The word "anesthesia" comes from the Greek word meaning "stupor", "numbness".

Anesthesia is necessary to block pain signals from the affected organs to the brain. Too strong a signal can overexcite one part of the brain so much that the work of the rest will go wrong. As a result, cardiac or respiratory arrest may occur.

Narcosis traces its history back to anesthesia used in surgical operations in Assyria, Egypt, India, China and other countries of the 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 tincture or set on fire, resulting in the formation of vapors that lulled the sick. In addition, anesthesia was caused by squeezing the vessels of the neck and limbs, releasing a large amount of blood, giving the patient wine or alcohol, applying cold.

In the XII 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 cause loss of consciousness, a wooden mallet was often used, with which the patient was beaten on the head.

IN early XIX V. the English scientist G. Devi accidentally inhaled a large dose of nitrous oxide N 2 O. At the same time, he felt extremely excited and intoxicated, he 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 an amazing substance. Laughing gas acted in different ways: some jumped on tables and chairs, others spoke incessantly, others got into a fight.

In 1844, the American dentist X. Wells used the narcotic effect of nitrous oxide for pain relief. He first asked his assistants to extract a tooth from him using this gas as an anesthetic. However, he did not feel 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 for the first time performed an abdominal surgical operation under full ether anesthesia. During it, complete anesthesia was carried out, muscles were relaxed, reflexes disappeared. The patient was immersed in a deep sleep, having lost sensitivity.

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 himself, 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 assistance on the battlefield.

In the same year, Pirogov performed intracheal anesthesia - the introduction of an anesthetic directly into the windpipe.

July 8, 1847 Pirogov leaves 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. On the way to 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 operate on purpose in the presence of other wounded, in order to convince them of the analgesic effect of ether vapors. Thanks to a clear example, other wounded were also fearlessly subjected to anesthesia. Arriving at the Samurt detachment, Pirogov conducted 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 (a total of 690 were performed in Russia from February 1847 to February 1848).

On November 4, 1847, the Scottish physician J. Simpson performed the first operation under chloroform sedation. The first operations under chloroform anesthesia in Russia were carried out: 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 vigorously introduced anesthesia into clinical practice. He continuously worked on improving the methods and techniques of anesthesia. Pirogov proposed a rectal method of anesthesia (introduction of ether into the rectum). For this great surgeon designed a special device 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. On the basis of 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 gained popularity. However, the idea of Pirogov about the possibility of introducing a 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. suggested to inject the hypnotic hedonal directly into the vein.

Along with general anesthesia, local anesthesia developed. For this, rubbing was used. various substances, compression of nerve trunks, etc.

In 1859, cocaine, an alkaloid from the leaves of the coca bush, was discovered. Studies have shown that it has analgesic properties. In 1884, the Russian doctor V.K. Anrep proposed the use of cocaine as an anesthetic, and in 1884 the Austrian Keller used cocaine anesthesia for eye operations. But unfortunately, long-term use of cocaine caused painful addiction.

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, various methods of local anesthesia began to develop: infiltration, conduction and spinal anesthesia.

In the first half of the XX century. anesthesia, the science of pain relief, has become an independent branch of medicine. She is engaged in preparing the patient for surgery, conducting anesthesia and monitoring during surgery and in the postoperative period.

During anesthesia, the patient's condition is monitored using electroencephalography and monitoring of the pulse and blood pressure. An important stage is the exit from anesthesia, since reflexes in patients are restored gradually and complications are possible.

The use of anesthesia made it possible to carry out operations on the heart, lungs, brain and spinal cord, which were previously impossible due to a powerful pain shock. Therefore, the anesthesiologist is no less important than the surgeon.

This text is an introductory piece.

"Divine art to destroy pain" for a long time was beyond the control of man. For centuries, patients have been forced to patiently endure torment, and healers have not been able to end 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 in the process of reading the article.

Anesthesia techniques in antiquity

Who invented anesthesia and why? Since the dawn of medical science, physicians have tried to solve important issues: how to make surgical manipulations as painless as possible for patients? With severe injuries, people died not only from the consequences of the injury, but also from the experienced pain shock. The surgeon had no more than 5 minutes to perform the operations, otherwise the pain became unbearable. The Aesculapius of antiquity were armed with various means.

In ancient Egypt, crocodile fat or alligator skin powder was used as an anesthetic. One of the ancient Egyptian manuscripts, dated 1500 BC, describes the analgesic properties of the opium poppy.

In ancient India, doctors used substances based on Indian hemp to obtain painkillers. Chinese physician Hua Tuo, who lived in the 2nd century BC. AD, offered patients to drink wine with the addition of marijuana before the operation.

Anesthesia methods in the Middle Ages

Who invented anesthesia? In the Middle Ages, the miraculous effect was attributed to the root of the mandrake. This plant from the nightshade family contains potent psychoactive alkaloids. Drugs with the addition of an extract from the mandrake had a narcotic effect on a person, clouded the mind, dulled the pain. However, the wrong dosage could lead to death, and frequent use caused drug addiction. The analgesic properties of mandrake for the first time in the 1st century AD. described by the ancient Greek philosopher Dioscorides. He gave them the name "anesthesia" - "without feeling."

In 1540, Paracelsus proposed to use for pain relief diethyl ether. 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, this method was forgotten.

To turn off a person's consciousness for the most complex manipulations, surgeons used a wooden hammer. The patient was struck on the head, and he temporarily fell into unconsciousness. The method was crude and inefficient.

The most common method of medieval anesthesiology was ligatura fortis, i.e., infringement of nerve endings. The measure allowed to slightly reduce pain. One of the apologists for this practice was Ambroise Pare, the court physician of the French monarchs.

Cooling and hypnosis as methods of pain relief

At the turn of the 16th and 17th centuries, the Neapolitan physician Aurelio Saverina reduced the sensitivity of operated organs with the help of cooling. The diseased part of the body was rubbed with snow, thus being subjected to a slight frost. Patients experienced less pain. This method has been described in the literature, but few people have resorted to it.

About anesthesia with the help of 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 ° C.

In the 19th century, during the mesmerization craze, attempts were made to hypnotize patients before surgery. A when and who invented anesthesia? We will talk about this further.

Chemical experiments of the XVIII-XIX centuries

With the development of 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 on the basis of personal experience that the inhalation of nitrous oxide vapors dulls the sensation of pain in a person. M. Faraday found that a similar effect is caused by a pair of sulfuric ether. Their discoveries did not find practical application.

In the mid 40s. XIX century dentist G. Wells from the USA became the first person in the world who underwent surgical manipulation while under the influence of an anesthetic - nitrous oxide or "laughing gas". Wells had a tooth removed, but he felt no pain. Wells was inspired by a successful experience and began to promote a new method. However, a repeated public demonstration of the action of a chemical anesthetic ended in failure. Wells failed to win the laurels of the discoverer of anesthesia.

The invention of ether anesthesia

W. Morton, who practiced in the field of dentistry, became interested in the study of the analgesic effect. He carried out a series of successful experiments on himself and on October 16, 1846, he immersed the first patient in a state of anesthesia. An operation was performed to painlessly remove the tumor on the neck. The event received a wide response. Morton patented his innovation. He is officially considered the inventor of anesthesia and the first anesthesiologist in the history of medicine.

In medical circles, the idea of ether anesthesia was picked up. Operations with its use were made by doctors in France, Great Britain, Germany.

Who invented anesthesia in Russia? First Russian doctor who ventured to test the advanced method on his patients was Fedor Ivanovich Inozemtsev. In 1847, he performed several complex abdominal operations on patients immersed in. Therefore, he is the discoverer of anesthesia in Russia.

The contribution of N. I. Pirogov to the world anesthesiology and traumatology

Other Russian doctors followed in the footsteps of Inozemtsev, including Nikolai Ivanovich Pirogov. He not only operated on patients, but also studied the effect of ethereal gas, tried different ways of introducing it 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 injured limbs with a plaster cast. The physician tested his method on wounded soldiers during Crimean War. However, Pirogov cannot be considered the discoverer of this method. Gypsum as a fixing material was used long before him (Arab doctors, the Dutch Hendrichs and Mathyssen, the Frenchman Lafargue, the Russians Gibental and Basov). Pirogov only improved plaster fixation, made 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, the Scottish obstetrician D. Simpson, actively introduced anesthesia for women in labor to facilitate 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 anesthesia. He quickly plunged a person into sleep, had a deeper effect. He did not need additional equipment, it was enough to inhale the vapors with gauze soaked in chloroform.

Cocaine - local anesthetic of South American Indians

Ancestors local anesthesia considered to be South American Indians. They have been practicing cocaine as an anesthetic since ancient times. This plant alkaloid was extracted from the leaves of the local shrub Erythroxylon coca.

The Indians considered the plant a gift from the gods. Coca was planted in special fields. Young leaves were carefully cut off 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 proceeded to the operation.

Koller's research in local anesthesia

The need to provide anesthesia in a limited area was especially acute for dentists. Extraction of teeth and other interventions in dental tissue caused unbearable pain in patients. Who Invented Local Anesthesia? In the 19th century, in parallel with the experiments on general anesthesia, the search for an effective method for limited (local) anesthesia was carried out. In 1894, a hollow needle was invented. To stop toothache, dentists used morphine and cocaine.

Vasily Konstantinovich Anrep, a professor from St. Petersburg, wrote about the properties of coca derivatives to reduce sensitivity in tissues. His works were studied in detail by the Austrian ophthalmologist Karl Koller. The young doctor decided to use cocaine as an anesthetic for eye surgery. The experiments were successful. Patients remained conscious and did not feel pain. In 1884, Koller informed the Viennese medical community of his achievements. Thus, the results of the Austrian doctor's experiments are the first officially confirmed examples of local anesthesia.

The history of the development of endotrachial anesthesia

In modern anesthesiology, endotracheal anesthesia, also called intubation or combined anesthesia, is most often practiced. This is the safest type of anesthesia for a person. Its use allows you to control the patient's condition, to carry out complex abdominal operations.

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 person and thereby saved his life.

André Vesalius, a professor of medicine from Padua, conducted experiments on animals in the 16th century 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 XIX century, the German surgeon Trendelenburg made a breathing tube equipped with a cuff.

The use of muscle relaxants in intubation anesthesia

The mass use of intubation anesthesia began in 1942, when Canadians Harold Griffith and Enid Johnson used muscle relaxants during surgery - drugs that relax muscles. They injected the patient with the alkaloid tubocurarine (intokostrin), obtained from the well-known poison of the South American curare Indians. The innovation facilitated the implementation of intubation measures 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. Traditional methods are successfully applied, the latest medical developments are being introduced. Anesthesia is a complex, multicomponent process on which the health and life of the patient depends.

This article about the great Russian doctor, scientist, surgeon and anesthesiologist was sent to us by our friend and colleague prof. Y. Moens. It was written by colleagues from the Netherlands and published in an anesthesiology journal. This is the story of a truly outstanding doctor and scientist.

F. Hendricks, J. G. Bovill, F. Boer, E.S. Houwaart and P.C.W. Hogendoorn.
PhD Student, Executive Board Department, 2. Emeritus Professor of Anesthesia 3. Staff Anesthetist and Director of Health Innovation, 4. Dean of the Leiden Faculty of Medicine, Leiden University Medical Center; Leiden, the Netherlands. 5. Professor of Medical History, Department of Public Health, Ethics, Society Studies, University of Maastricht; Maastricht, the Netherlands.

Summary:
The key figure who influenced the development of anesthesiology in Russia was Nikolai Ivanovich Pirogov (1810-1881). He experimented with ether and chloroform and organized the widespread use of the technique of general anesthesia in Russia in patients who were undergoing surgery. He was the first to conduct a systematic study of morbidity and mortality due to anesthesia. In more detail, he was one of the first to perform anesthesia with ether on the battlefield, where the very basic principles of military medicine he laid down remained practically unchanged until the outbreak of World War II.

Introduction

On Friday, October 16, 1846, in the operating theater of the Massachusetts General Hospital in Boston, William Morton conducted the first successful demonstration of the use of ether for anesthesia on adults. News of this discovery was reported in the Russian press in early 1847. Although B.F. Berenson January 15, 1847 in Riga (at that time part of the territory Russian Empire) and F. I. Inozemtsev February 7, 1847 - in Moscow, were the first in Russia to use ether anesthesia, Nikolai Ivanovich Pirogov (Fig. 1) was the first surgeon who introduced the widespread use of general anesthesia in this country , adapting it for use in military field conditions.

Rice. 1. Portrait of Nikolai Ivanovich Pirogov. Oil, canvas. The artist and date of execution of the portrait are unknown. Wellcome Library (published with permission)

Nikolai Ivanovich Pirogov was born on November 25, 1810 into a merchant family. At the age of 6, he taught himself to read. Later, home teachers were invited to him, thanks to whom he learned French and latin languages. At the age of 11, he was sent to a boarding school, but he stayed there for only two years, as the family had financial difficulties and the boarding school became too expensive for his parents. A family friend, Efrem Osipovich Mukhin, Professor of the Department of Anatomy and Physiology of Moscow University, helped young N.I. Pirogov to enter the Faculty of Medicine, although at that time N.I. Pirogov was only 13 years old, and was accepted there from 16. Medical education was of poor quality, students studied from outdated textbooks. Lectures were also given on the basis of old materials. By the fourth year of study, Pirogov had not yet performed a single independent autopsy and was present at only two operations. Nevertheless, in 1828 he was awarded the title of doctor. N.I. Pirogov was then only 17 years old.

After graduating from Moscow University, Pirogov continued his studies at the German-Baltic Derpt University (now Tartu, Estonia) in order to expand and deepen his knowledge and skills. He completed his studies in Dorpat in August 1832 and brilliantly defended his thesis on the topic “Num vinctura aortae abdominalis in aneurismate inhunali adhibitu facile ac turtum sut remedium” (“Is the ligation of the ventral aorta easy and effective method therapy to treat an inguinal aneurysm?”) while receiving his Ph.D. Derpt University closely cooperated with many specialists and scientists from educational institutions throughout Western Europe, which helped Pirogov to expand and accumulate knowledge in order to become an international-level specialist.

After graduating from the University of Dorpat, N.I. Pirogov continued his studies in Göttingen and Berlin. At the age of 25, in March 1826, N.I. Pirogov becomes a professor at Dorpat University and becomes the successor of his mentor and predecessor, Professor Moyer. In March 1841, he received the position of professor of hospital surgery at the Military Medical Academy and also the position of chief surgeon of the Medical and Surgical Academy of St. Petersburg (until 1917 it remained the capital of the Russian Empire), in which he remained for 15 years, until his resignation. In April 1856, Pirogov moved to Odessa, and later to Kyiv.

In St. Petersburg, he has to face the envy of his colleagues and the constant opposition of the local administration. But this did not stop N.I. Pirogov - he continued to engage in private and academic practice and teaching.

From newspapers and magazines, such as "Northern Bee", from the medical journals "Friend of Health", "St. Petersburg Vedomosti" N.I. Pirogov learns of Morton's demonstration of ether anesthesia.

Initially, N.I. Pirogov was skeptical about ether anesthesia. But the tsarist government was interested in conducting similar experiments and researching this method. Foundations were founded to study the properties of the ether.

In 1847 N.I. Pirogov begins his research and is convinced that all his fears were unfounded and that ether anesthesia was "a tool that can transform all surgery in an instant." In May 1847 he publishes his monograph on the subject. . In the monograph, he gives recommendations that it is first necessary to conduct a test anesthesia, since the reaction of the body to the introduction of anesthesia in each person is strictly individual. For patients who do not wish to inhale ether vapors, he suggests rectal anesthesia.

Figure 2. A device for inhalation of ether vapors, developed by N. I. Pirogov.

The ether vapors from the flask (m) enter the inhalation valve (h), where they mix with the inhaled air through the holes in the valve. The quantity of the mixture, and thus the concentration of ether inhaled, is controlled by a tap (i) in the upper half of the inhalation valve. The ether/air mixture was inhaled by the patient through a tight-fitting mask connected to an inhalation valve by a long tube containing an exhalation valve. The face mask was designed by N.I. Pirogov for comfortable fixation on the patient's mouth and nose, it was an innovative invention at that time.

N.I. Pirogov studied the clinical course of anesthesia on himself and his assistants before using it on patients. In February 1847, he performed the first two operations using ether anesthesia at the Second Military Land Hospital in St. Petersburg. To introduce the patient into a state of anesthesia, he used an ordinary green bottle with a simple rubber tube for inhalation through the patient's nose.

February 16, 1847 N.I. Pirogov performs the same operation at the Obukhov hospital. On February 27, the fourth operation with the use of ether anesthesia took place at the Peter and Paul Hospital in St. Petersburg. This operation was a palliative procedure that was performed on a young girl with purulent inflammation of the stump after the amputation of her leg. This time, the primitive equipment has been replaced by a device invented by the Frenchman Charrière. But it did not satisfy N.I. Pirogov, so he, together with the toolmaker L. Rooh, designed his own device and mask for ether inhalation (Fig. 2) . The mask made it possible to begin the introduction of anesthesia directly during the operation, without resorting to the help of an assistant. The valve made it possible to regulate the mixture of ether and air, enabling the doctor to track the depth of anesthesia. A year after Morton's demonstration of ether anesthesia, Pirogov performs more than 300 operations using ether anesthesia.

March 30, 1847 N.I. Pirogov sends an article to the Academy of Sciences in Paris, in which he describes his experiments on the use of ether by the rectal route. The article was only read in May 1847 . On June 21, 1847, he presents his second publication on the use of ether in animals by rectal administration. . This article became the material for his book, in which he described his experiments in administering ether to 40 animals and 50 patients. The goal was to provide practitioners with information about the effects of ether anesthesia and the design details of the device used for inhalation. This book deserves to be included in Sescher and Dinnik's list of the earliest manuals on general anesthesia.

Research on the rectal method of administering anesthesia N.I. Pirogov conducted mainly on dogs, but among the subjects were both rats and rabbits. His research was based on the work of the French physiologist François Magendie, who conducted experiments on animals using ether rectally. The ether, introduced in the form of vapors into the rectum with an elastic tube, was instantly absorbed by the blood and soon after that it could be detected in the exhaled air. Patients entered the state of anesthesia after 2-3 minutes from the beginning of the introduction of ether. Compared to inhalation, patients entered a deeper state of anesthesia with greater muscle relaxation. Such anesthesia lasted longer (15-20 minutes), making it possible to perform more complex operations. Due to the stronger relaxation of the muscles, this method of anesthesia is well suited for surgical intervention for inguinal hernia and habitual dislocations. However, this method had disadvantages. Among which it is noted: hot water is always needed for the tube, the rectum must first be cleaned with an enema, after cooling and liquefying the ether, patients often got colitis and diarrhea. At the beginning of his research, Pirogov was enthusiastic about the widespread use of this method of anesthesia, but later inclined to use this method as an antispasmodic in the elimination of stones in the urinary canal. However, rectal ether was never so widely used, although it was used in London by Dr. Buxton, at King's College Hospital in the operations of Sir Joseph Lister and Sir Victor Hosley. There were also reports of the use of ether anesthesia in obstetric practice in the 1930s in Canada. . Also N.I. Pirogov conducted experiments on animals on the intravenous administration of anesthesia. He demonstrated that narcosis occurs when and only when ether can be detected in the exhaled air: "Thus the arterial circulation provides a transport medium for vapors, and the calming effect is transmitted to the central nervous system." Scientific work and innovations of N.I. Pirogov had a huge influence on what in Russia at that time was called the "etherization process". Although he was convinced that the discovery of ether anesthesia was one of the significant scientific achievements, he was also quite aware of the existing limitations and dangers: “This type of anesthesia can disrupt or significantly reduce the activity of reflexes, and this is just one step away from of death" .

Caucasian War and anesthesia in the conditions of hostilities

In the spring of 1847, the highlanders in the Caucasus raise an uprising. Thousands of dead and seriously wounded. Field military hospitals are overflowing with soldiers with terrible wounds and injuries. The tsarist government insisted that anesthesia be used in all surgical operations for the duration of the entire military campaign. This decision was made not only on the basis of humane considerations. It was decided that soldiers, seeing how their comrades no longer experience excruciating pain during operations or amputations, would be sure that if they were injured, they would also not experience pain during the operation. This was supposed to raise morale among the soldiers.

May 25, 1847 at the conference of the Medical-Surgical Academy N.I. Pirogov was informed that he, as an ordinary professor and state adviser, was being sent to the Caucasus. He will have to instruct young doctors in the Separate Caucasian Corps on the use of ether anesthesia during surgical intervention. Assistants N.I. Pirogov were appointed Dr. P.I. Nemmert and I. Kalashnikov, senior paramedic of the Second Military Land Hospital. Preparations for departure took a week. They left St. Petersburg in June and went to the Caucasus in a carriage. N.I. Pirogov was very worried that due to strong shaking and heat (the air temperature was above 30 0 C), ether could leak. But all his fears were unfounded. Along the way, Pirogov visited several cities where he introduced ether anesthesia to local doctors. With him, Pirogov took not only ether, in a volume of 32 liters. From the factory for the production of surgical equipment (of which Pirogov was part-time director), he also captured 30 inhalers. Upon arrival at the destination, the ether was bottled in 800 ml bottles, which were placed in special boxes covered with a mat and oilcloth. . In the city of Pyatigorsk, in a military hospital, N.I. Pirogov organized theoretical and practical lessons for local doctors. Together with Dr. Nemmert, he performed 14 operations of varying degrees of complexity.

In the city of Ogly, the wounded were placed in tents in full view. N.I. Pirogov deliberately did not conduct operations indoors, allowing other wounded to see that their comrades did not experience inhuman pain during operations. And the soldiers were able to make sure that their comrades were just sleeping throughout the operation and did not feel anything. In his account of a trip to the Caucasus, he writes: “For the first time, operations were carried out without the groans and cries of the wounded ... the most comforting effect of etherization was that the operations were carried out in the presence of other wounded men who were not afraid, but, on the contrary, the operations encouraged them about their own position."

Then N.I. Pirogov arrives at the Samurt detachment, located near the fortified village of Salta. There, the field hospital was the most primitive - just stone tables covered with straw. Operate N.I. Pirogov had to kneel. Here, near Saltami, Pirogov performed more than 100 operations under ether anesthesia. Pirogov writes: “Of the surgical operations performed with the use of ether, 47 were performed personally by me; 35 by my assistant, Nemmert; 5 - under my supervision by the local doctor Dushinsky and the remaining 13 - under my supervision by the regimental doctors of the battalions. Of all these patients, only two received anesthesia by the rectal method, since it was impossible to put them into a state of anesthesia by inhalation: the conditions were very primitive and there was a source of open fire nearby. This was the first time in military history when soldiers underwent operations and amputations under general anesthesia. Pirogov also found time to demonstrate the technical aspects of ether anesthesia to local surgeons.

For a year (from February 1847 to February 1848) Pirogov and his assistant Dr. Nemmert collected enough data on operations using ether anesthesia in military and civilian hospitals and hospitals. (Table 1)

Table 1. Number of patients operated on by Nikolai Ivanovich Pirogov between February 1847 and February 1848, classified according to the type of anesthesia performed and the type of surgical procedure.

Type of anesthesia	Type of surgery		Deaths per surgical type
Ether through inhalation	Big	Small	Big	Small
adults	242	16	59	1
Children	29	4	4	0
Rectal ether
adults	58	14	13	1
Children	8	1	1	0
Chloroform
adults	104	74	25	1
Children	18	12	3	0

Of the 580 surgeries, 108 patients died, accounting for a mortality rate of 1 in 5.4 surgeries. Of these, 11 patients died within 48 hours after surgery. N.I. Pirogov describes his Caucasian experiments and his statistical analysis in the book “Report on a trip to the Caucasus”, in which he points out: “Russia, ahead of all Europe, shows the world by its actions not only the possibilities of application, but also the undeniable benefits of the etherization method for the benefit of the wounded on the battlefield . We hope that from now on, etherization will be, like the surgeon's knife, an indispensable attribute of every doctor during his actions on the battlefield. This unites his point of view on general anesthesia in particular and the importance of its use in surgery in general.

N.I. Pirogov and chloroform

After the return of N.I. Pirogov from the Caucasian War, December 21, 1847, he performed the first anesthesia using chloroform in Moscow. The test subject was a large dog. He meticulously recorded every detail of his operations and animal experiments. He describes the impact of anesthesia on the postoperative clinical course, in addition to his publications. As well as surgical mortality rates, he reports side effects caused by general anesthesia, which he defines as prolonged loss of consciousness, vomiting, delirium, headache discomfort in the abdominal cavity. He spoke of "death due to the use of anesthesia" if death occurred within 24-48 hours. At autopsy, no surgical reasons or other explanations of the reason for its onset could be found. Based on his observations and analyses, he was convinced that mortality did not increase with the introduction of ether or chloroform. This conflicted with the observations of French and British doctors (who may have been influenced by the Hannah Groener case) that the administration of chloroform could lead to cardiac arrest, or, as Glover suggested, death from toxic lung blockage during anesthesia. N.I. Pirogov suggested that the deaths described by French and British doctors were the result of too rapid administration of anesthesia or a violation of the dosage of anesthesia. Acute cardiac arrest, according to N.I. Pirogov, was the result of an overdose of chloroform. He demonstrated this in dogs and cats. In 1852 John Snow reported similar results.

On the battlefield, chloroform had a number of advantages over ether. The amount of the substance was much smaller, chloroform is not flammable and did not require sophisticated equipment in its application. From start to finish, the anesthesia process was carried out with simple items: bottles and rags. In the French medical service, chloroform was used during the Crimean War, and it was also used by some surgeons in the British Army.

From the practice of N.I. Pirogov on the use of chloroform, not a single death was associated with anesthesia. There were also no cases of death from the use of chloroform in Russian field hospitals. However, five patients developed severe shock during the operation. Of these, one patient died from blood loss, and the other four recovered within a few hours. One of these patients underwent a procedure to eliminate extensor contracture knee joint under deep anesthesia. After a small amount of chloroform given to induce muscle relaxation, bradycardia suddenly began to be observed. The patient's pulse ceased to be felt, breathing ceased to be recorded. The patient spent 45 minutes in this state, despite the use of all resuscitation means that existed at that time. Dilatation of the neck and arm veins was noted. Pirogov bled from the middle vein and found a release of gas with an audible hiss, but with little blood loss. Then, when massaging the neck veins and veins of the hands, even more blood appeared with gas bubbles and later - pure blood. And although N.I. Pirogov conducted his observations very carefully, he could not give an explanation for these extraordinary manifestations in the patient. Fortunately, the patient made a full recovery.

N.I. Pirogov formulated the following directions for the use of chloroform:

Chloroform should always be administered fractionally. This is especially true for severe injuries. Pirogov himself kept chloroform in bottles of dramm (3.9 grams)
Patients should be anesthetized in the supine position in any case.
Do not perform anesthesia immediately after eating or, conversely, after a long fast
Induction of anesthesia should be carried out by applying a cloth or sponge soaked in chloroform at a distance from the patient. Gradually, this distance is reduced until it reaches the patient. This will avoid laryngospasm or coughing.
The patient's pulse should be monitored by an experienced assistant or by the surgeon himself, managing the anesthesia process. If bradycardia sets in, chloroform should be withdrawn immediately.
Special care must be taken when anaesthetizing anemic patients, as they experience shock in the supine position if chloroform is administered too rapidly.

Also N.I. Pirogov gives several recommendations for resuscitation of patients, including squeezing the chest and opening the mouth, releasing accumulated sputum and blood in the throat, and completely protruding the tongue out. Although these actions are considered the standard in modern practice, in the time of N.I. Pirogov they were an innovation. He also insisted that during surgery, the surgeon should examine the color and amount of blood lost. If the arterial blood was black in color and its flow was weak, the administration of chloroform should have been discontinued. Pirogov believed that the amount of the substance should be limited and amount to about 3 drams, although for some patients, in his opinion, higher doses are possible. Even if shock did not occur, there was still a risk of its onset if the amount of anesthesia was applied inappropriately or if it was administered too quickly. Pirogov also used chloroform during operations to correct strabismus in children, in newborns, and for diagnostic procedures such as the diagnosis of hidden fractures.

Crimean War (1853 - 1856)

Pirogov served in the army as a surgeon during the Crimean War. On December 11, 1854, he was appointed chief surgeon of the besieged city of Sevastopol.

During the Crimean War, many operations were carried out in the besieged Sevastopol, which were led by N.I. Pirogov. He was the first who (with the assistance of the Grand Duchess Elena Pavlovna Romanova von Wüttemberg, cousin of Nicholas I) began recruiting women for nursing courses, who later became the "Sisters of Mercy". N.I. Pirogov trained them to assist the surgeon during operations, conduct general anesthesia and perform other nursing duties. This group of women became the founders of the Russian Red Cross. Unlike the British sisters of Florence Nightingale, the Russian sisters worked not only in a small area of medical units, but also on the battlefield itself, often under artillery fire. Seventeen Russian sisters died while doing their duty during the Crimean War, and six of them in the city of Simferopol alone.

During the defense of Sevastopol, N.I. Pirogov introduced the use of anesthesia and gained invaluable experience by performing thousands of operations. In 9 months, he performed more than 5,000 amputations, that is, 30 per day. Perhaps due to overexertion, he contracted typhus and was close to death for three weeks. But thankfully, he made a full recovery. In the book "Grundzuge der allgemeinen Kriegschirurgie usw" ("The Beginnings of General Military Field Surgery" - translator's note), he described his experiments on the use of general anesthesia. The book was published in 1864 and became the standard in field surgery. The basic principles laid down by N.I. Pirogov, soon found their followers around the world and remained virtually unchanged until the Second World War. On the Crimean front, the soldiers were so confident in the extraordinary abilities of N.I. Pirogov as a surgeon, who once brought him the body of a headless soldier. The doctor, who was on duty at the time, exclaimed: “What are you doing? Where are you taking him, can't you see that he has no head? “Nothing, they will bring the head now,” the men answered. "Doctor Pirogov is here, he'll find a way to put her back in her place."

Civil anesthesiology as a medical specialization

Considering his personal experience, N.I. Pirogov warned against conducting anesthesia by an insufficiently competent assistant. Based on the experience of conducting operations in the Caucasus, he was able to make sure that operations were carried out more efficiently with experienced assistants. His main argument was that operations under general anesthesia were more difficult and took longer. Due to this, the surgeon could not fully concentrate on the course of the operation and at the same time monitor the condition of the patient, immersed in anesthesia. Again, after studying the work of health services during the Franco-Prussian war of 1870 and in Bulgaria in 1877-78, Pirogov spoke out for the strengthening of the role of new means for conducting general anesthesia during surgical intervention. He also advocated the use of anesthesia for other procedures, in particular wound care.

In December 1938, at the 24th Union Congress of Surgeons in the Soviet Union, a decision was made on the special training of anesthesiologists. In 1955, at the 26th Congress of Surgeons of the USSR, this became a reality.

Impact of military anesthesiology on civilian practice

The contribution made by N.I. Pirogov in expanding assistance to medical personnel during the war, including the extensive use of anesthesia, definitely earned him the title of founding father of field medicine. He applied his extensive experience and knowledge, accumulated during the Caucasian and Crimean conflicts, in civilian practice. From his notes it follows that his experiments confirm the belief in the usefulness of general anesthesia. It is also true that the widespread use of N.I. Pirogov of general anesthesia in military surgery, together with colleagues in the medical units of the Russian army, was to have the most significant influence on the subsequent development of the principles and techniques of general anesthesia for the main part of the civilian population of Russia.

Traveling from St. Petersburg to the battlefield, he found time to stop in different cities and demonstrate the use of general anesthesia in surgical interventions. In addition, he left there equipment for the rectal method of administering anesthesia, left masks, taught local surgeons the technique and skills of working with ether. This stimulated interest in the use of general anesthesia in these regions. After the end of the Caucasian and Crimean conflicts, news came from these regions of successfully performed operations using general anesthesia. Military surgeons brought to civilian practice the knowledge that they used during the war. And the returning soldiers carried the news of this miraculous discovery.

In conclusion, it must be said that Nikolai Ivanovich Pirogov was the greatest Russian surgeon in the history of medicine. He played a key role in the development of anesthesia in Russia. He possessed a rare combination of scientific talent, an excellent teacher and an experienced surgeon. He taught his followers not only in hospitals, but also on the battlefield, where he was the first to use ether anesthesia. He became the creator of an alternative, rectal method of administering anesthesia, discovered the use of chloroform - first on animals, and then on humans. He was the first to carry out a systematic treatment of the phenomena of mortality and morbidity. He was sure that the discovery of general anesthesia was greatest achievement science, and he also warned of its threats and consequences.

N.I. Pirogov died on December 5, 1881 in the village of Vishnya (now part of the city limits of the city of Vinnitsa, Ukraine). His body was preserved using embalming techniques, which he himself developed shortly before his death, and rests in the church of Vinnitsa. Many recognitions of his achievements followed this event, including the naming of a glacier in Antarctica, a large hospital in Sofia, Bulgaria, and an asteroid discovered in August 1976 by Soviet astronomer Nikolai Chernykh after him. Stamps with his portrait were published in the Soviet Union for the 150th anniversary of his birth. Subsequently, the highest humanitarian award in the Soviet Union became Golden medal N.I. Pirogov. However, we believe that Nikolai Ivanovich Pirogov deserves recognition also outside of Russia for his contribution to the spread of general anesthesia.

Thanks

We are grateful for the endless and disinterested help we received from Lyudmila B. Narusova, President of the Anatoly Sobchak Foundation, for access to the museum's archives and libraries in St. Petersburg. We are also very grateful to the administration of the Military Medical Museum in St. Petersburg for their trust, kind support and enthusiasm.

Nikolai Ivanovich Pirogov is justly considered the "father of Russian surgery", the founder of military field surgery. Pirogov was the first in the world to use ether anesthesia in war conditions. October 16, 1846 is a significant date not only in the history of surgery, but also in the history of mankind. On this day, for the first time, a major surgical operation was performed under full ether anesthesia. Dreams and aspirations that seemed unrealizable even the day before came true - complete anesthesia was achieved, muscles were relaxed, reflexes disappeared. The patient fell into a deep sleep with loss of sensation. The hypnotic effect of ether (in the old days it was called "sweet vitriol") was known as early as 1540 to Paracelsus. IN late XVIII For centuries, inhalation of ether has been used to relieve the pain of consumption and intestinal colic. However, the scientific substantiation of the problem of anesthesia belongs to Nikolai Ivanovich Pirogov, then to the Russian scientists A. M. Filamofitsky, dean of the medical faculty of Moscow University, and anatomist L. S. Sevryuk. They tested the effect of ether on nervous system, on blood, they checked the dosage, the duration of the action of ether anesthesia, etc. Like any innovation, ether anesthesia immediately found both overly ardent adherents and prejudiced critics. Pirogov did not join any camp until he tested the properties of ether in laboratory conditions, on dogs, on calves, then on himself, on his closest assistants, and, finally, on a massive scale on the wounded on the Caucasian front in the summer of 1847 With the energy characteristic of Pirogov, he quickly transfers anesthesia from the experiment to the clinic. He performed his first operation under ether anesthesia on February 14, 1847 in the 2nd military land hospital, on February 16 he operated under ether anesthesia in the Obukhov hospital, on February 27 in Petropavlovsk (St. Petersburg).

Having further experienced ether anesthesia on healthy people, again on himself and having already 50 operations under ether anesthesia, Pirogov decided to use ether anesthesia in military field surgery - directly when providing surgical care on the battlefield. At that time, the Caucasus was a constant theater of military operations (there was a war with the highlanders), and on July 8, 1847, Pirogov left for the Caucasus with the main goal of testing the effect of ether anesthesia as an anesthetic on a large material. On the way to Pyatigorsk and Temir-Khan-Shur, Pirogov introduces doctors to the methods of esterization and performs a number of operations under anesthesia. In Ogly, where the wounded were placed in camp tents, and there was no separate room for operations, Pirogov began to operate on purpose in the presence of other wounded, in order to convince the latter of the analgesic effect of ether vapors. Such visual propaganda had a very beneficial effect on the wounded, and the latter were fearlessly subjected to anesthesia. Finally, Pirogov arrived at the Samurt detachment, which was located near the fortified village of Salta. Here, near Saltami, in a primitive infirmary, consisting of several huts made of tree branches, covered with straw on top, with two long benches made of stones, also covered with straw, kneeling, in a bent position, the great surgeon had to operate. Here, under anesthesia, Pirogov performed up to 100 operations. 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 (a total of 690 were performed in Russia from February 1847 to February 1848). Pirogov's thought is tirelessly working on improving the methods and techniques of anesthesia. He offers his rectal method of anesthesia (introduction of ether into the rectum). To do this, Pirogov designs a special device, improves the design of existing inhalation devices. Becomes an active promoter of anesthesia. Teaches physicians the technique of anesthesia.

Pirogov outlined his research and observations in several articles: "Report on a trip to the Caucasus" on French. In 1849, the "Report" was published as a separate edition in Russian. Personal experience Pirogov by this time was about 400 anesthesia with ether and about 300 with chloroform.

Thus, the main goal of Pirogov's scientific journey to the theater of operations in the Caucasus - the use of anesthesia on the battlefield - was achieved with brilliant success. In the process of experimental study of ether anesthesia, Pirogov also injected ether into veins and arteries, into the common carotid artery, into the internal jugular vein, into the femoral artery, femoral vein, and portal vein. The method of intravenous anesthesia with pure ether, as you know, has not received distribution. However, Pirogov's idea of the possibility of introducing a drug directly into the blood was subsequently implemented with great success. As is known, Russian scientists, pharmacologist N. P. Kravkov and surgeon S. P. Fedorov (1905, 1909) revived Pirogov’s idea of intravenous anesthesia by proposing to inject the hypnotic hedonal directly into a vein. This successful method of using non-inhalation anesthesia, even in foreign manuals, is known as the "Russian method". The idea of intravenous anesthesia belongs entirely to Nikolai Ivanovich Pirogov and later to other Russian scientists involved in the development of this issue, and not to Flurans and, moreover, Or (the latter used intravenous anesthesia with chloral hydrate in 1872) or Burkgardt (in 1909 he resumed experiments injection of ether and chloroform into a vein for the purpose of anesthesia), as, unfortunately, not only foreign, but also some domestic authors write about this. The same should be said about the priority of intratracheal anesthesia (introduced directly into the windpipe - trachea). In most manuals, the founder of this method of anesthesia is called the Englishman John Snow, who used this method of anesthesia in the experiment and in one case in the clinic in 1852. However, it is precisely established that in 1847, i.e. exactly five years earlier, experimentally this the method was successfully applied by Pirogov, which is also eloquently evidenced by the protocols of Pirogov's experiments.

The role of N.I. Pirogov in the development of anesthesia

Contribution of N.I. Pirogov in the field of development of painkillers is not appreciated not only for Russia, but throughout the world.

The means of anesthesia were constantly changing, the technique of anesthesia was being improved. However, Pirogov's ideas about the possibility of achieving anesthesia not only by inhalation remained unshakable and formed the basis of many types of anesthesia - intravenous, rectal, intratracheal, etc.

Pirogov tested the ether primarily on healthy people - on himself and his assistants. Pirogov performed his first operation under anesthesia on February 14, 1847, when he performed an amputation of a woman's breast under ether anesthesia.

Pirogov's initial hesitations regarding the use of ether anesthesia did not prevent him from starting to use it. However, as soon as Pirogov was convinced of the effectiveness of ether anesthesia, he became his ardent supporter and propagandist. After all, before the use of anesthesia, operations really resembled torture.

Pirogov studied the reactions of patients during and after anesthesia, analyzed the degree of harmfulness of drugs, developed equipment for the administration of anesthesia, empirically sought ways to reduce the harmful effects on the patient's body Pirogov experimentally developed and applied rectal ether anesthesia. For what he designed a special apparatus for introducing ether vapor into the rectum. Pirogov described the advantages of this method over inhalation, and also outlined the indications for the use of rectal anesthesia, as well as the target audience, which included even children. In June 1847, Pirogov used rectal anesthesia for the first time.

By April-May 1847, Pirogov completed the study of anesthesia by injection into the arteries and veins. He systematized the results of the experiments and published them approximately earlier than May 17th.

The physiologist Flourens makes his report at the French Academy of Sciences on March 22, 1847, in which he reports on his experiments with the introduction of anesthesia into the arteries and veins.

By this time, Pirogov had already completed his experiments, so he can safely be called the founder of intra-arterial and intravenous anesthesia, despite the late direct publication of the work.

Almost simultaneously with Pirogov, the Anesthesia Committee of the Faculty of Medicine of Moscow University, under the leadership of A.M., performed work on intravascular anesthesia. Filomafitsky. http: //web-medik.ru/history-of-anaesthesia.html Thus, the founders of intravenous anesthesia are Russian scientists Pirogov and Filomafitsky, although this is not reflected in the works of foreign authors. According to Russian authors, the founder of intratracheal anesthesia can also be considered Pirogov, who in 1847 conducted an experiment on introducing a narcotic substance into the trachea in order to obtain anesthesia. A large number of operations with the use of anesthesia Pirogov performed in the Caucasian war. After the first observations of the use of anesthesia in the war, Pirogov concludes that it is necessary to train a team of drug addicts.

Pirogov showed exceptional energy to popularize and spread ether anesthesia in Russia. Despite all the difficulties of movement in those days, he personally traveled to many cities, where he demonstrated ether anesthesia.

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