrait of Nikolai Pirogov by artist Ilya Repin, 1881.

War as an engine of progress

By the beginning of the Crimean War, Russia was largely unprepared. No, not in the sense that she did not know about the impending attack, like the USSR in June 1941. In those distant times, the habit of saying “I’m going to attack you” was still in use, and intelligence and counterintelligence were not yet so developed as to carefully conceal preparations for an attack. The country was not ready in the general, economic and social sense. There was a lack of a modern, modern fleet, railways (and this 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 2,000 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".

About how widely the plaster cast was used in Sevastopol and, in general, in 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 are repeated incessantly in various sizes,” Pirogov wrote to his wife on April 22, 1855. And according to eyewitnesses, the use of Pirogov's "stuck bandage" made it possible to reduce the number of amputations by several times. It turns out that only on that nightmarish day, about which the surgeon told his wife, gypsum was applied to two or three hundred wounded!

Nikolay Pirogov in Simferopol. The artist is not known.