The 19th century is rightfully considered the beginning new era in the development of surgery. This was greatly facilitated by two outstanding discoveries: methods of pain relief, asepsis and antiseptics. In a very short period of time, surgery has achieved such successes as it has not seen in the entire previous centuries-old history.

Invention and widespread implementation in medical practice plaster casting for bone fractures is also one of the most important achievements of surgery of 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. The works of Arab doctors, the Dutchman Hendrichs, the Russian surgeons K. Gibenthal and V. Basov, the Brussels surgeon Seten, the Frenchman Lafargue and others are well known. However, they did not use a bandage, but a plaster solution, sometimes mixing it with starch, adding blotting paper and other components to it. Plaster, not hardening well, did not create complete immobility of the bones, making patient care and especially transportation more difficult.

An example of this is the Basov method, proposed in 1842. The patient's broken arm or leg 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 Matthiessen already began using a plaster cast. He rubbed strips of cloth with dry plaster, wrapped them around the injured limb, and only then moistened them with water using a sponge. However, this dressing was not strong enough, because while it was being applied, the dry plaster easily fell off. And most importantly, reliable fixation of the fragments could not be achieved.

To achieve this, Pirogov is trying 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 still used almost unchanged today. The fact is that gypsum is precisely the most best material, the great surgeon became convinced after visiting the workshop of the then famous sculptor N.A. Stepanov, where “... for the first time I saw... the effect of gypsum mortar on the canvas. “I guessed it,” writes N.I. Pirogov - that it could be used in surgery, and immediately applied bandages and strips of canvas soaked in this solution to a complex fracture of the tibia. The success was remarkable. The bandage dried in a few minutes: an oblique fracture with strong bleeding and perforation of the skin... healed without suppuration... I was convinced that this bandage could find great application in military field practice, and therefore published a description of my method.”

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.

Pirogov first used a plaster cast in 1852 in a military hospital, and in 1854 - in the field, during the Sevastopol defense. The widespread use of the bone immobilization method he created made it possible to carry out, as he called, “saving treatment”: even with extensive bone damage, not to amputate, but to save the limbs of many hundreds of wounded people.

Proper treatment of fractures, especially gunshot fractures, during the war, which N.I. Pirogov figuratively called it a “traumatic epidemic,” which was the key to not only preserving a limb, but sometimes even the life of the wounded.

Gypsum bandage, as shown by long-term observations, has high medicinal properties. Plaster protects the wound from further contamination and infection, promotes the death of microbes in it, and does not prevent the penetration of air. And most importantly, it creates sufficient peace injured hand or leg. And the victim calmly endures even long-term transportation.

Nowadays, plaster casts are used in surgical and trauma clinics around the world. Its types are becoming more diverse, the composition of its components, and the 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.

"The Divine Art of Destroying Pain" for a long time was beyond the control of man. For centuries, patients were forced to endure suffering patiently, and doctors were unable to stop their suffering. In the 19th century, science was finally able to conquer pain.

Modern surgery uses for and A who first invented anesthesia? You will learn about this as you read the article.

Anesthesia techniques in ancient times

Who invented anesthesia and why? Since the birth of medical science, doctors have been trying to solve an important problem: how to make surgical procedures as painless as possible for patients? With severe injuries, people died not only from the consequences of the injury, but also from the painful shock they experienced. The surgeon had no more than 5 minutes to perform the operations, otherwise the pain would become unbearable. The aesculapians of antiquity were armed with various means.

IN Ancient Egypt crocodile fat or alligator skin powder were used as anesthetics. An ancient Egyptian manuscript dating back to 1500 BC describes the pain-relieving properties of the opium poppy.

IN Ancient India healers used substances based on Indian hemp to produce painkillers. Chinese doctor Hua Tuo, who lived in the 2nd century. AD, suggested that patients drink wine laced with marijuana before surgery.

Methods of pain relief in the Middle Ages

Who invented anesthesia? In the Middle Ages, the miraculous effect was attributed to the mandrake root. This plant from the nightshade family contains potent psychoactive alkaloids. Drugs with the addition of mandrake extract had a narcotic effect on a person, clouded consciousness, and dulled pain. However, incorrect dosage could lead to fatal outcome, and frequent use caused drug addiction. The analgesic properties of mandrake were first discovered in the 1st century AD. described by the ancient Greek philosopher Dioscorides. He gave them the name “anaesthesia” - “without feeling.”

In 1540, Paracelsus proposed the use of diethyl ether for pain relief. He repeatedly tried the substance in practice - the results looked encouraging. Other doctors did not support the innovation and after the death of the inventor they forgot about this method.

To turn off a person’s consciousness to carry out the most complex manipulations, surgeons used a wooden hammer. The patient was hit on the head and temporarily fell into unconsciousness. The method was crude and ineffective.

The most common method of medieval anesthesiology was ligatura fortis, i.e. pinching of nerve endings. The measure made it possible to slightly reduce painful sensations. One of the apologists of this practice was the court physician of the French monarchs, Ambroise Paré.

Cooling and hypnosis as methods of pain relief

At the turn of the 16th-17th centuries, the Neapolitan physician Aurelio Saverina reduced the sensitivity of the operated organs using cooling. The diseased part of the body was rubbed with snow, thus being slightly frozen. Patients experienced less suffering. This method has been described in the literature, but few people have resorted to it.

Pain relief using cold was remembered during the Napoleonic invasion of Russia. In the winter of 1812, the French surgeon Larrey carried out mass amputations of frostbitten limbs right on the street at a temperature of -20... -29 o C.

In the 19th century, during the period of mesmerization craze, attempts were made to hypnotize patients before surgery. A when and who invented anesthesia? We'll talk about this further.

Chemical experiments of the 18th-19th centuries

With the development of scientific knowledge, scientists began to gradually approach the solution of a complex problem. IN early XIX century, the English naturalist H. Davy established on the basis personal experience that inhaling nitrous oxide vapor dulls the sensation of pain in humans. M. Faraday found that a similar effect is caused by sulfuric ether vapor. Their discoveries did not find practical application.

In the mid-40s. XIX century dentist G. Wells from the USA became the first person in the world to undergo surgical manipulation while under the influence of an anesthetic - nitrous oxide or laughing gas. Wells had a tooth removed, but he did not feel any pain. Wells was inspired by the successful experience and began to promote new method. However, the repeated public demonstration of the action of the chemical anesthetic ended in failure. Wells failed to win the laurels of the discoverer of anesthesia.

Invention of ether anesthesia

W. Morton, who practiced in the field of dentistry, became interested in the study of analgesic effects. He carried out a series successful experiments on himself and on October 16, 1846 put the first patient into a state of anesthesia. An operation was performed to painlessly remove a tumor in the neck. The event received wide resonance. Morton patented his innovation. He is officially considered the inventor of anesthesia and the first anesthesiologist in the history of medicine.

The idea of ​​ether anesthesia was picked up in medical circles. Operations using it were performed by doctors in France, Great Britain, and Germany.

Who invented anesthesia in Russia? The first Russian doctor to risk testing best practice on his patients, was Fedor Ivanovich Inozemtsev. In 1847 he produced several complex abdominal operations over patients immersed in Therefore, he is the pioneer of anesthesia in Russia.

Contribution of N. I. Pirogov to world anesthesiology and traumatology

Other Russian doctors followed in Inozemtsev’s footsteps, including Nikolai Ivanovich Pirogov. He not only operated on patients, but also studied the effects of ethereal gas, tried different ways its introduction into the body. Pirogov summarized and published his observations. He was the first to describe the techniques of endotracheal, intravenous, spinal and rectal anesthesia. His contribution to the development of modern anesthesiology is invaluable.

Pirogov is the one. For the first time in Russia, he began to fix damaged limbs using a plaster cast. The doctor tested his method on wounded soldiers during the Crimean War. However, Pirogov cannot be considered a pioneer this method. Gypsum was used as a fixing material long before (Arab doctors, the Dutch Hendrichs and Matthiessen, the Frenchman Lafargue, the Russians Gibenthal and Basov). Pirogov only improved the plaster fixation, making it light and mobile.

Discovery of chloroform anesthesia

In the early 30s. Chloroform was discovered in the 19th century.

A new type of anesthesia using chloroform was officially presented to the medical community on November 10, 1847. Its inventor, Scottish obstetrician D. Simpson, actively introduced pain relief for women in labor to ease the process of childbirth. There is a legend that the first girl who was born painlessly was given the name Anasthesia. Simpson is rightfully considered the founder of obstetric anesthesiology.

Chloroform anesthesia was much more convenient and profitable than ether. It put a person to sleep faster and had a deeper effect. It did not require additional equipment; it was enough to inhale the vapor from gauze soaked in chloroform.

Cocaine is a local anesthetic used by South American Indians.

Forefathers local anesthesia are considered to be South American Indians. They have been using cocaine as a painkiller for a long time. This plant alkaloid was extracted from the leaves of the native Erythroxylon coca shrub.

The Indians considered the plant a gift from the gods. Coca was planted in special fields. Young leaves were carefully picked from the bush and dried. If necessary, the dried leaves were chewed and saliva was poured over the damaged area. It lost sensitivity and traditional healers started the operation.

Koller's research in local anesthesia

The need to provide pain relief in a limited area was especially acute for dentists. Tooth extraction and other interventions in dental tissue caused unbearable pain in patients. Who invented local anesthesia? In the 19th century, in parallel with experiments on general anesthesia searches were carried out effective method for limited (local) anesthesia. In 1894, the hollow needle was invented. Dentists used morphine and cocaine to relieve toothache.

A professor from St. Petersburg, Vasily Konstantinovich Anrep, wrote in his works about the properties of coca derivatives to reduce sensitivity in tissues. His works were studied in detail by the Austrian ophthalmologist Karl Koller. A young doctor decided to use cocaine as an anesthetic during eye surgery. The experiments turned out to be successful. The patients remained conscious and did not feel pain. In 1884, Koller informed the Viennese medical community about his achievements. Thus, the results of the Austrian doctor’s experiments are the first officially confirmed examples of local anesthesia.

History of the development of endotrachial anesthesia

In modern anesthesiology, endotracheal anesthesia, also called intubation or combined, is most often practiced. This is the safest type of anesthesia for humans. Its use allows you to keep the patient’s condition under control and perform complex abdominal operations.

Who invented endotrochial anesthesia? The first documented case of the use of a breathing tube in medical purposes associated with the name of Paracelsus. An outstanding doctor of the Middle Ages inserted a tube into the trachea of ​​a dying man and thereby saved his life.

In the 16th century, Andre Vesalius, a professor of medicine from Padua, conducted experiments on animals by inserting breathing tubes into their tracheas.

The occasional use of breathing tubes during operations provided the basis for further development in the field of anesthesiology. In the early 70s of the 19th century, the German surgeon Trendelenburg made a breathing tube equipped with a cuff.

The use of muscle relaxants in intubation anesthesia

The widespread use of intubation anesthesia began in 1942, when Canadians Harold Griffith and Enid Johnson used muscle relaxants - drugs that relax muscles - during surgery. They injected the patient with the alkaloid tubocurarine (intokostrin), obtained from the famous poison of the South American Indians, curare. The innovation made intubation procedures easier and made operations safer. Canadians are considered to be the innovators of endotracheal anesthesia.

Now you know who invented general anesthesia and local. Modern anesthesiology does not stand still. Successfully applied traditional methods, the latest medical developments are being introduced. Anesthesia is a complex, multicomponent process on which the health and life of the patient depends.

97. Plaster and plaster casts. Plaster bandages, splints. Basic types and rules for applying plaster casts.

Plaster casts are widely used in traumatology and orthopedics and are used to hold fragments of bones and joints in their given position.

Medical gypsum is a semi-aqueous calcium sulfate salt, available in powder form. When combined with water, the hardening process of the gypsum begins after 5–7 minutes and ends after 10–15 minutes. The plaster gains full strength after the entire bandage has dried.

Using various additives you can speed up or, conversely, slow down the hardening process of gypsum. If the plaster does not harden well, it must be soaked in warm water (35–40 °C). You can add aluminum alum to the water at the rate of 5–10 g per 1 liter or table salt (1 tablespoon per 1 liter). A 3% starch solution and glycerin delay the setting of gypsum.

Since gypsum is very hygroscopic, it is stored in a dry, warm place.

Plaster bandages are made from ordinary gauze. To do this, the bandage is gradually unwound and a thin layer of gypsum powder is applied to it, after which the bandage is again loosely rolled into a roll.

Ready-made non-shedding plaster bandages are very convenient for use. The plaster cast is intended to perform the following manipulations: pain relief for fractures, manual reposition of bone fragments and reposition using traction devices, application of adhesive traction, plaster and adhesive dressings. In some cases, it is permissible to apply skeletal traction.

Plaster bandages are immersed in cold or slightly warmed water, and air bubbles that are released when the bandages get wet are clearly visible. At this point, you should not press on the bandages, as part of the bandage may not be saturated with water. After 2–3 minutes, the bandages are ready for use. They are taken out, lightly wrung out and rolled out on a plaster table, or the damaged part of the patient’s body is directly bandaged. To make the bandage strong enough, you need at least 5 layers of bandage. When applying large plaster casts, you should not soak all the bandages at once, otherwise the nurse will not have time to use some of the bandages within 10 minutes, they will harden and will be unsuitable for further use.

Rules for applying bandages:

– before rolling out the plaster, measure the length of the applied bandage along the healthy limb;

– in most cases, the bandage is applied with the patient lying down. The part of the body on which the bandage is applied is raised above the table level using various devices;

– the plaster cast should prevent the formation of stiffness in the joints in a functionally unfavorable (vicious) position. To do this, the foot is placed at a right angle to the axis of the shin, the shin is in a position of slight flexion (165°) at the knee joint, the thigh is in a position of extension in the hip joint. Even with the formation of contracture in the joints lower limb in this case it will be supportive and the patient will be able to walk. On upper limb the fingers are placed in a position of slight palmar flexion with the first finger in opposition, the hand is in a position of dorsal extension at an angle of 45° in the wrist joint, the flexor forearm is at an angle of 90-100° in the elbow joint, the shoulder is abducted from the body at an angle of 15–20° at using a cotton-gauze roll placed in armpit. For some diseases and injuries, as directed by the traumatologist, a bandage may be applied in the so-called vicious position for a period of no more than one and a half to two months. After 3–4 weeks, when initial consolidation of the fragments appears, the bandage is removed, the limb is placed in the correct position and fixed with a plaster;

– plaster bandages should lie evenly, without folds or kinks. Anyone who does not know desmurgy techniques should not apply plaster casts;

– areas subject to the greatest load are additionally strengthened (joint area, sole of the foot, etc.);

– peripheral section limbs (toes, hands) are left open and accessible for observation in order to notice symptoms of compression of the limb in time and cut the bandage;

– before the plaster hardens, the bandage must be well modeled. By stroking the bandage, the body part is shaped. The bandage must be an exact cast of this part of the body with all its protrusions and depressions;

– after applying the bandage, it is marked, i.e., the diagram of the fracture, the date of the fracture, the date the bandage was applied, the date the bandage was removed, and the doctor’s name are applied to it.

Methods of applying plaster casts. According to the method of application, plaster casts are divided into lined and unlined. With padding, a limb or other part of the body is first wrapped in a thin layer of cotton wool, then plaster bandages are placed on top of the cotton wool. Unlined dressings are applied directly to the skin. Pre-bone protrusions (area of ​​the ankles, femoral condyles, iliac spines, etc.) are isolated with a thin layer of cotton wool. The first bandages do not compress the limb and do not cause pressure sores from the plaster, but do not fix bone fragments firmly enough, so when they are applied, secondary displacement of the fragments often occurs. Unlined bandages, if not carefully observed, can cause compression of the limb, leading to necrosis and pressure sores on the skin.

According to their structure, plaster casts are divided into longitudinal and circular. A circular plaster cast covers the damaged part of the body on all sides, while a splint cast covers only one part. A variety of circular dressings are fenestrated and bridge-like dressings. A windowed bandage is a circular bandage in which a window is cut out over a wound, fistula, drainage, etc. Care must be taken that the edges of the plaster in the window area do not cut into the skin, otherwise when walking soft fabrics will swell, which will worsen the wound healing conditions. Protrusion of soft tissues can be prevented by covering the window with a plaster flap each time after dressing.

A bridge bandage is indicated in cases where the wound is located throughout the entire circumference of the limb. First, circular bandages are applied proximally and distally to the wound, then both bandages are connected to each other with U-shaped curved metal stirrups. When connected only with plaster bandages, the bridge is fragile and breaks due to the weight of the peripheral part of the bandage.

Bandages applied to various parts of the body have their own names, for example, corset-coxite bandage, “boot”, etc. A bandage that fixes only one joint is called a splint. All other bandages must ensure immobility of at least 2 adjacent joints, and the hip bandage – three.

A plaster cast on the forearm is most often applied to fractures of the radius in a typical location. The bandages are laid out evenly over the entire length of the forearm from elbow joint to the base of the fingers. A plaster splint for the ankle joint is indicated for fractures of the lateral malleolus without displacement of the fragment and ligament ruptures ankle joint. Plaster bandages are rolled out with gradual expansion at the top of the bandage. The length of the patient’s foot is measured and, accordingly, 2 cuts are made on the splint in the transverse direction at the bend of the bandage. The splint is modeled and strengthened with a soft bandage. Splints are very easy to turn into circular bandages. To do this, it is enough to strengthen them on the limb not with gauze, but with 4–5 layers of plaster bandage.

A lining circular plaster cast is applied after orthopedic operations and in cases where bone fragments are welded together by callus and cannot move. First, the limb is wrapped in a thin layer of cotton wool, for which they take gray cotton wool rolled into a roll. It is impossible to cover it with separate pieces of cotton wool of different thicknesses, since the cotton wool will become matted and the bandage will cause a lot of inconvenience to the patient when wearing it. After this, a circular bandage in 5–6 layers is applied over the cotton wool with plaster bandages.

Removing the plaster cast. The bandage is removed using plaster scissors, a file, plaster forceps and a metal spatula. If the bandage is loose, you can immediately use plaster scissors to remove it. In other cases, you must first insert a spatula under the bandage in order to protect the skin from cuts from the scissors. The bandages are cut on the side where there is more soft tissue. For example, a circular bandage up to the middle third of the thigh - along the posterior outer surface, a corset - on the back, etc. To remove the splint, it is enough to cut the soft bandage.

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 in surgery of 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 plaster.

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

An example of this is the Basov method, proposed in 1842. The patient's broken arm or leg 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 Matthiessen already began using a plaster cast. He rubbed strips of cloth with dry plaster, wrapped them around the injured limb, and only then moistened them with water.

To achieve this, Pirogov is trying 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 still used almost unchanged today.

The great surgeon became convinced that gypsum is the best material 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 canvas. I guessed,” writes N.I. Pirogov, “that it could be used in surgery, and immediately applied bandages and strips of canvas soaked in this solution , for a complex fracture of the tibia. The success was remarkable. The bandage dried out in a few minutes: an oblique fracture with severe bleeding 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."

Pirogov first used a plaster cast in 1852 in a military hospital, and in 1854 in the field, during the defense of Sevastopol. The widespread use of the bone immobilization method he created made it possible to carry out, as he called, “saving treatment”: even with extensive bone damage, not to amputate, but to save the limbs of many hundreds of wounded people.

Proper treatment of fractures, especially gunshot fractures, during the war, which N.I. Pirogov figuratively called it a “traumatic epidemic,” which was the key to not only preserving a limb, but sometimes even the life of the wounded.

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