The use of N.I. Pirogov's inventions in modern medicine

Abstract

N.I. Pirogov is a brilliant domestic surgeon, the founder of hospital and military field surgery, topographic anatomy, an outstanding scientist, organizer, teacher and public figure. The clinician's talent, fundamental education, diligence, high morality, patriotism make his legacy invaluable, significant and relevant.

Full Text

Pirogov Nikolai Ivanovich (1810-1881) is rightfully called a brilliant Russian surgeon [2, p. 228], the leading figure of domestic and world medicine. This scientist, who experimented widely in different directions, is considered the founder of surgery as a medical scientific discipline, its theorist and practitioner.
Pirogov's extraordinary abilities, who was the thirteenth child in the family, his instructive diligence, fundamental education, a great desire to help and heal, allowed him to create topographic anatomy, operational and military field surgery [5, 7]. Professor Pirogov made a great contribution to pathological and surgical anatomy [4, p. 40], anesthesiology, general and hospital surgery and related disciplines.
Extensive education, social activity and high moral guidelines make Pirogov successful in pedagogy and public life of the Russian Empire. He is a trustee of the Odessa and Kiev districts, the head of young scientists who studied abroad. In his writings, N.I. Pirogov especially warned that education without education is a very dangerous occupation: "All those preparing to be useful citizens must first learn to be human" [6, stlb.54].
As a surgeon, Pirogov participated in the Crimean War (defense of Sevastopol 1854-55), as a full–time consultant - in the Franco-Prussian (1870-71) and Russian-Turkish (1877-78) wars [1, p. 557].
The remarkable surgeon's organizational talent was revealed in its entirety in the Crimea: he owns the winged words: "Not medicine, but administration plays the main role in helping the wounded and sick in the theater of war." The principle proposed by Pirogov of sorting the wounded for priority or delayed medical care and, if necessary, their evacuation, is fundamental in the conditions of military operations with the rapid appearance of a large number of people in need of emergency care. The sorting area was called a "folding place".
It was N.I. Pirogov who was the first to attract nurses to care for the wounded in places of military operations, dividing them into groups: dressings, nurses, pharmacists and attendants, ensuring their specialization and training. Therefore, he is considered the first organizer of the nursing service in the country.
Nikolai Ivanovich also had a gift for writing: his diary entries, letters, memoirs, literary articles, pedagogical essays and, of course, scientific works on practical and theoretical surgery are instructive and relevant. Every modern surgeon considers Nikolai Ivanovich a great founder of surgery; his portraits traditionally adorn the offices of surgical professors, lecture halls of students.
Natural abilities, the pursuit of truth, diligence, punctuality, the ability to record on paper his professional findings, as well as active participation as a doctor with a creative approach in military operations, lead Pirogov to numerous scientific discoveries. The result of the professor's organizational and medical activities was his catch phrase: "Not medicine, but administration plays a major role in helping the wounded and sick in the theater of war."
Nikolai Pirogov in 1828 became a graduate of the medical faculty (Moscow), and in 1832 – a professor (Dorpat). Already in 1835, he published a study: "On plastic surgery in general and on rhinoplasty in particular," becoming the first scientist in the country to declare the possibility of plastic interventions, and in the world – on the reconstruction of bone tissue. Having found out that if there is at least the slightest communication between the organism and its separated member, if at least a few thinnest vessels and nerve branches have been preserved between them, one can hope for complete success of the fusion of this part with the body. The regenerative ability of tissues was proved by the works of Nikolai Ivanovich, which was the key to the emergence and development of transplantology, maxillofacial and plastic surgery. Experimenting on animals, creating new surgical instruments, Pirogov successfully performs rhinoplasty, cheek plasty, creates an artificial lip, performs operations to fuse the Achilles tendon, heel bone with shin bones, performs primary plastic surgery after excision of tumors.
Nikolai Ivanovich devoted a lot of time to the treatment and removal of teeth, wrote and lectured on therapeutic and surgical dentistry. He designed special sets of surgical instruments, which included dental devices: dental keys and forceps, a device for ligating fractures of the lower jaw, a goat's leg, which was designed for better and humane tooth extraction. Also, by order of N.I. Pirogov, a satchel with surgical instruments was made, which included the tools he invented.
Even at the beginning of his professional career, N.I. Pirogov constantly dissected corpses, striving to create anatomical manuals for surgeons. In 1837, his work "Surgical anatomy of arterial trunks and fascia" appeared. Later, he used the freezing of the bodies of the deceased for layer-by-layer sawing of their various sections in three projections with a layer thickness of 0.5-2 cm, while creating a multitude of disks in transverse, longitudinal, anteroposterior, oblique planes. All anatomical formations of the sawn sections were transferred with absolute accuracy to glass or paper divided into small squares. The fruit of this long-term work (1852-59) was the book "Topographic Anatomy illustrated by sawing through frozen human corpses" [8, p. 5]. With his hard work, consistency and scrupulousness, Nikolai Ivanovich laid the model of an experimental direction in surgery.
At that time, the issue of anesthesia of surgical interventions, which were rarely used even in peacetime, was acute. In military conditions, it was vital for the prevention and control of pain shock. The discovery by N.I. Pirogov of the anesthetic effect of ether on the body (1847) and a thorough study of the features of its inhalation and non-inhalation (parenteral, rectal) methods of application make the scientist a pioneer in the field of anesthesiology. The use of ether anesthesia in military medicine has raised surgery to a qualitatively new level of medical care for the wounded.
In addition, during the Caucasian War (1847), he proposed to impregnate bandages with starch solution to immobilize injured parts of the body, and later in the Crimean War (1850) he began to use plaster for this purpose. And today, the most reliable and common way to treat fractures is a plaster splint and / or a plaster bandage.
Pirogov assumed the existence of "hospital miasma" – pathogenic microorganisms that cause suppuration of wounds and carried out appropriate sanitary and epidemiological measures. He considered cleanliness in the operating room and in the environment of the wound to be a prerequisite for the success of the postoperative period.
In 1849-50, a fundamental two–volume work was published - the monograph and Atlas "Pathological anatomy of Asian cholera" on the results of autopsies of about 900 corpses that died from this infection with a detailed description and images (engraved tables). It was Pirogov who proved the systematic manifestation of the disease, spoke about the contagiousness of the disease. He subjected biological material to microscopy, carefully conducting histological and anatomical studies [3, p. 54]. Similar autopsies were performed by him and with tubercle (tuberculosis).
It was at this time that Nikolai Ivanovich became addicted to cigars, which "beat off" the cadaverous smell, but eventually led to cancer of the upper jaw.
Thus, Nikolai Ivanovich skillfully combining theoretical and practical medicine, adequately responded to all the challenges of the time, opening "terra incognita".With his talents and efficiency, he laid the foundation for new concepts and trends in medicine, which, having withstood the test of time, are still relevant today, and contributed to the difficult victory over diseases, both in his personal practice and on the scale of the entire medical community.