PIES Nikolay Ivanovich

From Big Medical Encyclopedia

PIES Nikolay Ivanovich (1810 — 1881) — the great domestic doctor and the scientific, outstanding teacher and the public figure; one of founders of surgical anatomy and the anatomo-experimental direction in surgery, field surgery, the organization and tactics of medical support of troops; member correspondent. St. Petersburg academy of Sciences (1847), honorary member and honourable doctor of many domestic and foreign universities and medical societies.

PIES Nikolay Ivanovich

In 1824 (at the age of 14 years) N. I. Pirogov arrived on medical f-t Moscow un-that where among his teachers were the anatomist of X. I. Loder, clinical physicians M. Ya. Mudroye, E. O. Mukhin. In 1828 ended un-t and arrived among the first «professorial students» in Derptsky professorial in-t, created for training of professors from the «natural Russians» who successfully ended high fur boots and passed entrance examinations at the St. Petersburg academy of Sciences. Originally intended to specialize on physiology, but due to the lack of this profile of special preparation stopped the choice on surgery. In 1829 got a gold medal of Derptsky (nowadays Tartu) un-that for executed in surgical clinic professional. I. F. Moyer a competitive research on a subject: «What it must be kept in mind during the bandaging of big arteries during operations?», in 1832 protected dokt, the thesis on a subject: Whether «Bandaging of a ventral aorta at aneurism of inguinal area is easily feasible and safe intervention». In 1833 — 1835, completing preparation for professorate, N. I. Pirogov was in a business trip in Germany, was improved in anatomy and surgery, in particular in B. Langenbek's clinic. Upon return to Russia in 1835 worked in Derpta in clinic of the prof. I. F. Moyer; since 1836 — extraordinary, and since 1837 ordinary professor of theoretical and practical surgery of Derptsky un-that. In 1841 N. I. Pirogov created and till 1856 headed hospital surgical clinic of the St. Petersburg Medicochirurgical academy; at the same time the hl consisted. the doctor of surgical department of the 2nd military and overland hospital, the director of a technical part of the St. Petersburg tool plant, and since 1846 the director created at Medicochirurgical academy Ying-that practical anatomy. In 1846 N. I. Pirogov was approved in a rank of the academician of Medicochirurgical academy.

In 1856 N. I. Pirogov left service in academy («due to illness and to house circumstances») and accepted the offer to hold a position of the trustee of the Odessa educational district; from now on the period of its activity in the field of education began 10-years-ny. In 1858 N. I. Pirogov is appointed the trustee of the Kiev educational district (in 1861 he leaves for health reasons). Since 1862 N. I. Pirogov is the head of the young Russian scientists sent to Germany for preparation for professorial activity. The last years of life (since 1866) N. I. Pirogov carried out in the manor in the village Cherry near Vinnytsia from where he left as the consultant for military medicine on the battlefield during French-Prussian (1870 — 1871) and the Russian-Turkish (1877 — 1878) wars.

Scientific, practical and public work of N. I. Pirogov brought it international medical recognition, indisputable leadership in domestic surgery and nominated him in number of the largest representatives of the European medicine of the middle of 19 century. The scientific heritage of N. I. Pirogov belongs to various fields of medicine. In each of them it made the essential contribution which still did not lose the value. Despite more than century prescription, N. I. Pirogov's works continue to strike the reader with originality and depth of a thought.

Classical works N. And. Pirogova «Surgical anatomy of arterial trunks and fastion» (1837), «A full course of applied anatomy of a human body, with drawings (anatomy descriptive and physiological and surgical)» (1843 — 1848) and «The illustrated topographical anatomy of the cuts which are carried out in three directions through the frozen human body» (1852 — 1859); each of them was conferred the Demidovsky award of the St. Petersburg academy of Sciences and was the base of topographical anatomy and operational surgery. In them the principles of layer-by-layer preparation during the studying of anatomic areas and educations are stated and original ways of preparation of anatomic drugs — sawing of the frozen corpses («ice anatomy» which foundation was laid by I. V. Buyaljsky in 1836), a cutting from the frozen corpses of separate bodies («sculptural anatomy») are given that in total allowed to define interposition of bodies and fabrics with an accuracy unavailable at former methods of a research.

Studying materials of a large number of the openings (apprx. 800) which are carried out by him during the outbreak of cholera in St. Petersburg in 1848, N. I. Pirogov established that he at cholera initially is surprised went. - kish. the path, also stated a right guess about ways of spread of this disease, having specified that the disease-producing factor (on terminology of that time a miasma) comes to an organism with food and drink. N. I. Pirogov stated results of the researches in the monograph «Pathological Anatomy of Asian Cholera» published in 1849 in fr. language, and in 1850 in Russian and the conferred Demidovsky award of the St. Petersburg academy of Sciences.

In dokt, results of experimental studying of features of collateral circulation after operation and ways of reduction of surgical risk were stated to N. I. Pirogov's thesis devoted to technology of bandaging of a ventral aorta and clarification of reactions of vascular system and all organism on this operative measure. N. I monograph also belongs to the derptsky period. Pirogova «About section of an Achilles sinew as an operational ortopediche-skogo of means» (1840) in which the effective method of treatment of a clubfoot is stated are characterized biol, properties of a clot and it is defined it to lay down. a role in processes of mending of wounds.

N. I. Pies first among domestic scientists acted with the idea of plastic surgeries (a trial lecture in the St. Petersburg akadvkhmiya of sciences in 1835. «About plastic surgeries in general and about rhinoplasty in particular»), for the first time in the world put forward the idea of bone plastics, having published in 1854 work «Osteoplastic lengthening of bones of a shin at enucleation of foot». Its method of connection of a basic stump at amputation of a shin at the expense of a calcaneus is known as Pirogov's operation (see. Pirogova amputation ); it was an incitement to development of other osteoplastic operations. The Extra peritoneal access to an outside ileal artery (1833) and the lower third of an ureter offered by N. I. Pirogov received broad practical application and was called by his name.

N. I. Pirogov's role in development of a problem of anesthesia is exclusive. Anaesthesia (see) it was offered in 1846, and next year N. I. Pirogov carried out wide experimental and a wedge, check of the anesthetizing properties of vapors of ether. He studied their action in animal experiments (at various ways of introduction — inhalation, pryamokishechny, intravascular, intratracheal, subarachnoidal), and also on volunteers, including and on himself. One of the first in Russia (on February 14, 1847) it made under etherization the operation (removal of a mammary gland concerning cancer) continuing all 2,5min.; in the same month (for the first time in the world) it executed operation under pryamokishechny etherization for which implementation the special device was designed. Results of 50 operative measures which are carried out by him in-tsakh St. Petersburg, Moscow and Kiev it generalized in reports, oral and written messages (including in about-ve doctors of St. Petersburg and medical council of min.-va internal affairs, in the St. Petersburg and Parisian academies of Sciences) and monographic work «Observations over effect of radio vapors as boleutolitelny means in the surgeries» (1847) which were essential in promotion of a new method in Russia and implementation of an anesthesia in a wedge, practice. In July-August, 1847 N. I. Pies, sent on the Caucasian battlefield, for the first time applied etherization in the conditions of the acting troops (at a siege of the strengthened aul of Salta). The result was unprecedented in the history of wars: operations took place without groans and shouts of wounded. In «The report on a travel on the Caucasus» (1849) N. I. Pirogov wrote: «A possibility of an efirovaniye in the field of battle it is indisputable it is proved... The consolatoriest result of an efirovaniye was that the operations made by us in the presence of other wounded did not frighten at all, and, opposite to that, calmed them in own fate».

N. I. Pirogov's activity played a noticeable role in the history of an asepsis and antiseptic agents, to-rye along with anesthesia caused achievements of surgery in the last quarter of 19 century. Even before publication of works of L. Pasteur and J. Lister in the wedge, lectures on surgery N. I. Pirogov stated an ingenious guess that suppuration of wounds depends on live activators («hospital miasmata»): «A miasma, infecting, itself is also reproduced the infected organism. The miasma is not, like poison, the passive unit of chemically operating particles; it is organic, capable to develop and renew». From this theoretical situation he drew practical conclusions: allocated in the clinic special departments for infected with «hospital miasmata»; demanded «to separate absolutely all personnel of gangrenous department — doctors, sisters, paramedics and attendants, to give them and dressing means, special from other departments (a lint, bandage, rags) and special surgical instruments»; recommended that the doctor «miazmichesky and gangrenous department paid special attention to the dress and hands». Concerning bandaging of wounds a lint he wrote: «It is possible to imagine what shall be this lint under a microscope! How many in it eggs, fungi and different a dispute? As easily it becomes itself means to transferring of infections!». N. I. Pirogov consistently carried out antiputrefactive treatment of wounds, applying tincture of iodine, solutions of caustic silver, etc., the gigabyte emphasized value. died in treatment of wounded and patients.

N. I. Pirogov was an advocate of the preventive direction in medicine. It possesses the well-known words which became the motto of domestic medicine: «I believe in hygiene. Here where true progress of our science consists. The future belongs to medicine safety».

In 1870 in a review of «Works of constant medical commission of the Poltava provincial zemstvo» N. I. Pirogov advised a zemstvo to pay special attention of the medical organization on hygienic and a dignity. - a gleam. sections of its work and also not to lose sight of a food question in practical activities.

N. I. Pirogov's reputation as practical surgeon was so high, as well as his reputation of the scientist. During the derptsky period of its operation struck with courage of intention and skill of execution. Operations were performed at that time without anesthesia therefore they were aimed to be made as soon as possible. E.g., N. I. Pirogov carried out removal of a mammary gland or a stone from a bladder in 1,5 — 3 min. During the Crimean war in the main dressing point of Sevastopol on March 4, 1855 it made 10 amputations less than in 2 hours. The international medical authority of N. I. Pirogov is confirmed, in particular, by his invitation for advisory survey to the German chancellor O. Bismarck (1859) and the national hero of Italy J. Garibaldi (1862).

Military medicine (see. Meditsina military ) it is obliged to N. I. Pirogov by creation of scientific fundamentals of domestic field surgery and the new section of military medicine — the organizations and tactics of medical service (see. Organization and tactics of health service , Surgery field ). In 1854 — 1855 during the Crimean war N. I. Pirogov came out to the battlefield twice and directly participated in the organization of medical ensuring fighting of troops and in treatment of wounded, was an initiator of involvement of women («sisters of mercy») to care of wounded at the front. For acquaintance with work of dressing points, infirmaries and hospitals in the conditions of fighting it left also to Germany (1870) and Bulgaria (1877). Results of the observations N. I. Pirogov generalized in works «The beginnings of the general field surgery taken from observations of military and hospital practice and memories of the Crimean war and the Caucasian expedition» (1865 — 1866), «The report on visit of military and sanitary institutions in Germany, Lorraine and Alsace in 1870» (1871) and «Military-medical business and the private help on theater of war in Bulgaria and in the back of field army in 1877 — 1878» (1879). The practical conclusions stated by N. I. Pirogov in the form of «provisions», made a basis of the organizational, tactical and methodical principles of military medicine.

The first position of N. I. Pirogov says: «War is traumatic epidemic». This definition of war from the medical point of view was strongly included into military-medical literature. It follows from the fact that mass character and extreme irregularity of sanitary losses, and from here and irregularity of arrival of victims in field medical institutions is characteristic of fighting of troops. Already during the Crimean war shortage of doctors on dressing points and in field infirmaries was so big that about one intern was the share of 100 and more seriously wounded sometimes. Irregularity dignity. losses in the subsequent wars it was shown even more brightly, exerting the increasing impact on the organizational principles of creation of military-medical service, on policy strokes of its work and combat training of staff.

N. I. Pirogov did not consider fighting damage as simple mechanical disturbance of integrity of fabrics; he attached great value in emergence and the course of fighting damages to the general exhaustion and nervous tension, a sleep debt and malnutrition, cold, hunger and other inevitable adverse factors of a fighting situation promoting development of wound complications and emergence of a number of diseases in soldiers of field army.

The second position of N. I. Pirogov says: «Property of wounds, mortality and success of treatment depend preferential on various properties of weapon and in particular fire shells». N. I. Pirogov's views of surgical interventions, of preventive operations on dressing points and in field infirmaries changed throughout all his activity. In the beginning he was a resolute supporter of precautionary operations. After the careful analysis a wedge, outcomes of the wounds giving especially high mortality from complications of wounds putrefactive processes and also mortality among the patients operated in-tsakh and in the conditions of a private practice, N. I. Pirogov drew a conclusion on inexpediency of precautionary operations on dressing points and on powerlessness of the surgeon in these conditions in fight for decline in mortality and disability among wounded. Having examined during the Russian-Turkish war medical ensuring fighting of troops and statement of surgical work on the main dressing points and in military and time hospitals (in particular, with results of use of sheet-rovsky method of controlling with an infection at operations), N. I. Pirogov changed the relation to a role of surgical interventions in prevention of complications of bullet wounds. In the last work «Voyennovrachebny Business...» he spoke already about two ways of development of surgery (especially field): waiting and savings and aktivnoprofilaktichesky. With opening and implementation the surgery began to develop in surgical practice of antiseptics and an asepsis on the second way, about Krom N. I. Pirogov wrote: «For field surgery the extensive field of the most energetic activity on dressing point — primary operations in sizes unknown hitherto opens».

The third position of N. I. Pirogov which is closely connected with the first says: «Not the medicine, but administration plays a major role in the help to wounded and patients on theater of war». According to this situation success of medical ensuring fighting of troops depends on organizational structure of medical institutions, their quantity, subordination, appointment, mobility and relationship between them that, in turn, shall decide by features of the battlefield, the nature of war and methods of conducting combat operations, on the one hand, and achievements of medical science and practice of health care — on another.

N. I. Pirogov recognized need of a regulation of appointment and tasks of medical institutions, the rights and duties of officials, but emphasized that he for success of medical business in the war with its numerous surprises, bystry change of the fighting situation forcing to violate these regulations for the benefit of business, but at the same time emphasized that special value has the skillful management of military-medical service, a cut shall be authoritative, medical from top to bottom, capable to be responsible for the charged business on a being, but not in a form.

N. I. Pirogov considered the main task ensuring coherence of treatment and evacuation (see. Evacuation medical ); at the same time it proceeded from the defining value of a fighting situation in the solution of the main objectives of medical ensuring fighting of troops, in particular at establishment of dislocation and group of medical institutions, and also volume of the medical aid rendered in them struck and the patient.

N. I. Pirogov is the founder of the doctrine about medical sorting. He claimed that sorting of wounded according to urgency of rendering and volume of the surgical help and according to indications to evacuation is the main warning facility of «turmoil» and «confusion» in medical institutions. In this regard he considered necessary to have in the medical institutions intended for reception of wounded and patients and rendering to them to the qualified help, sorting and operative-dressing divisions, and also division for lightly wounded («weak-willed teams»), and on the ways of evacuation (in the area of concentration of hospitals) — «sortirovochnik» — classifying sections hospital (see. Sorting medical ).

Great value not only for field surgery, but also for a wedge, medicine in general had N. I. Pirogov's works on problems of an immobilization and shock. In 1847 on the Caucasian battlefield he for the first time in field practice used a motionless starched bandage at difficult fractures of extremities. During the Crimean war he also for the first time (1854) applied a plaster bandage in field conditions (see. Plaster equipment ). N. I. Pirogov possesses the detailed characteristic of a pathogeny, a statement of methods of prevention and treatment of shock; described by it a wedge, the picture of shock is classical and continues to appear in the guides and textbooks to surgery. It described also concussion, gas hypostasis of fabrics, allocated «a wound tuberculosis» as the special form of pathology known under the name «wound exhaustion» now.

Extreme self-criticism was characteristic feature of N. I. Pirogov — the doctor and the teacher —. Still in the beginning the professorial activity he published the two-volume work «Annals of Derptsky Surgical Clinic» (1837 — 1839), in Krom to ritichesky approach to own work and the analysis of the mistakes are considered as the most important condition of successful development of medical science and practice. In the preface to the 1st volume of «Annals» he wrote: «I consider a sacred duty of the conscientious teacher to immediately publish the mistakes and their effects for caution and edification of others, even less experienced, from similar delusions». I. Pavlov called the edition of «Annals» its first professorial feat: «... in the known relation the unknown edition. Such ruthless, frank criticism to itself and the activity hardly meets somewhere in medical literature. And it is a huge merit!». In 1854. «The military-medical magazine» published N. I. Pirogov's article «About difficulties of recognition of surgical diseases and about happiness in surgery», constructed on the analysis of hl. obr. own medical errors. This approach to self-criticism as to effective weapon in fight for original science is characteristic of N. I. Pirogova during the entire periods of his versatile activity.

N. I. Pirogova — the teacher search of new methods of teaching anatomy and surgery, carrying out a wedge, bypasses distinguished constant aspiration to bigger visualization of the stated material (e.g., broad carrying out demonstrations at lectures). His important merit in the field of medical education is the initiative of opening of hospital clinics for students of the 5th course. He proved by the first need of creation of such clinics and formulated the tasks facing them. In the project in Russia of hospital clinics (1840) he wrote about establishment: «Nothing so can promote distribution medical and especially the surgical data between pupils as the applied direction in teaching... Clinical teaching... has absolutely other purpose from practical prepodavaniye in big hospitals and one insufficiently for full education of the practical doctor..., professor of applied medicine, hospital, directs at the vizitation attention of listeners to the whole mass of identical painful cases, showing at volume and their individual shades;... his lectures consist in the review of the major cases, their comparisons and so forth; at it in hands means to advance science». In 1841 in the St. Petersburg medicochirurgical academy the hospital surgical clinic, and in 1842 — the first hospital therapeutic clinic began to function. In 1846 hospital clinics un-those were open in Moscow, and then in the Kazan, Derptsky and Kiev high fur boots with simultaneous introduction of the 5th course for students of medical f-comrade. The important reform of the higher medical education promoting improvement of training of domestic doctors was so carried out.

N. I. Pirogov's performances concerning education and education had great public outcry; its article «Questions of Life» published in 1856 in «The sea collection» received N. G. Chernyshevsky and N. A. Dobrolyubov's positive assessment. From same year N. N. Pirogov's activity in the field of education which was noted by constant fight against ignorance and stagnation in science and education, with protections and briberies began. N. I. Pirogov tried to obtain dissemination of knowledge among the people, demanded so-called autonomy of high fur boots, was a supporter of the competitions providing the place to more capable and aware applicants. He asserted the equal rights for education for all nationalities, big and small, and all estates, aimed at implementation of general elementary education and was the organizer of sunday national schools in Kiev. In a question of a ratio «scientific» and «educational» at the higher school he acted reshitelnsh as the opponent of opinion that high fur boots shall learn, and the academy of Sciences — «to move science forward», and claimed: «It is impossible to separate educational from scientific at university. But scientific and without educational after all shines and heats. And educational without scientific — as was... the primanchiva his appearance — only shines». He gave preference in assessment of advantages of the head of department to scientific, but not pedagogical abilities and was deeply convinced that the science is moved by a method. «Be professor at least mute — N. I wrote. Pies — yes teach an example, in practice, real a method of occupations a subject — it for science and for this purpose who wants to pursue science, is dearer than the most eloquent speaker...» A. I. Herzen called N. I. Pirogov one of the most visible figures in Russia bringing in his opinion, huge advantage to the Homeland not only as «the first operator» it, but also as the trustee of educational districts.

N. I. Pirogov is fairly called «the father of the Russian surgery» — his activity caused an exit of domestic surgery to the advanced boundaries of world medical science (see. Meditsina ). Its works on topographical anatomy, on problems of anesthesia, an immobilization, bone plastics, shock, wounds and wound complications, concerning the organization of field surgery and military-medical service in general are classical, fundamental. Its school of sciences is not limited by direct pupils: in essence all advanced domestic surgeons of the 2nd half of 19 century developed the anatomo-physiological direction in surgery on the basis of the provisions and methods developed by N. I. Pirogov. Its initiative in involvement of women to care of wounded, i.e. in the organization in-that sisters of mercy, played an important role in involvement of women to medicine and promoted, by A. Dunand's recognition, creation of the international Red Cross.

In May, 1881 in Moscow the 50 anniversary of versatile activity of N. I. Pirogov was solemnly celebrated; it was awarded ranks of the honourable citizen of Moscow. Posle his death it was based Ob-in of the Russian doctors in N. I. Pirogov's memory, regularly convoking Pirogovsky congresses (see). In 1897 in Moscow before the building of surgical clinic on Tsaritsynskaya Street (since 1919. Big Pirogovskaya) on the funds raised on a subscription the monument to N. I. Pirogov is established (sculptor V. O. Sherwood); in the State Tretyakov gallery there is his portrait of I. E. Repin's brush (1881). According to the decision of the Soviet government in 1947 in the village of Pirogovo (the former Cherry) where the crypt with an embalmed body of the great figure of domestic science remained, the memorial memorial estate is open. Since 1954 the presidium of the USSR Academy of Medical Sciences and board All-Union about-va surgeons carry out annual Pirogovsky readings. The St. 3 thousand books and articles in a domestic and foreign press are devoted to N. I. Pirogov. The name of N. I. Pirogov is carried Leningrad (former Russian) surgical about-in, the 2nd Moscow and Odessa medical in-you. Its works concerning the general and military medicine, education and education continue to draw attention of scientists, doctors and teachers.

Works: Num vinctura aortae abdominalis in aneurysmate inguinali adbibita facile ac tutum sit remedium? Dorpati, 1832; Practical and physiological observations over effect of vapors of ether on an animal organism, SPb., 1847; Report on a travel on the Caucasus, SPb., 1849; Military-medical business, SPb., 1879; Compositions, t. 1 — 2, SPb., 1887; Collected works, t. 1 — 8, M., 1957 — 1962.

Bibliography: Of St. George A.S. Nikolay Ivanovich Pirogov and «Voyennovrachebny business», JT., 1979; Of e with e of l e-in and the p A. M. Chronicle of life of N. I. Pirogov (1810 — 1881), M., 1976; Gesele-v and p A. M and Smirnov E. I. Nikolay Ivanovich Pirogov, M., 1960; Maksimenkov A. N. Nikolay Ivanovich Pirogov, L., 1961; Smirnov E. I. Modern value of original positions of N. I. Pirogov in field surgery, Vestn, hir., t. 83, No. 8, page 3, 1959.

E. I. Smirnov.