As mentioned earlier, the main striking factor on the fields of the Patriotic War was firearms. So, in the Battle of Borodino, the proportion of such wounded in hospitals was about 93%, of which from 78% to 84% with bullet wounds, the rest were hit by artillery. It can also be assumed that the wounds from sabers, broadswords and the peak were much more deadly, and the unfortunates simply did not have time to deliver to the dressing points and hospitals. Be that as it may, field doctors had to deal mainly with gunshot wounds. For this purpose, at the tool factory created by Jacob Willie in 1796, military medical kits were made - corps, regimental and battalion kits. The simplest, of course, was the battalion, which included only 9 devices for resection and amputation. The regimental set already contained 24 medical instruments, allowing, among other things, to connect and disconnect tissues. The corps medical kit consisted of 106 (according to other sources, 140) devices, with the help of which it was already possible to operate on severe craniocerebral wounds.
How did the doctor start working with the patient in the military-temporary hospital? First of all, the depth of the bullet wound and the presence of foreign bodies in it were determined. The surgeon, if necessary, removed the splinter or bullet with his fingers, forceps, a spatula, and other suitable devices.
In the historical literature, there are memoirs of an officer of the Russian army, illustrating the everyday life of the hospital:
“They moved the crowd apart, and my escorts introduced me to the doctor, who, with his sleeves rolled up to the elbow, stood at the board, stained with blood … To the doctor's request, where my wound was, I pointed out, and his companions, the paramedic, put me on the board so as not to disturb the wounded legs, swung the leggings and boots with a knife and, exposing my leg, tasted the wound, telling the doctor that my wound was strange: there was only one hole, but the bullets did not feel. I asked the doctor himself to take a closer look and explain to me frankly whether I would stay with my leg or should say goodbye to it. He also tried with a probe and said: "Something touches," and asked permission to test; he stuck his finger into the wound, the pain was unbearable, but I took courage, without showing the slightest weakness. Having searched, the doctor, according to my bone, said that the bullet was pinched in the bones, and it is difficult to remove from there, and it is not easy to endure the operation, “but I assure you with a noble word, the doctor objected that the wound is not dangerous, for the bone is not broken; let me dress your wound myself, and you can go anywhere. " In less than a minute, the wound was bandaged, and the doctor announced to me that he would not touch my wound and bandaging until 3 days.
Bleeding, which was inevitable when injured on the battlefield, was stopped by pulling tourniquets, laying snow or ice ("cooling off"), and also by tamponation, for example, with chewed paper. They could, if necessary, burn with red-hot steel, often the blade of a suitable saber or broadsword played this role. In those days, we were already familiar with the methods of ligation of large bleeding arteries and, if time allowed and an experienced doctor was present, then such a filigree operation was performed using an arterial hook. To wash the wound, red wine or clean cool water was used, to which salt and lime were often added. This was followed by drying and tight dressing of the wound. Sometimes the gaping wounds were sealed with plaster or simply sutured. The soldiers were tied up with improvised materials, and cambric shawls were used for generals and officers. As mentioned earlier, the main danger of wounds, especially gunshot wounds, was the development of "Anton's fire", or anaerobic infection. Fight with this "only through suppuration", which was regularly freed from pus or "excreted." In some cases, small fragments and bullets were not specially removed from shallow wounds, but waited until the foreign body came out along with the pus. They "defecated" the wound, releasing blood from nearby veins, and also dissecting the skin around the wound "lips" with lancets. In some cases, a positive role was played by the larvae of flies, which often, from unsanitary conditions, wound up in festering wounds - under the supervision of doctors, insects cleaned wounds and accelerated healing. Russian doctors did not forget about leeches - they were applied to inflamed tissues to remove "bad" blood. All surgical procedures, as can be understood from the description, were extremely painful for the wounded. Trying to avoid death from "nervous shock" (pain shock), doctors at the most critical moments anesthetized soldiers with ordinary vodka, and officers were already relied on opium and "sleeping potions" for this purpose. First of all, such a simple anesthesia was used for limb amputations. In the Russian army, depriving people of arms and legs was not abused, as in the French troops, where preventive amputation was practiced, but often it was impossible to do without it. Mortality after such operations was quite high, and the greatest difficulties for doctors were caused by high traumatic amputations of the hip and shoulder from a cannonball or saber. In such cases, it was necessary to completely remove the remnants of the limb, which most often led to the death of the unfortunate.
During amputation, soft tissues were dissected with lancets and amputation knives, and the bones were sawn with special saws. Infectious inflammation of the bone tissue (osteomyelitis, or "caries", which unambiguously became a diagnosis for limb amputation) became a real disaster in severe bullet wounds.
In the memoirs of the participants in the events of the Patriotic War, there are such blood-chilling lines:
“The cutters washed the wound, from which the meat hung in shreds and a sharp piece of bone was visible. The operator took a crooked knife out of the box, rolled up his sleeves up to the elbow, then quietly approached the injured hand, grabbed it and so deftly turned the knife above the shreds that they instantly fell off. Tutolmin screamed and began to groan, the surgeons began to speak to drown him out with their noise, and with hooks in their hands rushed to catch the veins from the fresh meat of the hand; they pulled them out and held them, meanwhile the operator began to saw through the bone. It seemed to cause terrible pain. Tutolmin, shuddering, groaned and, enduring torment, seemed exhausted to the point of fainting; he was often sprinkled with cold water and allowed to sniff alcohol. Sawing off the bone, they picked up the veins in one knot and tightened the cut off place with natural leather, which was left and folded for this; then they sewed it up with silk, applied a compress, tied the arm with bandages - and that was the end of the operation."
Medicines played an important role in therapy, which at that time did not differ in variety. Russian doctors used camphor and mercury, hoping in vain for their supposed anti-inflammatory and sedative effects. For the treatment of abscesses, they used the "Spanish fly", the wounds were healed with olive and sunflower oil, the bleeding was stopped with vinegar, and opium, in addition to its anesthetic effect, was used to slow down intestinal motility, which helped with injuries of the abdominal cavity.
The best in their field
A surgeon at a military field hospital in the early 19th century had to be able to carry out six types of operations: joining, disconnecting, extracting foreign bodies, amputation, addition and straightening. The instructions required at the first dressing of the wound to carry out its expansion "in order to change its property and give it the appearance of a fresh and bloody wound."
Particular emphasis was placed on the expansion of limb wounds in areas of high muscle mass:
“The wounds of the limbs, consisting of many muscles and clothed with a strong tendon membrane, must certainly be enlarged, which is, of course, about the postreline of the thigh, calf and shoulder. Incisions are not at all necessary and useless in places that are mostly made of bones and in which there is very little muscle being. These places should be understood as the head, chest, arm (excluding the palm), leg, lower calf and articulated structures."
The medical historian, Doctor of Science, Professor S. P. Glyantsev in his publications gives an example of the treatment of traumatic aneurysms (cavities) of large blood vessels. The wounded were prescribed
“Disgust of any strong movement of the heart and extreme calmness of the soul and body: cool atmosphere and diet, diminishing the amount of blood (bloodletting), quenching (slowing down) the movement of the heart, saltpeter, foxglove, lily of the valley, mineral water, external use of cold, constricting agents and light pressure as the entire penis, so especially the main trunk of the artery."
Concussions in Russian hospitals were treated simply by rest and observation of the patient, burns were abundantly lubricated with sour cream, honey, butter and fat (which often caused complications), frostbites were treated with ice water or snow. However, such "warming" of a frostbitten limb often led to gangrene with all the ensuing consequences.
With all the effectiveness of the work of military field medicine of the Russian army, there was one serious drawback, which was expressed in the treatment of fractures that was outdated at that time. In the war, splints or "devices for dressing fractures" were used to immobilize limbs, while a doctor from Vitebsk Karl Ivanovich Ghibental suggested using plaster casts. But a negative review of I. F. Bush, professor of the St. Petersburg Medical-Surgical Academy, ruled out the use of plaster for immobilization of fractures. Plastering of fractures came into the practice of Russian military field doctors only in the era of the legendary Nikolai Ivanovich Pirogov.
An important factor that influenced the effectiveness of the medical service of the Russian army was the chronic shortage of personnel - only 850 doctors participated in the war. That is, for one doctor there were 702 soldiers and officers at once. Unfortunately, it was easier for Russia to increase the size of the army at that time than to supply the necessary number of doctors. At the same time, Russian military doctors managed to perform unthinkable feats - mortality in hospitals was scanty for that time, 7-17%.
It is important to note that the saving tactics of treating wounds to the extremities had a positive effect on the fate of the war veterans of 1812. Many seriously wounded soldiers continued to serve for five to six years after the end of the war. So, in the list of soldiers of the Life Guards of the Lithuanian Regiment, dated 1818, you can find the following lines:
“Private Semyon Shevchuk, 35 years old, was wounded in the right leg below the knee with damage to bones and veins, which is why he has poor command of it; also wounded in the knee of the left leg. The guards officer is disabled.
Private Semyon Andreev, 34 years old. He was wounded in the thigh of his left leg right through with damage to his veins, which is why he has poor command of it. To the guards garrison.
Private Dementy Klumba, 35 years old. He was wounded in the right arm at the shoulder, as well as in the left leg, which is why he has poor control of both the arm and the leg. To the guards garrison.
Private Fyodor Moiseev, 39 years old. He was wounded in the left arm with shattered bones, which is why he poorly owns it; also in the right abscess, the veins are damaged, which is why the index finger is reduced. The guards officer is disabled.
Private Vasily Loginov, 50 years old. He was wounded by buckshot in the metatarsus of the left leg with fractured bones. The guards officer is disabled.
Private Franz Ryabchik, 51 years old. He was wounded by a bullet in the right leg below the knee and in the left leg in the thigh with damage to the bones. To the garrison."
The war heroes were demobilized with rather severe wounds only in 1818. In France, at this time, the tactics of preventive amputation triumphed, and soldiers with similar injuries were guaranteed to be left without fragments of arms and legs. In Russian hospitals, the disability of patients at discharge did not usually exceed 3%. It is worth remembering that military doctors had to work in an era where effective anesthesia did not exist, and they did not even suspect about asepsis with antiseptics.
Emperor Alexander I, in his Manifesto of November 6, 1819, noted the exceptional importance of Russian military medicine on the battlefield, thereby expressing gratitude to doctors from his contemporaries and descendants:
"On the battlefield, military doctors shared labor and danger on a par with military ranks, showing a worthy example of diligence and art in the performance of their duties and earned just gratitude from compatriots and respect from all our educated allies."
