Stages of development of surgery briefly. Brief description of the main periods in the development of surgery
Introduction.
Surgery is the most ancient medical science and literally means "handwork" (Greek)
Ancient surgical techniques, in all likelihood, were aimed at stopping bleeding and healing wounds. This is evidenced by the data of paleopathology, investigating the fossil skeletons of ancient man. 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 life-saving surgery, 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 limb amputations, castrations, 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 anesthesia during operations.
The first written evidence of surgical operations is contained in the hieroglyphic texts of ancient Egypt (II-I millennium BC), in the laws of Hammurabi (XVIII century BC), 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 Pergamum, Soranus from Ephesus), from the Byzantine Empire (Paul from the island of Aegina), the medieval East (Abul-Kasim al-Zahrawi, Ibn-Sina) and others.
Hippocrates was convinced that human diseases are based on disturbances in the relationship 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 festering wound, recommending various methods of their treatment. Hippocrates described the treatment of fractures and dislocations of bones. He described the technique of performing many operations, including punctures of the abdominal and chest walls, trepanation of the bones of the skull, drainage of the pleural cavity during suppuration, etc.
Great importance in the subsequent development of surgery was the activity of the Roman doctors Celsus and Galen. The writings of Celsus set forth the sum of all medical knowledge of that time. He proposed a number of improvements in many operations, for the first time applied the method of ligation of blood vessels with the help of ligatures, and outlined the doctrine of hernias. Galen, who served as a doctor in the school of Roman gladiators, was specially engaged in the study of anatomy. He described one of the ways to stop bleeding - twisting the vessel, and used silk sutures to sew up wounds.
The writings of Avicenna have survived to our time, where various methods of treating wounds are analyzed in detail, stone cutting and stone crushing operations are described for bladder stones. Ibn - Sina for the first time began to stitch together nerves in wounds, performed traction in the treatment of fractures of the bones of the extremities.
When at one time physicians 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 at that distant time there were surgical instruments, in particular, special copper needles for suturing 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, almost did not develop. The Church declared it a great sin to open corpses and “shedding blood”, forbade any operations whatsoever, and subjected people engaged in various scientific research to severe persecution. Surgery was not considered a field 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 in corporations by profession (bath attendants, barbers, surgeons), where the master surgeon passed on his knowledge to apprentice apprentices.
The further development of medicine and surgery, in particular, refers only to the beginning of the Renaissance. Outstanding surgeons of medieval Europe were Guy de Chauliac (XIV century), Paracelsus (1493-1541), Ambroise Pare (1517-1590). Pare reintroduced into surgery such forgotten
techniques, such as ligation of blood vessels, used special clamps to capture blood vessels and abandoned the then common method of treating wounds - pouring them with boiling oil. But his main achievement was prosthetic hands. Pare built an artificial hand with fingers, each of which could move separately, 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, at a rapid pace, surgery, like all medicine, began to develop only in the 19th century due to the general progress of science and technology.
Development of surgery in Russia.
The development of surgery in Russia can be judged from the multi-volume work of Wilhelm Richter "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, arriving in savagery, had no idea about doctors and medical care, used self-help, which sometimes brought some benefit, sometimes obviously harmed the 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 Grand Dukes. The same continued in the 17th century. “If,” says Richter, “to review the history of the 17th century and the preceding century, we will see that the doctors of medicine who lived in Russia were for the most part foreigners. Between them were the English, and especially the Germans, also the Dutch and Danes, but, what is very remarkable, there was not a single Frenchman at all. And in the first half of this (17th) century, the tsars began to send natural Russians, or such young foreigners, whom their fathers had settled here for a long time, partly at their own expense to send to foreign lands and specifically to England, Holland and Germany, to study medical science . During the period of the same (17th) century, one can 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 on the shelves. Meanwhile, there were no medical schools or practical hospitals for proper education.”
The first medical school in Russia was organized in 1654 under the Pharmaceutical Order, which was in charge of medicine at that time. And the first hospital in Russia was the Moscow hospital, 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 under it.
The educated Dutch doctor Nikolai Bidloo was placed at the head of the hospital and at the head of the medical-surgical school. Bidloo himself taught "the production surgical operations”, was highly devoted to his work and devoted his whole life to the hospital and the school. A lot of work has been done to organize the training. When the hospital was 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, and a preparator, and an intern of the hospital, and a surgeon, and a tutor of all special medical subjects, and the chief assistant to the doctor, and the manager of the hospital. Mostly foreign doctors treated and trained according to foreign models. The development of medicine in Russia lagged far behind European countries. So, if the education of medicine in Russia begins at the dawn of the 19th century, then in Italy it starts from 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 occurs in 1354. By the 18th century, Italy, France, England had a string of glorious surgical names, surgical academies, well-organized hospitals. The first teacher of surgery in Russia should be considered Nikolai Bidloo, and since his school, surgery has been developing with incredible speed.
Periods of the history of Russian surgery.
The history of Russian surgery easily falls into two large periods: the first of them captures the time from the beginning of the teaching of surgery in Russia to Pirogov, i.e. before starting his career. Since Pirogov received the chair at Dorpat University in 1836, and at the Medical and Surgical Academy the chair hospital surgery And pathological anatomy in 1836, then, consequently, the first period embraces less than a century and a half from 1706 to the present. 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, imitative. Surgery was transplanted to Russia from the West. Over the course of more than two centuries of its development, Russian surgery gradually stood on its own legs, turned into an independent science. Pirogov immediately put Russian surgery on his own and independently. Without refusing to get acquainted with the West, on the contrary, he greatly appreciated Western surgery, he always treated it critically, and he himself gave it a lot.
Initially, training in surgery at the Moscow Medical and Surgical School was conducted mainly in Latin, in St. Petersburg - mainly in German. Russian language was not allowed. In 1764 Dr. Shchepin was transferred from the Moscow school to the St. Petersburg school, from which the equal teaching of anatomy and surgery in Russian and German begins.
Throughout the 18th century, doctors of medicine in Russia were either foreigners or Russians, but they necessarily received a doctorate in medicine from foreign universities. As an exception, sometimes the kings themselves granted doctors the degree of doctor of medicine.
In 1776 medical-surgical schools were transformed into medical-surgical schools, which were granted the right to "bring to a doctoral degree, delivering them through natural Russian doctors to occupy positions corresponding to their rank." The right to raise to the degree of doctor of medicine was used by the medical board - 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 Elizaveta Petrovna on January 12, 1755. The university was opened on April 26, 1755. The university consisted of three faculties, among which there was also a medical department with three departments: chemistry with the application of pharmacy to chemistry, natural history and anatomy with medical practice. At the Faculty of Medicine of Moscow University, surgery was originally 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 raise to the degree of Doctor of Medicine. And in 1795. teaching 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 Medico-Surgical Institute (1795–1816) and the Medical Faculty of Moscow University (1813–1835), Mukhin published “Description of Surgical Operations” (1807), “The First Beginning of Bone-Setting Science” (1806) and “Course of Anatomy” 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 Medico-Surgical Academy, the teaching of anatomy on corpses and the manufacture 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 and Surgical Academy. Teaching at the Academy was practical: students performed anatomical dissections, observed a large number of operations and have themselves participated in some of them under the guidance of experienced surgeons. Among the professors of the Academy were P.A. Pirogov.
The teaching of the English surgeon J. Lister had a significant impact on the development of surgery, both Russian and foreign. Lister changed the whole idea of the surgical treatment of diseases, 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 method of surgical work 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 the disinfectant dressing. Surgeons in Russia spoke strongly about Lister's antiseptic 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 over this message on February 26, 1874. Kostarev, summing up his observations, comes to the conclusion that “only two methods of wound treatment should be recognized: a) the method of treatment without dressing (with treatment under the scab, as an option), b) the Lister disinfectant bandage method.” Moreover, according to Kostarev, the method of treatment without dressing should be immediately accepted as the only one that is completely and everywhere applicable. Kostarev believed that open way treatment above antiseptic.
Surgery, including Moscow surgery, followed Lister, not Kostarev. Nevertheless, Lister's antiseptic was hotly discussed and inculcated. 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 asepsis method was developed, aimed at preventing the entry of microorganisms into the wound. Asepsis is based on the action of physical factors and includes sterilization in boiling water or steam of instruments, dressing or suture material, a special system for washing the surgeon's hands, as well as a whole range of sanitary and 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, subsequently, surgical societies are created in different cities of Russia, which are crowned with congresses of surgeons, 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 a professorial institute that had just been established in Dorpat (now Tartu) to train professors from "born Russians". The first set of students of this institute also included G.I. As his future specialty, Nikolai Ivanovich chose surgery, 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 inguinal aneurysm an easy and safe intervention?” Her conclusions are based on experimental physiological studies on dogs, sheep, and calves.
N.I. Pirogov always closely combined clinical activity with anatomical and physiological research. That is why, during his scientific trip to Germany (1833-1835), he was surprised that “back in Berlin I found practical medicine, almost completely isolated from its main real foundations: anatomy and physiology. It was like anatomy and physiology in itself. And surgery itself had nothing to do with anatomy. Neither Rust, nor Grefe, nor Dieffenbach knew anatomy. Moreover, Dieffenbach simply ignored anatomy and made fun of the position of the various arteries.” In Berlin, N.I. Pirogov worked in the clinics of I.N. Rust, I.F. Dieffenbach, K.F. von Graefe, F. Schlemm, I.Kh. Jungen; In Göttingen - with B. Langenbeck, whom he highly appreciated and in whose clinic he improved his knowledge of anatomy and surgery, following the principle of Langenbeck: "A knife should be a bow in the hand of every surgeon."
Upon his return to Dorpat, already as a professor at Dorpat University, 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 and 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 organized at the Academy for the first time. Together with professors K.M. Ber and K.K. Seidlitz, he developed a 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 led a large surgical clinic and consulted in several St. Petersburg hospitals. After a working day, he performed autopsies and prepared material for atlases in the mortuary of the Obukhov hospital, where he worked by candlelight in a stuffy, poorly ventilated basement. For 15 years of work in St. Petersburg, he performed almost 12 thousand autopsies.
In building topographic anatomy an important place is occupied by the method of "ice anatomy". For the first time, freezing of corpses for the purpose of anatomical studies was carried out by E.O. Mukhin and his student I.V. Buyalsky, who in 1836. prepared a muscle preparation "lying body", subsequently cast in bronze. In 1851 Developing the method of "ice anatomy", N.I. Pirogov for the first time carried out the 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: “The Complete Course of Applied Anatomy human body with drawings (descriptive-physiological and surgical anatomy)" (1843-1848) and "Illustrated topographic 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 Asiatic Cholera", in the fight against epidemics of which he repeatedly took part in Dorpat and St. Petersburg.
The role of Pirogov is also great in solving one of the most important problems of surgery - anesthesia.
The era of anesthesia began with ether. The first experiments on its use during operations were made 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 in Russia under anesthesia 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 justification for the use of ether anesthesia was given by N.I. Pirogov. In experiments on animals, he conducted a wide experimental study of the properties of the ester in various ways of administration, followed by clinical testing of individual methods. After that, on February 14, 1847, he performed the first operation under anesthesia, removing the breast tumor in 2.5 minutes, and in the summer of 1847 N.I. Pirogov for the first time in the world applied ether anesthesia en masse at the theater of operations in Dagestan (during the siege of the village of Salty).
Speaking of Pirogov, one cannot 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 hundreds, he first substantiated and put into practice the sorting of the wounded into 4 groups. The first was made up of the hopelessly ill and mortally wounded. They were entrusted to the care of sisters of mercy and priests. The second group included the seriously wounded, requiring an urgent operation, which was performed right at the dressing station. The third group included wounded of moderate severity, which could be operated on the next day. The fourth group consisted of the lightly wounded. After rendering necessary assistance they went to the regiment.
Postoperative patients were first divided by Pirogov into two groups: pure 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 in the theater of war."
The name of Pirogov is associated with the world's first involvement of women in the care of the wounded in the theater of operations. During the Crimean events, more than 160 women worked under the leadership of Pirogov during the Crimean events of the “Exaltation of the Cross Community of Sisters for the Care of the Wounded and Sick Soldiers”, organized at her own expense by Grand Duchess Elena Pavlovna, sister of Emperor Nicholas I.
In the scientific and practical activities of N.I. Pirogov, much was done 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 of bone grafting (1854).
After N.I. Pirogov, the most prominent Russian surgeon was N.V. Sklifosovsky. He worked in Kyiv, St. Petersburg, Moscow. One of the first he began to develop the antiseptic method, he modified the Lister method, using sublimate, 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 constellation of outstanding surgeons, whose names entered the history of surgery forever. Among them, S.I. Spasokukotsky, who contributed to the development of pulmonary and abdominal surgery, developed the methods of asepsis and antisepsis. They 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, founder of cardiovascular surgery in our country, founder of the Institute of Cardiovascular Surgery in Moscow. Transplantology and microsurgery have been 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. Krylov. Plastic surgery was successfully developed by V.P. Filatov, N.A. Bogoraz, S.S. Yudin.
Conclusion.
Summing up the historical period described above, we can say that surgery was transplanted to Russia from the West. At first, the training was carried out by visiting doctors and healers. At the beginning of the 18th century, schools appeared in Russia to teach medicine in general, and 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 shone, placing himself and Russian surgery with him in a completely independent place. At the end of the 19th century, Russian surgery introduced Lister's antiseptic for the treatment of war wounded. In the 19th century, their own surgical societies appear, which are crowned with congresses of surgeons; there are surgical journals.
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 SINCE 1846, WITH THE DISCOVERY OF ANESTHESIA AND
POSSIBILITIES FOR CARRYING OUT A PAINLESS OPERATION.
EVERYTHING THAT HAPPENED BEFORE THIS CAN BE CONSIDERED NIGHT
ignorance, pain, fruitless attempts to feel in
DARKNESS.
(BERTRAND GOSSET, 1956) “ A person who lies on the operating table in
one of our clinics has a higher chance of dying
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
It continued from primitive times until the middle of the 19th century, when it could have been
only about the removal of 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 the present day.
Improvement of tools, development of natural science research, and
also technicians have determined 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 his experiences on
the 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
trepanations in detail. Elements
asepsis (i.e. maintaining cleanliness and
change of bandages) appear in his
wound care guide. In 1543 in Basel there was
collection “De humani
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, refuted over 200
medical theories that have been
accepted at the time. He installed
a lot of similarities and
differences existing in the device
living organisms based on
experiments performed on
animal models. During the siege at Damville 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, dinitrous oxide, nitrous oxide).
In 1800 the British chemist Humphry Davy (1778-1829) after
of his experiments comes to the conclusion that nitrous oxide
can be used for operative anesthesia.
American dentist Wells, became known as a pioneer
use of nitrous oxide anesthesia, he used it
for tooth extraction. Initial attempts to prevent wound infection were
by no means so successful. The surgical incisions were still followed by an irritating fever, which sometimes
lasted only a few days and was 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 to surgical science
huge. As you know, the basis that determined
development of surgery, constitute the creation
applied anatomy, introduction of anesthesia,
asepsis and antisepsis, stopping methods
bleeding, and in all these sections N.I. Pirogov
contributed. He created the modern
applied (topographic) anatomy, widely
introduced ether anesthesia (he was the first to use
anesthesia in military field conditions, with its
use performed 10,000 operations
wounded), developed new methods of anesthesia rectal and endotracheal .. N.I. Pirogov
anticipated Lister's research and
Semmelweis, believing that the cause of purulent
postoperative complications is contagious
beginning ("miasma"), which is transmitted from one
sick to another, and a carrier of "miasms"
may be medical personnel. To fight
"miasma" he used antiseptics: tincture
iodine, alcohol, silver nitrate solution, etc. 1860. Louis Pasteur (18221895) developed the “theory
origin". He also
suggested that
microbes that can
get into the tissue
surrounding her
spaces are
cause of infections and
pus formation. 1867. Sir Joseph Lister (18271912) professor of surgery in
Glasgow, based on the “theory
inception” Pasteur, introduces
disinfection in surgery. He
I was sure that even if
complex fractures
need to treat the wound
substances capable of
destroy bacteria. For these
purposes Lister used
carbolic acid (phenol). IN
operating lister sprayed
phenol on the operational field, on
instruments and dressing
material, and even just
air. His “antiseptic theory”
became revolutionary for
surgery, before that surgeons
could control the infection. In the future, significant
step, became the contribution of Ernst von
Bergmann (1836-1907) who
presented 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 he was
awarded the Nobel
awards for their work in
thyroid treatment
glands. 1881. Theodor Billroth
(1829-1894), Austrian
Surgeon. Conducts the first
successful gastrectomy
and first resection
esophagus. Introduces
statistical analysis in
medicine. 1889. Charles
Mc.Burney (18451913) American
surgeon. His report on
early operational
treatment
appendicitis, rendered
huge impact on
decline
mortality. Described
key
symptoms, access to
inflamed
appendix. 1895. Wilhelm Conrad
Rontgen (1845-1923),
German physicist,
opens R-radiation and
carries out
revolution in
diagnosis and treatment.
In 1901 he was awarded
for your discovery
Nobel Prize. William Halstead surgeon
John Medical School
Hopkins, who developed
surgical rubber
gloves. In 1890 he asked
Goodyear Rubber Company
Company make thin
surgical gloves for
older sister who suffered
dermatitis due to use
disinfectants.
Joseph K. Bloodgood (1867-1935)
who was a student of Halsted,
initiated routine
use of surgical
gloves in 1896. This method
reduced the incidence
dermatitis, as well as the amount
postoperative wound
infections. 1901. Karl
landsteiner
(1868-1943),
Austrian
pathologist,
discovered
blood types and
describing
ABO Rh system.
Awarded in 1930
Nobel
premiums. 1902. Alexis Karel (1873-1944), French surgeon,
developed and published
technique for anastomosis
blood vessels end in
end. so, he
created the surgical foundation
cardiovascular
surgery and transplantation
bodies At the beginning of the 20s of the 20th century.
William T. Bovie brought to
surgery in a unique way
incisions and
tissue coagulation with
alternating current. Way
greatly facilitated
carrying out intraoperatively
hemostasis.
Supported by Charite's
Berlin, they opened an institute
medical cinematography,
installing a special camera
above operating table, They
recorded operating
process for educational purposes,
films accurately conveyed
operational technology. Alfred Blalock (18991964) American
cardiac surgeon in
Baltimore. In the hospital
Hopkins, made
first successful
open surgery
baby heart,
who had the syndrome
tetrades of Fallot (1944) Dr. D. Lewis
performed the operation for the first time
defect suturing
interatrial
partitions in conditions
hypothermia. It Happened 2
September 1952
He cooled the child down to 30°C,
opened the chest
pinched hollow
veins, opened the atrium,
sutured the defect. The first artificial
blood circulation (autojet) was
designed by Soviet
scientists S. S. Bryukhonenko and S. I. Chechulin in
1926. The device has been used in
experiments on dogs, but this
the device has not been used in clinical
practice in human heart surgery. 3
July 1952 in the US American
cardiac surgeon and inventor Forest Dewey
Dodrill performed the first successful operation on
open human heart using
apparatus cardiopulmonary bypass
"Dodrill-GMR", developed by him in
collaboration with General Motors. 1954. Joseph E. Murray (1919-)
completed the world's first
successful kidney transplant
between identical twins
Peter Bent Brigham's Hospital
Boston. He was awarded
Nobel Prize in 1990.
His surgical technique- With
with minor modifications is still in use. 1967 Christian Needing Barnard
(1922-2001) performed the first in
world transplantation
human heart in
Cape Town, South Africa.
The donor heart came from a 24-year-old woman who died in
the result of a traffic accident.
The recipient was a 54 year old
Ludovic Washkansky. Operation
took 3 hours. Washkansky
survived the operation and lived
eighteen (18) days, but then
died due to severe infection. 1985. Erich Muret (1938-2005) performed the first
laparoscopic
cholecystectomy. At that
time, german
surgical society
called this method “keyhole surgery”
well" 1998 FriedrichWilhelm Mohr s
using
surgical
da vinci robot
fulfilled
first
robotic
th cordial
shunt in the center
heart of Leipzig
(Germany) 2001. In New York Jacques
maresco used
Zeus robot for
fulfillment
laparoscopic
cholecystectomy in a 68 year old woman
Strasbourg (France) Sergio Canavero, Italian surgeon
announces the development of a transplant technique
heads in 2013
2015 Declares readiness
holding
The operation was scheduled for the end
2017 beginning of 2018. Thus, over the past 150 years, surgery has solved the most important tasks for itself.
1. Pain
2. Infection
3. Outdated technology
4. Mysterious pathophysiological changes in the perioperative period
The decision of which saved more than one million human lives. But the development of surgery on this is not
stopped, before modern surgery and now there are a large number of interesting tasks,
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. until the second half of the 19th century In ancient times, surgery was primarily manual. Then, with hands or simple tools, they corrected external defects and assisted with injuries.
Surgery has made great strides in Ancient Greece and Ancient Rome. Doctors were highly respected by the population, as evidenced by the lines of Homer: "Many warriors are worth one skilled healer." Hippocrates (460-377 BC), who opened a hospital on the island of Kos, prescribed massage and exercise therapy as remedies. He treated broken bones, dislocations and wounds. They described tetanus. Among the many purulent diseases, Hippocrates singled out the general 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. A special place in Roman medicine of that time was occupied by the works of Celsus and Galen. Celsus (30 BC-38 AD) left numerous treatises testifying to the achievements of surgery of that time (cataract removal, craniotomy, lithotripsy, treatment of fractures and dislocations). They proposed ways to stop bleeding - with the help of tamponade and ligatures on a 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 still have not lost their significance (twisting a bleeding vessel, suturing with silk threads), developed an operation technique for cleft lip And so on.
Of great importance were the works of Ibn Sina (980-1037), known in Europe under the name of Avicenna. In his book The Canon of Medicine, many chapters are devoted to surgery - the recognition of tumors, the suturing of nerves, tracheotomy, the treatment of wounds and burns, etc.
In Europe, the beginning of significant progress in science dates back to the Renaissance (XY1 c). 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 is the French surgeon Ambroise Pare (1517-1590). He created a new doctrine of gunshot wounds: he proved that this is a special kind of bruised wounds, and not poisoned with poisons, as was believed at that time. The second period (the 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 made 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 in the use of local anesthesia were the surgeons of our country V.K. Anrep (1880) and A.I. Lukashevich (1886). The clinic of N.M. 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 widest application in all areas of surgery.
The greatest event of the 19th century was the work of L. Pasteur, who discovered the microworld 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. Thus was born the antiseptic method in surgery, 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 the conditions for the rapid development of abdominal surgery.
The third period (beginning of the 20th century) can be called physiological and experimental in connection with the decisive influence on the development of surgery of experimental physiological research by Sechenov and Pavlov. They created the conditions for the emergence of new surgical areas and the development of anesthesiology and transfusiology. urology , neurosurgery, etc.
The fourth period (modern) - the period of recovery and reconstructive surgery characterized by in-depth scientific research new ideas in the development of diagnostic and treatment methods based on the widespread introduction of microsurgery into scientific research and practice of surgery, new instruments and equipment, physical, pharmacological and other methods of influencing the human body during various diseases, as well as organ and tissue transplants, the use of artificial organs and tissues.
The conditionality of such periodization is obvious. in the history of surgery, these periods were layered one on another, 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 distribution.
In Russia, surgery began to develop much later than in Western countries. Until the 18th century, there were no surgeons in Russia, barbers and healers provided surgical assistance, who performed only cauterization, opening of abscesses, "bleeding" 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 establishment of chiropractic schools.
In 1706, Peter 1 founded the first state medical institution- a hospital in Moscow across the Yauza River - now the hospital named after N.V. Burdenko, which at the same time became the first higher medical and 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 a medical faculty. A group of anatomists arose at the Faculty of Medicine in Moscow, headed by the famous scientist P.A. Zagorsky (1764 - 1646). He wrote the first Russian textbook on anatomy. A group of scientists - surgeons was formed under the leadership of E.O. Mukhin, a former paramedic in the Suvorov troops, who wrote the book Description of Surgical Operations. We owe him the nomination of N.I. Pirogov. A team of surgeons headed by I.F. Bush (1771–1843), who created the first Russian manual on surgery, was formed at the St. Petersburg Medical and Surgical Academy. His student Professor I.V. Buyalsky created an anatomical and surgical atlas.
THE ROLE OF N.I. PIROGOV IN THE DEVELOPMENT OF RUSSIAN SURGERY.
founder domestic surgery deservedly considered the great physician of the 19th century, Nikolai Ivanovich Pirogov. He was born in 1810 in Moscow
Graduated from the Medical Faculty of Moscow University. Then he passes special training to professorship at Yuriev 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 in passing. N.I. Pirogov put the question differently: "Surgery without accurate and complete knowledge of anatomy is not possible." If an anatomist studies anatomy by systems, then the surgeon must know the layered anatomy of the organ where he performs the operation, and the organ on which the operation is performed. This innovation of Pirogov led to the appearance new science- topographic anatomy. This science is the basis of modern surgery, but at that time it was underdeveloped. 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 their cuts. The cuts were used to study the position of various organs, their relationship with the surrounding tissues.
The result of many years of activity of N.I. Pirogov became a four-volume atlas of anatomy (1852) - a fundamental work that everyone who deals with topographic anatomy and operative surgery. N.I. Pirogov developed the technique of many operations, proved the possibility of performing osteoplastic surgical interventions.
N.I. Pirogov did not pass by 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 widely used ether anesthesia during operations during the war in the Caucasus in 1847.
In order to prevent suppuration of wounds, Pirogov organized a special mode of operation of the surgical department. He demanded that rooms for patients be well ventilated, that doctors monitor the cleanliness of hands and tools, introduced special teapots, from which wounds were washed with flowing boiled water. As microbiology developed, Pirogov began to point out that “spores”, “fungi”, “embryos”, as the first researchers called pathogenic bacteria, are the very “miasma” mentioned by Hippocrates, the origin of which has been discussed and argued 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 owns the idea that the "miasma" complicating the course of wounds are living beings that can and should be fought. Given all this, Pirogov should be recognized as the founder of the science of surgical infection in Russia.
N.I. Pirogov is considered to be the founder of military field surgery. He introduced the concept into practice: 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 suggested paying special attention to sorting the wounded "in the theater of operations." For the first time in Russia and the world, they were offered plaster bandages for the treatment of fractures.
The brilliant scientist and organizer N.I. Pirogov, not only in Russia, but also abroad, is deservedly considered the founder of such important sections of surgery as surgical anatomy and military field surgery .. He was an erudite scientist who left works on all sections of surgery (anesthesia, shock, wound healing, fracture treatment etc.) The teachings and works of Pirogov 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-Pirogovsky 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) - an outstanding surgeon, scientist and public figure who developed operations for goiter, and cerebral hernia, etc. He is the creator of the first Russian surgical journals and the founder of the Pirogov Congresses.
S.I. Spasokukotsky (1870-1943), the 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 processing the surgeon's hands according to Spasokukotsky-Kochergin has not lost its significance today.
N.N. Burdenko (1878-1946) was the first president of the USSR Academy of Sciences. An important role in the progress of surgery was played by his works on military field surgery and shock, wound treatment, neurosurgery, etc. While holding the post of chief surgeon of the Soviet army, he developed the doctrine of assisting the wounded at all stages of treatment during the Great Patriotic War, which made it possible to return 73% of the wounded to service.
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 medical measures, for many diseases, an oil-balsamic dressing was proposed, which played an important role during the years of 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) the creator of the modern system of cancer control.
Thoracic and vascular surgery has received rapid development 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 those on the heart, 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 applied in the experiment a special apparatus - an autojet.
Modern surgery continues to develop rapidly. Transplantology, reconstructive surgery, and microsurgery continue to improve.
The 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) folk medicine for a long time remained the basis; healing. There were the beginnings of surgical knowledge that was used in civilian life and on the battlefield: they removed arrows, bandaged wounds, stopped bleeding, using pain-reducing agents during operations: opium, henbane hemp, mandrake. On the territory of these states, during excavations, many surgical instruments were discovered.
The development of surgery was greatly influenced by the doctors of ancient Greece and ancient rome such as Asclepius (Aesculapius)! Asklepiades (128 - 56 BC). Celsus (I century BC) wrote a major work on surgery, where he first listed the signs of inflammation: rubor (inflammation), tumor (edema), caler (fever), dolor (pain), suggested the use of ligatures for ligation of blood vessels during the operation, described the methods of amputation and reduction of dislocations, developed the doctrine of hernias. Hippocrates (460 -370 BC) wrote several works on surgery, first described the features of wound healing, signs of phlegmon and sepsis, symptoms of tetanus, developed a rib resection operation 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.
The medicine of the Middle Ages (XII-XIII centuries) was under the yoke of church ideology. The centers of medicine during this period were Universities in Salerno, Bologna, Paris (Sorbonne), Padua, Oxford, Prague, Vienna. However, the statutes of all universities were controlled by the church. At that time, the most developed area of medicine in connection with the constantly ongoing wars was surgery, which was not performed by doctors, but by chiropractors and barbers. Surgeons were not accepted into the so-called society of scientific doctors, they were considered ordinary performers. Such a situation could not last long. Experience and observations on the battlefields created the prerequisites for the active development of surgery.
In the Renaissance (XV-XVI centuries), a galaxy of outstanding doctors and naturalists appeared who made a significant contribution to the development of anatomy, physiology and surgery: Paracelsus (Theophast 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 because he claimed that a man has 12 pairs of ribs, 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 were opened, and in mid-eighteenth V. - higher educational institution - surgical academy. A prominent representative of the French school of surgeons was A.Pare (1517-1590), the founder of the Scientific Surgery of Modern Times.
In the 19th century appeared new requirements for 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 XIX century. the wounds festered. The Hungarian obstetrician I. Semmelweis (1818 - 1865) in 1847 began to use chlorine water as a disinfectant. The English surgeon J. Lister (1827 - 1912) proved that the cause of suppuration is living microorganisms that enter the wound from the air, and suggested using carbolic acid (phenol) to fight 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 anesthesia during tooth extraction. The German surgeon F. Esmarch (1823-1908), one of the pioneers of asepsis and antiseptics, 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 through opaque bodies.
The discovery of blood groups (L. Landsteiner, 1900; Ya. Yamsky, 1907) gave surgeons an effective means of dealing with acute blood loss. The French physiologist C. Bernard (1813-1873) created experimental medicine.
In Russia, surgery began to develop much later than in Western Europe. Until the 18th century in Russia, surgical care was almost completely absent. Such manipulations as bloodletting, cauterization, opening of 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. On the basis of hospitals, schools began to be created, which in 1786 were transformed into medical and surgical schools. In 1798 medical and 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 attached to it.
First half of the 19th century gave the world such remarkable 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. Ya.Preobrazhensky, A.A.Bobrov, P.I.Dyakonov and others.
The great surgeon and anatomist N. I. Pirogov (1810-1881) is considered to be the founder of Russian surgery. Using the methods of freezing corpses and their cuts, he studied in detail all areas of the human body and wrote a four-volume atlas of topographic anatomy, which for a long time was the handbook of surgeons. N. I. Pirogov headed the Department of Surgery at the University of Derpt, the Department of Hospital Surgery and Pathological Anatomy at the St. Petersburg Medical and Surgical Academy. N.I. Pirogov, earlier than L. Pasteur, suggested the presence of microorganisms in a purulent wound, having allocated for this purpose in his clinic a department for "infected with hospital miasms." It was N. I. Pirogov who was the first in the world to use ether anesthesia during the Caucasian howl (1847). Being the founder of military field surgery, the scientist developed the principles of organizing care for the wounded - sorting, depending on the urgency of providing assistance, evacuation, hospitalization. He introduced qualitatively new methods of immobilization, treatment of gunshot wounds, introduced a motionless plaster cast. N. I. Pirogov organized the first detachments of sisters of mercy, who provided assistance to the wounded on the battlefield.
N.V. Sklifosovsky (1836-1904) developed operations for cancer of the tongue, goiter, 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. VA Oppel studied a lot 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, 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 domestic urology and biliary surgery.
P.A. Herzen (1871 - 1947) was one of the founders of the Soviet clinical oncology. He proposed methods for the treatment of 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, was the organizer of the Institute of Surgery of the USSR Academy of Medical Sciences in Moscow.
Surgeons - the first academicians of the Academy of Medical Sciences of the USSR
1 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, during the Great Patriotic War was the chief surgeon of the Red Army. He became one of the founders of Soviet neurosurgery and the first president of the USSR Academy of Medical Sciences.
LN 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 for the first time in the world transfused human cadaveric blood. He also proposed a method for creating an artificial esophagus. S.S. Yudin for a long time was the chief surgeon of the Institute of Emergency Medicine. N. V. Sklifosovsky.
Currently, Russian surgery continues to develop successfully. A great contribution to the development of modern domestic surgery was made by outstanding surgeons academicians V.S. Savelyev, V.D. Fedorov, M.I. Kuzin, A.V. Pokrovsky, M.I. Davydov, G. I. areas are operations in pressure 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 methods 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 well-organized 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. Feldsher-midwife stations mainly provide emergency first to medical assistance and prevent diseases and injuries.
2. District hospitals (polyclinics) provide emergency and urgent surgical care for certain diseases and injuries that do not require extended surgical interventions, and also manage the work of feldsher-obstetric stations.
3. The surgical departments of the central district hospitals (CRH) provide qualified surgical care for acute surgical diseases and injuries, as well as routine 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 profiled 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.
Allocate emergency (urgent) and planned, outpatient and inpatient surgical care.
Emergency surgical care in urban conditions during the daytime, district surgeons of polyclinics or ambulance doctors provide it around the clock. They establish a diagnosis, provide first aid and, if necessary, ensure the transportation of patients to the on-duty surgical departments, where qualified and specialized surgical care is provided according to urgent indications.
In rural areas, emergency care is provided at a feldsher-obstetric station or a district hospital. In the absence of a surgeon, if an acute surgical pathology is suspected, the patient must be transported to the district hospital or the 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 turns out both in the surgical departments of polyclinics, where small and simple operations on superficial tissues are performed, and in hospitals. In the system of compulsory medical insurance (CHI), the patient must be referred to planned operation within 6-12 months after contacting the clinic and establishing the diagnosis.
Outpatient surgical care population is the most massive and consists in carrying out diagnostic, therapeutic and preventive work. This assistance to patients with surgical diseases and injuries is provided in different volumes in the surgical departments and offices of polyclinics, outpatient clinics of district hospitals, and emergency rooms. First aid can be provided in feldsher health centers and feldsher-obstetric 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 the main types of qualified inpatient surgical care to a large part of the country's population. In surgical departments, more than half of the patients are patients with acute surgical pathology and a quarter - with injuries and diseases of the musculoskeletal system. Every year, emergency surgical care is provided to an average of one in 200 residents of Russia. In large hospitals, surgical departments are being reorganized into specialized ones: traumatology, urology, coloproctology, etc. In medical departments without specialization, profiled beds are allocated.
Surgical departments are organized, as a rule, for 60 beds. The number of beds in a specialized "department can be reduced to 25 - 40 units. The provision of emergency surgical care to patients with acute surgical diseases and injuries of the abdominal organs makes up the majority of the work of surgical hospitals. The number of surgical beds required for emergency care is calculated according to the norms 1 .5 - 2.0 beds per 1,000 people The provision of emergency surgical care in large departments with the provision of round-the-clock work of laboratory, radiological, and endoscopic services significantly improves the results of treatment.
1.4. The role of the paramedic in the treatment of surgical patients
An average medical worker - a paramedic - is the closest and direct assistant to a doctor. In some cases, the life of the patient depends on the correctness and efficiency of the work of the paramedic. 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 is obliged to apply, if necessary, in any period of his activity. He must be able to:
timely 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;
provide prompt and qualified first aid;
organize the correct transportation of the victim to a medical institution (correctly choose the 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 carried out by paramedical workers, but also on the organization of the implementation medical appointments and patient care in the postoperative period and during the rehabilitation period (restoration of working capacity and elimination of the consequences of the operation).
Deontology should always be kept in mind when working with surgical patients. The main deontological principles are formulated in the Hippocratic oath. Deontology refers to the preservation of medical secrecy.
Healthcare professionals need to communicate professionally and sensitively with patients. Wrong actions, a carelessly spoken word, test results or a medical history that have become available to the patient can lead to psychological discomfort, fear of the disease, and often cause complaints or even litigation.
The nature of the activity of the paramedic is different and depends on the medical unit in which he works.
The work of a paramedic in the ambulance team. Field teams are divided into feldsher and medical teams, which will not be considered in the textbook. The paramedic team consists of two paramedics, a nurse and a driver, and provides the necessary medical care within the limits of professional competence. It solves the following tasks:
Immediate departure and arrival at the place of the call;
Establishing a diagnosis, providing an ambulance medical care;
Implementation of measures that contribute to the stabilization or improvement of the patient's condition, and, according to indications, the delivery of the patient to a surgical hospital;
transfer of the patient and the corresponding medical records the doctor on duty at the hospital;
· providing medical triage of sick and injured, establishing the order and sequence of medical measures in case of mass injuries and other emergencies.
The work of a paramedic in a surgical hospital. In a surgical hospital, a paramedic can perform the duties of a ward, procedural 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), 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 nurse(paramedic). IN preoperative period when the patient is being examined, the paramedic monitors the timely conduct diagnostic studies, compliance with all the rules for preparing for them prescribed by the doctor. Any inaccuracy in the conduct of 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 performs the various prescribed by the doctor before the operation. healing procedures. For example, an improperly performed cleansing enema in a patient with a disease of the colon can cause divergence of sutures and peritonitis, which in most cases ends in his death.
The paramedic should pay special attention to the operated patient. The paramedic should promptly identify emerging and postoperative complications and be able to provide the necessary assistance in each case. In a timely manner Taken measures at the slightest deterioration in 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 - a change in pulse, blood pressure (BP), respiration, behavior, consciousness - the paramedic must immediately report this to the doctor.
The paramedic must take care of the sick, feed the seriously ill, sanitize surgical patients upon admission. As prescribed by the doctor, the paramedic applies all types of bandage bandages, makes subcutaneous injections and infusions, intramuscular injections, enemas, venipuncture and intravenous infusions. Under the supervision of a doctor, a paramedic can catheterize bladder soft catheter, make dressings, perform gastric probing.
The paramedic is an active assistant to the doctor when puncturing cavities and removing exudate from them, applying bandages, venipuncture and intravenous infusions, blood transfusions, and central vein catheterization.
The work of a paramedic at the feldsher-obstetric station. A feldsher-obstetric station is a primary pre-medical medical institution that provides medical and sanitary assistance to the rural population within the competence and rights of a feldsher and midwife under the guidance of a district doctor. In this case, the paramedic provides the population with basic assistance. He conducts outpatient reception of 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; organizes and conducts preventive examinations; selects patients for dispensary observation.
The work of 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, a standard minimum examination must be performed. The paramedic writes out referrals to the patient for a general blood test, a general urinalysis, an analysis to determine the time of blood clotting, blood tests for bilirubin, urea, glucose, to determine the blood group and Rh factor, for antibodies to HIV infection, HBs antigen. The paramedic also directs the patient to a large-frame fluorography (if it has not been performed during the year), an ECG with a transcript, a consultation with a therapist (if necessary, also other specialists) and, for women, a gynecologist.
After making a diagnosis, assessing the operational risk, having performed all the necessary examinations and making sure that the patient needs to be hospitalized, the surgeon of the polyclinic 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 aftercare to the clinic at the place of residence, and working patients after a series of surgical interventions (cholecystectomy, gastric resection, etc.) - directly from the hospital to a sanatorium (dispensary) for a course of rehabilitation treatment. In the postoperative period, the main tasks of the paramedic are the prevention of postoperative complications, the acceleration of regeneration processes, and the restoration of working capacity.
Control questions
1. Define surgery. What are 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 merits of this scientist to world and domestic surgery.
5. Name the outstanding Russian surgeons of our time.
6. List medical institutions who care for surgical patients.
7. Name the types of surgical care. Where is emergency surgery provided?
8. Formulate the basic principles of organizing inpatient surgical care.
9. What should a paramedic be able to do when assisting 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 feldsher-obstetric station, in a polyclinic?
CHAPTER 2
PREVENTION OF SURGICAL HOSPITAL INFECTION
2.1 Brief history of the development of antisepsis and asepsis
At the heart of the work of any modern medical facility is the obligatory observance of the rules of asepsis and antisepsis. The term "antiseptic" was first proposed in 1750 by Dr. English doctor I. Pringle to designate the antiseptic action of inorganic acids. The fight against wound infection began long before our era and continues to this day. For 500 years BC. in India, it was known that smooth healing of wounds is possible only after their thorough cleaning of foreign bodies. In ancient Greece, Hippocrates always covered the surgical field with a clean cloth, during the operation he used only boiled water. IN traditional medicine for several centuries, myrrh, frankincense, chamomile, wormwood, aloe, rose hips, alcohol, honey, sugar, sulfur, kerosene, salt, etc. have been used for antiseptic purposes.
Before the introduction of antiseptic methods into surgery, postoperative mortality reached 80%, as patients died from a variety of pyoinflammatory complications. The nature of putrefaction and fermentation, discovered in 1863 by L. Pasteur, became a stimulus for the development of practical surgery, made it possible to assert that microorganisms are also the cause of many wound complications.
The founder of asepsis and antiseptics is the English surgeon D. Lister, who in 1867 developed a number of methods for the destruction of 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, 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. Semmelvsijs, on the basis of many years of observations, proved that puerperal fever, which is the main cause of death after childbirth, is transmitted in maternity hospitals through the hands medical personnel. In Viennese hospitals, he introduced the obligatory and thorough treatment of the hands of medical personnel with a solution of bleach. Morbidity and mortality from puerperal fever as a result of this measure were significantly reduced.
The 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 the hospital infection” (Pirogov N.I. Sevastopol letters and memoirs N.I. Pirogov. - M., 1950. - S. 459). For the prevention of suppuration and the 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 form for doctors of surgical departments in the form white coat and hats.
The antiseptic method for the prevention and treatment of purulent wounds by D. Lister quickly gained recognition and distribution. However, its shortcomings were also revealed - a pronounced local and general toxic effect of carbolic acid on the body of a patient and a medical worker. The development of scientific ideas about the pathogens of suppuration, the ways of their spread, the sensitivity of microbes to various factors led to a broad criticism of the septic system and the formation of a new medical doctrine of asepsis (R. Koch, 1878; E. Bergman, 1878; K. Schimmelbusch, 1KCH2 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, hospital, nosomial). Any infectious disease that affects a patient who is being treated in a health facility or who has applied to it for medical care, 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, influenza, herpes, HIV, etc.);
fungi (causative agents of candidiasis, aspergillosis, etc.);
mycoplasmas;
protozoa (pneumocysts);
Monocultural infection caused by one pathogen is rare, more often an association of microflora consisting of several microbes is detected. The most common (up to 98%) pathogen is staphylococcus aureus.
entrance gate infection is 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 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 ( hematogenous pathway) and lymphatic vessels (lymphogenic pathway) and by contact ( contact way) from organs or tissues affected by the 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, air and drip.
Contact infection is the most practical value, since in most cases contamination of wounds occurs by 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 “miasma” and is transmitted through the hands of surgeons, instruments, through linen, bedding.
Implantation infection is introduced into the tissues by injection or with foreign bodies, prostheses, suture material. For prevention, it is necessary to carefully sterilize the suture material, prostheses, objects implanted in the tissues of the body. Implantation infection can manifest itself long after surgery or injury, proceeding as a "dormant" infection.
Air infection is the infection of a wound with microbes from the operating room air. Such an infection is prevented by strict adherence to the regimen of the operating block.
Droplet infection is the contamination of a wound with an infection from droplets of saliva falling into it, flying through the air when talking. Prevention consists in wearing a mask, limiting conversations in the operating room and dressing room.
Sanitary and anti-epidemic regime. A set of organizational, sanitary, preventive and anti-epidemiological measures that prevent the occurrence of nosocomial infection is called a sanitary and anti-epidemiological regime. It is regulated by several normative documents: by order of the USSR Ministry of Health of July 31 1 "78, No. 720 "On improving medical care for patients with purulent surgical diseases and strengthening measures to combat nosocomial infection" (determines the placement, internal organization and the 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 introduction of OST 42-21-2-85" Sterilization and disinfection of products medical purpose. Methods, means, modes” (determines the modes of disinfection and sterilization of instruments, dressings, surgical linen).
Measures to prevent surgical infection include:
1) interruption of infection transmission routes by strict observance of the rules of asepsis and antisepsis: treatment of the hands of surgeons and the operating field, sterilization of instruments, dressings, suture material, prostheses, operating linen; compliance with the strict regimen of the operating unit, the implementation of 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 duration of the patient's stay in a hospital bed by reducing the 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 body (immunity) of a person (vaccinations against influenza, diphtheria, tetanus, hepatitis; BCG, etc.);
5) execution special tricks preventing pollution operating wound infected contents of internal organs.
The dressing gown of the medical worker must be clean and well ironed, all buttons are neatly fastened, the straps are 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, change clothes from wool to cotton. When visiting the dressing rooms or the operating unit, you should cover your nose and mouth with a gauze mask. It must always be remembered that the medical worker not only protects the patient from infection, but also protects himself in a measured turn from microbial infection.
Antiseptics
2.3 .1. Physical antiseptic
Antiseptics (from the Greek anti - against, septikos - causing putrefaction, putrefactive) - a complex 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 antiseptic is the application of physical factors to fight infection. The main principle of physical antisepsis is to ensure drainage from an infected wound - the outflow of its discharge to the outside and thereby its purification from microbes, toxins and tissue decay products. For drainage use various means: hygroscopic gauze, plastic and rubber tubes, glove rubber strips, as well as synthetic material in the form of wicks. In addition, various devices are used that provide outflow by creating a discharged space. Drainages, in addition to creating an outflow from a wound or cavity, are also used to administer antibiotics and other drugs with antiseptic action, washing cavities. Drainages can be inserted into cavities (abdominal, pleural), lumen of internal organs ( gallbladder, bladder, etc.).
Drainage methods can be active, passive and flow-flushing.
Active drainage. Active drainage is based on the removal of fluid from the cavity using a rarefied (vacuum) space. It provides mechanical cleansing of the purulent focus, has a direct antibacterial effect on the wound microflora. Active drainage is only possible
Surgery (from Gr. cheir - hand, ergon - action) - this is handicraft, 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 eliminate it.
One fourth of all diseases are surgical diseases. These are diseases for which surgery is the only reliable therapeutic measure.
Historically world development of surgery begins from ancient times, it distinguishes four periods:
First period - before opening general anesthesia(until the second half of the nineteenth century).
Second period - coincides with the period of development of anesthesiology and the introduction of asepsis and antisepsis into practice (second half of the 19th century).
Third period - associated with the rapid development of physiological and experimental studies in medicine (early twentieth century). During this period, independent sections of surgery began to stand out - anesthesiology, resuscitation, urology, neurosurgery, etc.
The fourth period - modern. Development of surgery this period, characterized by the improvement surgical methods treatment, the development of restorative, reconstructive surgery, transplantology, the emergence of new medical equipment.
Surgery is considered to be the leading among the ancient professions in the situation of medicine.
In the countries of the Old East (Egypt, India, China, Mesopotamia), ethnic medicine remained the basis of healing for a long time. There were rudiments of surgical knowledge that could be used in civilian life and on the battlefield: they removed arrows, bandaged wounds, stopped bleeding, using pain-reducing agents during operations: opium, henbane, hemp, mandrake. During excavations, a large number of surgical instruments were found on the lands of these countries.
The doctors of ancient Greece and ancient Rome, including Asclepius (Aesculapius), Asklepiades (128 - 56 BC), had a great influence on the development of surgery. Celsus (I century BC) prescribed a major work on surgery, where for the first time he listed the symptoms of inflammation: rubor (inflammation), tumor (edema), caler (temperature increase), dolor (pain), suggested the use of ligatures for ligation of blood vessels during the operation, outlined the methods of amputation and reduction of dislocations, came up with the doctrine of hernias. Hippocrates (460 - 370 BC) wrote a few works on surgery, for the first time described the unusual wound healing, symptoms of phlegmon and sepsis, signs of tetanus, invented the operation of resection of the rib for purulent pleurisy. Claudius Galen (131-201) suggested using silk to suture wounds.
Surgery had a significant development in the Arab caliphates (VII - XIII centuries). In Bukhara, Khorezm, Merv, Samarkand, Damascus, Baghdad, Cairo, the outstanding healers Ar-Razi (Ra-zes) (865-920) and Ibn Sina (Avicenna) (980-1037) lived and worked.
The 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, Vienna. But the statutes of all institutions were controlled by the church. At that time, a more developed area of medicine associated with continuously ongoing wars was surgery, which was traded not by medical workers, but by chiropractors and barbers. Doctors were not taken on by the so-called society of medical scientists, they were considered mere performers. This position did not have the opportunity to be present for a long time. Skill and research on the battlefields made promises for the intensive development of surgery.
During the Renaissance (XV-XVI centuries), a constellation of prominent medical workers and naturalists was noticed who made a significant contribution to the development of anatomy, physiology and surgery: Paracelsus (Theophast 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 because, in fact, 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 field of medicine, doctors were the first to achieve equality. Specifically, the 1st averages were revealed here. educational establishments doctors, but in the middle of the XVIII century. - university - surgical academy. A clear adherent of the French secondary educational institutions of doctors was the founder of the scientific surgery of modern times, A. Pare (1517 - 1590).
In the 19th century new claims to medical science were discovered, which in fact 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 has been used as an anesthetic in dental practice. In 1847 gram. Scottish surgeon and obstetrician J. Simeon adopted chloroform for pain relief, in 1905 gram. German doctor A. Eingorn synthesized novocaine.
The main task of surgery in the 2nd half of the XIX century. there was suppuration of wounds. Hungarian obstetrician I. Semmelweis (1818 - 1865) in 1847 began to use chlorine water as a disinfectant. The British surgeon J. Lister (1827-1912) proved that the smallest living organisms that enter the wound from the air are considered to be the basis of suppuration, and suggested using carbolic acid (phenol) to combat pathogens. Therefore, in 1865 gram. he used antiseptics and asepsis in surgical practice.
In 1857 gram. the French scientist L. Pasteur (1822-1895) discovered the nature of fermentation. In 1864 gram. South American dental health worker Conv. 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. proposed to adopt a hemostatic tourniquet, a flexible bandage and an anesthetic mask. Devices of the Swiss doctors T. Kocher (1841 - 1917) and J. Pean (1830 - 1898) allowed to operate in a "dry" wound. In 1895 gram. the German physicist V. K. Roentgen (1845-1923) discovered rays that can penetrate through opaque bodies.
The discovery of blood groups (Lt. 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 Europe. Until the 18th century in Russia, surgical support was almost completely absent. These manipulations, like bloodletting, cauterization, opening of abscesses, were performed by healers and barbers.
Under Peter I in 1725. Petersburg Academy of Sciences, army land and admiralty hospitals were opened. On the basis of hospitals, secondary educational institutions began to be created, 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. at the initiative of Mr. V. Lomonosov, the Capital Institute was opened, but in 1764. with him - the medical faculty.
Early 19th century provided the world with these remarkable Russian scientists, 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 legitimately said to be the founder of Russian surgery. With the help of methods of freezing the dead and their cuts, he thoroughly studied all areas of the human body and prescribed a four-volume atlas of topographic anatomy, which for a long time was considered a doctor's desk book. N.I. Pirogov managed the Department of Surgery at the Derpt Institute, the Department of Hospital Surgery and Pathological Anatomy at the St. Petersburg Medical and Surgical Academy. N. I. Pirogov, earlier than L. Pasteur, presented the presence of microorganisms in a purulent wound, emphasizing for this purpose in his own hospital a branch for “infected with hospital miasms”. Specifically, N. I. Pirogov was the first in the world to use ether anesthesia during the Caucasian War (1847). Being the founder of military field surgery, the scientist came up with the basics of organizing support for the wounded - sorting based on the urgency of offering support, evacuation, hospitalization. He introduced superbly the latest methods of immobilization, healing bullet wounds, and used a fixed plaster cast. N. I. Pirogov organized the first units of the sisters of mercy, who provided support to the wounded on the battlefield.
N.V. Sklifosovsky (1836-1904) invented operations for cancer of the tongue, goiter, cerebral hernia.
V.A.Oppel (1872-1932) - military field surgeon, founder of the doctrine of the staged cure of the crippled, was one of the founders of endocrine surgery in Russia. V. A. Oppel did a lot of research on vascular diseases and abdominal surgery.
S.I. Spasokukotsky (1870-1943) worked in many areas of surgery, came up with a highly effective technique for preparing the doctor’s hands for surgery, fresh 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 to heal fractures.
S.P. Fedorov (1869-1936) appeared as the founder of domestic urology and biliary surgery.
PA Herzen (1871 - 1947) was one of the founders of Russian medical oncology. He proposed ways to heal hernias, for the first time in the world he successfully performed an operation to create an artificial origin of the alimentary tract.
A.V. Vishnevsky (1874-1948) invented different types novocaine blockades, traded in issues of purulent surgery, urology, neurosurgery, was the instigator of the Institute of Surgery of the USSR Academy of Medical Sciences in the Capital.
N.N. Burdenko (1876-1946), a general surgeon, during the years of the Famous Patriotic Army, he picked up the Army. 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 world he transfused the cadaveric blood of an inhabitant of our planet. In addition, he proposed a way to create an artificial origin of the alimentary canal. S.S. Yudin for a long time was the main doctor of the Higher Educational Institution of Emergency Medical Care. N. V. Sklifosovsky.
Today, Russian surgery continues to develop successfully. A considerable contribution to the development of progressive domestic surgery was made by outstanding doctors academicians V.S. Saveliev, V.D. Fedorov, M.I. Kuzin, A.V. Pokrovsky, M.I. Davydov, G.I. Operations in pressure chambers, microsurgery, plastic surgery, organ and tissue transplantation, open heart surgery using a synthetic circulation unit, and others are considered promising areas. The work in these instructions will successfully last. Revised methodologies are being improved many times over, and Newest technologies using the latest instruments, devices and devices.
