One of the most important inventions of the genius Russian doctor who was the first to use anesthesia on the battlefield and who 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 outside 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". And what is behind her? Behind it is a classic medical office, the appearance of which is distinguished only by 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 the initial examination by a traumatologist and an X-ray. What for? So that the bones grow together the way they should, and not just randomly. And so that the skin can still breathe. And so as not to disturb the broken limb with a careless movement. And … What is there to ask! After all, everyone knows: since something is broken, it is necessary to apply a plaster cast.
But this "everyone knows" - 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 did this. Well, after it, it turns out that anyone, anywhere, does it. But the "Pirogov" plaster cast is just the priority that is not disputed by anyone in the world. Simply because it is impossible to dispute the obvious: the fact that gypsum as a medicine is 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 coming attack, like the USSR in June 1941. In those distant times, the habit of saying "I'm going for you" was still in use, and intelligence and counterintelligence were not yet developed enough to carefully conceal preparations for an attack. The country was not ready in the general, economic and social sense. There was a lack of modern weapons, a modern fleet, railways (and this turned out to be critical!) Leading to the theater of operations …
The Russian army also lacked doctors. By the beginning of the Crimean War, the organization of medical service in the army was proceeding in accordance with the manual written a quarter of a century earlier. According to his requirements, after the outbreak of hostilities, the troops should have had more than 2,000 doctors, almost 3,500 medical assistants and 350 medical assistant students. In reality, there was no one: neither doctors (tenth part), nor paramedics (twentieth part), and their students were not 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 was accounted for three hundred people wounded." To change this ratio, according to the historian Nikolai Gyubbenet, during the Crimean War more than a thousand doctors were recruited, including foreigners and students who received a diploma but did not complete their studies. And almost 4,000 paramedics and their apprentices, half of whom were out of order during the fighting.
In such a situation and taking into account the rear organized disorder, which was, alas, the Russian army of that time, the number of permanently disabled wounded had to reach at least a quarter. But as the resilience of the defenders of Sevastopol amazed the allies who were preparing for a quick victory, so the efforts of the doctors gave an unexpectedly much better result. The result, which had several explanations, but one name - Pirogov. After all, it was he who introduced immobilizing plaster casts into the practice of military field surgery.
What did this give the army? First of all, the opportunity 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 very simple. If a person with a broken bullet or a fragment of an arm or leg got on the table to surgeons, he was most often awaited by amputation. Soldiers - by the decision of doctors, officers - by the results of negotiations with doctors. Otherwise, the wounded man would not have returned to service with a high probability. After all, unfixed bones fused at random, and the person remained crippled.
From workshop to operating room
As Nikolai Pirogov himself wrote, "war is a traumatic epidemic." And as for any epidemic, for the war some kind of vaccine, figuratively speaking, had to be found. She - in part, because not all wounds are limited to broken bones - and there was a plaster cast.
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. Rather, at hand. Since the final decision to use plaster of Paris, 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 action of the plaster solution on the canvas,” the doctor wrote. - I guessed that it could be used in surgery, and immediately applied bandages and strips of canvas, soaked in this solution, on a complex fracture of the lower leg. The success was remarkable. The bandage dried up in a few minutes: an oblique fracture with severe blood stains and skin perforation … healed without suppuration and without any seizures. I am convinced that this bandage can find great application in military field practice. As, in fact, it happened.
But Dr. Pirogov's discovery was not only the result of an accidental insight. Nikolai Ivanovich fought over the problem of a reliable fixation bandage for several years. By 1852, Pirogov already had the experience of using linden splints and a starch bandage behind him. The latter was something very similar to a plaster cast. Pieces of canvas soaked in a solution of starch were applied layer by layer to the broken limb - just like in the papier-mâché technique. This process was quite long, the starch did not freeze immediately, and the bandage turned out to be bulky, heavy and not waterproof. In addition, she did not allow air to pass through well, which negatively affected the wound if the fracture was open.
By the same time, ideas with the use of plaster were already known. For example, in 1843, a thirty-year-old doctor Vasily Basov suggested fixing a broken leg or arm with alabaster, poured into a large box - a "dressing shell". Then this box was lifted on blocks to the ceiling and fastened in this position - in almost the same way as today, if necessary, plaster limbs are attached. But the weight was, of course, prohibitive, and the breathability was none.
And in 1851, the Dutch military doctor Antonius Mathijsen put into practice his own method of fixing broken bones using bandages rubbed with plaster, which were applied to the fracture site and wetted with water right there. He wrote about this innovation in February 1852 in the Belgian medical journal Reportorium. So the idea was in the air in the full sense of the word. But only Pirogov was able to fully appreciate it and find the most convenient way of casting. And not just anywhere, but in the war.
"Safety manual" in Pirogov style
Let's return to besieged Sevastopol, during the Crimean War. The surgeon Nikolai Pirogov, already famous by that time, arrived on 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 the shortcomings of the organization of medical care in the troops showed themselves to the fullest.
Painting "Twentieth Infantry Regiment in 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 it was not unexpected: it was foreseen, destined 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 threw them on the ground, on bunks, for weeks they were not bandaged or even fed. After Alma, the British were rebuked for not doing anything in favor of the wounded enemy; we ourselves did nothing on October 24. Arriving in Sevastopol on November 12, therefore, 18 days after the case, I found too 2000 wounded, crowded together, lying on dirty mattresses, mixed, and for 10 whole 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 Dr. Pirogov's talents were fully manifested. Firstly, it is he who is credited with introducing the system of sorting the wounded into practice: “I was the first to introduce sorting of the wounded at the Sevastopol dressing stations and thereby destroyed the chaos that reigned there,” the great surgeon himself wrote about this. According to Pirogov, each wounded had to be attributed 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 - seriously wounded, "who also require urgent, but more protective benefits." Fourth - "the wounded, for whom immediate surgical assistance is necessary only in order to make possible transportation." And, finally, the fifth - "lightly wounded, or those in whom the first benefit is limited to the imposition of a light dressing or removal of 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 can be judged by a simple fact. It was for him that Pirogov singled out a special type of wounded - those requiring "safety benefits".
How widely the plaster cast was used in Sevastopol and, in general, in the Crimean War, can be judged only by indirect signs. Alas, even Pirogov, who meticulously described everything that happened to him in the Crimea, did not bother to leave accurate information on this matter to his descendants - 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 … it took its toll and became a necessary accessory to field surgical practice. I will allow myself to think that the introduction of a plaster cast by me 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 "safety benefit"! It was for him that, as Nikolai Pirogov called it, "a molded alabaster (plaster) bandage" was used in Sevastopol. And the frequency of its use directly depended on how many wounded the doctor tried to protect from amputation - which means how many soldiers needed to apply plaster cast on gunshot fractures of arms and legs. And apparently, they were in the hundreds.“We suddenly had up to six hundred wounded in one night, and we did too seventy amputations in 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 "molded bandage" made it possible to reduce the number of amputations several times. It turns out that only on that nightmarish day about which the surgeon told his wife, a plaster cast was applied to two or three hundred wounded!
Nikolai Pirogov in Simferopol. The artist is unknown. Source: garbuzenko62.ru
And we must remember that the whole city was under siege, not only the troops, and among those who received the latest help from Pirogov's assistants, there were many civilians of Sevastopol. Here is what the surgeon himself wrote about this in a letter to his wife dated April 7, 1855: “In addition to soldiers, children are brought to the dressing station, with their limbs torn off from the bombs that fall into Korabelnaya Slobodka, a part of the city, where, despite the visible danger, sailor's wives and children continue to live. We are busy night and day and night, as if on purpose, even more than during the day, because all work, sorties, attacks on lodgements, etc. are carried out at night […] … I sleep and spend the whole day and night at the dressing station - in the Assembly of the Nobility, the parquet of which is covered with bark of dried blood, hundreds of amputated people are lying in the dance hall, and lint and bandages are placed in the choir and billiards. Ten doctors in my presence and eight sisters are working vigilantly, alternately day and night, operating and bandaging the wounded. Instead of dance music, groans of the wounded are heard in the huge Assembly Hall."
Plaster of paris, ether and sisters of mercy
“Hundreds of amputated” means thousands of those who were plastered. And the plastered ones mean the rescued, since it was the death rate from amputations that was one of the most common reasons for the death of Russian soldiers during the Crimean War. So is it any wonder that where Pirogov was present with his novelty, mortality declined sharply?
But the merit of Pirogov is not only that he was the first in the world to use a plaster cast in military field surgery. He also belongs, say, the primacy in the use of ether anesthesia in a hospital in the field army. And he did it even earlier, in the summer of 1847, during his participation in the Caucasian War. The hospital in which Pirogov operated was located in the rear of the troops besieging the village of Salty. It was here, by order of Nikolai Ivanovich, that all the necessary equipment for ether anesthesia was delivered, which he tested for the first time on February 14 of the same year.
For a month and a half of the siege, Salta Pirogov performed almost 100 operations with ether anesthesia, and a large part of them were public. After all, Doctor Pirogov needed not only to operate on the wounded, but also to convince them that anesthesia is a safe and necessary remedy for the cause. And this technique had its effect, and in some ways even exceeded the doctor's expectations. Having seen enough of the comrades who endured surgical manipulations with serene faces, the soldiers believed so much in Pirogov's ability that several times after that they tried to get him to operate on their already dead comrades, believing that this doctor could do anything.
Not everything, but Pirogov really could do a lot. In Sevastopol, he also widely used ether anesthesia - which means that he did everything to prevent the wounded from dying on his table from painful shock. It is difficult to calculate the exact number of those rescued in this way, but if Nikolai Ivanovich had more than 10,000 operations with anesthesia on his account, then at least half of them fell on Sevastopol times.
Plaster cast, ether, sorting of the wounded … Is there something else that Pirogov was the first of his colleagues to do? There is! He can be credited with the introduction in the Russian army of such an institution as sisters of mercy. Nikolai Ivanovich was one of the initiators of the creation of the Holy Cross Women's Community of Sisters of Mercy, whose members played a huge role in saving the wounded near Sevastopol. “About five days ago, the Exaltation of the Cross community of the sisters of Elena Pavlovna, up to thirty in number, came here and zealously set to work; if they do as they do now, they will, no doubt, bring a lot of benefit, - Pirogov writes to his wife in a letter from Crimea dated December 6, 1854. “They alternate day and night in hospitals, help with dressings, also during operations, distribute tea and wine to the sick and watch the attendants and caretakers and even the doctors. The presence of a woman, neatly dressed and with the participation of helping, revives the deplorable vale of suffering and calamity."
The first detachment of Russian sisters of mercy before leaving for the area of hostilities during the Crimean War, 1854. Photo from the archives of the Museum-Estate of N. I. Pirogov in Vinnitsa / Reproduction TASS
Having received the sisters of mercy under his command, Pirogov rather quickly introduced a specialization division between them. He divided them into dressing and operating rooms, pharmacies, attendants, transport and housewives who were responsible for food. A familiar division, isn't it? It turns out that the same Nikolai Pirogov was the first to introduce it …
"… Before other nations"
Great people are great because they remain in the memory of grateful descendants not by one of their achievements, but by many. After all, the ability to see the new, clothe it in form and put it into circulation cannot be exhausted in any one invention or innovation. So Nikolai Ivanovich Pirogov entered the national and world history of medicine with several of his innovations at once. But above all - as the inventor of the plaster cast.
So now, having met a person with a plaster cast on the street or in the courtyard, know that this is one of those many inventions for which Russia has become famous. And which we have the right to be proud of. As the inventor himself, Nikolai Pirogov, was proud of him: "The benefits of anesthesia and this bandage in military field practice were actually discovered by us before other nations." And it is true.
