The word "anesthesia" comes from a Greek word meaning "numbness", "numbness".
Anesthesia is necessary to block pain signals from the affected organs to the brain. Too powerful a signal can overstimulate one part of the brain, causing the rest to malfunction. As a result, cardiac or respiratory arrest may occur.
Anesthesia traces its history back to pain relief used during surgical operations in Assyria, Egypt, India, China and other countries. Ancient world. The first painkillers were made from plants and used in the form of infusions, decoctions and “sleepy sponges” soaked in the juice of henbane, hemp, opium, and hemlock. The sponge was soaked in the tincture or set on fire, resulting in the formation of vapors that put the sick to sleep. In addition, pain relief was induced by squeezing the vessels of the neck and limbs, releasing large amounts of blood, giving the patient wine or alcohol, and applying cold.
In the 12th century. At the University of Bologna, about 150 prescriptions for painkillers were collected. Around 1200, R. Lull discovered ether, the painkillers of which were described in 1540 by Paracelsus.
Despite these studies, during operations, in order to induce loss of consciousness, wooden mallet with which the patient was hit on the head.
IN early XIX V. English scientist G. Devi accidentally inhaled a large dose of nitrous oxide N 2 O. At the same time, he felt extreme excitement and intoxication, and danced like a madman. Having learned about the properties of “laughing gas,” respectable ladies and gentlemen began to come to Devi’s laboratory to breathe in the amazing substance. Laughing gas had different effects: some jumped on tables and chairs, others talked incessantly, and others got into a fight.
In 1844, the American dentist H. Wells used the narcotic effect of nitrous oxide for pain relief. First, he asked his assistants to pull out his tooth, using this gas as an anesthetic. However, he did not feel any pain at all. Later, he tried this anesthesia on his patients, but the public demonstration of tooth extraction ended in failure: the patient screamed loudly, either from pain or at the sight of medical instruments. Failure and ridicule drove the pioneering dentist to suicide.
On October 16, 1846, N.I. Pirogov performed abdominal surgery for the first time under full ether anesthesia. During the procedure, complete anesthesia was achieved, muscles were relaxed, and reflexes disappeared. The patient was plunged into deep sleep, losing sensation.
On February 14, 1847, N.I. Pirogov performed the first operation under ether anesthesia in the 2nd military land hospital.
Having tested etherization (ether anesthesia) on healthy people, again on myself, and having the material after 50 operations under ether anesthesia (using it in hospital and private practice), Pirogov decided to use ether anesthesia directly when providing surgical care on the battlefield.
In the same year, Pirogov performed intracheal anesthesia - injecting an anesthetic directly into the windpipe.
On July 8, 1847, Pirogov left for the Caucasus, where there was a war with the highlanders, in order to test the effect of ether anesthesia as an anesthetic on a large scale. Along the way, in Pyatigorsk and Temir-Khan-Shura, Pirogov introduced doctors to the methods of etherization and performed a number of operations under anesthesia. In Ogly, where there was no separate room for operations, Pirogov began to specifically operate in the presence of other wounded people in order to convince them of the analgesic effect of ethereal vapors. Thanks to clear example other wounded were also subjected to anesthesia without fear. Arriving at the Samurt detachment, Pirogov performed about 100 operations in a primitive “infirmary”. Thus, Pirogov was the first in the world to use ether anesthesia on the battlefield. During the year, Pirogov performed about 300 operations under ether anesthesia (in total, 690 of them were performed in Russia from February 1847 to February 1848).
On November 4, 1847, the Scottish doctor J. Simpson performed the first operation under chloroform euthanasia. The first operations under chloroform anesthesia in Russia were performed: December 8, 1847 by Lossievsky in Warsaw, December 9, 1847 by Paul in Moscow, December 27, 1847 in St. Petersburg at the Pirogov clinic.
Pirogov energetically introduced anesthesia into clinical practice. He continuously worked to improve the methods and techniques of anesthesia. Pirogov proposed a rectal method of anesthesia (injection of ether into the rectum). For this, the great surgeon designed a special apparatus and improved the design of existing inhalation devices.
While studying ether anesthesia, Pirogov also injected ether into the carotid and femoral arteries, into the internal jugular vein, femoral and portal veins. Based on experimental data, Pirogov came to the conclusion that when liquid ether is injected into a vein, instant death occurs.
The method of intravenous anesthesia with pure ether has not become widespread. However, Pirogov’s idea about the possibility of introducing a narcotic drug directly into the blood was put into practice by Russian scientists N.P. Kravkov and S.P. Fedorov, who at the beginning of the 20th century. They suggested injecting the sleeping pill hedonal directly into a vein.
Along with general anesthesia, local anesthesia developed. To do this, they used rubbing of various substances, squeezing nerve trunks and so on.
In 1859, cocaine was discovered, an alkaloid from the leaves of the coca bush. Research has shown that it has pain-relieving properties. In 1884, the Russian doctor V.K. Anrep proposed using cocaine as an anesthetic, and in 1884 the Austrian Keller used cocaine anesthesia during eye surgeries. But unfortunately, with long-term use, cocaine was painfully addictive.
A new stage in local anesthesia began with the advent of novocaine, created on the basis of cocaine, but not addictive. With the introduction of novocaine solutions into practice, they began to develop various ways local anesthesia: infiltration, conduction and spinal anesthesia.
In the first half of the 20th century. Anesthesia, the science of pain relief, has become an independent branch of medicine. She prepares the patient for surgery, administers anesthesia and monitors during operations and in the postoperative period.
During anesthesia, the patient's condition is monitored using electroencephalography and monitoring pulse and blood pressure. An important step is recovery from anesthesia, since reflexes in patients are restored gradually and complications are possible.
The use of anesthesia made it possible to perform operations on the heart, lungs, brain and spinal cord, previously impossible due to powerful pain shock. Therefore, an anesthesiologist is no less important than a surgeon.
This text is an introductory fragment.The creation and fairly widespread use in medical practice of plaster casts for bone fractures is the most important achievement of surgery of the last century. It was N.I. Pirogov was the first in the whole world to create and put into practice a completely different method of dressing, which was impregnated with liquid plaster. However, it is impossible to say that Pirogov did not try to use gypsum before. Most famous scientists: Arab doctors, the Dutchman Hendrichs, Russian surgeons K. Gibenthal and V. Basova, the Brussels surgeon Setena, the Frenchman Lafargue and others also tried to use a bandage, but it was a solution of plaster, which in some cases was mixed with starch and blotter paper.
A striking example of this is the Basov method, which was proposed in 1842. A person’s broken arm or leg was placed in a special box, which was filled with alabaster solution; the box was then attached to the ceiling using a block. The patient was practically confined to his bed. In 1851, the Dutch physician Matthiessen began using plaster bandages. This scientist rubbed dry plaster onto strips of material, wrapped it around the patient's leg, and then moistened it with the liquid.
To obtain the desired effect, Pirogov tried to use any raw material for the dressing - starch, colloidin and even gutta-percha. However, each of these materials had its drawbacks. N.I. Pirogov decided to create his own plaster cast, which is used in almost the same form today. Realize that plaster is the most the best material, the famous surgeon was able, after visiting the workshop of the then popular sculptor N.A. Stepanova. There he first saw the effect of a gypsum solution on a canvas. He immediately guessed that it could be used in surgery, and immediately applied bandages and strips of canvas, which were soaked in this solution, to a rather complex fracture of the leg. He had a wonderful effect before his eyes. The bandage dried instantly: the oblique fracture, which also had a strong blood leak, healed even without suppuration. Then the scientist realized that this bandage could find wide application in military field practice.
First use of a plaster cast.
Pirogov used a plaster cast for the first time in 1852 in a military hospital. Let's take a closer look at those times when a scientist, under flying bullets, tried to find a way to preserve the limbs of the majority of the wounded. During the first expedition to clear the Salt area from the invasion of enemies, a second one followed, also successful. At this time, some pretty terrible hand-to-hand fighting took place. During military operations, bayonets, sabers and daggers were used. The army managed to maintain its position at a high cost. On the battlefield there were approximately three hundred killed and wounded soldiers of our troops, as well as officers.
Pirogov had already begun to suffer during the battle. He had to work about twelve hours a day, and he even forgot to eat something. Ether anesthesia was widely used by a surgeon in combat situations. During the same period, the brilliant scientist managed to make another amazing discovery. In order to treat bone fractures, instead of linden bast, he began to use a fixed starch bandage. Pieces of canvas soaked in starch were placed layer by layer on a broken leg or arm. The starch began to harden, and in a motionless state the bone began to grow together over time. There was a fairly strong bone callus at the fracture site. Under the whistle of numerous bullets that flew over the tents of the infirmary, Nikolai Ivanovich realized what great benefit a medical scientist can bring to the soldiers.
And already at the beginning of 1854, the scientist Pirogov began to understand that it was quite possible to replace the rather convenient starch dressing with plaster. Gypsum, which is calcium sulfate, is a very fine powder that is extremely hygroscopic. If you mix it with water in the required proportions, it begins to harden in about 5-10 minutes. Before this scientist, gypsum began to be used by architects, builders, and sculptors. In medicine, Pirogov widely used a plaster cast to fix and consolidate an injured limb.
Plaster bandages began to be used quite widely during transportation and in the treatment of patients whose limbs were injured. Not without a sense of pride for his nation, N.I. Pirogov recalls that “our nation discovered the benefits of anesthesia and this bandage in military field practice earlier than other nations.” The fairly widespread use of the bone immobilization method he invented made it possible to carry out, as the creator himself claimed, “saving treatment.” Even with fairly extensive bone damage, do not amputate the limbs, but preserve them. Competent treatment of various fractures during the war was the key to preserving the limbs and life of the patient.
Plaster cast today.
Based on the results of numerous observations, the plaster cast has high healing characteristics. Plaster is a kind of protection of the wound from further contamination and infection, helps to destroy the microbes in it, and also allows air to penetrate the wound. And the most important thing is that the necessary rest is created for broken limbs - an arm or a leg. A patient in a cast tolerates even long-term transportation quite calmly.Today, plaster casts are used both in traumatology and surgical clinics all over the world. Scientists today are trying to create different kinds such dressings, improve the composition of its components, devices that are designed for applying and removing casts. The method originally created by Pirogov has not changed significantly. The plaster cast has passed one of the most severe tests - the test of time.
"The Divine Art of Destroying Pain" for a long time was beyond the control of man. For centuries, patients were forced to endure suffering patiently, and doctors were unable to stop their suffering. In the 19th century, science was finally able to conquer pain.
Modern surgery uses for and A who first invented anesthesia? You will learn about this as you read the article.
Anesthesia techniques in ancient times
Who invented anesthesia and why? Since the birth of medical science, doctors have been trying to solve an important problem: how to make surgical procedures as painless as possible for patients? With severe injuries, people died not only from the consequences of the injury, but also from the painful shock they experienced. The surgeon had no more than 5 minutes to perform the operations, otherwise the pain would become unbearable. The aesculapians of antiquity were armed with various means.
IN Ancient Egypt crocodile fat or alligator skin powder were used as anesthetics. An ancient Egyptian manuscript dating back to 1500 BC describes the pain-relieving properties of the opium poppy.
IN Ancient India healers used substances based on Indian hemp to produce painkillers. Chinese doctor Hua Tuo, who lived in the 2nd century. AD, suggested that patients drink wine laced with marijuana before surgery.
Methods of pain relief in the Middle Ages
Who invented anesthesia? In the Middle Ages, the miraculous effect was attributed to the mandrake root. This plant from the nightshade family contains potent psychoactive alkaloids. Medicines with the addition of mandrake extract provided narcotic influence on a person, clouded consciousness, dulled pain. However, the wrong dosage could be fatal, and frequent use caused drug addiction. The analgesic properties of mandrake were first discovered in the 1st century AD. described ancient Greek philosopher Dioscorides. He gave them the name “anaesthesia” - “without feeling.”
In 1540, Paracelsus proposed the use of diethyl ether for pain relief. He repeatedly tried the substance in practice - the results looked encouraging. Other doctors did not support the innovation and after the death of the inventor they forgot about this method.
To turn off a person’s consciousness to carry out the most complex manipulations, surgeons used a wooden hammer. The patient was hit on the head and temporarily fell into unconsciousness. The method was crude and ineffective.
The most common method of medieval anesthesiology was ligatura fortis, i.e. pinching of nerve endings. The measure allowed for a slight reduction in pain. One of the apologists of this practice was the court physician of the French monarchs, Ambroise Paré.
Cooling and hypnosis as methods of pain relief
At the turn of the 16th-17th centuries, the Neapolitan physician Aurelio Saverina reduced the sensitivity of the operated organs using cooling. The diseased part of the body was rubbed with snow, thus being slightly frozen. Patients experienced less suffering. This method has been described in the literature, but few people have resorted to it.
Pain relief using cold was remembered during the Napoleonic invasion of Russia. In the winter of 1812, the French surgeon Larrey carried out mass amputations of frostbitten limbs right on the street at a temperature of -20... -29 o C.
In the 19th century, during the period of mesmerization craze, attempts were made to hypnotize patients before surgery. A when and who invented anesthesia? We'll talk about this further.
Chemical experiments of the 18th-19th centuries
With development scientific knowledge Scientists began to gradually approach the solution of a complex problem. At the beginning of the 19th century, the English naturalist H. Davy established, based on personal experience that inhaling nitrous oxide vapor dulls the sensation of pain in humans. M. Faraday found that a similar effect is caused by sulfuric ether vapor. Their discoveries did not find practical application.
In the mid-40s. 19th century dentist G. Wells from the USA became the first person in the world to undergo surgical manipulation while under the influence of an anesthetic - nitrous oxide or “laughing gas”. Wells had a tooth removed, but he did not feel any pain. Wells was inspired by the successful experience and began to promote new method. However, the repeated public demonstration of the action of the chemical anesthetic ended in failure. Wells failed to win the laurels of the discoverer of anesthesia.
Invention of ether anesthesia
W. Morton, who practiced in the field of dentistry, became interested in the study of analgesic effects. He carried out a series of successful experiments on himself and on October 16, 1846, put the first patient into a state of anesthesia. An operation was performed to painlessly remove a tumor in the neck. The event received wide resonance. Morton patented his innovation. He is officially considered the inventor of anesthesia and the first anesthesiologist in the history of medicine.
The idea of ether anesthesia was picked up in medical circles. Operations using it were performed by doctors in France, Great Britain, and Germany.
Who invented anesthesia in Russia? The first Russian doctor who risked testing the advanced method on his patients was Fedor Ivanovich Inozemtsev. In 1847, he performed several complex abdominal operations on patients immersed in water. Therefore, he is the pioneer of anesthesia in Russia.
Contribution of N. I. Pirogov to world anesthesiology and traumatology
Others followed in Inozemtsev’s footsteps Russian doctors, including Nikolai Ivanovich Pirogov. He not only operated on patients, but also studied the effects of ethereal gas, tried different ways its introduction into the body. Pirogov summarized and published his observations. He was the first to describe the techniques of endotracheal, intravenous, spinal and rectal anesthesia. His contribution to the development of modern anesthesiology is invaluable.
Pirogov is the one. For the first time in Russia, he began to fix damaged limbs using a plaster cast. The doctor tested his method on wounded soldiers during Crimean War. However, Pirogov cannot be considered a pioneer this method. Gypsum was used as a fixing material long before (Arab doctors, the Dutch Hendrichs and Matthiessen, the Frenchman Lafargue, the Russians Gibenthal and Basov). Pirogov only improved the plaster fixation, making it light and mobile.
Discovery of chloroform anesthesia
In the early 30s. Chloroform was discovered in the 19th century.
A new type of anesthesia using chloroform was officially presented to the medical community on November 10, 1847. Its inventor, Scottish obstetrician D. Simpson, actively introduced pain relief for women in labor to ease the process of childbirth. There is a legend that the first girl who was born painlessly was given the name Anasthesia. Simpson is rightfully considered the founder of obstetric anesthesiology.
Chloroform anesthesia was much more convenient and profitable than ether. It put a person to sleep faster and had a deeper effect. It did not require additional equipment; it was enough to inhale the vapor from gauze soaked in chloroform.
Cocaine is a local anesthetic used by South American Indians.
The ancestors of local anesthesia are considered to be South American Indians. They have been using cocaine as a painkiller for a long time. This plant alkaloid was extracted from the leaves of the native Erythroxylon coca shrub.
The Indians considered the plant a gift from the gods. Coca was planted in special fields. Young leaves were carefully picked from the bush and dried. If necessary, the dried leaves were chewed and saliva was poured over the damaged area. It lost sensitivity, and traditional healers began surgery.
Koller's research in local anesthesia
The need to provide pain relief in a limited area was especially acute for dentists. Tooth extraction and other interventions in dental tissue caused unbearable pain in patients. Who invented local anesthesia? In the 19th century, in parallel with experiments on general anesthesia, searches were carried out effective method for limited (local) anesthesia. In 1894, the hollow needle was invented. Dentists used morphine and cocaine to relieve toothache.
A professor from St. Petersburg, Vasily Konstantinovich Anrep, wrote in his works about the properties of coca derivatives to reduce sensitivity in tissues. His works were studied in detail by the Austrian ophthalmologist Karl Koller. A young doctor decided to use cocaine as an anesthetic during eye surgery. The experiments turned out to be successful. The patients remained conscious and did not feel pain. In 1884, Koller informed the Viennese medical community about his achievements. Thus, the results of the Austrian doctor’s experiments are the first officially confirmed examples of local anesthesia.
History of the development of endotrachial anesthesia
In modern anesthesiology, endotracheal anesthesia, also called intubation or combined, is most often practiced. This is the safest type of anesthesia for humans. Its use allows you to keep the patient’s condition under control and perform complex abdominal surgeries.
Who invented endotrochial anesthesia? The first documented case of the use of a breathing tube for medical purposes is associated with the name of Paracelsus. An outstanding doctor of the Middle Ages inserted a tube into the trachea of a dying man and thereby saved his life.
In the 16th century, Andre Vesalius, a professor of medicine from Padua, conducted experiments on animals by inserting breathing tubes into their tracheas.
The occasional use of breathing tubes during operations provided the basis for further developments in the field of anesthesiology. In the early 70s of the 19th century, the German surgeon Trendelenburg made a breathing tube equipped with a cuff.
The use of muscle relaxants in intubation anesthesia
The widespread use of intubation anesthesia began in 1942, when Canadians Harold Griffith and Enid Johnson used muscle relaxants - drugs that relax muscles - during surgery. They injected the patient with the alkaloid tubocurarine (intokostrin), obtained from the famous poison of the South American Indians, curare. The innovation made intubation procedures easier and made operations safer. Canadians are considered to be the innovators of endotracheal anesthesia.
Now you know who invented general and local anesthesia. Modern anesthesiology does not stand still. Successfully applied traditional methods, the latest medical developments are being introduced. Anesthesia is a complex, multicomponent process on which the health and life of the patient depends.
Great, brilliant, famous - about the doctor Nikolai Pirogov descendants speak in a superlative sense. He really managed to make discoveries that were ahead of his time and became the founder of military field surgery in Russia. AiF.ru recalls the biography of a famous physician.
Aesculapius games
Nikolai Pirogov was born on November 25, 1810 into the patriarchal family of a treasury official. The boy was the 13th child of his parents. And his path to medicine began already in childhood with his first meeting with a famous Moscow doctor at that time Efrem Osipovich Mukhin.
In 1820, when little Kolya was only 10 years old, one of his older brothers fell seriously ill with rheumatism. One doctor replaced another at the patient’s bedside, but there was no result. After an unsuccessful visit to the fifth doctor, the neighbors advised the Pirogovs to invite Professor Mukhin, a celebrity at the time. Nikolai’s father doubted whether such a doctor would accept the invitation of a poor man? But Mukhin agreed - he was always interested in severe cases that were difficult to treat.
- Well, young man, what happened to you? — he carefully examined the patient, listened to complaints, and began treatment. And after several sessions, relief came. “And you, sir, would make a good doctor,” said Mukhin, addressing 10-year-old Kolya as if he were an adult. “I understood this from the way you looked after your brother.”
Afterwards, Mukhin often visited the Pirogovs’ house. Nikolai liked the doctor’s manners and behavior so much that he regularly played “Mukhin” with his family - he “listened” to them with his pipe many times, coughed and imitated Mukhin’s voice while prescribing medicine.
As a result, when the young man graduated from school, he family council They again remembered the famous doctor’s prediction - and decided to send Pirogov Jr. to medical school. However, there was a problem - the boy was barely 14 years old. It’s too early - they won’t accept... And then Mukhin came to the rescue again. He personally addressed the rector himself, telling him: “I feel in my gut, Your Excellency, that the boy will be a good one.”
...And there was a point
Nikolai Pirogov graduated from the university in 1828. Moreover, his student years were during difficult years, when various medical experiments and experiments, as well as the preparation of various anatomical preparations, were prohibited as an “ungodly” matter. After graduating from university, he went to the city of Dorpat to prepare for a professorship and practice anatomy and surgery under the guidance of a respected mentor Ivan Moyer. Moreover, in 1832, at the age of 22, he had already defended his dissertation “Is ligation of the abdominal aorta for an aneurysm groin area an easily feasible and safe intervention?”, which completely changed the understanding of procedures of this kind and refuted a number of statements by eminent foreign doctors.
Pirogov did not want to sit in one place - as a result, he managed to work in Dorpat and visit Germany, everywhere improving as a doctor, gaining experience and conducting experiments.
Each discovery and statement of the young physician was scientifically and factually supported by many different experiments and studies. For example, while preparing his work on ligation of the Achilles tendon as a means of orthopedic treatment, he made no less than 80 experiments in this industry! Based on his empirical findings, he was able to come up with an excellent treatment option.
In 1841, Pirogov became the head of the hospital surgery clinic, where he was able to improve his skills and knowledge, and also received a fairly wide field for research. In 1847, the doctor went as a military field surgeon to the Caucasus in the active army. His work there opened a new page in the history of Russian medicine.
Russian anesthesiologist
Literally a year before going to war, the surgeon learned about the use of ether as anesthesia. He closely followed all modern discoveries in the field of health and read such magazines and newspapers as “Northern Bee”, “Friend of Health”, “St. Petersburg Vedomosti”. And it was from them that he learned about the successful demonstration of the use of ether as an anesthesia William Morton.
Initially, the doctor was skeptical and negative towards this kind of pain relief and attempted to find his own option. However, the successful experiment of a foreign colleague forced him to reconsider his views. Pirogov begins research and becomes convinced that all his doubts were unfounded, and ether anesthesia is “a tool that can instantly transform the entire surgery.”
IN field conditions the doctor began to actively use anesthesia, which significantly improved recovery rates - now patients did not suffer from pain and did not die from shock. The monograph published by the famous surgeon indicated his recommendations for the use of such anesthesia. He believed that it was first necessary to test the patient's "susceptibility" to the drug, because Each body's reaction is individual.
The war in which the doctor took part made it possible to reconsider the principle of providing first aid according to the degree of urgency. “I was the first to introduce triage of the wounded at the Sevastopol dressing stations and thereby destroyed the chaos that reigned there,” the surgeon himself wrote. According to his opinion, it was necessary to divide the soldiers arriving from the front line according to the degree of urgency of providing medical care: the most severe ones forward, those with minor wounds - to wait. In addition, it was at his instigation that sisters of mercy appeared in Russia - they helped nurse the sick, did the necessary dressings and washings.
Pirogov triangle
Nikolai Pirogov is responsible for many medical discoveries. A number of anatomical formations are named after him - Pirogov’s triangle, Pirogov’s ring, etc. Some operations are also named in his honor.
In addition, an outstanding Russian doctor created new section anatomy - topographic study of organs. Previously, it was almost impossible to study the location of organs inside using dummies and created models. Anatomical autopsies also did not provide a complete picture. Pirogov proposed a series of experiments that allowed him to significantly correct the overall picture and gave doctors a more complete vision of what is happening inside the human body. The result was a 4-volume book that brought the Russian doctor worldwide fame.
Nikolai Pirogov also took care of the students, believing that there is no better experience than practical one. Therefore, he tried to create such conditions so that every surgical student could participate in various experiments and surgical interventions.
...The name of Nikolai Pirogov is now well known not only to medical students. Pirogov congresses and readings are held in his honor, and even a medical society named after Pirogov was created. Also, many hospitals, several streets, embankments and even an asteroid are named after him.
And you say: I slipped and fell. Closed fracture! Lost consciousness, woke up - a cast. (film “The Diamond Arm”)
Since ancient times, in order to maintain immobility in the fracture area, immobilization of damaged bone fragments has been used. various materials. The very fact that bones grow together much better if they are immobilized relative to each other was obvious even primitive people. The vast majority of fractures will heal without any need for surgery if the broken bone is properly aligned and immobilized. Obviously, in those ancient times, the standard method of treating fractures was immobilization (limitation of mobility). In those days, at the dawn of history, how could you fix a broken bone? According to extant text from the papyrus of Edwin Smith (1600 BC), hardening bandages were used, probably derived from the bandages used in embalming. Also while excavating tombs of the Fifth Dynasty (2494-2345 BC), Edwin Smith describes two sets of immobilization splints. It was a very long time before the first plaster cast appeared...
Detailed recommendations for the treatment of fractures are given in the “Hippocratic Collection”. The treatises “On Fractures” and “On Joints” provide techniques for realigning joints, eliminating deformities of the limbs during fractures, and, of course, methods of immobilization. Hardening dressings made from a mixture of wax and resin were used (by the way, the method was very popular not only in Greece), as well as splints made of “thick leather and lead.”
More later description methods for fixing broken limbs, in the 10th century AD. A talented surgeon from the Cordoba Caliphate (the territory of modern Spain) proposed using a mixture of clay, flour and egg white to create a dense fixing bandage. These were materials that, along with starch, were used everywhere until the beginning of the 19th century and technically underwent only minor changes. Another thing is interesting. Why wasn't plaster used for this? The history of the plaster cast, exactly as we know it today, dates back only 150 years. How about plaster? construction material was used back in the 3rd millennium BC. Has no one thought of using gypsum for immobilization in 5 thousand years? The thing is that to create a plaster cast you need not just plaster, but one from which excess moisture has been removed - alabaster. In the Middle Ages, the name “Parisian plaster” was assigned to it.
History of gypsum: from the first sculptures to Parisian plaster
Gypsum as a building material was used 5 thousand years ago, and was used everywhere in works of art and buildings of ancient civilizations. The Egyptians, for example, used it to decorate the tombs of the pharaohs in the pyramids. IN Ancient Greece gypsum was very widely used to create magnificent sculptures. In fact, the Greeks gave this natural material its name. “Gypros” in Greek means “boiling stone” (obviously due to its lightness and porous structure). It also became widespread in the works of the ancient Romans.
Historically, the most famous building material was also used by architects in the rest of Europe. Moreover, making stucco and sculpture is not the only use of gypsum. It was also used for making decorative plaster for processing wooden houses in cities. Huge interest in gypsum plaster arose due to a misfortune quite common in those days - fire, namely the Great Fire of London in 1666. Fires were not uncommon then, but then more than 13 thousand burned out wooden buildings. It turned out that those buildings that were covered gypsum plaster, were much more resistant to fire. Therefore, in France they began to actively use gypsum to protect buildings from fires. An important point: in France there is the largest deposit of gypsum stone - Montmartre. That’s why the name “Parisian plaster” stuck.
From plaster of Paris to the first plaster cast
If we talk about hardening materials used in the “pre-gypsum” era, then it is worth remembering the famous Ambroise Paré. The French surgeon impregnated the bandages with a composition based on egg whites, as he writes about in his ten-volume manual on surgery. It was the 16th century and firearms began to be actively used. Immobilizing bandages were used not only to treat fractures, but also to treat gunshot wounds. European surgeons then experimented with dextrin, starch, and wood glue. Personal doctor Napoleon Bonaparte, Jean Dominique Larrey used bandages soaked in a composition of camphor alcohol, lead acetate and egg white. The method was not widespread due to its labor intensity.
But who was the first to think of using a plaster cast, that is, fabric impregnated with plaster, is unclear. Apparently, it was the Dutch doctor Antony Matthiessen who used it in 1851. He tried rubbing the dressing material with gypsum powder, which, after application, was moistened with a sponge and water. Moreover, at a meeting of the Belgian Society of Medical Sciences, it was sharply criticized: the surgeons did not like that the plaster stained the doctor’s clothes and quickly hardened. Matthiessen's headbands were strips of coarse cotton fabric with applied thin layer Parisian plaster. This method of preparing a plaster cast was used until 1950.
It is worth saying that long before this there was evidence that gypsum was used for immobilization, but in a slightly different way. The leg was placed in a box filled with alabaster - a “dressing shell”. When the plaster set, the limb ended up with such a heavy blank. The downside was that it severely limited the patient's mobility. The next breakthrough in immobilization, as usual, was the war. In war, everything must be fast, practical and convenient for mass use. Who will deal with boxes of alabaster in war? It was our compatriot, Nikolai Ivanovich Pirogov, who first used a plaster cast in 1852 in one of the military hospitals.
The first ever use of a plaster cast
But why plaster? Gypsum is one of the most common minerals in earth's crust. It is calcium sulfate bound to two water molecules (CaSO4*2H2O). When heated to 100-180 degrees, gypsum begins to lose water. Depending on the temperature, you get either alabaster (120-180 degrees Celsius). This is the same Parisian plaster. At a temperature of 95-100 degrees, low-firing gypsum is obtained, called high-strength gypsum. The latter is precisely more preferable for sculptural compositions.
He was the first to use the familiar plaster cast. He, like other doctors, tried to use to create a tight bandage different materials: starch, colloidin (a mixture of birch tar, salicylic acid and colloid), gutta-percha (a polymer very similar to rubber). All of these products had a big disadvantage - they dried very slowly. Blood and pus soaked the bandage and it often broke. The method proposed by Matthiessen was also not perfect. Due to uneven saturation of the fabric with plaster, the bandage crumbled and was fragile.
Even in ancient times, there were attempts to use cement for immobilization, but the disadvantage was also the long curing time. Try sitting motionless for a whole day with a broken leg...
As N.I. wrote Pirogov in his “Sevastopol Letters and Memoirs” he saw the effect of gypsum on canvas in the studio of the famous sculptor of those days, N.A. Stepanov. The sculptor used thin strips of linen dipped in a liquid mixture of plaster of Paris to make the models. “I guessed that it could be used in surgery, and immediately applied bandages and strips of canvas soaked in this solution to a complex fracture of the leg. The success was remarkable. The bandage dried in a few minutes... The complex fracture healed without suppuration or any seizures.”
During the Crimean War, the method of using plaster casts was widely introduced into practice. The method for preparing a plaster cast according to Pirogov looked like this. The damaged limb was wrapped in cloth, and the bony protrusions were additionally covered. A plaster solution was prepared and strips of shirts or underpants were immersed in it (there is no time for fat in war). In general, everything was suitable for bandages.
If you have a plaster solution, you can turn anything into an immobilizing bandage (from the film “Gentlemen of Fortune”)
The plaster mixture was distributed over the tissue and applied along the limb. Then the longitudinal strips were strengthened with transverse strips. It turned out robust design. After the war, Pirogov improved his method: a piece of fabric corresponding to the size of the damaged limb was cut out from rough canvas in advance and soaked in a plaster solution before use.
Matthiessen’s technique was popular abroad. The fabric was rubbed with dry plaster powder and placed on the patient's limb. The gypsum composition was stored separately in sealed containers. Subsequently, bandages sprinkled with the same composition were produced. But they were wetted after bandaging.
Pros and cons of a plaster cast
What are the advantages of a plaster-based fixation bandage? Convenience and speed of use. The plaster is hypoallergenic (I remember only one case of contact allergy). A very important point: the bandage “breathes” due to the porous structure of the mineral. A microclimate is created. This is a definite bonus, in contrast to modern polymer dressings, which also have a hydrophobic backing. Of the minuses: not always sufficient strength (although a lot depends on the manufacturing technique). Plaster crumbles and is very heavy. And for those who have suffered misfortune and had to contact a traumatologist, the question is often tormented: how to scratch under a cast? However, under a plaster cast it itches more often than under a polymer bandage: it dries out the skin (remember the hygroscopicity of plaster). Various wire devices are used. Anyone who has encountered this will understand. In a plastic bandage, on the contrary, everything “sinks.” The substrate is hydrophobic, that is, it does not absorb water. But what about the main bonus of polymer dressings - the ability to take a shower? Of course, the bandages created on a 3D printer do not have all these disadvantages. But so far such bandages are only in development.
Polymer and 3D printer as a means of immobilization
Will the plaster cast become a thing of the past?
Modern capabilities of a 3D printer in creating fixation bandages
Undoubtedly. But I think that this will not happen very soon. Fast growing modern technologies, new materials will still take their toll. The plaster cast still has very important advantage. Very low price. And although new ones appear polymer materials, the immobilizing bandage of which is much lighter and stronger (by the way, it is much more difficult to remove this one than a regular plaster cast), fixing bandages of the “external skeleton” type (printed on a 3D printer), the history of the plaster bandage is not over yet.
Palamarchuk Vyacheslav
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