Invention and widespread implementation in medical practice plaster cast for bone fractures is one of the most important achievements of 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 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 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
One of most important inventions 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 find yourself there not for personal reasons, that is, not with an injury that distracts you from any extraneous observations, but as a random passerby. But - with the opportunity to look into any office. And so, walking along the corridor, you notice a door with the inscription “Gypsum”. And what's behind it? Behind her is a classic medical office, the appearance of which differs only from the low square bathtub in one of the corners.
Yes, yes, this is the same place where, on a broken arm or leg, after initial examination a traumatologist and an x-ray taken, a plaster cast will be applied. For what? So that the bones grow together as they should, and not at random. And at the same time, the skin can still breathe. And so as not to disturb the broken limb with a careless movement. And... Why ask! After all, everyone knows: if something is broken, it is necessary to apply a plaster cast.
But this “everyone knows” is at most 160 years old. Because the first time a plaster cast was used as a means of treatment was in 1852 by the great Russian doctor, surgeon Nikolai Pirogov. No one in the world had done anything like this before. Well, after it, it turns out, anyone can do it, anywhere. But "Pirogovskaya" gypsum bandage- this is precisely the priority that is not disputed by anyone in the world. Simply because it is impossible to dispute the obvious: the fact that gypsum is like medical product- one of the purely Russian inventions.
Portrait of Nikolai Pirogov by artist Ilya Repin, 1881.
War as an engine of progress
By the start 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 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 modern weapons, a modern fleet, railways(and this turned out to be critical!) leading to the theater of military operations...
And also in Russian army there were not enough doctors. By the beginning of the Crimean War, the organization medical service in the army was 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 paramedics and 350 paramedic students. In reality, there was no one enough: neither doctors (a tenth part), nor paramedics (a twentieth part), and their students were not there at all.
It would seem that there is not such a significant shortage. But nevertheless, as military researcher Ivan Bliokh wrote, “at the beginning of the siege of Sevastopol, there was one doctor for every three hundred wounded people.” To change this ratio, according to historian Nikolai Gübbenet, during the Crimean War more than a thousand doctors were recruited into service, 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 were disabled during the fighting.
In such a situation and taking into account, alas, the rear organized disorder inherent, alas, in the Russian army of that time, the number of wounded who were permanently incapacitated should have reached at least a quarter. But just as the resilience of the defenders of Sevastopol amazed the allies who were preparing for a quick victory, the efforts of the doctors unexpectedly gave a much better result. A result that 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, it is an opportunity to return to duty 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 came to the surgeons table with an arm or leg broken by a bullet or shrapnel, he most often faced amputation. For soldiers - according to the decision of doctors, for officers - based on the results of negotiations with doctors. Otherwise, the wounded man would still most likely not return to duty. After all, the unfixed bones grew together haphazardly, and the person remained crippled.
From the workshop to the operating room
As Nikolai Pirogov himself wrote, “war is a traumatic epidemic.” And like any epidemic, a war had to find its own, figuratively speaking, vaccine. This - partly because not all wounds are limited to broken bones - was plaster.
As often happens with brilliant inventions, Dr. Pirogov came up with the idea of making his immobilizing bandage literally from what was lying under his feet. Or rather, at hand. Because the final decision to use plaster of Paris, moistened with water and fixed with a bandage for a bandage, came to him in... a sculptor’s workshop.
In 1852, Nikolai Pirogov, as he himself recalled a decade and a half later, watched the sculptor Nikolai Stepanov work. “For the first time I saw... the effect of a gypsum solution on a 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 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 and without any seizures. I was convinced that this bandage could find great application in military field practice.” Which is exactly what happened.
But Dr. Pirogov’s discovery was not only the result of an accidental insight. Nikolai Ivanovich struggled with the problem of a reliable fixation bandage for many years. By 1852, Pirogov already had experience in using linden splints and starch dressings. The latter was something very similar to a plaster cast. Pieces of canvas soaked in a starch solution were placed layer by layer on the broken limb - just like in the papier-mâché technique. This process was quite long, the starch did not harden immediately, and the dressing 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 gypsum were already known. For example, in 1843, 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 was raised on blocks to the ceiling and secured in this position - almost the same way today, if necessary, plastered limbs are secured. But the weight was, of course, prohibitive, and there was no breathability.
And in 1851, the Dutch military doctor Antonius Mathijsen introduced into practice his own method of fixing broken bones using 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 war.
“Safety benefit” in Pirogov style
Let's return to besieged Sevastopol, during the Crimean War. The already famous surgeon Nikolai Pirogov arrived at it on October 24, 1854, at the very height of the events. It was on this day that the infamous Battle of Inkerman took place, which ended in a major failure for the Russian troops. And here are the shortcomings of the organization medical care they showed themselves to the fullest in the troops.
Painting “The Twentieth 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, October 24 was not unexpected: it was foreseen, planned 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; They left them like dogs on the ground, on bunks; for whole weeks they were not bandaged or even fed. The British were reproached after Alma for not doing anything in favor of the wounded enemy; We ourselves did nothing on October 24th. Arriving in Sevastopol on November 12, therefore, 18 days after the case, I found too 2000 wounded, crowded together, lying on dirty mattresses, mixed up, and for 10 whole days, almost from morning to evening, I had to operate on those who should have had the operation immediately after battles."
It was in this environment that Dr. Pirogov’s talents fully manifested themselves. Firstly, it was to him that he was credited with introducing into practice the system of sorting the wounded: “I was the first to introduce the sorting of the wounded at the 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 classified into one of five types. The first is the hopeless and mortally wounded, who no longer need doctors, but comforters: nurses or priests. The second is seriously and dangerously wounded, requiring immediate assistance. The third is the seriously wounded, “who also require immediate, but more protective benefits.” The fourth is "the wounded for whom immediate surgical care is necessary only to make possible transportation." And, finally, the fifth - “slightly wounded, or those for whom the first benefit is limited to applying a light bandage or removing a superficially seated bullet.”
And secondly, it was here, in Sevastopol, that Nikolai Ivanovich began to widely use the plaster cast he had just invented. How much great importance he gave this innovation, can be judged by a simple fact. It was for him that Pirogov identified 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 only be judged by indirect signs. Alas, even Pirogov, who meticulously described everything that happened to him in Crimea, did not bother to leave to his descendants accurate information on this matter - mostly value judgments. Shortly before his death, in 1879, Pirogov wrote: “I first introduced the plaster cast into military hospital practice in 1852, and into military field practice in 1854, finally... took its toll and became a necessary accessory to field surgical practice. I allow myself to think that my introduction of a plaster cast into field surgery mainly contributed to the spread of cost-saving treatment in field practice.”
Here it is, that very “saving treatment”, it is also a “preventive benefit”! It was for this purpose that what Nikolai Pirogov called “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 have plaster applied to gunshot fractures of their arms and legs. And apparently they numbered in the hundreds. “We suddenly had up to six hundred wounded in one night, and we performed too many 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 “stick-on bandage” made it possible to reduce the number of amputations several times. It turns out that only on that terrible day that the surgeon told his wife about, plaster was applied to two or three hundred wounded people!
And you say: I slipped and fell. Closed fracture! Lost consciousness, woke up - a cast. (film “The Diamond Arm”)
Since ancient times, various materials have been used to maintain immobility in the fracture area and immobilize damaged bone fragments. The very fact that bones grow together much better if they are immobilized relative to each other was obvious to primitive people. The vast majority of fractures will heal without any need for surgery if the broken bone is properly aligned and immobilized. It is obvious that in that ancient time standard method Treatment of fractures was immobilization (limitation of mobility). In those days, at the dawn of history, how could you fix a broken bone? According to extant text from the papyrus of Edwin Smith (1600 BC), hardening bandages were used, probably derived from the bandages used in embalming. Also, while excavating tombs of the Fifth Dynasty (2494-2345 BC), Edwin Smith describes two sets of immobilization splints. It was a very long time before the first plaster cast appeared...
Detailed recommendations for the treatment of fractures are given in the “Hippocratic Collection”. The treatises “On Fractures” and “On Joints” provide techniques for realigning joints, eliminating deformities of the limbs during fractures, and, of course, methods of immobilization. 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 splints made of “thick leather and lead.”
Later descriptions of methods for fixing broken limbs, in the 10th century AD. A talented surgeon from the Cordoba Caliphate (the territory of modern Spain) proposed using a mixture of clay, flour and egg white to create a dense 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 wasn't plaster used for this? The history of the plaster cast, exactly as we know it today, dates back only 150 years. And gypsum was used as a building material back in the 3rd millennium BC. Has no one thought of using gypsum for immobilization in 5 thousand years? The thing is that to create a plaster cast you need not just plaster, but one from which excess moisture has been removed - alabaster. In the Middle Ages, the name “Parisian plaster” was assigned to it.
History of gypsum: 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 and buildings of ancient civilizations. The Egyptians, for example, used it to decorate the tombs of the pharaohs in the pyramids. IN Ancient Greece gypsum was very widely used to create magnificent sculptures. In fact, the Greeks gave this natural material its name. “Gypros” in Greek means “boiling stone” (obviously due to its lightness and porous structure). It also became widespread in the works of the ancient Romans.
Historically, the most famous building material was also used by architects in the rest of Europe. Moreover, making stucco and sculpture is not the only use of gypsum. It was also used for the manufacture of decorative plaster for the treatment of wooden houses in cities. Huge interest in gypsum plaster arose due to a misfortune 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. That’s why the name “Parisian plaster” stuck.
From plaster of Paris 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 Paré. The French surgeon impregnated the bandages with a composition based on egg whites, as he writes about in his ten-volume manual on surgery. It was the 16th century and began to be actively used firearms. Immobilizing bandages were used not only to treat fractures, but also to treat gunshot wounds. European surgeons then experimented with dextrin, starch, and wood glue. Napoleon Bonaparte's personal physician, Jean Dominique Larrey, used bandages soaked in a mixture of camphor alcohol, lead acetate and egg white. The method was not widespread due to its labor intensity.
But who was the first to think of using a plaster cast, that is, fabric impregnated with plaster, is unclear. Apparently, it was the Dutch doctor Antony Matthiessen who used it in 1851. He tried rubbing the dressing material with gypsum powder, which, after application, was moistened with a sponge and water. Moreover, at a meeting of the Belgian Society of Medical Sciences, it was sharply criticized: the surgeons did not like that the plaster stained the doctor’s clothes and quickly hardened. Matthiessen's headbands consisted of strips of coarse cotton fabric coated with a thin layer of Parisian plaster. This method of preparing a plaster cast was used until 1950.
It is worth saying that long before this there was 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 shell”. When the plaster set, the limb ended up with such a heavy blank. The downside was that it severely limited the patient's mobility. The next breakthrough in immobilization, as usual, was the war. In war, everything must be fast, practical and convenient for mass use. Who will deal with boxes of alabaster in war? It was our compatriot, Nikolai Ivanovich Pirogov, who first used a plaster cast in 1852 in one of the military hospitals.
The first ever use of a plaster cast
But why plaster? 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, you get either alabaster (120-180 degrees Celsius). This is the same Parisian plaster. At a temperature of 95-100 degrees, low-firing gypsum is obtained, called high-strength gypsum. The latter is precisely more preferable for sculptural compositions.
He was the first to use the familiar plaster cast. He, like other doctors, tried to use different materials to create a tight bandage: starch, colloidin (a mixture of birch tar, salicylic acid and colloid), gutta-percha (a polymer very similar to rubber). All of these products had a big disadvantage - they dried very slowly. Blood and pus soaked the bandage and it often broke. The method proposed by Matthiessen was also not perfect. Due to uneven saturation of the fabric with plaster, the bandage crumbled and was fragile.
Even in ancient times, there were attempts to use cement for immobilization, but the disadvantage was also long time curing. Try sitting motionless for a whole day with a broken leg...
As N.I. wrote Pirogov in his “Sevastopol Letters and Memoirs” he saw the effect of gypsum on canvas in the studio of the famous sculptor of those days, N.A. Stepanov. The sculptor used thin strips of linen dipped in a liquid mixture of plaster of Paris to make the models. “I guessed 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 leg. The success was remarkable. The bandage dried in a few minutes... The complex fracture healed without suppuration or any seizures.”
During the Crimean War, the method of using plaster casts was widely introduced into practice. The method for preparing a plaster cast according to Pirogov looked like this. The damaged limb was wrapped in cloth, and the bony protrusions were additionally covered. A plaster solution was prepared and strips of shirts or underpants were immersed in it (there is no time for fat in war). In general, everything was suitable for bandages.
If you have a plaster solution, you can turn anything into an immobilizing bandage (from the film “Gentlemen of Fortune”)
The plaster mixture was distributed over the tissue and applied along the limb. Then the longitudinal strips were strengthened with transverse strips. The result was a durable structure. After the war, Pirogov improved his method: a piece of fabric corresponding to the size of the damaged limb was cut out from rough canvas in advance and soaked in a plaster solution before use.
Matthiessen’s technique was popular abroad. The fabric was rubbed with dry plaster powder and placed on the patient's limb. The gypsum composition was stored separately in sealed containers. Subsequently, bandages sprinkled with the same composition were produced. But they were wetted after bandaging.
Pros and cons of a plaster cast
What are the advantages of a plaster-based fixation bandage? Convenience and speed of use. The plaster is hypoallergenic (I remember only one case of contact allergy). Very important point: the dressing “breathes” due to the porous structure of the mineral. A microclimate is created. This is a definite bonus, in contrast to modern polymer dressings, which also have a hydrophobic backing. Of the minuses: not always sufficient strength (although a lot depends on the manufacturing technique). Plaster crumbles and is very heavy. And for those who have suffered misfortune and had to contact a traumatologist, the question is often tormented: how to scratch under a cast? However, under a plaster cast it itches more often than under a polymer bandage: it dries out the skin (remember the hygroscopicity of plaster). Various wire devices are used. Anyone who has encountered this will understand. In a plastic bandage, on the contrary, everything “sinks.” 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, the bandages created on a 3D printer do not have all these disadvantages. 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 creating fixation bandages
Undoubtedly. But I think that this will not happen very soon. Fast growing modern technologies, new materials will still take their toll. The plaster cast still has very important advantage. Very low price. And, although new polymer materials are appearing, the immobilizing bandage of which is much lighter and stronger (by the way, it is much more difficult to remove 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
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Home -> Encyclopedia -> Medicine and healthWho came up with the idea of using plaster to fix fractures and speed up their healing?
Not probably, but definitely Pirogov!!! It seems that everything had happened before him - there was plaster, and there were bandages - but in order to connect them together and apply them in medicine, a brilliant Pirogov, obsessed with his profession, was needed!
People called Nikolai Ivanovich Pirogov (1810-1881) a wonderful doctor. The “miracles” that this wonderful doctor and scientist performed for half a century were a manifestation of not only his high talent. All of Pirogov’s thoughts and quests were guided by love for people, for his homeland.
Pirogov was one of the most prominent figures in medicine of the last century. His scientific works in anatomy human body and innovation in surgery brought him worldwide fame.
In 1847, for the first time in the world, Pirogov, working in a field hospital in the Caucasus, used ether during operations on the battlefield. Five years later, for the first time in world practice, he performed an unprecedented operation - he lengthened the leg bone while removing the foot, marking the beginning of a new direction in medicine - osteoplastic operations. At the same time, he was the first to use plaster and plaster bandages for fractures.
When the Crimean War began in 1853 and rumors about the heroic defenders of Sevastopol spread throughout the country, Pirogov decided that his place was not in the capital, but in the besieged city. He achieved appointment to the active army. A group of doctors and medical students followed him there.
Pirogov worked almost around the clock, saving the heroes of Sevastopol. During the war, doctors were forced to resort very often, even with simple fractures, to amputation (removal) of limbs. Pirogov was the first to use a plaster cast. She saved many soldiers and officers from crippling surgery. This discovery was the fruit of the surgeon's observation. Once in the sculptor’s workshop, Nikolai Ivanovich noticed how quickly the plaster, to which the artist gave the intended shape, hardened. The surgeon immediately decided to use plaster for broken bones and other injuries.
