Medical, scientific, pedagogical and social activities of N. Works of N.V. Sklifosovsky
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2). N.V. Sklifosovsky’s contribution to the development of aseptic and antiseptic methods, and to the development of abdominal surgery.
N.V. Sklifosovsky, traveling through Germany, France, and England from 1866 to 1868, saw everything that world medical science could show the young surgeon. It was in those years that wound infection bacteria were discovered, Lister’s “anti-putrefactive” method (antiseptic), general anesthesia with ether and chloroform came into practice, and the approach to surgery itself fundamentally changed. Unfortunately, the lack of sterility during operations often led to disastrous results. Sklifosovsky is credited with introducing antiseptics into Russian surgical practice, that is, active disinfection using chemicals.
However, the antiseptic method was not used for long.
Fifteen years later it gave way to a more progressive one - aseptic, “putrefactive”. It became clear that the antiseptic solutions previously used to clean wounds - carbolic acid and sublimate - acted not only on bacteria, but also directly on living tissues of the body. Studies have shown that acid solutions have little effect on pathogenic forms of microbes and have virtually no effect on their spores. But the same acids had a detrimental effect on living tissues.
It was much more effective to solve these problems by installing some artificial barriers to prevent bacteria from entering the wound. For example, boiling or exposure to steam under high pressure practically destroyed not only microbes, but also all types of their spores. When this fact was finally established, the impact high temperature everything that was used during the operation began to be exposed: bandages, gowns, gloves, instruments, even a special antiseptic method was developed for treating hands (Fig. 2).
N.V. Sklifosovsky widely promoted the methods of antisepsis and asepsis and was one of the first in Russia to introduce both methods into surgical practice. As the honorary chairman of the 1st Pirogov Congress in 1885, he gave a speech on antiseptics - “On the successes of surgery under the influence of the antiputrefactive method.” In Russia, this was the moment of turning from old surgery to new.
N.V. Sklifosovsky was the first in Russia to begin performing gastric excision surgery, closed suture Bladder, goiter surgery, excision of tongue cancer with preliminary ligation of the lingual artery, removal of the larynx, urinary hernia surgery. He was not afraid to perform the most complex plastic surgeries and was constantly looking for new methods. For example, an operation for false joints so I entered world literature called "Sklifosovsky Castle". To hold the ends at the fracture site femur in their direct contact, a cut was made in the middle of both ends of the bone, then at the end of the first cut, a second cut was made in a direction transverse to it. Both halves sawn at the ends were removed so that the resulting surfaces came into contact with each other, then they were secured with metal seams. Special attention The scientist paid attention to abdominal surgery: in the Moscow period he was one of the first to use gastrostomy, and in St. Petersburg - the “Murphy button”. Another of his outstanding innovations in Russian surgery was the use of a bubble suture.
He outlined the successes of practical surgery in his publications. He wrote 114 scientific papers, which reflected personal experience and innovative ideas. The works were devoted to new methods of operations, bone and plastic surgery, gynecology, military field surgery and were a valuable contribution to the treasury of world science.
3). Development and application of new methods in military field surgery.
“N.V. Sklifosovsky,” wrote Professor V.V. Kovanov, “infected everyone around him with his hard work, instilled in them cheerfulness and fortitude, and forced them to meekly endure all the hardships and hardships of front-line life. Eyewitnesses tell how this outwardly elegant and well-groomed civil general in a spotlessly clean uniform was able to remain for several days without food and without sleep, being continuously for several days without food and without sleep, constantly being at the operating table in the dressing room or in the triage room. departments of the main hospital. The care of doctors and nurses for him was touching; during work they brought him a sip of wine or a piece of bread to maintain his strength. Great help His wife, Sofya Alexandrovna, assisted him in his work, caring for the wounded. She was with him throughout the entire company, enduring all the hardships of camp life.”
Taking part in the wars (Austro-Prussian 1866, Slavic in Montenegro 1876, Russian-Turkish 1877-1878), N.V. Sklifosovsky gained vast experience in organizing medical support and tactics for treating the wounded (Fig. 4, 5). Thousands of wounded and sick passed through his hands. A thorough analysis of the course of gunshot wounds and fractures allowed him to offer a number of valuable organizational and therapeutic measures. Like N.I. Pirogov, he considered sorting the wounded to be the most important task requiring a qualified and timely solution. When sorting, he proposed dividing the wounded into 3 categories - non-transportable, who were left in the hospital: subject to plaster casting; receiving a simple dressing and the wounded, who returned to the front after 1-2 days. In the category of non-transportable N.V. Sklifosovsky singled out the wounded with penetrating wounds of the chest and abdomen, with complex gunshot wounds of large joints. In addition, he determined the timing of the evacuation of this category of wounded.
Penetrating wounds chest, from the point of view of N.V. Sklifosovsky, proceeded more favorably and more often had a happy outcome when the wounded were not subjected to rapid transportation along dirt roads on unsuitable peasant carts, which caused great harm to the wounded. He believed that the effectiveness of medical support for troops depended entirely on the flexibility of management, the competence of the heads of the medical service, and the level of their special training.
N.V. Sklifosovsky became convinced of the importance of dispersing the wounded and sick in hospitals, considering the concentration of the wounded in one place unacceptable, which inevitably leads to an outbreak of intra-hospital infection and the death of a large number of wounded. He promoted wide application tents to accommodate the wounded, arriving in hospitals in huge numbers after battles, and very much regretted that this was N.I.’s proposal. Pirogov did not find practical application in the Russian army.
N.V. Sklifosovsky was the first to express the idea of the advisability of using railway transport for the evacuation of the wounded.
He came up with the idea of creating mobile “flying teams” that should work in places with the greatest concentration of wounded to strengthen hospitals.
He emphasized the importance of early application of plaster casts for wounds of extremities with damage bone tissue and believed that a plaster cast was a more reliable method of treatment, protecting against severe complications.
4). Social and medical activities of a scientist.
N.V. Sklifosovsky also left a bright mark as a prominent public figure who was involved in improving the conditions for teaching and improving the material base of hospitals and clinics. Enormous work was carried out during the preparation for the XII International Congress of Doctors in Moscow (1885-1890). Over the years, N.V. Sklifosovsky managed to get land plot on Devichye Pole and build the main buildings of Moscow University clinics. During construction, the latest achievements in construction technology were taken into account and the achievements of science in the field of combating purulent infection were taken into account. Moscow University in 1897 could show foreign participants of the congress the best hospital town for that time in Europe.
He took the initiative to hold special Pirogov medical congresses (Fig. 7). He was one of the organizers and chairmen of the 1st Congress of Russian Surgeons in 1900. At this congress he was honored on the occasion of the fortieth anniversary of scientific and surgical activity. Congresses were held by members of the Society of Russian Doctors - the most representative scientific society of pre-revolutionary Russia, uniting representatives of all medical specialties. Two, or even two and a half thousand people gathered at these congresses, that is, almost every ninth doctor in Russia came.
One of the most important achievements of Nikolai Vasilyevich is considered to be the introduction of antiseptics into surgical practice - active disinfection using chemicals. Sklifosovsky developed a strict hygienic regime in the capital’s clinics. However, the professor's innovations were met with hostility. Only N.V. Sklifosovsky, thanks to his authority, managed to break this resistance, first in Moscow, and then throughout Russia. At the First Pirogov Congress in 1885, he made a brilliant speech in defense of antiseptics - with a report “On the successes of surgery under the influence of the antiputrefactive method.” This report was the starting point new surgery in Russia. Indeed, before Sklifosovsky’s innovation, the lack of sterility during operations often led to sad results.
Sklifosovsky was the first in the world to use local anesthesia cocaine solution during cleft surgery hard palate. The professor designed a device that made it possible to maintain anesthesia during surgery on the jaws and oral cavity. By the way, before using anesthesia, everything, even the most complex operations, lasted no more than a couple of minutes.
Another important merit of Sklifosovsky can be considered the fact that he introduced X-ray examinations into surgical practice since 1898.
Nikolai Vasilyevich was a “pioneer” in several branches of medicine. He was one of the first to perform operations to remove ovarian cysts. During the Moscow period, he was one of the first to use gastrostomy, and in St. Petersburg - the “Murphy button”. Among his other outstanding innovations in Russian surgery, the use of a bubble suture is noted. Sklifosovsky also proposed surgical treatment of cerebral hernias, hernias abdominal wall, cancer of the tongue and jaws, stomach, surgical removal bladder stones. In addition, he developed indications for surgical treatment gallbladder diseases, surgical techniques.
The professor was one of the founders of the Pirogov congresses, which played a large role in domestic medicine. IN different years was the chairman of the 1st Congress Russian surgeons, organizer of the international congress in Moscow and its surgical section. In addition, he was one of the founding members of the Society of Russian Doctors and the Moscow Surgical Society. Sklifosovsky’s merits in the magazine business are also noted. He was the founder and editor of the Chronicle of Russian Surgery and the Russian Surgical Archive.
“Sklifosovsky Castle”, otherwise known as “Russian castle”, is what surgeons still call fixing the broken ends of the femur with metal sutures. It was invented, as the name suggests, by Sklifosovsky.
Sklifosovsky introduced many innovations in the field military medicine. He developed the principle of approximation medical care to the battlefield, the principle of “saving treatment” gunshot wounds. The professor introduced the widespread use of plaster casts. And this is not all of his merits. Sklifosovsky was a doctor in the war more than once. First he went to the Austro-Prussian War. There he worked at dressing stations and in a military hospital until the end of the campaign. After the end of the war, the professor wrote a long article about his work experience. Next came the Franco-Prussian War and Sklifosovsky again asked to go to the front. Sklifosovsky's military experience was again in demand during the Balkan and Russian-Turkish wars. In works written later, Nikolai Vasilyevich analyzed the problems of organizing the transportation of the wounded, treating gunshot injuries and private assistance in war. He insisted that treatment of penetrating chest wounds should be carried out directly on the spot, without transportation. During the fighting, Sklifosovsky provided practical assistance to soldiers under enemy bullets. Colleagues noted that he kept the patients in good spirits and forced them to endure all the hardships and hardships of front-line life without complaint.
The meaning of N.V. Sklifosovsky is very important in the history of Russian surgery. He lived in one of the most interesting eras of surgery: the mid-19th century. was marked by important discoveries - the introduction of Lister's method, i.e. administration of antiseptics, and administration general anesthesia ether and chloroform. These discoveries divided the history of surgery into two periods. A large number of purulent, putrefactive inflammations, anaerobic phlegmon(inflammation subcutaneous tissue) and gangrene (death), septic (putrefactive) and septicopyemic (pyogenic) wound complications with colossal mortality characterized the previous period in the history of surgery. The lack of anesthesia led to a significant limitation of use surgical interventions: only short-term operations could be transferred without heavy excruciating pain. Surgeons became virtuoso technicians. To shorten the operation time, they tried to develop a quick operating technique. One must be amazed at the brilliant surgical techniques acquired by surgeons of that time; The duration of the operation was calculated in minutes and sometimes seconds.
N.V. Sklifosovsky deserves great credit, first of all, for introducing into surgical practice the principles of antiseptics (disinfection using chemicals), and then asepsis (disinfection using physical means) here in Russia. As often happens, new discoveries do not always come into life easily. The same thing happened with antiseptics. Even major specialists in Europe and Russia not only did not want to recognize the method that opened a new era in surgery, but even scoffed at this method of fighting microbes with the help of antiseptics.
As surgeon N.V. Sklifosovsky enjoyed well-deserved world fame. We can say that in the second half of the 19th century. among surgeons he was the largest figure. As a true student and follower of Pirogov, N.V. Sklifosovsky carefully studied anatomy, spending a lot of time dissecting corpses. Already at the beginning of his work in Odessa, he usually, after classes in the operating room and wards, went to study topographic anatomy and operative surgery. He was not embarrassed by the poor equipment of the sectional room or the lack of ventilation. He spent too much time studying anatomy, sometimes to the point of complete exhaustion, so that one day he was found lying near a corpse in a state of deep fainting.
Thanks to the constant practical study of the fundamentals of surgery N.V. Sklifosovsky brilliantly mastered operational technology. Already in pre-antiseptic times, he successfully performed such major operations as removal of the ovary, when these operations were not yet performed in many large clinics in Europe. He was one of the first to introduce laparotomy (chnotomy) - opening of the abdominal cavity.
He not only kept pace with the times, but as a scientist and surgeon he was often ahead of them. He was one of the first to perform gastrostomy surgery (excision of the stomach), use the Murphy button, the first in Russia to introduce a blind suture of the bladder, goiter surgery, excision of tongue cancer with preliminary ligature of the lingual artery, removal of the larynx, cerebral hernia surgery, etc. Finally, complex operations By plastic surgery also found in N.V. Sklifosovsky is not only a master of surgical technique, but also the author of new surgical methods. One of these operations for false joints called the “Sklifosovsky castle” or “Russian castle”, successfully performed by him, is described in Russian and foreign textbooks. N.V. Sklifosovsky operated in all areas of surgery; he was an equally brilliant surgeon, both in peacetime and in military field surgery. This was a consequence of N.V.’s exceptional talent. Sklifosovsky and his tireless studies in the sectional room, operating room, on the battlefield, in the library, in foreign and domestic clinics. This was a consequence of the widespread introduction into practice of all the achievements of science. It is not surprising that even the greatest surgeons called N.V. Sklifosovsky with “golden hands”.
Name N.V. Sklifosovsky as a major scientist was known throughout the world. Developing and expanding the scope of surgery, giving a number of new methods of surgical technique, he acted as an innovator in surgery, closely connecting theory with practice. Having essentially assessed all the advantages of the antiseptic method, N.V. Sklifosovsky did not limit himself to the use of carbolic acid, but replaced antiseptics accordingly, their testing by science. A very strong authority was needed, such as N.V. Sklifosovsky had among European scientists, among professors, doctors and the general public, in order to introduce new antiseptic methods in Russia.
Peru N.V. Sklifosovsky owns more than 110 scientific papers devoted to the most diverse areas of surgery:
a) gynecology (which at that time was a department of surgery and was just beginning to practically dissociate itself from it); N.V. Sklifosovsky devoted his dissertation and a number of works to this section;
b) new methods of operations, first used in Russia (goiter operations, gastrostomy, cholecystostomy, bladder suture, resection of cerebral hernia, etc.);
c) bone and osteoplastic surgery: resection of joints, jaws, operations for false joints, etc.;
d) issues of military field surgery, which N.V. Sklifosovsky, as a participant in four wars, knew it very well.
The main works of N.V. Sklifosovsky: About a blood circulatory tumor. Dissertation for the degree of Doctor of Medicine, Odessa, 1863; science articles: On the issue of Pirogov’s osteoplastic ablation of the tibia, “Military Medical Journal”, 1877, May; About a wound to the peritoneum, in the same place, July; From observations during the Slavic War of 1867-1877, in the same place, November; Thyreotomia for neoplasms in the laryngeal cavity, ibid., 1879, March; Excision of a tumor of the uterus, both ovaries, "Medical Bulletin", 1869; Transport machine in a carriage for transporting the wounded. Transporting the wounded from the battlefield. Our hospital work during the war, in the same place, 1877; Gastrostomy for narrowing of the esophagus, in the same place, 1878; Cutting out the tongue after preliminary ligation of the lingual arteries, "Doctor", 1880; Is it possible to excise the abdominal press (pressum abdominale) in a person? The use of iodoform in surgery, ibid., 1882; Suture of the bladder with a suprapubic section, in the same place, 1887; Excision of a liver tumor, in the same place, 1890; Hernia meninges. Removal of a cerebral hernia sac by cutting out, "Chronicles of the Surgical Society in Moscow", 1881 and many other articles are scattered across various medical journals; a list of them is given in Spizharny’s article.
N.V. Sklifosovsky was not an armchair scientist. He brought the light of science to the broad masses of medical practitioners, organized scientific work in clinics.
His clinic stood high both in practical, therapeutic, and scientific terms. He entered first clinical experiences with medical histories modeled on reports from foreign clinics. N.V. had the same reporting. Sklifosovsky and after the war (Plevna and others), where he processed observations on large quantities cases.
Having been engaged in scientific surgery all his life, N.V. Sklifosovsky did a lot for the organization of science in Russia. He was a model of service to his homeland: he is a founding member of the Society of Russian Doctors, a member of the Moscow Surgical Society, in which he took an active part; he was a founding member and chairman of the 1st and 6th Congresses of Surgeons. Before the Great October Socialist Revolution, the Pirogov Congresses were of great importance. N.V. Sklifosovsky was the organizer, honorary chairman and active participant these congresses. The organizational activities of N.V. are especially striking. Sklifosovsky was expressed in the brilliant holding of the 12th International Congress of Surgeons in Moscow in 1897, as well as in the organization medical education like at Moscow University, where he was dean for 8 years Faculty of Medicine, and in St. Petersburg - as director of the Institute for Advanced Medical Studies.
N.V. Sklifosovsky took a large part in the creation of a clinical campus on Devichye Pole in Moscow, where the clinics of Moscow University (now the 1st Moscow Order of Lenin Medical Institute) later flourished.
As a true scientist N.V. Sklifosovsky attached great importance medical press, exchange of experience and observations of surgeons. N.V. Sklifosovsky was the editor of the first special scientific surgical journals in Moscow at that time: “Surgical Chronicle” and “Chronicle of Russian Surgeons”. He spent significant sums of money on the publication of these magazines. own funds. Congresses, meetings of scientific societies and journals contributed greatly to the development of surgical thought and the education of surgeons. Attaching great importance to the improvement of doctors, N.V. Sklifosovsky eagerly set about organizing the Institute for Advanced Medical Studies in St. Petersburg. Just as Odessa did not want to let go of the still young surgeon Sklifosovsky and offered him a professorship “unlike others,” N.V. was so reluctant to let go. Sklifosovsky and Moscow. The farewell was touching; The address presented by N.V. breathes with sincerity. Sklifosovsky, with hundreds of signatures of his students and admirers. He was loved as a doctor-professor, as a person, scientist and public figure. But N.V. Sklifosovsky believed that he had to fulfill his duty towards the doctors who usually visited his clinic in large numbers, towards those who needed organized improvement and advanced training. For 7 years of managing the Institute for Advanced Training of Physicians N.V. Sklifosovsky built new buildings, electrified them, achieved a significant increase in allocations for the Institute, rebuilt operating rooms, increased staff, salaries, etc. During this time, the Institute grew into an institution of which Europe could be proud. It is not surprising that on the day of the 25th anniversary of his professorial activity, among hundreds of telegrams received by N.V. Sklifosovsky, Dean of the Faculty of Medicine in Lausanne, Prof. Larguier de Vincel wrote: “You stand at the head of an institution that is envied by other peoples of Europe.”
Dream N.V. Sklifosovsky’s proposal to qualify doctors was fully realized after the Great October Socialist Revolution: before Patriotic War we had 12 institutes for advanced training of doctors, admitting up to 16,000 doctors per year.
Sklifosovsky was in charge of the clinic for fourteen years, and during this time many doctors from different countries peace. Sklifosovsky believed that doctors should be periodically gathered for professional retraining in accordance with latest achievements medicine. For this he organized educational institution a new type - an institute for advanced training of doctors. This new business also required a lot of effort from him: it was necessary not only to rebuild the old buildings, but also to equip them with everything necessary. But Sklifosovsky was already over 60 at that time.
10.11.2015
NIKOLAY VASILIEVICH SKLIFOSVSKY AND THE DEVELOPMENT OF MILITARY SURGERY, TRAUMATOLOGY AND ORTHOPEDICS IN RUSSIA
The talent of the remarkable Russian scientist, surgeon and public figure Nikolai Vasilyevich Sklifosovsky (1836–1904) manifested itself in many areas of medicine. A whole stage in the development of medical science is associated with his name, the creation of a school of Russian surgeons, which received international recognition.
The talent of the remarkable Russian scientist, surgeon and public figure Nikolai Vasilyevich Sklifosovsky (1836–1904) manifested itself in many areas of medicine. An entire stage in the development of medical science is associated with his name, the creation of a school of Russian surgeons, which received international recognition. After graduating from the Faculty of Medicine of Moscow University, Nikolai Vasilyevich began his practical work at the Odessa City Hospital, first as a resident, then as head of the surgical department. He published articles on surgical treatment of uterine tumors and strangulated hernia, and also describes the operations of elbow resection and upper jaw. For more than two years, N.V. Sklifosovsky trained abroad for pathological anatomy at Rudolf Virchow and at the Bernard Langenbeck Clinic for surgery. After completing his participation in the Austro-Prussian War, Nikolai Vasilyevich moved to France and then to England, where he became acquainted with leading European surgical schools and directions in the development of medical science. In the future, Nikolai Vasilyevich always followed the development of European medicine, maintained contacts with clinics, often visited them, and took part in international congresses.
Being a true follower of N.I. Pirogov, Nikolai Vasilyevich correctly assessed the importance of practical education for a surgeon, especially knowledge of military field surgery. In 1871, leaving the department of Kyiv University, he went to the Franco-Prussian War, where he studied the work of military hospitals. Here he witnessed the widespread use in the Prussian army of Russian-style hospital tents, which at one time were proposed by N.I. Pirogov, but, unfortunately, they were not used in the practice of military field medicine in Russia.
The prevalence of military conflicts led to a significant increase in the number of wounded and the need for medical personnel, who, in turn, also suffered heavy losses. Only on the territory of Bulgaria during the Russian-Turkish War of 1877–1878. More than 500 doctors died.
During the Crimean campaign of 1854–1855. The experience of inviting foreign doctors to provide assistance to the wounded and sick did not justify itself. In the work “Our hospital work in the war” N.V. Sklifosovsky wrote: “During Crimean War More than 100 foreign doctors were invited for the army, most of whom turned out to be extremely ignorant; Moreover, they did not know the Russian language and were, therefore, useless for the Russian soldier.” At the same time, supporting the feasibility of the Institute of Field Surgeons formed in 1869, he noted: “The wonderful idea underlying the establishment of the Institute of Field Surgeons could not be implemented quite fruitfully. The program is too large short term training (only a year), the lack of a special clinical base for future surgeons made it impossible to provide sufficient clinical training future specialists.” Nikolai Vasilyevich said: “The army needs doctors, it needs specially trained doctors, and mainly surgeons. The Institute of Field Surgeons can serve as a breeding ground for surgeons and supplement the Army's needs. Another breeding ground for surgeons could be all the surgical clinics of the empire, where the military department could have their pets as assistants. Such assistants, changing every two years, for example, would within a few years constitute a contingent of fully trained surgeons that the military department could have at its disposal in wartime. And since not all young doctors remain in the military department for life, many of them after some time become zemstvo, city doctors, and generally public figures in the field of medicine, then, incidentally, the maintenance and improvement of the institute of field surgeons receives enormous educational significance.”
Ideas N.V. Sklifosovsky were fully implemented in the system of modern training of military doctors. The period of work at the St. Petersburg Medical-Surgical Academy (1871–1880) was twice interrupted by the participation of N.V. Sklifosovsky in wars. At first he was seconded as a Red Cross consultant surgeon to Montenegro, then in 1877 he left for the Russian-Turkish (Balkan) War. The experience of previous wars made his work during the Russian-Turkish War very fruitful. He proved himself not only as a highly qualified field surgeon, but also as a talented organizer, taking part in the treatment of thousands of wounded. Analysis of the course of gunshot wounds and fractures allowed him to propose a number of valuable organizational and therapeutic measures.
Characteristic feature military medicine during the Russian-Turkish War of 1877–1878. There was widespread use of the system of dispersing and triaging the wounded. Special place N.V. Sklifosovsky devoted the triage of the wounded at the main dressing station: “Sorting the wounded at the main dressing station is the most significant issue.” The correct organization of triage of the wounded made it possible to timely identify those in need of assistance. emergency care. During triage, he proposed dividing the wounded into 4 categories: 1) non-transportable; 2) subject to plastering; 3) receiving a simple dressing; 4) lightly wounded who returned to the front after 1–2 days. The category of non-transportable included wounded with penetrating wounds of the chest and abdomen, with complex gunshot wounds of large joints. In addition, the timing of the evacuation of this category of wounded was determined. From Nikolai Vasilyevich’s point of view, severe wounds progressed more favorably and more often had a good outcome if it was not possible to quickly transport the wounded.
He was the first to express the idea of the advisability of using railway transport to evacuate the wounded, using special devices such as Gorodetsky’s machine. In the published article “Tarantas machine in a carriage for transporting the wounded” N.V. Sklifosovsky noted the following advantages of the Gorodetsky system: the Gorodetsky machine can be easily and quickly installed in any car; it takes up little space in the carriage, without interfering with the free movement of medical personnel; placing and removing the wounded is quite simple; The shaking of the carriage is not felt by the wounded; The machine can be disassembled and folded within a few minutes.
As it turned out, Gorodetsky’s machine found application not only in railway transport, but also in equipping simple sanitary carts. However, Nikolai Vasilyevich, not without regret, noted in his work “Transportation of the Wounded in War” that such devices on carts were extremely rare. " For the most part the wounded were transported along dirt roads in unequipped peasant carts, in which it was good if enough straw could be supplied; It wasn’t even possible without straw.”
This method of transporting the wounded, as pointed out by N.V. Sklifosovsky, caused great harm wounded, especially those undergoing surgery. Negative results He attributed the treatment of the wounded and sick after the Battle of Plevna on July 18, 1877 to unacceptable transportation. “Under the influence of the panic on July 19, our wounded were carried 5-6 versts at a gallop, many of them fled on foot.
The wounded arrived in Zimnicha two and three days later. They were transported in the same primitive way. The consequences were the saddest,” wrote N.V. Sklifosovsky. From personal experience, Nikolai Vasilyevich became convinced of the importance of dispersing the wounded and sick in hospitals, considering the concentration of the wounded in one place unacceptable, which inevitably led to the spread of hospital-acquired infection and the death of a large number of wounded. He came up with the idea of creating mobile “flying teams” that were supposed to work in places with the greatest concentration of wounded to strengthen hospitals.
He proposed introducing the staffing of sanitary companies with specially trained orderly porters. N.V. Sklifosovsky emphasized the importance of early application of immobilizing bandages for injuries of the extremities with damage to bone tissue and considered the use of plaster cast, which prevented the development of severe local complications. During the Balkan War of 1877–1878. N.V. Sklifosovsky was the first among Russian surgeons to use antiseptics in military field conditions.
He made a great contribution to the introduction of the antiseptic method (and subsequently surgical asepsis) into Russian surgery. Not limiting himself to using the new method in practice, Nikolai Vasilyevich promoted antiseptics in scientific societies and at congresses: thus, being the honorary chairman of the First Pirogov Congress in 1885, he devoted his speech to antiseptics. Extensive experience of military surgeon N.V. Sklifosovsky generalized in articles published in the Military Medical Journal and the Medical Bulletin newspaper. Many of his works are united by the idea that efficiency medical support troops entirely depends on the flexibility of management and the competence of the heads of the medical service. N.V. Sklifosovsky made contributions to various areas of surgery of that time, including the development of traumatology and orthopedics. He operated extensively on bones and joints. For false joints, he suggested original way operation, known as the “Sklifosovsky castle” or “Russian castle”. During this operation, a cut was made in the middle of both ends of the femur, then at the end of the first cut a second cut was made in the transverse direction. The halves cut at both ends of the bone were removed so that the resulting surfaces came into contact with each other; then they were secured with one or two metal seams, thereby obtaining the shape of a lock, similar to a carpenter's lock for connecting logs when building a wooden house.
The original operations of N.V. are known. Sklifosovsky on the elbow, knee and foot joints. The methods of operations he proposed were distinguished by their simplicity, careful treatment of tissues, and were functionally gentle. In this regard, he consistently defended and implemented the ideas of N.I. Pirogov. Nikolai Vasilyevich successfully performed various operations on bones and large joints of the limbs. He published the following works: “Cases of resection elbow joint", "Surgical treatment of immobility knee joint", "Complete dislocation of the talus. Excision of it."
In addition, based on his observations, he spoke in print in defense of N.I.’s osteoplastic surgery. Pirogov, the report of which was received quite negatively by foreign surgeons. The significance of Pirogov’s operation lies in the fact that he was the first in the world to initiate osteoplasty. The further development of medical science proved N.I. to be right. Pirogov and N.V. Sklifosovsky.
Nikolai Vasilyevich defended the priority in the invention of a new osteoplastic method of foot amputation, which belonged to the Russian scientist Vladimirov. The result of this activity of the true Russian patriot N.V. Sklifosovsky recognized Vladimirov’s priority in proposing a new method of foot surgery. At the International Congress of Doctors in 1884, Nikolai Vasilyevich was concerned about the health of the younger generation. In 1883 in Odessa, at the VII Congress of Doctors and Naturalists, he made a report on the causes of spinal curvature in children school age. Later, the newspaper “Vrach” published an article “Materials for the etiology of school spinal curvature.” Analyzing various scientific theories of this disease and his own research, the author came to the conclusion, Received June 28, 2011, that scoliosis is based mainly on two reasons: the tendency of the vertebrae to pathological process, which is observed during the period rapid growth skeleton in adolescents 7–14 years old, and the effect of a number of factors causing uneven load on the spine. The impact of both factors depends entirely on the socio-economic living conditions and sanitary and hygienic literacy of the population. Thus, scoliosis can be prevented, and this should become a concern of the state, Nikolai Vasilyevich believed.
Many proposals from N.V. Sklifosovsky and today have not lost their relevance for orthopedists, traumatologists, military doctors, and also formed the basis of modern ideas about the organization and tactics of medical services in combat conditions and during mass casualties of the population in emergency situations.
Tags: Sklifosovsky, traumatology
Start of activity (date): 11/10/2015 17:39:00
Created by (ID): 645
Keywords: Sklifosovsky, Pirogov, traumatology
The significance of Sklifosovsky in the history of Russian surgery is very great. He is credited with introducing into surgical practice the principles of antiseptics (disinfection using chemical agents), and then asepsis (disinfection using physical means). However, even major specialists in Europe and Russia did not want to recognize this method.
As a true student and follower of Pirogov, Sklifosovsky carefully studied anatomy, spending a lot of time dissecting corpses. Thanks to constant practical study of the fundamentals of surgery, he brilliantly mastered surgical techniques. Even in pre-antiseptic times, he successfully performed such major operations as removal of an ovary. Sklifosovsky was one of the first to introduce laparotomy (transection) - opening the abdominal cavity.
He was one of the first to perform gastrostomy surgery (excision of the stomach), use the Murphy button, the first in Russia to introduce a blind suture of the bladder, goiter surgery, excision of tongue cancer with preliminary ligature of the lingual artery, removal of the larynx, cerebral hernia surgery, etc. Finally, complex operations in plastic surgery they also found in Sklifosovsky not only a master of surgical technique, but also an author of new methods of operations. One of these operations for false joints is called the “Sklifosovsky castle” or “Russian castle”. To keep the ends of the femur in direct contact at the fracture site, a median cut is made at both ends of the bone, then at the end of the first cut a second cut is made in the transverse direction; the sawn halves are removed and the surfaces at the ends come into contact with each other. They are secured with 1-2 metal seams.
Peru N.V. Sklifosovsky owns more than 110 scientific papers devoted to the most diverse areas of surgery:
1. gynecology (which at that time was a department of surgery and was just beginning to practically dissociate itself from it);
2. new methods of operations, first used in Russia (goiter operations, gastrostomy, cholecystostomy, bladder suture, resection of cerebral hernia, etc.);
3. bone and osteoplastic surgery: resection of joints, jaws, operations for false joints, etc.;
4. issues of military field surgery, which Sklifosovsky, as a participant in four wars, knew very well.
Until the middle of the 19th century. More than 80% of those operated on died from purulent, putrefactive and gangrenous complications of surgical wounds.
The empirical principles of antiseptics (antiseptics are a set of measures aimed at destroying microorganisms in a wound, pathological focus or the body as a whole) are associated with the name of the Hungarian obstetrician Ignaz Semmelweis, who worked in the obstetric clinic of Professor Klein and drew attention to the fact that in this department where they studied students, the mortality rate from puerperal fever reached 30%, and in another, where students were not allowed, the mortality rate was “low.” After long observations, Semmelweis established that the infectious principle, which is the cause of puerperal fever, is introduced by the contaminated hands of students who come to maternity ward after dissecting the corpses. Having understood the reason, he proposed a method of protection - washing hands with a bleach solution. As a result, mortality in the maternity ward dropped to 1-3% (1847). However, during Semmelweis's lifetime, the largest Western European authorities in the field of obstetrics and gynecology did not accept his discoveries.
The scientific substantiation of antisepsis and asepsis became possible only after the work of Louis Pasteur, who showed that the processes of fermentation and decay are associated with the vital activity of microorganisms (1863).
Pasteur's idea was first introduced into surgery by the English surgeon Joseph Lister, the founder of antiseptics (1867). Linking the suppuration of wounds with the entry and development of bacteria in them, he gave a scientific explanation surgical infection and for the first time developed a set of measures to combat it.
The Lister method is based on the use of a 2-5% solution of carbolic acid and represents a harmonious system of antiseptics (destruction of microbes in the wound itself) with elements of asepsis (processing of objects in contact with the wound).
Lister attached particular importance to airborne infection. Therefore, before and during the operation, carbolic acid was sprayed into the air of the operating room using a special sprayer. After surgery, the wound was covered with a multilayer airtight bandage. Its first layer consisted of thin silk impregnated with a 5% solution of carbolic acid in a resinous substance. Eight layers of gauze treated with carbolic acid, rosin and paraffin were placed on top of the silk. The whole thing was covered with oilcloth and bandaged with a bandage soaked in carbolic acid.
Thanks to the Lister method, postoperative complications and mortality have decreased several times. Lister's teachings opened a new antiseptic era in surgery.
