The stages of development of surgery briefly. Brief description of the main periods of development of surgery
Introduction.
Surgery is the most ancient medical science and literally means “handwork” (Greek)
Ancient surgical techniques were most likely aimed at stopping bleeding and treating wounds. This is evidenced by paleopathology data examining fossil skeletons of ancient humans. It is known that people performed bloodletting, amputation of limbs and a number of other operations several thousand years ago in Egypt, Assyria, and Babylon. In India, about three thousand years ago, they not only resorted to surgery to save human life, such as a caesarean section, but also performed various plastic surgeries for cosmetic purposes, transplanting skin flaps to form the nose and ears. The ancient Egyptians knew how to perform amputation of limbs, castration, and stone cutting. They mastered the technique of applying hard bandages for bone fractures, knew a number of methods for treating wounds, and used various methods of pain relief during operations.
The first written evidence of surgical operations is contained in the hieroglyphic texts of ancient Egypt (II-I millennia BC), in the laws of Hammurabi (XVIII century BC), and Indian Samhitas (first centuries AD). The development of surgery is devoted to the works of the “Hippocratic Collection”, the works of outstanding doctors of ancient Rome (Aulus Cornelius Celsus, Galen from Pergamon, Soranus from Ephesus), from the Byzantine Empire (Paul from the island of Aegina), the medieval East (Abu l-Qasim al-Zahrawi, Ibn Sina) and others.
Hippocrates was convinced that human diseases are based on disturbances in the relationships of body fluids. For the first time in history, he drew attention to the difference in the healing time of an open and closed wound, a clean wound and a suppurating wound, recommending various methods of treating them. Hippocrates described methods for treating fractures and dislocations of bones. He described the technique of performing many operations, including punctures of the abdominal and chest wall, trephination of the skull bones, drainage of the pleural cavity during suppuration, etc.
Great importance The subsequent development of surgery was influenced by the activities of the Roman doctors Celsus and Galen. The works of Celsus set forth the sum of all medical knowledge of that time. He proposed a number of improvements in many operations, was the first to use the method of ligating blood vessels using ligatures, and outlined the doctrine of hernias. Galen, who served as a doctor in the school of Roman gladiators, specially studied anatomy. He described one of the ways to stop bleeding - twisting the vessel, and used silk sutures to sew up wounds.
The works of Avicenna have survived to this day, where various methods of treating wounds are discussed in detail, and the operations of stone cutting and stone crushing for bladder stones are described. Ibn Sina was the first to stitch together nerves in case of wounds and performed traction in the treatment of fractures of the bones of the extremities.
When at one time doctors had the opportunity to get acquainted with the so-called Smith papyrus, written in Ancient Egypt in 1700. BC, they were amazed. It turned out that already in that distant time there were surgical instruments, in particular special copper needles for stitching wounds, probes, hooks, and tweezers.
T
types of tools: 1 - tool in the form of a chisel; 2-4 - hooks; 5 - probe in the form of a flat needle; 6-8 - needles; 9-12 - tweezers
In the Middle Ages, medicine, like other sciences, hardly developed. The Church declared dissection of corpses and “shedding of blood” a great sin, prohibited any operations, and subjected people engaged in various scientific research to severe persecution. Surgery was not considered a branch of medicine. Most surgeons did not have a university education and were not admitted to the class of doctors. They were artisans and, according to the guild organization of the medieval city, they united into corporations by profession (bath attendants, barbers, surgeons), where the master surgeon passed on his knowledge to apprentices.
The further development of medicine and surgery, in particular, dates back only to the beginning of the Renaissance. Outstanding surgeons of medieval Europe were Guy de Chauliac (XIV century), Paracelsus (1493-1541), Ambroise Paré (1517–1590). Paré reintroduced such forgotten
techniques such as ligation of blood vessels, used special clamps to grasp vessels and abandoned the then common method of treating wounds - pouring boiling oil over them. But his main achievement was prosthetic arms. Pare built an artificial hand with fingers, each of which could move individually, driven by a complex system of microscopic gears and levers.
Outstanding scientists of the Renaissance had a great influence on the development of surgery: the anatomist Vesalius, who made a huge contribution to the development of anatomy, the physiologist Harvey, who discovered the laws of blood circulation in 1605.
However, surgery, like all medicine, began to develop at a rapid pace only in the 19th century in connection with the general progress of science and technology.
Development of surgery in Russia.
The development of surgery in Russia can be judged from the data of Wilhelm Richter’s multi-volume work “History of Medicine in Russia,” published in Moscow in 1820. Richter points out that the first doctors appeared at the courts of princes, since only wealthy people could afford to prescribe a doctor. The population that arrived in savagery had no idea about doctors and medical care, they used self-help, which sometimes brought some benefit, sometimes clearly harmed those who were sick.
According to Richter, the first knowledge of surgery spread from Greece. But Greek medicine somehow did not take root in Russia.
Starting from the 16th century, Western European culture began to penetrate into Russia, and with it doctors and surgeons appeared, of course, primarily at the court of the great princes. The same thing continued into the 17th century. “If,” says Richter, “we look at the history of the 17th century and the century that preceded it, we will see that the doctors of medicine who lived in Russia were mostly foreigners. Between them were the British, and especially the Germans, also the Dutch and Danes, but, which is very remarkable, there was not a single Frenchman at all. And in the first half of this (17th) century, the tsars and natural Russians, or such young foreigners, whose fathers had settled here for a long time, partly at their own expense, began to send to foreign lands, and specifically to England, Holland and Germany, to study medical science . During the same (17th) century, one can also notice the definition of genuine regimental doctors in the Russian army. Before Tsar Boris Godunov there were none at all. Under Alexei Mikhailovich, not only many doctors, but also pharmacists and barbers or ore throwers began to be stationed on the shelves. Meanwhile, for proper education there were no medical schools or practical hospitals at that time.”
The first medical school in Russia was organized in 1654 under the Pharmacy Prikaz, which was in charge of medicine at that time. And the first hospital in Russia was the Moscow “gospital”, built by decree of Peter I in 1706. This hospital was the first medical school or medical-surgical school in Russia, since the teaching of medicine was organized there.
The educated Dutch doctor Nikolai Bidloo was placed at the head of the hospital and the head of the medical-surgical school. Bidloo himself taught “production surgical operations“, was highly devoted to his work and devoted his entire life to the hospital and school. A lot of work was done to organize the training. When the hospital opened, there was not only not a single skeleton, but not even a single bone for teaching osteology. The doctor-teacher had to serve at the same time as a dissector, a preparator, a hospital resident, a surgeon, a tutor of all special medical subjects, a chief assistant to the doctor, and the manager of the hospital. They were treated and trained mainly by foreign doctors according to foreign models. The development of medicine in Russia lagged significantly behind European countries. So, if the training of medicine in Russia begins at the dawn of the 19th century, then in Italy it has been going on since the 9th-12th centuries, in France from the 13th, in Germany from the 14th. In England, the development of surgery followed a rather independent path, but even there the first mention of surgeons was found in 1354. By the 18th century, Italy, France, and England had strings of famous surgical names, surgical academies, and well-organized hospitals. Nikolai Bidloo should be considered the first teacher of surgery in Russia, and since his school, surgery has developed with incredible speed.
Periods in the history of Russian surgery.
The history of Russian surgery easily falls into two large periods: the first of them covers the time from the beginning of the teaching of surgery in Russia to Pirogov, i.e. before the start of his professional activities. Since Pirogov received the department at the University of Dorpat in 1836, and the department at the Medical-Surgical Academy hospital surgery And pathological anatomy in 1836, then, consequently, the first period embraces less than a century and a half from 1706. to 1841 The second period begins with Pirogov and continues to the present.
Pirogov is often called the “father”, “creator”, “creator” of Russian surgery, accepting that before Pirogov there was nothing original, independent, and that all surgery was borrowed and imitative. Surgery was transplanted to Russia from the West. Over the course of just over two centuries of its development, Russian surgery gradually stood on its own legs and turned into an independent science. Pirogov immediately established Russian surgery completely independently and independently. Without refusing to get acquainted with the West, on the contrary, he greatly appreciated Western surgery, he was always critical of it, and he himself gave a lot to it.
Initially, surgery training at the Moscow Medical-Surgical School was conducted primarily in Latin, while in St. Petersburg it was primarily in German. Russian language was not allowed. In 1764 Doctor Shchepin was transferred from the Moscow school to St. Petersburg, from which equal teaching of anatomy and surgery in Russian and German began.
Throughout the 18th century, doctors of medicine in Russia were either foreigners or Russians, but they necessarily received a doctorate of medicine from foreign universities. As an exception, sometimes the kings themselves awarded doctors the degree of Doctor of Medicine.
In 1776 Medical-surgical schools were transformed into medical-surgical schools, which were given the right to “advance to the doctoral degree, delivering them through natural Russian doctors to occupy places corresponding to their rank.” The right to confer the degree of Doctor of Medicine was enjoyed by the Medical College, the governing medical body in Russia.
The first higher educational institution in Russia is Moscow University, the project of which, developed by Shuvalov, was approved by Empress Elizabeth Petrovna on January 12, 1755. The university was opened on April 26, 1755. The university consisted of three faculties, among which there was a medical one with three departments: chemistry with application to pharmaceutical chemistry, natural history and anatomy with medical practice. At the Faculty of Medicine of Moscow University, surgery was initially taught as part of “practical medicine”. Only in 1764 Professor Erasmus was the first to open the “department of anatomy, surgery and midwifery.” September 29, 1791 Moscow University received the right to confer the degree of Doctor of Medicine. And in 1795 Teaching of medicine begins to be carried out only in Russian.
In Moscow, the development of surgery is closely connected with the activities of Efrem Osipovich Mukhin (1766-1859), a prominent Russian anatomist and physiologist, surgeon, hygienist and forensic physician. As a professor at the Moscow Medical-Surgical (1795–1816) and medical faculty of Moscow University (1813–1835), Mukhin published “Description of surgical operations” (1807), “The first beginning of bone-setting science” (1806) and “Anatomy course” in the 8th parts (1818). He made a significant contribution to the development of Russian anatomical nomenclature. On his initiative, anatomical rooms were created at Moscow University and the Medical-Surgical Academy, the teaching of anatomy on corpses and the production of anatomical preparations from frozen corpses were introduced.
In the first half of the 19th century, the leading center for the development of surgery in Russia was the St. Petersburg Medical-Surgical Academy. Teaching at the Academy was practical: students performed anatomical dissections, observed a large number of operations and themselves participated in some of them under the guidance of experienced surgeons. Among the professors of the Academy were P.A. Zagorsky, I.F. Bush - the author of the first “Manual for teaching surgery” in three parts (1807), I.V. Buyalsky - a student of I.F. Bush and an outstanding predecessor of N.I. Pirogov.
The teachings of the English surgeon J. Lister had a significant impact on the development of surgery, both Russian and foreign. Lister changed the entire understanding of the surgical treatment of diseases and gave, from the point of view of even the beginning of the 19th century, an absolutely incredible impetus to the development of surgery. Lister's antiseptic surgical method was based on the use of carbolic acid solutions. They were sprayed into the air of the operating room, treated the hands of surgeons and disinfected instruments and dressings. Lister attached great importance to disinfecting dressings. Surgeons in Russia started talking a lot about Lister's antiseptics in the early 70s of the 19th century. At the first scientific meeting of the oldest surgical society in Moscow (December 4, 1873), Dr. Kostarev made a report on “various methods of dressing wounds”; in the debate regarding this message on February 26, 1874. Kostarev, summing up his observations, comes to the conclusion that “only two methods of treating wounds should be recognized: a) the method of treatment without dressing (with treatment under a scab, as an option), b) the method of Lister’s disinfectant bandage.” Moreover, Kostarev argues, the method of treatment without dressing should be immediately accepted as the only one completely applicable everywhere. Kostarev believed that open method treatment is higher than antiseptic.
Surgery, including Moscow, followed Lister, not Kostarev. Nevertheless, Lister's antisepsis was hotly debated and adopted. Thanks to the Lister method, postoperative complications and mortality have decreased several times.
In the late 80s of the 19th century, in addition to the antiseptic method, an aseptic method was developed aimed at preventing microorganisms from entering the wound. Asepsis is based on the action of physical factors and includes sterilization in boiling water or steam of instruments, dressings or sutures, a special system for washing the surgeon’s hands, as well as a whole range of sanitary, hygienic and organizational measures. The founders of asepsis were the German surgeons Ernst Bergmann and Kurt Schimmelbusch. In Russia, the founders of asepsis were P.P. Pelekhin, M.S. Subbotin and P.I. Dyakonov.
A significant milestone in the history of Russian surgery is the creation in 1873 of the first Russian surgical society in Moscow. In his likeness, surgical societies were subsequently created in different cities of Russia, which culminated in congresses of surgeons and the emergence of surgical journals.
The next period in the history of Russian surgery is crowned by Nikolai Ivanovich Pirogov (1810-1881).
In 1828 After graduating from Moscow University, the 17-year-old “doctor of the 1st department” Pirogov, on the recommendation of Professor E.O. Mukhin, was sent to the professorial institute that had just been established in Dorpat (now Tartu) to train professors from “born Russians”. The first set of students at this institute also included G.I. Sokolsky, F.I. Inozemtsev, A.M. Filomafitsky and other young scientists who made the glory of Russian science. Nikolai Ivanovich chose surgery as his future specialty, which he studied under the guidance of Professor I.F. Moyer.
In 1832 at the age of 22, Pirogov defended his dissertation “Is ligation of the abdominal aorta for an aneurysm of the groin area an easy and safe intervention?” Her conclusions are based on experimental physiological studies on dogs, rams, and calves.
N.I. Pirogov always closely combined clinical activities with anatomical and physiological research. That is why, during his scientific trip to Germany (1833-1835), he was surprised that “he found practical medicine in Berlin, almost completely isolated from its main real foundations: anatomy and physiology. It was like anatomy and physiology on their own. And surgery itself had nothing to do with anatomy. Neither Rust, nor Graefe, nor Dieffenbach knew anatomy. Moreover, Dieffenbach simply ignored anatomy and made fun of the position of various arteries." In Berlin, N.I. Pirogov worked in the clinics of I.N. Rust, I.F. Dieffenbach, K.F. von Graefe, F. Schlemma, I.H. Yungen; In Gottingen - with B. Langenbeck, whom he highly valued and in whose clinic he improved his knowledge of anatomy and surgery, following Langenbeck’s principle: “The knife should be a bow in the hand of every surgeon.”
Upon returning to Dorpat, already as a professor at the University of Dorpat, N.I. Pirogov wrote several major works on surgery. The main one is “Surgical anatomy of arterial trunks and fascia” (1837), awarded in 1840. Demidov Prize of the St. Petersburg Academy of Sciences - the highest award for scientific achievements in Russia at that time. This work marked the beginning of a new surgical approach to the study of anatomy. Thus, N.I. Pirogov was the founder of a new branch of anatomy - surgical (topographic in modern terminology) anatomy, which studies the relative position of tissues, organs and body parts.
In 1841 N.I. Pirogov was sent to the St. Petersburg Medical-Surgical Academy. The years of work at the Academy (1841-1846) became the most fruitful period of his scientific and practical activity.
At the insistence of Pirogov, the Department of Hospital Surgery was first organized at the Academy. Together with professors K.M.Ber and K.K. With Seydlitz, he developed the project for the Institute of Practical Anatomy, which was created at the Academy in 1846.
At the same time heading both the department and the anatomical institute, Pirogov directed a large surgical clinic and consulted in several St. Petersburg hospitals. After a working day, he performed autopsies on corpses and prepared material for atlases in the morgue of the Obukhov hospital, where he worked by candlelight in a stuffy, poorly ventilated basement. Over 15 years of work in St. Petersburg, he performed almost 12 thousand autopsies.
In building topographic anatomy The “ice anatomy” method occupies an important place. For the first time, freezing corpses for the purpose of anatomical research was carried out by E.O. Mukhin and his student I.V. Buyalsky, who in 1836. prepared a muscular preparation of a “lying body”, subsequently cast in bronze. In 1851 developing the “ice anatomy” method, N.I. Pirogov for the first time carried out total sawing of frozen corpses into thin plates (5-10 mm thick) in three planes. The result of his titanic many years of work in St. Petersburg were two classic works: “A Complete Course of Applied Anatomy human body with drawings (descriptive-physiological and surgical anatomy)" (1843-1848) and "Illustrated topographical anatomy of cuts made in three directions through a frozen human body" in four volumes (1852-1859). Both of them were awarded the Demidov Prizes of the St. Petersburg Academy of Sciences in 1844 and 1860.
Another Demidov Prize was awarded to N.I. Pirogov in 1851. for the book “Pathological Anatomy of Asian Cholera”, in the fight against epidemics of which he repeatedly took part in Dorpat and St. Petersburg.
Pirogov’s role is also great in solving one of the most important problems of surgery – pain relief.
The era of anesthesia began with ether. The first experiments in its use during operations were carried out in America by doctors K. Long, J. Warren, and dentist William Morton. Russia was one of the first countries where ether anesthesia found the most wide application. The first operations under anesthesia in Russia were performed: in Riga (B.F. Burns, January 1847), Moscow (F.I. Inozemtsev, February 7, 1847), St. Petersburg (N.I. Pirogov, February 14, 1847 G.).
The scientific basis for the use of ether anesthesia was given by N.I. Pirogov. In experiments on animals, he conducted an extensive experimental study of the properties of ether under various routes of administration, followed by clinical testing of individual methods. After which, on February 14, 1847, he performed the first operation under anesthesia, removing a breast tumor in 2.5 minutes, and in the summer of 1847 N.I. Pirogov was the first in the world to use ether anesthesia en masse at the theater of military operations in Dagestan (during the siege of the village of Salta).
Speaking about Pirogov, one cannot help but say that he is the founder of military field surgery in Russia. In Sevastopol during the Crimean War (1854-1856), when the wounded arrived at the dressing station in the hundreds, he was the first to justify and put into practice the sorting of the wounded into 4 groups. The first group consisted of the hopelessly ill and mortally wounded. They were entrusted to the care of nurses and priests. The second group included seriously wounded people requiring urgent surgery, which was performed right at the dressing station. The third group included moderately wounded people who could be operated on the next day. The fourth group consisted of the lightly wounded. After rendering necessary assistance they went to the regiment.
For the first time, postoperative patients were divided by Pirogov into two groups: clean and purulent. Patients of the second group were placed in special gangrenous departments.
Assessing the war as a “traumatic epidemic,” N.I. Pirogov was convinced that “it is not medicine, but the administration that plays the main role in helping the wounded and sick at the theater of war.”
The name of Pirogov is associated with the world's first involvement of women in caring for the wounded at the theater of military operations. Under the leadership of Pirogov, during the Crimean events, more than 160 women of the “Krestovozdvizhenskaya community of sisters caring for wounded and sick soldiers” worked, organized with their own money by Grand Duchess Elena Pavlovna, sister of Emperor Nicholas I.
In the scientific and practical activities of N.I. Pirogov, many things were accomplished for the first time: from the creation of entire sciences (topographic anatomy and military field surgery), the first operation under rectal anesthesia (1847) to the first plaster cast in the field (1854) and the first idea about bone grafting (1854).
After N.I. Pirogov, the most outstanding Russian surgeon was N.V. Sklifosovsky. He worked in Kyiv, St. Petersburg, Moscow. He was one of the first to develop an antiseptic method and modified Lister's method using sublimate and iodoform. He developed many surgical operations and paid great attention to the training of surgical personnel.
It should also be noted such remarkable figures of domestic medicine as S.P. Botkin and I.I. Mechnikov. They considered themselves students of Pirogov, and their achievements in medicine can hardly be overestimated.
Soviet science was replenished with a brilliant galaxy of outstanding surgeons, whose names will forever go down in the history of surgery. Among them is S.I. Spasokukotsky, who contributed to the development of pulmonary and abdominal surgery, developed methods of asepsis and antisepsis. He created a large surgical school. N.N. Burdenko, who developed military field surgery, developed neurosurgery. V.A. Vishnevsky, who developed the technique of local anesthesia. A.N. Bakulev, the founder of cardiovascular surgery in our country, founder of the Institute of Cardiovascular Surgery in Moscow. Transplantology and microsurgery have developed in our country in the last 30-40 years thanks to the work of Z.P. Demikhova, B.V. Petrovsky, N.A. Lopatkina, V.S. Krylova. Plastic surgery was successfully developed by V.P. Filatov, N.A. Bogoraz, S.S. Yudin.
Conclusion.
To sum up the historical period described above, we can say that surgery was transplanted to Russia from the West. At first, training was carried out by visiting doctors and healers. At the beginning of the 18th century, Russia had its own schools for teaching medicine in general, surgery in particular. At the end of the 18th century, teaching began to be conducted in Russian, and doctors of medicine appeared. In the first half of the 19th century, Pirogov began to shine, placing himself and Russian surgery in a completely independent place. At the end of the 19th century, Russian surgery introduced Lister antiseptics to treat war wounded. In the 19th century, their own surgical societies appeared, which culminated in congresses of surgeons; surgical journals appear.
The development of surgery continues. This development is based on scientific and technological progress: achievements in biology, pathological anatomy and physiology, biochemistry, pharmacology, physics, etc.
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Completed by: Igolnikov Ilya
OBNINSK 2018
The history of surgery is the history of the last hundred years, which began in 1846, with the discovery of anesthesia and the possibility of
THE HISTORY OF SURGERY IS THE HISTORY OF THE LAST HUNDRED YEARS,WHICH STARTED IN 1846, WITH THE DISCOVERY OF NARCOSIS AND
POSSIBILITIES OF CONDUCTING A PAINLESS OPERATION.
EVERYTHING THAT HAPPENED BEFORE CAN BE CONSIDERED AT NIGHT
IGNORANCE, PAIN, FRUITLESS ATTEMPTES TO TOUCH IN
DARKNESS.
(BERTRAND GOSSET, 1956) “A man who lies down on the operating table in
one of our clinics is more likely to die
than the English soldier who fought at Waterloo"
Joseph Lister
The history of surgery is divided into three periods:
THE HISTORY OF SURGERY IS DIVIDED INTO THREEPERIOD:
I. Period
Continued from primitive times until the mid-19th century, when speech could
only about removing the affected parts of the body.
II. Period
The period began with the discovery of anesthesia (1846) and continued until the 60s of the 20th century.
This period is characterized not only by the removal of the affected parts, but also by their
reconstruction. During this period, the principles of asepsis and antisepsis were introduced,
blood groups were discovered, intensive care was actively developed.
III. Period
This period began in the 60s and continues to this day.
Improving tools, developing natural science research, and
Technicians have also identified gigantic progress in the development and implementation of new
approaches and interventions.
I. Period
I. PERIODHippocrates (5th century BC) famous
as the founder of the rational-empirical school of therapy. He
treated patients, taught his
students, and recorded their experiences on
island of Kos. In his work “Corpus
Hippocraticum” we can read
about the technique of applying bandages,
treatment of fractures, dislocations;
empyema of the chest cavity and even about
trephination in detail. Elements
asepsis (i.e. maintaining cleanliness and
change of bandages) appear in his
wound care guide. In 1543 in Basel there was
the collection “De humani” was published
corparis fabrica”, about the structure
human body. These works were
written by teacher
University of Padua Andreas
Vesalius (1514-1564). Flemish
anatomist and surgeon, born in
Brussels, denied more than 200
medical theories that were
accepted at that time. He installed
a huge number of similarities and
differences existing in the device
living organisms, based on
experiments performed on
animal models. During the siege of Damvilliers in 1552,
for the first time since the Roman Empire
Ambroise Pare (1510-1590) applied
vascular clamp. He also became
the first to use ligatures
to stop bleeding.
II. Period
II. PERIOD1772 British scientist Joseph Presley (1733-1804)
opens laughing gas (N20, dinitrogen oxide, nitrous oxide).
In 1800, British chemist Humphrey Davy (1778-1829)
his experiments come to the conclusion that nitrous oxide
can be used for surgical anesthesia.
American dentist Wells, became known as a pioneer
using nitrous oxide anesthesia, he used it
for tooth extraction. Initial attempts to prevent wound infection were
by no means so successful. Surgical incisions were still followed by an irritating fever, which sometimes
lasted only a few days and were accompanied by pus bonum et
laudabile (good and commendable pus, Galen), but even the most brilliant
surgeons had to humbly take into account the possible fatal
postoperative infection, which crossed out all their work. N.I. Pirogov (1810-1881)
Contribution of N.I. Pirogov into surgical science
huge. As is known, the basis that determined
development of surgery constitute the creation
applied anatomy, introduction of anesthesia,
asepsis and antiseptics, methods of stopping
bleeding, and in all these sections of N.I. Pirogov
contributed. He created modern
applied (topographic) anatomy, widely
introduced ether anesthesia (he was the first to use
anesthesia in military field conditions, with its
10,000 operations performed using
wounded), developed new methods of rectal and endotracheal anesthesia.. N.I. Pirogov
anticipated Lister's research and
Semmelweis, believing that the cause of purulent
postoperative complications are contagious
beginning (“miasma”), which is transmitted from one
sick to another, and a carrier of “miasma”
may be medical personnel. To combat
"miasma" he used antiseptics: tincture
iodine, alcohol, silver nitrate solution, etc. 1860. Louis Pasteur (1822-1895) developed the “theory
origin." He also
suggested that
microbes that can
get into the tissue from
surrounding her
spaces are
cause of infections and
formation of pus. 1867. Sir Joseph Lister (1827-1912) Professor of Surgery in
Glasgow, based on the “theory
Origins” of Pasteur, introduces
disinfection in surgery. He
I was sure that even in the event
complex fractures
the wound needs to be treated
substances capable
destroy bacteria. For these
purposes Lister used
carbolic acid (phenol). IN
Operating room Lister sprayed
phenol on the surgical field, on
instruments and dressing
material, and even just in
air. His “antiseptic theory”
became revolutionary for
surgery, before this surgeons
could control the infection. In the future, significant
step, was the contribution of Ernst von
Bergmann (1836-1907) who
introduced his antiseptic (1887) and
steam sterilization (1886) a
then initiated aseptic
wound management. 1878 Kocher (1841-1917)
Swiss surgeon
wrote a book about
surgical methods
goiter treatment. Learned
preserve the nerves of the larynx and
neck muscles, achieved
good cosmetic
effect. In 1909 there was
awarded the Nobel Prize
awards for their work in
thyroid treatment
glands. 1881. Theodor Billroth
(1829-1894), Austrian
Surgeon. Conducts the first
successful gastrectomy
and the first resection
esophagus. Enters
statistical analysis in
medicine. 1889. Charles
Mc.Burney (18451913) American
surgeon. His report on
early operational
treatment
appendicitis, rendered
huge influence on
decline
mortality. Described
key
symptoms, access to
inflamed
appendix. 1895. Wilhelm Conrad
Röntgen (1845-1923),
German physicist,
opens R-radiation and
carries out
revolution in
diagnostics and treatment.
In 1901 he was awarded
for his discovery
Nobel Prize. William Halstead surgeon
John Medical School
Hopkins, who developed
surgical rubber
gloves. In 1890 he asked
Goodyear Rubber Company
Company produce thin
surgical gloves for your
older sister who suffered
dermatitis due to use
disinfectants.
Joseph K. Bloodgood (1867-1935),
who was Halstead's student,
initiated routine
use of surgical
gloves in 1896. This method
reduced morbidity
dermatitis, as well as the amount
postoperative wound
infections. 1901. Karl
Landsteiner
(1868-1943),
Austrian
pathologist,
discoverer
blood types and
described
ABO Rh system
In 1930 awarded
Nobel
awards. 1902. Alexis Carel (18731944), French surgeon,
developed and published
anastomosis technique
blood vessels end in
end. so, he
created a surgical basis
cardiovascular
surgery and transplantation
organs In the early 20s of the 20th century.
William T. Bovie contributed
surgery in a unique way
making cuts and
tissue coagulation using
alternating current. Way
made it much easier
carrying out intraoperatively
hemostasis.
With the support of Charite
Berlin, they opened an institute
medical cinematography,
installing a special camera
above operating table, They
recorded the operating
process for educational purposes,
the films accurately conveyed
operational technology. Alfred Blalock (1899-1964) American
cardiac surgeon in
Baltimore. In the hospital
Hopkins, committed
first successful
open surgery
baby's heart
which had a syndrome
tetralogy of Fallot (1944) Dr. J. Lewis
performed the operation for the first time
suturing the defect
interatrial
partitions in conditions
hypothermia. This happened 2
September 1952,
He cooled the child to 30°C,
opened the chest
squeezed the hollow ones
veins, opened the atrium,
repaired the defect. The first artificial
blood circulation (autojector) was
designed by Soviet
scientists S. S. Bryukhonenko and S. I. Chechulin in
1926. The device was used in
experiments on dogs, but this
the device has not been used clinically
practice during operations on the human heart. 3
July 1952 in the USA American
heart surgeon and inventor Forest Dewey
Dodrill performed the first successful operation on
open heart of a person using
apparatus cardiopulmonary bypass
"Dodrill-GMR", developed by him in
collaboration with General Motors. 1954. Joseph E. Murray (1919-)
completed the first in the world
successful kidney transplant
between identical twins
Peter Bent Brigham Hospital
Boston. He was awarded
Nobel Prize in 1990.
His surgical technique- With
with minor changes still in use. 1967. Christian Neething Barnard
(1922-2001) performed the first
world transplant
human heart in
Cape Town, South Africa.
The donor's heart came from a 24-year-old woman who died in
as a result of a traffic accident.
The recipient was a 54-year-old
Louis Washkansky. Operation
took 3 hours. Vashkansky
survived the operation and lived
eighteen (18) days, but then
died due to severe infection. 1985. Erich Muret (1938-2005) completed the first
laparoscopic
cholecystectomy. At that
time, german
surgical society
referred to this method as “keyhole surgery”
well" 1998. Friedrich Wilhelm Mohr s
using
surgical
Da Vinci robot
completed
first
robotic
heartfelt
shunt in the center
hearts of Leipzig
(Germany) 2001. In New York Jacques
Maresco used
Zeus robot for
execution
laparoscopic
cholecystectomy in a 68-year-old woman in
Strasbourg (France) Sergio Canavero, Italian surgeon
announces development of transplantation technique
heads 2013
2015 Declares readiness
carrying out
The operation was planned for the end
2017 early 2018. Thus, over the past 150 years, surgery has solved the most important problems for itself
1. Pain
2. Infection
3. Outdated technology
4. Mysterious pathophysiological changes in the perioperative period
The solution of which saved more than one million human lives. But this is not the extent of the development of surgery.
stopped, modern surgery now faces a large number of interesting challenges,
who are waiting for permission. Who will solve these problems is up to you and me.
In the centuries-old history of the development of surgery, four main periods can be distinguished. The first period was before the discovery of anesthesia, antisepsis and asepsis, i.e. until the second half of the 19th century. In ancient times, surgery was primarily manual. Then they corrected external defects with their hands or the simplest instruments and provided assistance for injuries.
Surgery has achieved particular success in Ancient Greece and Ancient Rome. Doctors enjoyed great respect from the population, as evidenced by the lines of Homer: “One skilled healer is worth many warriors.” Hippocrates (460-377 BC), who opened a hospital on the island of Kos, prescribed massage and physical therapy as remedies. He treated broken bones, dislocations and wounds. He described tetanus. Among many purulent diseases, Hippocrates identified a common purulent infection. Hippocrates also created the first code of medical honor, called the “Hippocratic Oath,” which still underlies the oath of a doctor who receives the right to treat patients.
After the fall of Ancient Greece, Rome became the center of scientific development. The works of Celsus and Galen occupied a special place in Roman medicine of that time. Celsus (30 BC-38 AD) left numerous treatises testifying to the achievements of surgery of that time (cataract removal, craniotomy, stone cutting, treatment of fractures and dislocations). They were offered ways to stop bleeding - using tamponade and applying ligatures to the bleeding vessel.
The works of the outstanding scientist and physician Galen (130-210) remained fundamental for more than 1000 years after his death. He devoted a lot of time to the study of anatomy, described many surgical techniques that have not yet lost their significance (twisting a bleeding vessel, suturing with silk threads), developed a surgical technique for cleft lip And so on.
The works of Ibn Sina (980-1037), known in Europe under the name Avicenna, were of great importance. In his book “The Canon of Medical Science” many chapters are devoted to surgery - recognition of tumors, suturing of nerves, tracheotomy, treatment of wounds and burns, etc.
In European countries, the beginning of significant progress in science dates back to the Renaissance (XY1st century). The works of Vesalius and Harvey on anatomy and physiology played a special role. The most prominent representative of the surgical direction of medicine of that time was the French surgeon Ambroise Paré (1517-1590). He created a new doctrine about gunshot wounds: he proved that these were a special type of bruised wounds, and not poisoned with poisons, as was believed at that time. The second period (second half of the 19th century) is associated with the discovery and introduction into practice of anesthesia, antisepsis and asepsis. The first public demonstration of the use of ether anesthesia was held on October 16, 1846. dentist M. Morton in Boston (USA). Already in December 1846, Liston operated under ether anesthesia in England and N.I. Pirogov in Russia.
The pioneers of the use of local anesthesia were our country’s surgeons V.K. Anrep (1880) and A.I. Lukashevich (1886). N.M.’s clinic played a big role in this. Monastyrsky (1847-1880), where for the first time under local anesthesia abdominal operations were performed.
A new era in the development of local anesthesia began in 1905, when the German chemist Eingorn synthesized novocaine, which quickly became widespread as a local anesthetic. The development of local anesthesia is associated with the name of A.V. Vishnevsky (1874-1948). The method of infiltration anesthesia proposed by him has received the most widespread use in all areas of surgery.
The greatest event of the 19th century was the work of L. Pasteur, who discovered the microcosm and laid the foundation for microbiology. D. Lister, comparing his observations of the course of the wound process, came to the conclusion that suppuration is associated with the penetration of microorganisms into the wound and, in order to prevent this complication, they must be destroyed. To do this, he proposed using a solution of carbolic acid. This is how the antiseptic method in surgery was born, and then the aseptic method, which was based on the principle: everything that touches the wound must be sterile. The introduction of asepsis and anesthesia created conditions for the rapid development of abdominal surgery.
The third period (the beginning of the 20th century) can be called physiological-experimental due to the decisive influence on the development of surgery of the experimental physiological studies of Sechenov and Pavlov. They created conditions for the emergence of new surgical directions and the development of anesthesiology and transfusiology. urology , neurosurgery, etc.
The fourth period (modern) is a period of restoration and reconstructive surgery characterized by in-depth scientific search new ideas in the development of diagnostic and treatment methods based on the widespread introduction of microsurgery, new devices and equipment, physical, pharmacological and other methods of influencing the human body into various diseases, as well as organ and tissue transplants, the use of artificial organs and tissues.
The conventionality of such periodization is obvious because in the history of surgery, these periods were layered one on top of the other; there were not only periods of prosperity, but also a slowdown in the pace of movement, stagnation and even regression, when much that had already been achieved was lost in order to be revived and gain recognition and dissemination.
In Russia, surgery began to develop much later than in Western countries. Until the 18th century, there were no surgeons in Russia; surgical assistance was provided by barbers and healers, who only performed cauterizations, opening abscesses, “letting blood” and others. The beginning of organized training for chiropractors involved in surgery is considered to be 1654, when Tsar Alexei Mikhailovich issued a decree on the creation of chiropractic schools.
In 1706, Peter 1 founded the first state medical institution- a hospital in Moscow across the Yauza River - now a hospital named after N.V. Burdenko, which simultaneously became the first higher medical-surgical school.
By decree of Peter 1, a military hospital was opened in St. Petersburg in 1716, and in 1719 the Admiralty Hospital, which became a school for training Russian doctors in surgery. During the 18th century, the Medical and Surgical Academy was opened in St. Petersburg and on the initiative of M.V. Lomonosov - Moscow University with the Faculty of Medicine. At the Faculty of Medicine in Moscow, a group of anatomists arose, headed by the famous scientist P.A. Zagorsky (1764 – 1646). He wrote the first Russian textbook on anatomy. A group of scientist-surgeons was formed under the leadership of E.O. Mukhin, a former paramedic in Suvorov’s troops, who wrote the book “Description of Surgical Operations.” We owe him the nomination of N.I. Pirogov. The St. Petersburg Medical-Surgical Academy formed a team of surgeons headed by I.F. Bush (1771–1843), who created the first Russian manual on surgery. His student Professor I.V. Buyalsky created an anatomical and surgical atlas.
ROLE OF N.I. PIROGOV IN THE DEVELOPMENT OF RUSSIAN SURGERY.
Founder domestic surgery The great physician of the 19th century, Nikolai Ivanovich Pirogov, is deservedly considered. He was born in 1810 in Moscow
Graduated from the Faculty of Medicine of Moscow University. Then he passes special training to professorship at Yuryev University. At the age of 26, he took the chair of surgery and soon published the work “Surgical Anatomy of the Arterial Trunks and Fascia.” It was the first scientific study of anatomy subordinated to the tasks of surgery.
Previously, surgeons turned to anatomy along the way. N.I. Pirogov posed the question differently: “Surgery is not possible without accurate and complete knowledge of anatomy.” If an anatomist studies anatomy by systems, then the surgeon must know the layer-by-layer anatomy of the organ where the operation is performed and the organ on which the operation is performed. This innovation by Pirogov led to the appearance new science- topographic anatomy. This science is the basis of modern surgery, but at that time it was not sufficiently developed. N.I. Pirogov studied the topographic anatomy of all areas of the human body. To do this, he proposed and developed in detail methods for freezing corpses and cutting them up. The positions of various organs and their relationship with surrounding tissues were studied on the cuts.
The result of many years of activity of N.I. Pirogov became a four-volume atlas of anatomy (1852) - a fundamental work to which all those involved in topographic anatomy and operative surgery. N.I. Pirogov developed the technique of many operations and proved the possibility of performing osteoplastic surgical interventions.
N.I. Pirogov did not ignore the fact that the operation itself, as a tissue injury, is associated with very acute pain. He was the first to understand the message of the dentist Morton and the chemist Jackson (1846) about ether anesthesia and developed the theory of anesthesia with ether. He conducted a series of experiments on animals, tested the effect of ether on himself, and then for the first time in the world, ether anesthesia was widely used during operations during the war in the Caucasus in 1847.
In order to prevent suppuration of wounds, Pirogov organized a special operating regime for the surgical department. He demanded that rooms for patients be well ventilated, that doctors monitor the cleanliness of their hands and instruments, and introduced special kettles from which wounds were washed with running boiled water. As microbiology developed, Pirogov began to point out that “spores”, “fungi”, “embryos”, as the first researchers called pathogenic bacteria, are the same “miasmas” mentioned by Hippocrates, the origin of which has been discussed and debated for centuries in medicine.
D. Lister (1867) was the first to prove the causes of purulent infection of wounds and showed that if appropriate measures are taken against bacteria, then suppuration may not occur. However, Pirogov foresaw all this before Lister. He came up with the idea that the “miasmas” that complicate the course of wounds are living beings that can and should be fought. Taking all this into account, Pirogov should be recognized as the founder of the science of surgical infection in Russia.
N.I. Pirogov is rightfully considered the founder of military field surgery. He introduced into practice the concept: war is a “traumatic epidemic.” In the book “The Beginnings of General Military Field Surgery,” in addition to measures to prevent and treat wounds, N.I. Pirogov proposed paying special attention to triage of the wounded “at the theater of military operations.” For the first time in Russia and the world, they proposed plaster casts for the treatment of fractures.
Brilliant scientist and organizer N.I. Pirogov, not only in Russia, but also abroad, is deservedly considered the founder of such important branches of surgery as surgical anatomy and military field surgery. He was an erudite scientist who wrote works in all branches of surgery (anesthesia, shock, wound healing, treatment of fractures etc.) Pirogov’s teachings and works served as the basis for the training of subsequent generations of Russian surgeons.
A domestic school of Russian surgery was founded, freed from the influence of Western schools.
In the post-Pirogov period (80s of the 19th century), not only Moscow and St. Petersburg surgical schools appeared, but peripheral ones, and zemstvo surgery also developed.
N.V. Sklifosovsky (1836-1904) is an outstanding surgeon, scientist and public figure who developed operations for goiter, cerebral hernias, etc. He is the creator of the first Russian surgical journals and the founder of the Pirogov congresses.
S.I. Spasokukotsky (1870-1943), founder of a large surgical school, enriched this branch of medicine fundamental research on surgery of purulent diseases of the lungs and pleura. He developed various aspects of blood transfusion. The method of treating the surgeon’s hands according to Spasokukotsky-Kochergin has not lost its importance today.
N.N. Burdenko (1878-1946) was the first president of the USSR Academy of Sciences. His works on military field surgery and shock, wound treatment, neurosurgery, etc. played a major role in the progress of surgery. Occupying the post of chief surgeon of the Soviet army, he developed a doctrine of providing assistance to the wounded at all stages of treatment during the Great Patriotic War, which made it possible to return 73% of the wounded to duty.
A.V. Vishnevsky (1874-1948) devoted all his research to the problem of trophic function nervous system. He developed novocaine blockades included in the complex therapeutic measures, for many diseases, an oil-balsamic dressing was proposed, which played an important role during the Second World War in the treatment of wounds. He was a passionate promoter of local anesthesia. He created a special type of infiltration anesthesia, which is still used today for the most serious operations.
N.P. Petrov (1876-1962) creator of the modern system of fighting cancer.
Thoracic and vascular surgery has developed rapidly in the last decade. A student of S.I. Spasokukotsky, Academician A.N. Bakulev, was a pioneer of cardiovascular surgery in our country and made a huge contribution to the development of this branch of medicine.
Many complex operations, including heart surgery, and heart transplantation are not possible without the use of artificial circulation, which was proposed in 1927. Soviet surgeon S.s. Bryukhonenko. He designed and used in the experiment a special apparatus - an auto-projector.
Modern surgery continues to develop rapidly. Transplantology, reconstructive surgery, and microsurgery continue to improve.
Main stages in the development of surgery
Surgery is one of the most ancient specialties in the history of medicine.
In states Ancient East(Egypt, India, China, Mesopotamia) traditional medicine for a long time remained the basis; healing. There were rudiments of surgical knowledge that were used in peaceful life and on the battlefield: they removed arrows, bandaged wounds, stopped bleeding, using pain-reducing agents during operations: opium, henbane, mandrake. During excavations on the territory of these states, many surgical instruments were discovered.
The doctors of Ancient Greece had a great influence on the development of surgery. Ancient Rome, such as Asclepius (Aesculapius)! Asclepiades (128 - 56 BC). Celsus (1st century BC) wrote a major work on surgery, where he was the first to list the signs of inflammation: rubor (inflammation), tumor (swelling), caler (fever), dolor (pain), and suggested the use of ligatures for ligating blood vessels during surgery, described methods of amputation and reduction of dislocations, and developed the doctrine of hernias. Hippocrates (460 -370 BC) wrote several works on surgery. He was the first to describe the features of wound healing, signs of phlegmon and sepsis, symptoms of tetanus, and developed the operation of rib resection for purulent pleurisy. Claudius Galen (131 - 201) proposed the use of silk for suturing wounds.
Surgery received significant development in the Arab caliphates (VII-XIII centuries). Outstanding doctors Ar-Razi (Razes) (865 - 920) and Ibn Sina (Avicenna) (980-1037) lived and worked in Bukhara, Khorezm, Merv, Samarkand, Damascus, Baghdad, Cairo.
Medicine of the Middle Ages (XII-XIII centuries) was under the yoke of church ideology. The centers of medicine during this period were the Universities of Salerno, Bologna, Paris (Sorbonne), Padua, Oxford, Prague, and Vienna. However, the charters of all universities were controlled by the church. At that time, the most developed area of medicine, due to the constantly ongoing wars, was surgery, which was practiced not by doctors, but by chiropractors and barbers. Surgeons were not accepted into the so-called community of medical scientists; they were considered ordinary performers. This situation could not last long. Experience and observations on the battlefield created the prerequisites for the active development of surgery.
During the Renaissance (XV-XVI centuries) a galaxy of outstanding doctors and natural scientists appeared who made a significant contribution to the development of anatomy, physiology and surgery: Paracelsus (Theofast von Hohenheim) (1493-1541), Leonardo da Vinci (1452-1519), V. Harvey (1578-1657). The outstanding anatomist A. Vesalius (1514-1564) was handed over to the Inquisition only for claiming that a man has 12 pairs of ribs, and not 11 (one rib should have been used to create Eve).
In France, where surgery was stubbornly not recognized as a field of medicine, surgeons were the first to achieve equality. It was here that the first schools of surgeons opened, and in mid-18th century V. - higher educational institution - surgical academy. A prominent representative of the French school of surgeons was the founder of Scientific Surgery of the Modern Age, A. Paré (1517-1590).
In the 19th century new demands appeared on medical science, but led to new discoveries in the field of surgery. In 1800, the English chemist G. Devi described the phenomena of intoxication and convulsive laughter when inhaling nitrous oxide, calling it laughing gas. In 1844, nitrous oxide was used as an anesthetic in dental practice. In 1847, the Scottish surgeon and obstetrician J. Simeon used chloroform for pain relief, and in 1905, the German physician A. Eingorn synthesized novocaine.
The main problem of surgery in the second half of the 19th century. suppuration of wounds appeared. The Hungarian obstetrician I. Semmelweis (1818 - 1865) began to use chlorine water as a disinfectant in 1847. The English surgeon J. Lister (1827 - 1912) proved that the cause of suppuration is living microorganisms entering the wound from the air, and proposed the use of carbolic acid (phenol) to combat infectious agents. Thus, in 1865 he introduced antisepsis and asepsis into surgical practice.
In 1857, the French scientist L. Pasteur (1822-1895) discovered the nature of fermentation. In 1864, the American dentist W. Morton used ether for pain relief during tooth extraction. The German surgeon F. Esmarch (1823-1908), one of the pioneers of asepsis and antisepsis, in 1873 proposed the use of a hemostatic tourniquet, elastic bandage and anesthesia mask. The instruments of the Swiss surgeons T. Kocher (1841 - 1917) and J. Pean (1830 - 1898) made it possible to operate in a “dry” wound. In 1895, the German physicist W. K. Roentgen (1845 - 1923) discovered rays capable of penetrating opaque bodies.
The discovery of blood groups (L. Landsteiner, 1900; Ya. Yamsky, 1907) gave surgeons an effective means of combating acute blood loss. French physiologist C. Bernard (1813-1873) created experimental medicine.
In Russia, surgery began to develop much later than in Western European countries. Until the 18th century In Russia, surgical care was almost completely absent. Manipulations such as bloodletting, cauterization, and opening abscesses were performed by healers and barbers.
Under Peter I in 1725, the St. Petersburg Academy of Sciences, military land and admiralty hospitals were opened. Schools began to be created on the basis of hospitals, which in 1786 were transformed into medical-surgical schools. In 1798, medical-surgical academies were organized in St. Petersburg and Moscow. In 1755, on the initiative of M.V. Lomonosov, Moscow University was opened, and in 1764, the Faculty of Medicine was opened under it.
First half of the 19th century gave the world such wonderful Russian scientists as P.A. Zagorsky, I.F. Bush, I.V. Buyalsky, E.O. Mukhin, F.I. Inozemtsev, I.N. Sechenov, I.P. Pavlov, N.E. Vvedensky, V.V. Pashugin, I.I. Mechnikov, S.N. Vinogradsky, N.F. Gamaleya, L. I. Lukashevich, L. O. Heidenreich, M. S. Subbotin, M. Y. Preobrazhensky, A. A. Bobrov, P. I. Dyakonov and others.
The great surgeon and anatomist N.I. Pirogov (1810-1881) is rightfully considered the founder of Russian surgery. Using methods of freezing corpses and cutting them, he studied in detail all areas of the human body and wrote a four-volume atlas on topographic anatomy, which for a long time was a reference book for surgeons. N.I. Pirogov headed the department of surgery at the University of Dorpat, the department of hospital surgery and pathological anatomy at the St. Petersburg Medical-Surgical Academy. N.I. Pirogov, before L. Pasteur, suggested the presence of microorganisms in a purulent wound, and for this purpose allocated a department in his clinic for “those infected with hospital miasmas.” It was N.I. Pirogov who was the first in the world to use ether anesthesia during the Caucasian war (1847). Being the founder of military field surgery, the scientist developed the principles of organizing care for the wounded - triage depending on the urgency of care, evacuation, hospitalization. He introduced qualitatively new methods of immobilization, treatment of gunshot wounds, introduced immobile plaster cast. N.I. Pirogov organized the first detachments of nurses who provided assistance to the wounded on the battlefield.
N.V. Sklifosovsky (1836-1904) developed operations for tongue cancer, goiter, and cerebral hernias.
V.A. Oppel (1872-1932) - military field surgeon, founder of the doctrine of staged treatment wounded, was one of the founders of endocrine surgery in Russia. V.A. Oppel was involved in the study of vascular diseases and abdominal surgery.
S.I. Spasokukotsky (1870-1943) worked in many areas of surgery, developed a highly effective method of preparing the surgeon’s hands for surgery, and new methods of operations for inguinal hernias. He was one of the pioneers of thoracic surgery and was also one of the first to use skeletal traction in the treatment of fractures.
S.P. Fedorov (1869-1936) was the founder of Russian urology and biliary surgery.
P.A. Herzen (1871 - 1947) was one of the founders of the Soviet clinical oncology. He proposed methods for treating hernias and, for the first time in the world, successfully performed an operation to create an artificial esophagus.
A.V. Vishnevsky (1874-1948) developed different kinds novocaine blockades, dealt with issues of purulent surgery, urology, neurosurgery, and was the organizer of the Institute of Surgery of the USSR Academy of Medical Sciences in Moscow.
Surgeons - the first academicians of the USSR Academy of Medical Sciences
1st row - V.P. Filatov (1); S.S. Girgolav (2); S.S. Yudin (4); N.N. Burdenko (5);
2nd row - V.N. Shevkunenko (6); Yu.Yu.Dzhanelidze (8); P.A. Kupriyanov (12)
N.N. Burdenko (1876-1946), a general surgeon, was the chief surgeon of the Red Army during the Great Patriotic War. He became one of the founders of Soviet neurosurgery and the first president of the USSR Academy of Medical Sciences.
L.N. Bakulev (1890-1967) was one of the founders of cardiovascular and pulmonary surgery, subsections of thoracic surgery in the USSR.
Alexander Nikolaevich Bakulev (1890-1967)
S.S. Yudin (1891-1954) in 1930 was the first in the world to transfuse human cadaveric blood. He also proposed a method for creating an artificial esophagus. S.S. Yudin was for a long time the chief surgeon of the Institute of Emergency Medicine named after. N.V. Sklifosovsky.
Currently, Russian surgery continues to develop successfully. Outstanding surgeons, academicians V.S. Savelyev, V.D. Fedorov, M.I. Kuzin, A.V. Pokrovsky, M.I. Davydov, G.I. Vorobyov and others made a great contribution to the development of modern domestic surgery. areas include operations in hyperbaric chambers, microsurgery, plastic surgery, transplantation of organs and tissues, open-heart surgery using a heart-lung machine, etc. Work in these areas continues successfully. Already proven techniques are constantly being improved, new technologies are being actively introduced using the most modern tools, devices and devices.
1.3. Organization of surgical care in Russia
In Russia, a coherent system of providing surgical care to the population has been created, ensuring the unity of preventive and therapeutic measures. Surgical care is provided by several types of medical institutions.
1. Paramedic and midwife stations mainly provide emergency first aid medical assistance, and also carry out the prevention of diseases and injuries.
2. Local hospitals (polyclinics) provide emergency and urgent surgical care for certain diseases and injuries that do not require extensive surgical interventions, and also manage the work of paramedic and obstetric centers.
3. Surgical departments of central district hospitals (CRH) provide qualified surgical care for acute surgical diseases and injuries, as well as planned treatment of the most common surgical diseases (hernia repair, cholecystectomy, etc.).
4. Specialized surgical departments of multidisciplinary city and regional hospitals, in addition to the full scope of general surgical care, provide specialized types of care (urological, oncological, traumatological, orthopedic, etc.). In large cities, specialized care can be provided in hospitals that are fully specialized in accordance with one or another type of surgical care.
5. In surgical clinics of medical universities and postgraduate training institutes, they provide both general surgical and specialized surgical care, carry out scientific development of various areas of surgery, train students, interns and improve the qualifications of doctors.
6. Research institutes provide specialized surgical care depending on their profile and are scientific and methodological centers.
There are emergency (urgent) and planned, outpatient and inpatient surgical care.
Emergency surgical care in urban conditions, during the daytime, it is provided by local surgeons at polyclinics or emergency doctors who provide it around the clock. They establish a diagnosis, provide first aid and, if necessary, ensure transportation of patients to on-duty surgical departments, where qualified and specialized surgical care is provided for urgent indications.
In rural areas, emergency care is provided at a feldsher-midwife station or local hospital. In the absence of a surgeon, if acute surgical pathology is suspected, the patient must be transported to a district hospital or central district hospital. At this stage, qualified surgical care is provided in full, and in some cases patients are transported to regional center or call the appropriate specialist from the regional center.
Planned surgical care It appears both in surgical departments of clinics, where minor and simple operations on superficial tissues are performed, and in hospitals. In the compulsory health insurance (CHI) system, the patient must be referred to planned surgery within 6-12 months after visiting the clinic and establishing a diagnosis.
Outpatient surgical care to the population is the most widespread and consists of conducting diagnostic, therapeutic and preventive work. This assistance to patients with surgical diseases and injuries is provided in varying amounts in surgical departments and clinics, outpatient clinics of local hospitals, and emergency rooms. First aid can be provided at paramedic health centers and paramedic-midwife stations.
Inpatient surgical care carried out in general surgical departments, specialized departments and highly specialized centers.
Surgical departments are organized as part of district and city hospitals (color insert, Fig. 1). They provide basic types of qualified inpatient surgical care to most of the country's population. In surgical departments, more than half of the patients are patients with acute surgical pathology and a quarter are with injuries and diseases of the musculoskeletal system. Every year, emergency surgical care is provided to an average of one in 200 Russian residents. In large hospitals, surgical departments are reorganized into specialized ones: traumatology, urology, coloproctology, etc. In medical departments without specialization, profiled beds are allocated.
Surgical departments are organized, as a rule, with 60 beds. The number of beds in a specialized department can be reduced to 25 - 40 units. Providing emergency surgical care to patients with acute surgical diseases and injuries of the abdominal organs constitutes the majority of the work of surgical hospitals. The number of surgical beds required to provide emergency care is calculated according to standards 1 .5 - 2.0 beds per 1,000 people Providing emergency surgical care in large departments with round-the-clock operation of laboratory, X-ray, and endoscopic services significantly improves treatment results.
1.4. The role of the paramedic in the treatment of surgical patients
A paramedic - a paramedic - is the closest and direct assistant to a doctor. In some cases, the patient’s life depends on the correctness and efficiency of the paramedic’s work. IN rural hospitals A paramedic may be assigned daily duty in a hospital or emergency department.
A paramedic devotes about a third of his working time to surgical activities. He needs to know the basics of surgery and master certain manipulations that the paramedic must apply, if necessary, at any period of his activity. He must be able to:
· promptly diagnose acute surgical diseases, most surgical diseases and, if they are suspected, refer patients to the hospital;
· quickly navigate in case of accidents and damage;
· quickly and competently provide pre-hospital medical care;
· organize proper transportation of the victim to a medical facility (choose the correct type of transport and the position of the patient during transportation).
The participation of a paramedic in the treatment of a surgical patient is no less important than the participation of a surgeon. The result of the operation depends not only on the careful preparation of the patient for the operation by paramedical workers, but also on the organization of the execution medical appointments and patient care in the postoperative period and during the rehabilitation period (restoration of performance and elimination of the consequences of the surgery).
When working with surgical patients, you should always remember deontology. Basic deontological principles are formulated in the Hippocratic Oath. Deontology includes maintaining medical confidentiality.
Healthcare professionals need to communicate professionally and sensitively with patients. Wrong actions, a carelessly spoken word, test results or medical history that become available to the patient can lead to psychological discomfort, fear of illness, and often cause complaints or even litigation.
The nature of the work of a paramedic is different and depends on the medical unit in which he works.
The work of a paramedic as part of an emergency medical team. Mobile teams are divided into paramedic and medical teams, which will not be discussed in the textbook. The paramedic team consists of two paramedics, an orderly and a driver and provides the necessary medical care within the limits of professional competence. It solves the following problems:
· immediate departure and arrival at the place of call;
Establishing a diagnosis, providing emergency services medical care;
· implementation of measures to help stabilize or improve the patient’s condition, and, if indicated, delivery of the patient to a surgical hospital;
handover of the patient and related medical documentation the hospital doctor on duty;
· ensuring medical triage of sick and injured people, establishing the priority and sequence of medical measures in case of mass injuries and other emergency situations.
The work of a paramedic in a surgical hospital. In a surgical hospital, a paramedic can perform the duties of a ward, procedure or dressing nurse, anesthetist nurse or intensive care unit nurse.
On the day of admission, each patient must be examined by the attending (duty) doctor and nurse(ward duty officer), he must be assigned necessary examinations, appropriate diet, regimen and treatment. If the patient’s condition allows, the paramedic introduces him to the internal regulations.
Most duties and responsibilities ward sister(paramedic). IN preoperative period, when the patient undergoes an examination, the paramedic monitors the timely implementation diagnostic studies, compliance with all the rules of preparation for them prescribed by the doctor. Any inaccuracy during the study may lead to erroneous results, incorrect assessment of the patient’s condition and, as a result, cause an unfavorable outcome of treatment.
The outcome of the operation may depend on how accurately the paramedic carries out various procedures prescribed by the doctor before the operation. healing procedures. For example, an incorrectly performed cleansing enema in a patient with a disease of the colon can cause rupture of sutures and peritonitis, which in most cases ends in his death.
The paramedic should pay special attention to the operated patient. The paramedic must promptly identify complications that arise during the postoperative period and be able to provide the assistance necessary in each specific case. In a timely manner Taken measures at the slightest deterioration of the patient’s condition, they can prevent dangerous and even fatal complications. It is easier to prevent complications than to treat them, therefore, at the slightest deterioration in the patient’s condition - changes in pulse, blood pressure (BP), breathing, behavior, consciousness - the paramedic is obliged to immediately report this to the doctor.
The paramedic must care for the sick, feed the seriously ill, and carry out sanitary treatment of surgical patients upon admission. As prescribed by the doctor, the paramedic applies all types of bandages, makes subcutaneous injections and infusions, intramuscular injections, gives enemas, performs venipuncture and intravenous infusions. Under the supervision of a physician, a paramedic can catheterize bladder with a soft catheter, make dressings, and probe the stomach.
The paramedic is an active assistant to the physician during puncture of cavities and removal of exudate from them, application of bandages, venipuncture and intravenous infusions, blood transfusions, and catheterization of central veins.
The work of a paramedic at a medical and obstetric station. A paramedic-midwife station is a primary pre-hospital medical institution that provides health care to the rural population within the competence and rights of a paramedic and midwife under the guidance of a local doctor. In this case, the paramedic provides the main assistance to the population. He provides outpatient services to the population; provides medical assistance in case of acute illnesses and accidents; deals with early detection of diseases and timely referral for consultation and hospitalization; conducts an examination of temporary disability and issues sick leave certificates; organizes and conducts preventive examinations; selects patients for clinical observation.
Work as a paramedic in a clinic. Planned patients are admitted to the hospital partially or fully examined, with an established clinical or preliminary diagnosis. For planned hospitalization, it is necessary to perform a standard minimum examination. The paramedic writes out directions to the patient for a general blood test, a general urinalysis, a test to determine blood clotting time, blood tests for bilirubin, urea, glucose, to determine the blood group and Rh factor, for antibodies to HIV infection, and HBs antigen. The paramedic also refers the patient to a large-frame fluorography (if it has not been performed within a year), an ECG with interpretation, a consultation with a therapist (if necessary, also other specialists) and for women - a gynecologist.
After making a diagnosis, assessing the operational risk, completing all the necessary examinations and making sure that the patient needs to be hospitalized, the clinic surgeon writes a referral for hospitalization, which must indicate the name of the insurance company and all the necessary details.
After discharge from the hospital, the patient is sent for follow-up treatment to the clinic at the place of residence, and working patients after a series of surgical interventions (cholecystectomy, gastrectomy, etc.) are sent directly from the hospital to a sanatorium (dispensary) to undergo a course of rehabilitation treatment. In the postoperative period, the main tasks of the paramedic are the prevention of postoperative complications, acceleration of regeneration processes, and restoration of working capacity.
Control questions
1. Define surgery. Name the main features of modern surgery.
2. What main types of surgical diseases do you know?
3. Name the most famous history medicine of foreign surgeons, what are their merits?
4. Who is the founder of Russian surgery? List the ionic services of this scientist to world and domestic surgery.
5. Name the outstanding Russian surgeons of our time.
6. List medical institutions who provide care to surgical patients.
7. Name the types of surgical care. Where is emergency surgical care provided?
8. Formulate the basic principles of organizing inpatient surgical care.
9.What should a paramedic be able to do when providing assistance to a patient with an acute surgical disease?
10. What are the features of the surgical work of a paramedic as part of an ambulance team, in a surgical hospital, at a paramedic-obstetric station, in a clinic?
CHAPTER 2
PREVENTION OF SURGICAL IN-HOSPITAL INFECTION
2.1 Brief history of the development of antisepsis and asepsis
The basis of the work of any modern health care facility is the mandatory observance of the rules of asepsis and antisepsis. The term "antiseptic" was first proposed in 1750. English doctor I. Pringle to designate the antiputrefactive action of inorganic acids. The fight against wound infection began long before our era and continues to this day. 500 BC In India, it was known that smooth healing of wounds is possible only after they are thoroughly cleaned of foreign bodies. In Ancient Greece, Hippocrates always covered the surgical field with a clean cloth and used only boiled water during the operation. IN folk medicine For several centuries, myrrh, frankincense, chamomile, wormwood, aloe, rose hips, alcohol, honey, sugar, sulfur, kerosene, salt, etc. were used for antiseptic purposes.
Before the introduction of antiseptic methods into surgery, postoperative mortality reached 80%, as patients died from a variety of purulent-inflammatory complications. The nature of rotting and fermentation, discovered by L. Pasteur in 1863, became a stimulus for the development of practical surgery and allowed us to assert that the cause of many wound complications are also microorganisms.
The founder of asepsis and antisepsis is the English surgeon D. Lister, who in 1867 developed a number of methods for destroying microbes in the air, on the hands, in the wound, as well as on objects in contact with the wound. As an antimicrobial agent, D. Lister used carbolic acid (phenol solution), which he used to treat the wound, healthy skin around the wound, instruments, the surgeon's hands, sprayed the air in the operating room. The success exceeded all expectations - the number of purulent-inflammatory complications and mortality decreased significantly. Simultaneously with D. Lister, the Austrian obstetrician I. Semmelvs, based on many years of observations, proved that puerperal fever, which is the main cause of death after childbirth, is transmitted in maternity hospitals through hands medical personnel. In Viennese hospitals, he introduced mandatory and thorough cleaning of the hands of medical personnel with a solution of bleach. Morbidity and mortality from puerperal fever were significantly reduced as a result of this measure.
Russian surgeon N.I. Pirogov wrote: “We can safely say that most of the wounded die not so much from the injuries themselves, but from hospital infection” (Pirogov N.I. Sevastopol letters and memoirs of N.I. Pirogov. - M., 1950. – P. 459). For the prevention of suppuration and treatment of wounds in Crimean War(1853-1856) he widely used bleach solution, ethanol, silver nitrate. At the same time, the German surgeon T. Billroth introduced a uniform for doctors of surgical departments in the form white coat and hats.
D. Lister's antiseptic method of prevention and treatment of purulent wounds quickly gained recognition and distribution. However, its disadvantages also emerged - the pronounced local and general toxic effect of carbolic acid on the body of the patient and the medical worker. The development of scientific ideas about the causative agents of suppuration, the ways of their spread, the sensitivity of microbes to various factors led to widespread criticism of septic tanks and the formation of a new medical doctrine of asepsis (R. Koch, 1878; E. Bergman, 1878; K. Schimmelbusch, 1КЧ2 G.). Initially, asepsis arose as an alternative to antisepsis, but subsequent development showed that asepsis and antisepsis do not contradict, but complement each other.
2.2. The concept of “nosocomial infection”
Nosocomial infection (hospital-acquired, nosocomial, nosomal). Any infectious disease that affects a patient being treated in a health care facility or who has applied to it for medical help, or employees of this institution is called nosocomial infection.
The main causative agents of nosocomial infections are:
· bacteria (staphylococcus, streptococcus, Escherichia coli, Proteus, Pseudomonas aeruginosa, spore-bearing non-clostridial and clostridial anaerobes, etc.);
· viruses ( viral hepatitis, flu, herpes, HIV, etc.);
· mushrooms (causative agents of candidiasis, aspergillosis, etc.);
mycoplasma;
Protozoa (Pneumocystis);
A monoculture infection caused by a single pathogen is rare; an association of microflora consisting of several microbes is more often detected. The most common (up to 98%) pathogen is staphylococcus.
Entrance gate infections are any violation of the integrity of the skin and mucous membranes. Even minor damage to the skin (for example, a needle prick) or mucous membrane must be treated with an antiseptic. Healthy skin and mucous membranes reliably protect the body from microbial infection. A patient who is weakened by illness or surgery is more susceptible to infection.
There are two sources of surgical infection - exogenous (external) and endogenous (internal).
Endogenous infection is less common and comes from chronic, sluggish foci of infection in the human body. The source of this infection can be carious teeth, chronic inflammation in the gums, tonsils (tonsillitis), pustular skin lesions, and other chronic inflammatory processes in organism. Endogenous infection can spread through the blood vessels ( hematogenous route) and lymphatic vessels (lymphogenous pathway) and upon contact ( contact path) from organs or tissues affected by infection. It is always necessary to remember about endogenous infection in the preoperative period and carefully prepare the patient - to identify and eliminate foci of chronic infection in his body before surgery.
There are four types of exogenous infection: contact, implantation, airborne and droplet.
Contact infection has the greatest practical significance, since in most cases wound contamination occurs through contact. Currently, the prevention of contact infection is the main task of operating nurses and surgeons. Even N.I. Pirogov, not knowing about the existence of microbes, expressed the idea that infection of wounds is caused by “miasmas” and is transmitted through the hands of surgeons, instruments, through linen, and bedding.
Implantation infection is introduced deep into tissues through injections or foreign bodies, prostheses, suture material. For prevention, it is necessary to carefully sterilize suture material, prostheses, and objects implanted into body tissues. An implantation infection can appear long after surgery or injury, occurring as a “dormant” infection.
Airborne infection is the infection of a wound by microbes from the operating room air. Such an infection is prevented by strict adherence to the operating room regimen.
Droplet infection is the contamination of a wound with infection from droplets of saliva entering it and flying through the air during conversation. Prevention consists of wearing a mask and limiting conversations in the operating room and dressing room.
Sanitary and anti-epidemiological regime. A set of organizational, sanitary, preventive and anti-epidemiological measures that prevent the occurrence of nosocomial infections is called a sanitary and anti-epidemiological regime. It is regulated by several regulatory documents: by order of the USSR Ministry of Health dated July 31, 1")78 No. 720 “On improving medical care for patients with purulent surgical diseases and strengthening measures to combat nosocomial infections” (determines the placement, internal organization and sanitary and hygienic regime of surgical departments and operating units), by order of the USSR Ministry of Health dated May 23, 1985 No. 770 “On the implementation of OST 42-21-2-85 “Sterilization and disinfection of products medical purposes. Methods, means, modes" (determines the modes of disinfection and sterilization of instruments, dressings, surgical linen).
Measures to prevent surgical infection include:
1) interruption of transmission routes of infection through strict adherence to the rules of asepsis and antisepsis: cleaning the hands of surgeons and the surgical field, sterilization of instruments, dressings, suture material, prostheses, surgical linen; compliance with the strict regime of the operating unit, effective control of sterilization and disinfection;
2) destruction of infectious agents: examination of patients and medical personnel, rational prescription of antibiotics, change of antiseptics;
3) reducing the length of a patient’s stay in a hospital bed by reducing pre- and postoperative periods. After 10 days of stay in surgical department more than 50% of patients are infected with nosocomial strains of microbes;
4) increasing the resistance of the human body (immunity) (vaccinations against influenza, diphtheria, tetanus, hepatitis; BCG, etc.);
5) execution special techniques, preventing pollution surgical wound infected contents of internal organs.
The medical worker's robe must be clean and well ironed, all buttons neatly fastened, straps tied. A cap is put on the head or a scarf is tied under which the hair is hidden. When entering the room, you need to change your shoes and change from woolen clothes to cotton ones. When visiting the dressing room or operating room, you should cover your nose and mouth with a gauze mask. You should always remember that a medical worker not only protects the patient from infection, but also, in turn, protects himself from microbial infection.
Antiseptics
2.3 .1. Physical antisepsis
Antiseptics (from the Greek anti - against, septikos - causing decay, putrefactive) is a set of therapeutic and preventive measures aimed at destroying microbes on the skin, in a wound, pathological formation or the body as a whole.
There are physical, mechanical, chemical, biological and mixed antiseptics.
Physical antisepsis is the use of physical factors to fight infection. The main principle of physical antiseptics is to ensure drainage from an infected wound - the outflow of its discharge to the outside and thereby cleanse it of microbes, toxins and tissue decay products. Used for drainage various means: absorbent gauze, plastic and rubber tubes, strips of rubber gloves, as well as synthetic material in the form of wicks. In addition, various devices are used that provide outflow by creating a discharged space. In addition to creating an outflow from a wound or cavity, drains are also used to administer antibiotics and other drugs with antiseptic effect, rinsing cavities. Drainages can be inserted into cavities (abdominal, pleural), the lumen of internal organs ( gallbladder, bladder, etc.).
Drainage methods can be active, passive and flow-wash.
Active drainage. Active drainage is based on removing fluid from the cavity using a discharged (vacuum) space. It provides mechanical cleansing of the purulent focus and has a direct antibacterial effect on the wound microflora. Active drainage is only possible
Surgery (from the gr. cheir - hand, ergon - action) - this is handiwork, craft, skill. Currently, surgery is understood as one of the leading specialties medical science, which studies diseases for the treatment of which the method of mechanical action on tissues is mainly used, their dissection to detect the pathological focus and its elimination.
One fourth of all diseases are surgical diseases. These are diseases for which surgery is the only reliable treatment measure.
Historically world development of surgery begins from ancient times, it is distinguished four periods:
First period - before opening general anesthesia(until the second half of the 19th century).
Second period - coincides with the period of development of anesthesiology and the introduction of asepsis and antiseptics into practical activities (second half of the 19th century).
Third period - associated with the rapid development of physiological and experimental research in medicine (beginning of the twentieth century). During this period, independent branches of surgery began to emerge - anesthesiology, resuscitation, urology, neurosurgery, etc.
The fourth period - modern. Development of surgery this period is characterized by improvement surgical methods treatment, the development of restorative, reconstructive surgery, transplantology, and the emergence of new medical equipment.
Surgery is considered the leading among the ancient professions in the medical situation.
In the countries of the Old East (Egypt, India, China, Mesopotamia), ethnic medicine remained the basis of healing for a long time. There were the rudiments of surgical knowledge that could be used in peaceful life and on the battlefield: they removed arrows, bandaged wounds, stopped bleeding, using pain-reducing agents during operations: opium, henbane, hemp, mandrake. A large number of surgical instruments were discovered during excavations on the lands of these countries.
The healers of Ancient Greece and Ancient Rome, including Asclepius (Aesculapius), Asclepiad (128 - 56 BC), had a great influence on the development of surgery. Celsus (1st century BC) prescribed a major work on surgery, where for the first time he listed the symptoms of inflammation: rubor (inflammation), tumor (swelling), caler (increase in temperature), dolor (pain), suggested the use of ligatures for ligation of blood vessels during surgery, outlined methods of amputation and reduction of dislocations, and invented the doctrine of hernias. Hippocrates (460 - 370 BC) wrote a few works on surgery, for the first time outlined the peculiarities of wound healing, symptoms of phlegmon and sepsis, signs of tetanus, and invented the operation of rib resection for purulent pleurisy. Claudius Galen (131 -201) proposed the use of silk for suturing wounds.
Surgery had its significant development in the Arab caliphates (VII - XIII centuries). Outstanding healers Ar-Razi (Razes) (865-920) and Ibn Sina (Avicenna) (980-1037) lived and worked in Bukhara, Khorezm, Merv, Samarkand, Damascus, Baghdad, Cairo.
Medicine of the Middle Ages (XII-XIII centuries) was under the yoke of church ideology. The centers of medicine in this period were institutes in Salerno, Bologna, Paris (Sorbonne), Padua, Oxford, Prague, and Vienna. But the charters of all institutions were controlled by the church. At that time, the more developed field of medicine associated with the continuously ongoing wars was surgery, which was practiced not by medical workers, but by chiropractors and barbers. Doctors were not accepted into the so-called society of scientific doctors; they were considered simple performers. This position did not have the opportunity to last long. Skill and research on the battlefields laid the foundation for the intensive development of surgery.
During the Renaissance (XV-XVI centuries) a constellation of outstanding medical workers and natural scientists was noticed who made a significant contribution to the development of anatomy, physiology and surgery: Paracelsus (Theofast von Hohenheim) (1493-1541), Leonardo da Vinci (1452-1519) , W. Harvey (1578-1657). The outstanding anatomist A. Vesalius (1514-1564) was handed over to the Inquisition only for the fact that, in fact, he stated that the representatives of the stronger sex had 12 pairs of ribs, but not 11 (one rib had to be used for the creation of Eve).
In France, where surgery was stubbornly rejected as a branch of medicine, doctors were the earliest to achieve equality. It was here that the first averages were revealed educational establishments doctors, but in the middle of the 18th century. - university - surgical academy. A clear adherent of the French secondary educational institutions for doctors was the founder of scientific surgery of modern times, A. Paré (1517 - 1590).
In the 19th century new claims to medical science were discovered, which actually led to fresh discoveries in the field of surgery. At 1800 grams. British chemist G. Devi described the effects of intoxication and convulsive laughter when inhaling nitrous oxide, calling it a mixing gas. In 1844 gram. Nitrous oxide was used as an anesthetic in dental practice. In 1847 gram. Scottish surgeon and obstetrician J. Simeon adopted chloroform for pain relief in 1905. German doctor A. Eingorn synthesized novocaine.
The main task of surgery in the 2nd half of the 19th century. suppuration of the wounds appeared. Hungarian obstetrician I. Semmelweis (1818 - 1865) in 1847. I started using chlorine water as a disinfectant. The British surgeon J. Lister (1827-1912) proved that the actual cause of suppuration is considered to be living tiny organisms that enter the wound from the air, and proposed the use of carbolic acid (phenol) to combat infectious agents. Consequently, in 1865 gram. he used antisepsis and asepsis in surgical practice.
In 1857 gram. French scientist L. Pasteur (1822-1895) discovered the nature of fermentation. In 1864 gram. South American dental health worker Cond. Morton adopted ether for pain relief during tooth extraction. German surgeon F. Esmarch (1823 - 1908), one of the pioneers of asepsis and antisepsis, in 1873. suggested using a hemostatic tourniquet, a flexible bandage and an anesthesia mask. The devices of the Swiss doctors T. Kocher (1841 - 1917) and J. Pean (1830 - 1898) made it possible to operate on a “dry” wound. In 1895 German physicist W. K. Roentgen (1845-1923) discovered rays capable of leaking through opaque bodies.
The discovery of blood groups (L. Landsteiner, 1900; Ya. Yansky, 1907) gave doctors an effective means of combating acute blood loss. The French physiologist C. Bernard (1813-1873) made experimental medicine.
In Russia, surgery began to develop much later than in Western European countries. Until the 18th century In Russia, surgical support was almost completely absent. These manipulations, such as bloodletting, cauterization, opening abscesses, were performed by healers and barbers.
Under Peter I in 1725. The St. Petersburg Academy of Sciences, army land and admiralty hospitals were opened. Secondary educational institutions began to be created on the basis of hospitals, which in 1786. were transformed into medical-surgical schools. In 1798 gram. Medical and surgical academies were organized in St. Petersburg and the Capital. In 1755 gram. on the initiative of Mtr. V. Lomonosov opened the Capital Institute, but in 1764. there is a medical faculty with him.
Beginning of the 19th century provided the world with these remarkable Russian scientific workers as P. A. Zagorsky, I. F. Bush, F. I. Inozemtsev, I. N. Sechenov, I. P. Pavlov, N. E. Vvedensky, V. V. Pashugin, I. I. Mechnikov, S. N. Vinogradsky, N. F. Gamaleya, L. I. Lukashevich, L. O. Heidenreich, M.S. Subbotin, M.Ya. Preobrazhensky, A.A. Bobrov, P.I. Dyakonov and others.
The famous surgeon and anatomist N.I. Pirogov (1810-1881) is rightfully said to be the founder of Russian surgery. Using methods of freezing the dead and cutting them up, he thoroughly studied all areas of the human body and wrote a four-volume atlas on topographic anatomy, which for a long time was considered a reference book for doctors. N.I. Pirogov headed the department of surgery at the Dorpat Institute, the department of hospital surgery and pathological anatomy at the St. Petersburg Medical-Surgical Academy. N.I. Pirogov, earlier than L. Pasteur, introduced the presence of microorganisms in a purulent wound, emphasizing for this purpose in his own hospital a branch for “those infected with hospital miasmas.” Specifically, N.I. Pirogov was the first in the whole world to use ether anesthesia during the Caucasian War (1847). Being the founder of military field surgery, the scientist came up with the basics for organizing support for the wounded - triage based on the urgency of offering support, evacuation, hospitalization. He introduced the latest methods of immobilization, healing bullet wounds, and used a fixed plaster cast. N.I. Pirogov organized the 1st units of nurses, who provided support to the wounded on the battlefield.
N.V. Sklifosovsky (1836-1904) invented operations for tongue cancer, goiter, and cerebral hernias.
V.A. Oppel (1872-1932) - military field surgeon, founder of the doctrine of stage-by-stage healing of the crippled, was one of the founders of endocrine surgery in the Russian Federation. V. A. Oppel spent a lot of his time researching vascular diseases and abdominal surgery.
S.I. Spasokukotsky (1870-1943) worked in many areas of surgery, came up with a highly effective method of preparing the doctor’s hands for surgery, and new techniques for operations for inguinal hernias. He was one of the pioneers of thoracic surgery and was also one of the first to use skeletal traction to heal fractures.
S.P. Fedorov (1869-1936) became the founder of Russian urology and biliary surgery.
P.A. Herzen (1871 - 1947) was one of the founders of Russian medical oncology. He proposed methods for healing hernias, and for the first time in the world he successfully performed an operation to create an artificial gastrointestinal tract.
A.V. Vishnevsky (1874-1948) came up with different types novocaine blockades, dealt with issues of purulent surgery, urology, neurosurgery, and was the founder of the University of Surgery of the USSR Academy of Medical Sciences in the capital.
N.N. Burdenko (1876-1946), general surgeon, recruited to the Army during the years of the Famous Patriotic War. He became one of the founders of Russian neurosurgery and the first president of the USSR Academy of Medical Sciences.
A.N. Bakulev (1890-1967) was one of the founders of cardiovascular and pulmonary surgery - subsections of thoracic surgery in the USSR.
S.S. Yudin (1891-1954) in 1930. for the first time in the whole world he transfused the cadaveric blood of an inhabitant of our planet. In addition, he proposed a method for creating an artificial food tract. S.S. Yudin for a long time was the main doctor of the University of Emergency Medical Care named after. N.V.Sklifosovsky.
Today, Russian surgery continues to develop successfully. Outstanding doctors, academicians V.S. Savelyev, V.D. Fedorov, M.I. Kuzin, A.V. Pokrovsky, M.I. Davydov, G.I. Vorobyov and others made a significant contribution to the development of progressive domestic surgery. Promising areas include operations in pressure chambers, microsurgery, plastic surgery, organ and tissue transplantation, open heart surgery using a synthetic circulation unit, and others. The work in these instructions will continue successfully. The revised methodologies are being repeatedly improved and vigorously implemented Newest technologies using the latest instruments, devices and devices.
