Origins of military field surgery in Russia
Systematic training of military physicians in Russia began in 1700 with the opening of the Hospital School under Peter I. Later, I.F. Busch separated traumatology into a distinct course, and his students introduced important innovations: I.V. Buyalsky first applied the starch bandage, and H.H. Solomon prohibited primary closure of gunshot wounds, introducing the rule to "widen wounds via incision."
A fundamental breakthrough was made by N.I. Pirogov. He created topographical anatomy and laid the foundations of military field surgery:
- Organization of care: widespread use of hospital tents, involvement of women in caring for the wounded, training soldiers in self- and mutual aid, and the concept of a mobile bed capacity.
- Medical triage: the allocation of wounded became dependent solely on the severity of trauma and the need for care.
- Innovations: first to use ether anesthesia in the field and mass plaster immobilization, became the pioneer of osteoplastic surgery, and extensively applied antisepsis (in 1877–1878).
- Pathophysiology: came very close to understanding wound infection, described traumatic shock and wound exhaustion.
Development of traumatology and orthopedics
Treatment of injuries has evolved since antiquity: from fixation with resin-coated papyrus leaves in Ancient Egypt (the Edwin Smith papyrus) to Hippocrates' methods of reducing dislocations and Galen's treatment of gladiators. In the Middle Ages, Ambroise Paré created prostheses for knights and introduced the specialty's emblem, while the term "orthopedics" itself was proposed by the Frenchman Andry in the 18th century. In 1891, the first German textbook on orthopedics by Albert Hoffa was published.
A colossal impact on diagnostics was made by W.C. Röntgen's discovery of X-rays in 1895. This allowed for the precise detection of fractures, aseptic necrosis, and osteochondropathies.
In Russia, orthopedics developed thanks to outstanding scientists:
- G.I. Turner — founder of the Russian school and the first clinic of pediatric orthopedics (1900). He focused on the treatment of Bekhterev's disease, march fractures, and hip pathologies.
- R.R. Vreden — founder of adult orthopedics, author of over 30 surgeries and a manual on military field surgery. He headed the first orthopedic institute (1906).
- G.A. Albrecht — creator of the research and practice school of prosthetics, developer of active upper limb prostheses.
- N.N. Priorov and G.A. Ilizarov — founders of TsITO and the Kurgan school, respectively. Ilizarov invented the famous apparatus for transosseous osteosynthesis.
Development of specialized and emergency care
In addition to treating acute injuries, medicine combated severe diseases. T.P. Krasnobaev developed the sanatorium-orthopedic method for treating bone tuberculosis, saving children from disability. In Kharkiv, M.I. Sitenko created the Ukrainian school of orthopedists and founded the journal "Orthopedics and Traumatology".
A crucial milestone was the organization of emergency care. In 1917, A.L. Polenov opened the first First Aid Station in Petrograd. Following its example, a similar station appeared in Moscow in 1919 (the future N.V. Sklifosovsky Institute).
World War I revealed an acute need for the treatment of maxillofacial injuries. In 1914–1915, specialized infirmaries opened. Dentist S.S. Tigerstedt together with K.P. Tarasov organized "mobile detachments" on the front lines, and Tigerstedt himself developed a system for jaw immobilization using bent aluminum splints. Statistics were harsh: mobile infirmaries operated on only 10% of facial trauma casualties, and no more than 21.7% returned to duty.
A new stage began after the October Revolution: in 1918, V.I. Lenin signed a decree establishing the People's Commissariat of Health (Narkomzdrav), where the dentistry subsection was headed by P.G. Dauge.
To memorize the pioneers of Russian orthopedics, use the mnemonic: "Trudno Vylechit Perelom Inache" (Turner for pediatric, Vreden for adult, Priorov for TsITO, Ilizarov for the apparatus).
Class and exam questions
Who laid down the basic principles of medical triage?
The founder of medical triage is N.I. Pirogov. He established that the priority and scope of care should depend exclusively on the nature of the injury and the needs of the wounded.
What is H.H. Solomon's rule in the treatment of gunshot wounds?
H.H. Solomon categorically rejected the primary closure of gunshot wounds. He introduced the mandatory rule to "widen wounds via incision" for adequate drainage and infection prevention.
What invention by S.S. Tigerstedt changed the treatment of jaw injuries?
In 1915, S.S. Tigerstedt developed an immobilization system for jaw fractures using bent aluminum splints, which became the standard in military field conditions.
What else to study on this topic
- Pathophysiology of combat trauma: traumatic shock and wound exhaustion according to N.I. Pirogov.
- Evolution of immobilization methods: from I.V. Buyalsky's starch bandage to G.A. Ilizarov's apparatus.
- Organization of maxillofacial infirmaries and hospitals during World War I.
- G.A. Albrecht's contribution to the development of domestic prosthetics and the creation of active prostheses.
- T.P. Krasnobaev's sanatorium-orthopedic method for treating bone tuberculosis.
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