H and pies thought that. Nikolai Pirogov

Portrait of Nikolai Pirogov by Ilya Repin, 1881.

There was no nose - and suddenly appeared

Nikolai Ivanovich Pirogov was born in 1810 in Moscow, in a poor, paradoxical as it may sound, family of a military treasurer. Major Ivan Ivanovich Pirogov was afraid to steal, but he had children without measure. The future father of Russian surgery was the thirteenth child.

So the boarding school, in which the boy had entered at the age of eleven, soon had to be left - there was nothing to pay for him.

However, he entered the university as a student of his own. Here the mother of the family, Elizaveta Ivanovna, nee Novikova, a lady of merchant blood, had already insisted. To be state-owned, that is, not to pay for education, seemed humiliating to her.

Nicholas was only fourteen at the time, but he said he was sixteen. The serious young man looked convincing, no one even doubted. The young man received his higher medical education at the age of seventeen. Then he went to probation in Dorpat.

At Dorpat University, the character of Nikolai Ivanovich was especially pronounced - in contrast to another future medical luminary, Fedor Inozemtsev. Ironically, they were placed in the same room. Comrades constantly came to the cheerful and merry Inozemtsev, played the guitar, cooked zhzhenka, dabbled in cigars. And poor Pirogov, who never let go of his textbook for a minute, had to endure all this.

It didn’t even occur to him to leave his studies for at least an hour and enjoy the romance of student life, ennobled by an early bald head and decorated with boring sideburns-brushes.

Then - the University of Berlin. There is not much study. And in 1836, Nikolai Ivanovich finally accepted the appointment of a professor of theoretical and practical surgery at the Imperial Derpt University, which he knew well. There, he first builds a nose for the barber Otto, and then for another Estonian girl. Literally builds like a surgeon. There was no nose - and suddenly it appeared. Pirogov took the skin for this wonderful decoration from the forehead of the patient.

Both were, of course, in seventh heaven with happiness. Oddly enough, the barber was especially jubilant, either having lost his nose in a fight, or accidentally cutting it off while serving another client: “During my suffering, they still took part in me; with the loss of the nose, it passed. Everything ran away from me, even my faithful wife. All my family has moved away from me; friends have left me. After a long retreat, I went one evening to a tavern. The owner asked me to leave at once.”

Meanwhile, Pirogov was already reporting on his plastic experiments to the scientific medical community, using a simple rag doll as a visual aid.

Life among the dead

The building of Dorpat University. Image from wikipedia.org

In Derpt, and then in the capital, the surgical talent of Nikolai Ivanovich is finally fully revealed. He cuts people almost non-stop. But his head is constantly working in favor of the patient. How can amputation be avoided? How to reduce pain? How will the unfortunate person live after the operation?

He invents a new surgical technique that went down in the history of medicine as Pirogov's operation. In order not to go into juicy medical details, the leg is not cut where it was cut before, but in a slightly different place, and as a result, one can hobble on what remains of it.

Today, this method is recognized as obsolete - there were too many problems in the postoperative period, Nikolai Ivanovich violated the laws of nature too radically. But then, in 1852, it was considered a great breakthrough.

Saint Petersburg. Military-medical Academy. Image: retro-piter.livejournal.com

Another problem is how to reduce unnecessary movements with a scalpel, how to quickly determine exactly where surgery is required. Before Pirogov, no one was seriously engaged in this at all - they were poking around in a living person like a baby in a sandbox. He, studying frozen corpses (at the same time gave rise to a new direction - “ice anatomy”), compiled the first detailed anatomical atlas in history. A much-needed manual for fellow surgeons was published under the title "Topographic Anatomy Illustrated by Cuts Through the Frozen Human Body in Three Directions".

In fact, 3D.

True, this 3D cost him a month and a half of bed rest - he did not get out of the dead room for days, inhaled harmful fumes there and almost went to the forefathers himself.

Left much to be desired and surgical instruments of that time. What to do with it? Our hero is used to solving problems radically. He becomes, among other things, the director of the Tool Plant, where he actively improves the product range. Of course, due to products of their own invention.

Nikolai Ivanovich is worried about another serious problem - anesthesia. And not so much the first part of it - how to put a person to sleep before the operation, but the second - how to make sure that later he still wakes up. Our hero becomes the absolute champion in carrying out operations under the ether.

"Traumatic Epidemic"

In 1847, Pirogov, who had just received the title of Corresponding Member of the Imperial St. Petersburg Academy of Sciences, went to the Caucasian War. It was there that he received unlimited opportunities for his ethereal experiments - the theater of war constantly supplied him with people in need of help.

He performed several thousand such operations, most of them successful. If a soldier can boast of how many people he took their lives, then Nikolai Ivanovich had a reverse count. He, in fact, pulled several thousand people out of the hands of death. He brought one of them back to life, and immediately they put another on the table.

You need to have some kind of completely superman psyche to withstand this. And Nikolai Pirogov was such a superman.

Then - another war, the Crimean. Experiments with ether continue. At the same time, plaster fixing bandages are being improved. Pirogov first began to use them during the Crimean campaign. But even in the Caucasus, starch dressings, also put into practice by Dr. Pirogov, were considered an unprecedented innovation. He overtook himself.

Plus a new approach to the evacuation of the wounded from the battlefield. Previously, everyone who was able to be pulled out was indiscriminately sent to the rear. Pirogov introduced just this analysis. The wounded were examined already at the field dressing station. Those who could be helped on the spot were released, and servicemen with serious injuries were sent to the rear hospital. Thus, such scarce places in military transport were given to those who really needed them.

The word "logistics" did not yet exist at that time, and Pirogov was already actively using it, but there, God forbid, modern supervisors never appear.

And being the chief surgeon of the besieged Sevastopol is an enviable position, isn't it? - Nikolai Ivanovich debugged the work of the sisters of mercy to unprecedented perfection.

What kind of cellos, chess and jokes are there. He gutted living people from morning to night!

N.I. Pirogov. Photo by P.S. Zhukov, 1870. Image from wikipedia.org

Pirogov didn't even have friends. That's what he said to himself - "I have no friends." Calmly and without regret. About the war, he argued that it was a “traumatic epidemic”. It was vital for him to put everything in its place.

At the end of the war (which Russia, by the way, lost), Emperor Alexander Nikolayevich, the future tsar-liberator, summoned Pirogov for a report. Better not to call.

The doctor, without any respect and rank, dumped out to the emperor everything that he had learned about the unforgivable backwardness of the country both in military affairs and in medicine. The autocrat did not like this, and he, in fact, exiled the obstinate doctor out of sight - to Odessa, to the post of trustee of the Odessa educational district.

Herzen subsequently kicked the tsar in The Bell: "It was one of the most vile deeds of Alexander, dismissing a man Russia is proud of."

Alexander II, photo portrait, 1880. Image from runivers.ru

And suddenly, quite unexpectedly, a new stage in the activity of this great man began - pedagogical. Pirogov turned out to be a born teacher. In 1856, he published an article entitled "Questions of Life", in which, in fact, he considers questions of education.

The main idea of ​​this is the need for a humane attitude of the teacher to the students. In everyone, one should first of all see a free personality, which should be respected unquestioningly.

He also complained about the fact that the existing educational system is aimed at training narrow-profile specialists: “I know very well that the gigantic successes of the sciences and arts of our century have made specialism a necessary need of society; but at the same time, true specialists have never needed so much a preliminary general human education as in our century.

A one-sided specialist is either a crude empiricist or a street charlatan.

This was especially true for the upbringing and education of young ladies. According to Nikolai Ivanovich, women's education should not be limited to homework skills. The doctor was not shy in his arguments: “What if a calm, carefree wife in the family circle looks at your cherished struggle with a senseless smile of an idiot? Or… squandering all the possible cares of domestic life, will be imbued with only one thought: to please and improve your material, earthly existence?

However, men also got it: “And what is it like for a woman in whom the need to love, participate and sacrifice is developed incomparably more and who still lacks enough experience to calmly endure the deceit of hope - tell me what it should be like for her in the field of life, walking hand in hand with the one in which she was so pathetically deceived, who, correcting her consoling convictions, laughs at her shrine, jokes with her inspirations?

And, of course, no corporal punishment. Nikolai Ivanovich even devoted a separate note to this topical topic - “Is it necessary to flog children, and flog in the presence of other children?”

Pirogov, remembering his conversation with the tsar, was immediately suspected of excessive freethinking.

And he was transferred to Kyiv, where he took up the duties of a trustee of the Kyiv educational district. There, thanks again to his principles, straightforwardness and disregard for ranks, Nikolai Ivanovich finally fell out of favor and was demoted to a simple member of the Main Board of Schools.

In particular, he categorically refused, at the request of the ministry, to establish secret supervision over the students of the Kyiv educational district. Herzen wrote: "Pirogov was too tall for the role of a spy and could not justify meanness with state considerations."

Nikolai Ivanovich Pirogov, posthumous portrait. Engraving by I.I. Matyushina, 1881. Image from dlib.rsl.ru

Pirogov died at the age of 71. Died in six months from cancer of the upper jaw, which was diagnosed by Nikolai Sklifosovsky. He was buried in a mausoleum on his own estate.

The body was embalmed according to his own technology and placed in a transparent sarcophagus, "so that the students and successors of the noble and charitable deeds of N.I. Pirogov could see his bright appearance." The Church, "taking into account the merits of N.I. Pirogov as an exemplary Christian and a world-famous scientist," did not object.

Nikolai Ivanovich Pirogov would have made a very bad therapist. A doctor of this profile needs a smile and participation, a kind of conspiratorial wink, so that he gently feels his stomach with a plump hand of a sybarite and says: “Well, what happened to us, my friend? Nothing, sir, before the wedding will heal.

And so that the ailment would recede from this alone, life would light up in the eyes and the patient himself would ask for a cup of broth, although an hour ago he could not even drink a sip.

Pirogov would not have succeeded in this way. And he had a completely different life.

The ingenious mind and incomprehensible scientific intuition of Pirogov were so ahead of their time that his bold ideas, for example, an artificial joint, seemed fantastic even to the world's luminaries of surgery. They simply shrugged their shoulders, made fun of his thoughts, which led so far into the 21st century.

Nikolai Pirogov was born on November 13, 1810 in Moscow, in the family of a treasury official. The Pirogov family was patriarchal, well-established, strong. Nikolai was the thirteenth child in her. As a child, little Kolya was impressed by Dr. Efrem Osipovich Mukhin (1766-1850), well-known in Moscow to the same extent as Mudrov. Mukhin began as a military doctor under Potemkin. He was the dean of the department of medical sciences, by 1832 he had written 17 treatises on medicine. Dr. Mukhin treated brother Nikolai for a cold. He often visited their house, and always, on the occasion of his arrival, a special atmosphere arose in the house. Nikolai liked the bewitching manners of the Aesculapius so much that he began to play Dr. Mukhin with his family. Many times he listened to everyone at home with his pipe, coughed and, imitating Mukhina's voice, prescribed medicines. Nikolai played so much that he really became a doctor. Yes, how! The famous Russian surgeon, teacher and public figure, the founder of the Russian school of surgery.

Nikolai received his initial education at home, later he studied at a private boarding school. He loved poetry and wrote poems himself. Nikolai stayed at the boarding house for only two years instead of the prescribed four years. His father went bankrupt, there was nothing to pay for education. On the advice of Professor of Anatomy E.O. Mukhin's father, with great difficulty, "corrected" Nikolai's age in the document (someone had to "grease") from fourteen to sixteen. People were admitted to Moscow University from the age of sixteen. Ivan Ivanovich Pirogov made it on time. A year later he died, the family began to beg.

On September 22, 1824, Nikolai Pirogov entered the medical faculty of Moscow University, graduating in 1828. Pirogov's student years passed during a period of reaction, when the preparation of anatomical preparations was prohibited as a "godless" thing, and anatomical museums were destroyed. After graduating from the university, he went to the city of Dorpat (Yuriev) to prepare for a professorship, where he studied anatomy and surgery under the guidance of Professor Ivan Filippovich Moyer.

On August 31, 1832, Nikolai Ivanovich defended his dissertation: “Is the ligation of the abdominal aorta for an aneurysm of the inguinal region an easy and safe intervention?” In this work, he raised and resolved a number of fundamentally important questions concerning not so much the technique of aortic ligation, but rather the elucidation of the reactions to this intervention of both the vascular system and the organism as a whole. With his data, he refuted the ideas of the then-famous English surgeon A. Cooper about the causes of death during this operation.

In 1833-1835, Pirogov was in Germany, where he continued to study anatomy and surgery. In 1836, he was elected professor at the Department of Surgery at the Dorpat (now Tartu) University. In 1849, his monograph "On the transection of the Achilles tendon as an operative-orthopedic remedy" was published. Pirogov conducted more than eighty experiments, studied in detail the anatomical structure of the tendon and the process of its fusion after transection. He used this operation to treat clubfoot. At the end of the winter of 1841, at the invitation of the Medical and Surgical Academy (in St. Petersburg), he took the chair of surgery and was appointed head of the hospital surgery clinic, organized on his initiative from the 2nd Military Land Hospital. At that time, Nikolai Ivanovich lived on the left side of Liteiny Prospekt, in a small house, on the second floor. In the same house, in the same entrance, on the second floor, opposite his apartment, there is the Sovremennik magazine, edited by N.G. Chernyshevsky and N.A. Nekrasov.

Dr. Pirogov in 1847 went to the Caucasus to the active army, where, during the siege of the village of Salty, for the first time in the history of surgery, he used ether for anesthesia in the field. In 1854 he took part in the defense of Sevastopol, where he proved himself not only as a clinical surgeon, but above all as an organizer of medical care for the wounded; at this time, for the first time in the field, he used the help of the sisters of mercy.

Upon his return from Sevastopol (1856) he left the Medico-Surgical Academy and was appointed trustee of the Odessa, and later (1858) Kyiv educational districts. However, in 1861, for progressive ideas in the field of education at that time, he was dismissed from this post. In 1862-1866 he was sent abroad as a leader of young scientists sent to prepare for a professorship. Upon his return from abroad, he settled in his estate, the village of Vishnya (now the village of Pirogovo, near the city of Vinnitsa), where he lived almost without a break.

Nikolai Ivanovich Pirogov also found ideas that reduced all the variety of surgical techniques to three basic rules: "... cut the soft parts, drink the hard ones, where it flows - bandage it there." He revolutionized surgery. His research laid the foundation for the scientific anatomical and experimental direction in surgery; Pirogov laid the foundation for military field surgery and surgical anatomy.

The merits of Nikolai Ivanovich to world and domestic surgery are enormous. In 1847 he was elected a corresponding member of the St. Petersburg Academy of Sciences. His works put forward Russian surgery to one of the first places in the world. Already in the first years of scientific, pedagogical and practical activities, he harmoniously combined theory and practice, widely using the experimental method in order to clarify a number of clinically important issues. He built his practical work on the basis of careful anatomical and physiological research. In 1837-1838 he published the work "Surgical anatomy of arterial trunks and fascia"; this study laid the foundations of surgical anatomy and determined the ways of its further development.

Paying great attention to the clinic, he reorganized the teaching of surgery in order to provide every student with an opportunity for practical study of the subject. Pirogov paid special attention to the analysis of the mistakes made in the treatment of patients, considering practice to be the main method for improving scientific and pedagogical work (in 1837-1839), he published two volumes of Clinical Annals, in which he criticized his own mistakes in the treatment of patients).

In 1846, according to the project of Pirogov, the first anatomical institute in Russia was created at the Medico-Surgical Academy, which allowed students and doctors to engage in applied anatomy, practice operations, and conduct experimental observations. The creation of a hospital surgical clinic, an anatomical institute allowed Pirogov to carry out a number of important studies that determined the further paths for the development of surgery. Attaching particular importance to the knowledge of anatomy by doctors, Pirogov in 1846 published "Anatomical images of the human body, assigned mainly to forensic doctors", and in 1850 - "Anatomical images of the appearance and position of the organs contained in the three main cavities of the human body."

After the death of his wife, Ekaterina Dmitrievna Berezina, Pirogov wanted to marry twice. By calculation. I didn't believe that I could still love. His wife, leaving Pirogov two sons, Nikolai and Vladimir, died in January 1846, twenty-four years old, from a postpartum illness. In 1850, Nikolai Ivanovich finally fell in love and got married. Four months before marriage, he bombarded the bride with letters. He sent them several times a day - three, ten, twenty, forty pages of small, compact handwriting! He revealed to the bride his soul, his thoughts, views, feelings. Not forgetting their "bad sides", "irregularities of character", "weaknesses". He did not want her to love him only for "great things". He wanted her to love him for who he is. While he was preparing for the wedding with the nineteen-year-old Baroness Alexandra Antonovna Bistrom, the niece of General Kozen, his mother died.

Pirogov's method of "ice sculpture" is known. May this smile be forgiven the author: maniacs are forbidden to read further, so as not to become a guide to action. Having set himself the task of finding out the forms of various organs, their relative positions, as well as their displacement and deformation under the influence of physiological and pathological processes, Pirogov developed special methods of anatomical research on a frozen human corpse. Consistently removing tissue with a chisel and hammer, he left the organ or system of interest to him. In other cases, with a specially designed saw, Pirogov made serial cuts in the transverse, longitudinal, and front-rear directions. As a result of his research, he created an atlas "Topographic anatomy, illustrated by cuts made through the frozen human body in three directions", provided with an explanatory text.

This work brought Pirogov worldwide fame. The atlas not only gave a description of the topographic relationship of individual organs and tissues in different planes, but also showed for the first time the significance of experimental studies on a corpse.

Pirogov's works on surgical anatomy and operative surgery laid the scientific foundations for the development of surgery. An outstanding surgeon, who possessed a brilliant technique of operations, Pirogov did not limit himself to the use of surgical approaches and techniques known at that time; he created a number of new methods of operations that bear his name. The osteoplastic amputation of the foot, proposed by him for the first time in world practice, marked the beginning of the development of osteoplastic surgery. Pirogov's pathological anatomy did not go unnoticed. His well-known work "The Pathological Anatomy of Asiatic Cholera" (atlas 1849, text 1850), awarded the Demidov Prize, is still an unsurpassed study.

The rich personal experience of a surgeon, obtained by Pirogov during the wars in the Caucasus and in the Crimea, allowed him to develop for the first time a clear system for organizing surgical care for the wounded in the war.

The operation of resection of the elbow joint developed by Pirogov contributed to a certain extent to limiting amputations. In "The Beginnings of General Military Field Surgery ..." (published in 1864 in German; in 1865-1866, in two parts - in Russian, in two parts in 1941-1944), which are a generalization military surgical practice of Pirogov, he outlined and fundamentally resolved the main issues of military field surgery (issues of organization, the doctrine of shock, wounds, pyemia, etc.). As a clinician, Pirogov was exceptionally observant; his statements concerning wound infection, the meaning of miasma, the use of various antiseptic substances in the treatment of wounds (iodine tincture, bleach solution, silver nitrate), are essentially an anticipation of the work of the English surgeon J. Lister.

Great is the merit of Pirogov in the development of anesthesia issues. In 1847, less than a year after the discovery of ether anesthesia by the American physician W. Morton, Pirogov published an experimental study of exceptional importance on the effect of ether on the animal organism (“Anatomical and physiological studies on etherization”). He proposed a number of new methods of ether anesthesia (intravenous, intratracheal, rectal), and devices for "ether" were created. Along with the Russian physiologist Alexei Matveyevich Filomafitsky (1807-1849), professor at Moscow University, he made the first attempts to explain the essence of anesthesia; he pointed out that the narcotic substance has an effect on the central nervous system and this action is carried out through the blood, regardless of the ways it is introduced into the body.

At seventy, Pirogov became quite an old man. The cataract closed the joy of seeing the colors of the world clearly. His face still lived swiftness and will. There were almost no teeth. It made it difficult to speak. In addition, he suffered from a painful ulcer on the hard palate. The ulcer appeared in the winter of 1881. Pirogov mistook it for a burn. He had a habit of rinsing his mouth with hot water to keep the smell of tobacco out. A few weeks later, he dropped in front of his wife: "It's like cancer." In Moscow, Pirogov was examined by Sklifosovsky, then Val, Grube, Bogdanovsky. They suggested surgery. His wife took Pirogov to Vienna, to the famous Billroth. Billroth persuaded not to be operated on, swore that the ulcer was benign. Pirogov was hard to deceive. Against cancer, even the almighty Pirogov was powerless.

In Moscow in 1881, the 50th anniversary of Pirogov's scientific, pedagogical and social activities was celebrated; he was awarded the title of honorary citizen of Moscow. On November 23 of the same year, Pirogov died in his estate Vishnya, near the Ukrainian city of Vinnitsa, his body was embalmed and placed in a crypt. In 1897, a monument to Pirogov was erected in Moscow with funds raised by subscription. In the estate where Pirogov lived, a memorial museum named after him was organized in 1947; Pirogov's body was restored and placed for viewing in a specially rebuilt crypt.

Nikolai Vasilyevich Sklifosovsky (1836-1904) - Honored Professor, Director of the Imperial Clinical Institute of Grand Duchess Elena Pavlovna in St. Petersburg

After examining Pirogov, N.V. Sklifosovsky said to S. Shklyarevsky: “There can be no doubt that the ulcers are malignant, that there is a neoplasm of an epithelial nature. It is necessary to operate as soon as possible, otherwise a week or two - and it will be too late ... ”This message struck Shklyarevsky like a thunder, he did not dare to tell the truth even to Pirogov’s wife, Alexandra Antonovna. Of course, one can hardly assume that N.I. Pirogov, a brilliant surgeon, a highly qualified diagnostician, through whose hands dozens of oncological patients passed, could not make a diagnosis himself.
On May 25, 1881, a council was held in Moscow, consisting of the professor of surgery at the University of Dorpat E.K. Val, professor of surgery at Kharkov University V.F. Grube and two St. Petersburg professors E.E. Eichwald and E.I. Bogdanovsky, who came to the conclusion that Nikolai Ivanovich had cancer, the situation was serious, and he needed to be operated on as soon as possible. Presiding over the council N.V. Sklifosovsky said: "Now I will remove everything clean in 20 minutes, and in two weeks it will hardly be possible." Everyone agreed with him.
But who will find the courage to tell Nikolai Ivanovich about this? asked Eichwald, given that Pirogov was in close friendship with his father and transferred his attitude to his son. He categorically protested: "I? .. No way!". I had to do it myself.
This is how he describes the scene Nikolai Sklifosovsky: “... I was afraid that my voice would tremble and tears would betray everything that was in my soul ...
- Nikolay Ivanovich! I began, looking intently into his face. - We decided to offer you to cut out the ulcer.
Calmly, with complete self-control, he listened to me. Not a single muscle in his face twitched. It seemed to me that before me rose the image of the sage of antiquity. Yes, only Socrates could listen with the same equanimity to the harsh verdict of approaching death!
There was a deep silence. Oh, this terrible moment!.. I still feel it with pain.
- I ask you, Nikolai Vasilyevich, and you, Val, - Nikolai Ivanovich told us, - to perform an operation on me, but not here. We have just finished the celebration, and suddenly then a feast! Can you come to my village?
Of course, we agreed. The operation, however, was not destined to come true ... "
Like all women, Alexandra Antonovna still hoped that salvation was possible: what if the diagnosis was wrong? Together with his son N.N. Pirogov, she convinced her husband to go to the famous Theodor Billroth to Vienna for a consultation and accompanies him on a trip together with his personal doctor S. Shklyarevsky.

Theodor Billroth (1829-1894) - the largest German surgeon

On June 14, 1881, a new consultation took place. After a thorough examination, T. Billroth recognized the diagnosis as correct, but, given the clinical manifestations of the disease and the age of the patient, he reassured that the granulations are small and sluggish, and neither the bottom nor the edges of the ulcers have the appearance of a malignant formation.
Parting with an eminent patient, T. Billroth said: “Truth and clarity in thinking and feeling, both in words and in deeds, are steps on the ladder that lead humanity to the bosom of the gods. To follow you, both a brave and confident leader, on this not always safe path, has always been my deep desire. Consequently, T. Billroth, who examined the patient, was convinced of a difficult diagnosis, but realized that the operation was impossible due to the difficult moral and physical condition of the patient, so he "rejected the diagnosis" made by Russian doctors. Of course, many people had a question, how could the experienced Theodor Billroth overlook the tumor and not perform the operation? Realizing that he must discover the cause of his own holy lie, Billroth sent a letter to D. Vyvodtsev, in which he explained: “My thirty years of surgical experience taught me that sarcomatous and cancerous tumors starting behind the upper jaw can never be radically removed ... I did not receive would have a favorable result. I wanted, having dissuaded, to cheer up the patient who had fallen in spirit a little and persuade him to patience ... ".
Christian Albert Theodor Billroth was in love with Pirogov, called him a teacher, a brave and confident leader. At parting, the German scientist presented N.I. Pirogov his portrait, on the reverse side of which memorable words were written: “Dear Maestro Nikolai Pirogov! Truthfulness and clarity in thoughts and feelings, in words and deeds - these are the steps of the ladder that leads people to the abode of the gods. To be like you, a brave and confident mentor on this not always safe path, to follow you steadily is my most zealous aspiration. Your sincere admirer and friend Theodor Billroth. Date 14 June 1881 Vienna. N.I. Pirogov expressed compliments, also recorded on Billroth's gift. “He,” wrote N.I., “is our great scientist and outstanding mind. His work is recognized and appreciated. May it be allowed for me to turn out to be just as worthy and highly useful as his like-minded and reformer. The wife of Nikolai Ivanovich, Alexandra Anatolyevna, added to these words: “What is written on this portrait of Mr. Billroth belongs to my husband. The portrait hung in his study." Biographers of Pirogov do not always pay attention to the fact that Billroth also had his portrait.
Cheered up, Pirogov went to his place in Cherry, staying all summer in a cheerful state of mind. Despite the progression of the disease, the conviction that it was not cancer helped him to live, even to consult patients, to participate in the anniversary celebrations dedicated to the 70th anniversary of his birth. He worked on a diary, worked in the garden, walked, received patients, but did not risk operating. Methodically rinsed his mouth with a solution of alum and changed the protector. It didn't last long. In July 1881, while relaxing at the dacha of I. Bertenson on the estuary in Odessa, Pirogov again met with S. Shklyarevsky.
It was already difficult to recognize Nikolai Ivanovich. “Gloomy and focused on himself, he willingly let me look at his mouth and, keeping calm, with a gesture, said several times significant: “It doesn’t heal! .. It doesn’t heal! .. Yes, of course, I fully understand the nature of the ulcer, but, agree yourself, it’s not worth it: a quick relapse, spread to neighboring glands, and besides, all this at my age cannot promise not only success, but can hardly promise relief ... ”He knew what awaited him. And being convinced of the imminent sad outcome, he refused the recommendation of S. Shklyarevsky to try electrolysis treatment.
He looked quite old. The cataract stole from him the bright joy of the world. Through the muddy veil, it seemed gray and dull. In order to see better, he threw back his head, screwed up his eyes piercingly, thrusting forward his overgrown gray chin - swiftness and will still lived in his face.
The more severe his sufferings, the more insistently he went on with The Old Doctor's Diary, filling the pages with an impatient, sweeping handwriting that grew larger and more illegible. For a whole year I was thinking on paper about human existence and consciousness, about materialism, about religion and science. But when he looked into the eyes of death, he almost abandoned philosophizing and began to hastily describe his life.
Creativity distracted him. Without wasting a single day, he was in a hurry. On September 15, he suddenly caught a cold and went to bed. The catarrhal condition and enlarged lymphatic glands of the neck aggravated the condition. But he continued to write lying down. “From the 1st sheet to the 79th, that is, university life in Moscow and Dorpat, was written by me from September 12 to October 1 (1881) in the days of suffering.” Judging by the diary, from October 1 to October 9, Nikolai Ivanovich did not leave a single line on paper. On October 10, he picked up a pencil and began like this: “Will I still make it until my birthday ... (until November 13th). I must hurry with my diary ... ”As a doctor, he clearly imagined the hopelessness of the situation and foresaw a quick denouement.
Prostration. He spoke little, ate reluctantly. He was no longer the same, a non-puppet person who did not know boredom, constantly smoking a pipe, smelling through and through of alcohol and disinfection. Sharp, noisy Russian doctor.
He relieved pain in the facial and cervical nerves with palliative means. As S. Shklyarevsky wrote, “an ointment with chloroform and subcutaneous injections of morphine with atropine are Nikolai Ivanovich’s favorite remedy for the sick and seriously wounded in the first time after injury and when driving on dirt roads. Finally, in recent days, Nikolai Ivanovich almost exclusively drank kvass, mulled wine and champagne, sometimes in significant quantities.
Reading the last pages of the diary, one involuntarily marvels at the enormous will of Pirogov. When the pains became unbearable, he began the next chapter with the words: “Oh, hurry, hurry! .. Bad, bad ... So, perhaps, I won’t have time to describe even half of St. Petersburg life ...” - and continued on. Phrases are already completely illegible, words are abbreviated strangely. “For the first time, I wished for immortality - the afterlife. Love did it. I wanted love to be eternal; it was so sweet. To die at a time when you love, and to die forever, irrevocably, it seemed to me then, for the first time in my life, something unusually terrible ... Over time, I learned from experience that not only love is the reason for the desire to live forever ... ". The manuscript of the diary breaks off in the middle of a sentence. On October 22, the pencil fell out of the surgeon's hand. Many mysteries from the life of N.I. Pirogov keeps this manuscript.
Completely exhausted, Nikolai Ivanovich asked to be taken out onto the veranda, looked at his favorite linden alley to the veranda, and for some reason began to read Pushkin aloud: “A gift in vain, a random gift. Life, why are you given to me? ". He suddenly drew himself up, smiled stubbornly, and then clearly and firmly said: “No! Life, you are given to me with a purpose! ". These were the last words of the great son of Russia, the genius Nikolai Ivanovich Pirogov.
A note was found on the desk among the papers. Skipping letters, Pirogov wrote (spelling preserved): “Neither Sklefasovsky, Val and Grube; neither Billroth recognized my ulcus oris men. mus. cancrosum serpeginosum (lat. - creeping membranous mucous cancerous mouth ulcer), otherwise the first three would not advise surgery, and the second would not recognize the disease as benign. Note marked October 27, 1881.
Less than a month before his death, Nikolai Ivanovich made his own diagnosis. A person who has medical knowledge treats his illness in a completely different way than a patient who is far from medicine. Doctors often underestimate the appearance of the initial signs of the disease, do not pay attention to them, are treated reluctantly and irregularly, hoping that "it will pass by itself." The ingenious doctor Pirogov was absolutely sure: all attempts are futile and unsuccessful. Distinguished by great self-control, he worked courageously to the end.
The last days and minutes of N.I. Pirogov was described in detail in a letter to Alexandra Antonovna by Olga Antonova, a sister of mercy from Tulchin, who was constantly at the bedside of a dying man: “1881, December 9, m. Tulchin. Dear Alexandra Antonovna! ... The last days of the professor - on the 22nd and 23rd I am writing to you. On the 22nd Sunday, at half past two in the morning, the professor woke up, they transferred him to another bed, he spoke with difficulty, phlegm stopped in his throat, and he could not cough up. I drank sherry with water. Then he fell asleep until 8 am. Woke up with increased rales from stopping the sputum; the lymph nodes were very swollen, they were lubricated with a mixture of iodoform and collodion, camphor oil was poured onto cotton wool, although with difficulty, he rinsed his mouth and drank tea. At 12 pm he drank champagne with water, after which he was transferred to another bed and all clean linen was changed; pulse was 135, respiration 28. At 4 days the patient became very delirious, they gave camphor with champagne, one gram as prescribed by Dr. Shavinsky, and then every three quarters of an hour they gave camphor with champagne. At 12 o'clock at night, the pulse was 120. On the 23rd, Monday, at one in the morning, Nikolai Ivanovich completely weakened, the delirium became more incomprehensible. They continued to give camphor and champagne, after three quarters of an hour, and so on until 6 in the morning. The delirium intensified and became more indistinct with each passing hour. When I served the last time at 6 o'clock in the morning wine with camphor, the professor waved his hand and did not accept it. After that, he did not take anything, he was unconscious, strong convulsive twitching of his arms and legs appeared. The agony began at 4 o'clock in the morning and this state lasted until 7 o'clock in the evening. Then he became calmer and slept in an even deep sleep until 8 in the evening, then the contractions of the heart began and therefore breathing was interrupted several times, which lasted for a minute. These sobs were repeated 6 times, the 6th was the professor's last breath. Everything that I wrote down in my notebook I pass on to you. Then I testify my deep respect and deep respect for you and your family, ready to serve you. Sister of Mercy Olga Antonova.
On November 23, 1881, at 8:25 pm, the father of Russian surgery passed away. His son, Vladimir Nikolaevich, recalled that immediately before the agony of Nikolai Ivanovich, "a lunar eclipse began, which ended immediately after the denouement".
He was dying, and nature mourned him: an eclipse of the sun suddenly came - the whole village of Cherry was plunged into darkness.
Shortly before his death, Pirogov received a book by his student, a well-known surgeon from the St. Petersburg Medical and Surgical Academy, embalmer and anatomist, a native of Vinnitsa D. Vyvodtsev, “Embalming and methods of preserving anatomical preparations ...”, in which the author described the method of embalming he found. Pirogov praised the book.
Long before his death, Nikolai Ivanovich wished to be buried in his estate, and just before the end he reminded him of this again. Immediately after the death of the scientist, the family filed a corresponding request to St. Petersburg. Soon an answer was received, in which it was reported that the desire of N.I. Pirogov can be satisfied only if the heirs give a signature on the transfer of the body of Nikolai Ivanovich from the estate to another place in the event of the transfer of the estate to new owners. Family members N.I. Pirogov did not agree with this.
A month before the death of Nikolai Ivanovich, his wife Alexandra Antonovna, most likely at his request, turned to D.I. Vyvodtsev with a request to embalm the body of the deceased. He agreed, but at the same time drew attention to the fact that the permission of the authorities was required for the long-term preservation of the body. Then, through the local priest, a petition is written "To His Eminence Bishop of Podolsky and Brailovsky ...". He, in turn, applies for the highest permission to the Holy Synod in St. Petersburg. The case in the history of Christianity is unique - the church, taking into account the merits of N. Pirogov as an exemplary Christian and a world-famous scientist, allowed not to betray the body to the earth, but to leave it incorrupt, “so that the disciples and continuers of the noble and charitable deeds of the servant of God N.I. Pirogov could see his bright appearance.
What made Pirogov refuse to be buried and leave his body on the ground? This riddle N.I. Pitrogov will remain unsolved for a long time.
DI. Vyvodtsev embalmed the body of N.I. Pirogov and excised tissue affected by a malignant process for histological examination. Part of the drug was sent to Vienna, the other was handed over to the laboratories of Toms in Kyiv and Ivanovsky in St. Petersburg, where they confirmed that it was squamous epithelial cancer.
In an effort to implement the idea of ​​preserving her husband's body, Alexandra Antonovna ordered a special coffin during his lifetime in Vienna. The question arose, where to keep the body permanently? The widow found a way out. At this time, a new cemetery was being laid near the house. For 200 silver rubles, she buys a piece of land for a family crypt from a rural community, encloses it with a brick fence, and the builders begin the construction of the crypt. The construction of the crypt and the delivery of a special coffin from Vienna took almost two months.
Only on January 24, 1882 at 12 noon did the official funeral take place. The weather was cloudy, the frost was accompanied by a piercing wind, but, despite this, the medical and pedagogical community of Vinnytsia gathered at the rural cemetery to see off the great doctor and teacher on his last journey. An open black coffin is placed on a pedestal. Pirogov in the dark uniform of the Privy Councilor of the Ministry of Public Education of the Russian Empire. This rank was equivalent to the rank of general. Four years later, according to the plan of the academician of architecture V. Sychugov, the construction of the funeral-red brick ritual church of St. Nicholas the Wonderworker with a beautiful iconostasis was completed above the tomb.
And today the body of the great surgeon, constantly reembalmed, can be seen in the crypt. Vishnu operates Museum of N.I. Pirogov. During the Second World War, during the retreat of the Soviet troops, the sarcophagus with the body of Pirogov was hidden in the ground, while being damaged, which led to damage to the body, which was subsequently restored and re-embalmed. Officially, the tomb of Pirogov is called the "church-necropolis", consecrated in honor of St. Nicholas of Myra. The body is below ground level in the mourning hall - the basement of the Orthodox church, in a glazed sarcophagus, which can be accessed by those wishing to pay tribute to the memory of the great scientist.
It is now obvious that N.I. Pirogov gave a powerful impetus to the development of scientific medical thought. “With the clear eyes of a man of genius, at the very first time, at the first touch of his specialty - surgery, he discovered the natural scientific foundations of this science - normal and pathological anatomy and physiological experience - and in a short time he established himself on this basis so much that he became a creator in his field. ”, - wrote the great Russian physiologist I.P. Pavlov.
Take, for example, "Illustrated Topographical Anatomy of Cuts Made in Three Dimensions Through a Frozen Human Body." To create the atlas, Nikolai Ivanovich used the original method - sculptural (ice) anatomy. He designed a special saw and sawed frozen corpses in three mutually perpendicular planes. Thus, he studied the shape and position of normal and pathologically altered organs. It turned out that their location was not at all what it seemed at autopsy due to a violation of the tightness of the closed cavities. With the exception of the pharynx, nose, tympanic cavity, respiratory and digestive canals, no empty space was found in any part of the body in the normal state. The walls of the cavities adhered tightly to the organs enclosed in them. Today, this remarkable work by N.I. Pirogov is experiencing a rebirth: the drawings of his cuts are surprisingly similar to the images obtained with CT and MRI.
Pirogov's name bears many of the morphological formations he described. Most are valuable reference points for interventions. A man of exceptional conscientiousness, Pirogov was always critical of conclusions, avoided a priori judgments, supported every thought with anatomical research, and if that was not enough, he experimented.
In his research, Nikolai Ivanovich was consistent - at first he analyzed clinical observations, then conducted experiments, and only then suggested an operation. His work “On the Achilles tendon transection as an operative-orthopedic treatment” is very indicative. Before him, no one dared to do this. “When I was in Berlin,” Pirogov wrote, “I had not yet heard a word about operative orthopedics ... I carried out a somewhat risky undertaking when, in 1836, I first decided to cut the Achilles tendon in my private practice.” Initially, the method was tested on 80 animals. The first operation was performed on a 14-year-old girl who suffered from clubfoot. He saved 40 children aged 1-6 years from this shortcoming, eliminated contractures of the ankle, knee and hip joints. He used an extension apparatus of his own design, gradually stretching (dorsal flexion) of the foot with the help of steel springs.
Nikolai Ivanovich operated on a cleft lip, cleft palate, tubercular "boneworm", "saccular" tumors of the extremities, "white tumors" (tuberculosis) of the joints, removed the thyroid gland, corrected convergent strabismus, etc. The scientist took into account the anatomical features of childhood, under his scalpel were newborns and teenagers. He can also be considered the founder of pediatric surgery and orthopedics in Russia. In 1854, the work “Osteoplastic elongation of the bones of the lower leg during exfoliation of the foot” was published, which marked the beginning of osteoplastic surgery. Anticipating the great possibilities of organ and tissue transplantation, Pirogov with his students K.K. Strauch and Yu.K. Shimanovsky was one of the first to perform a skin and cornea transplant.
The introduction of ether and chloroform anesthesia into practice allowed Nikolai Ivanovich to significantly expand the range of surgical interventions even before the beginning of the era of antiseptics. He did not limit himself to the use of well-known surgical techniques, he offered his own. These are operations for rupture of the perineum during childbirth, for prolapse of the rectum, nose plastic surgery, osteoplastic elongation of the bones of the lower leg, the cone-shaped method of amputation of the limbs, isolation of the IV and V metacarpal bones, access to the iliac and hyoid arteries, the method of ligation of the innominate artery and much more .
To evaluate the contribution of N.I. Pirogov to military field surgery, you need to know her condition before him. Helping the wounded was chaotic. Mortality reached 80% and above. The officer of the Napoleonic army F. de Forer wrote: “After the end of the battle, the field of the Battle of Borodino presented a terrible impression with almost no sanitary service ... All the villages and living quarters were crammed with the wounded of both sides in the most helpless position. Villages perished from incessant chronic fires ... Those of the wounded who managed to escape from the fire crawled by the thousands along the main road, looking for means to continue their miserable existence. An almost similar picture was in Sevastopol during the Crimean War. Amputations for gunshot fractures of the extremities were considered as an imperative requirement and were performed on the first day after the injury. The rule was: "By missing time for the primary amputation, we lose more wounded than we save arms and legs."
His observations of the military surgeon N.I. Pirogov outlined in the "Report on a trip to the Caucasus" (1849), reporting on the use of ether for pain relief and the effectiveness of an immobilizing starch bandage. He proposed to expand the inlet and outlet of the bullet wound, excision of its edges, which was experimentally proven later. The rich experience in the defense of Sevastopol is described by Pirogov in the "Principles of General Military Field Surgery" (1865).
Nikolai Ivanovich emphasized the fundamental difference between general and military field surgery. “A beginner,” he wrote, “can still heal the wounded, not knowing well either head, or chest, or abdominal wounds; but in practice his activity will be more than hopeless if he does not comprehend the significance of traumatic concussions, tension, pressure, general stiffness, local asphyxia and violation of organic integrity.
According to Pirogov, the war is a traumatic epidemic, and the activity of administrative doctors is important here. “I am convinced from experience that what is needed to achieve good results in a military field hospital is not so much scientific surgery and medical art, but a efficient and well-established administration.” It is not in vain that he is considered the creator of the medical evacuation system that was perfect for that time. Sorting of the wounded in European armies began to be carried out only after a few decades.
Acquaintance in the fortification of Salta with the methods of treatment by gakims (local doctors) of the highlanders convinced Nikolai Ivanovich that some gunshot wounds heal without medical intervention. He studied the properties of bullets used in the wars of 1847-1878. and concluded that “the wound should be left as quiet as possible and the damaged parts should not be exposed. I consider it a duty of conscience to warn young doctors against examining bullet wounds with their fingers, from extracting fragments, and in general from any new traumatic violence.
To avoid the danger of severe infectious complications after traumatic operations, Pirogov recommended dissecting the fascia to relieve the “tension” of the tissues, believing that it was harmful to tightly suture the wound after amputation, as advised by European surgeons. Long before, he spoke of the importance of wide drainage in suppurations in order to release "miasmatic wanderers." Nikolai Ivanovich developed the doctrine of immobilizing dressings - starch, "stuck on alabaster" (gypsum). In the latter, he saw an effective means of facilitating the transportation of the wounded, the bandage saved many soldiers and officers from the mutilation operation.
Already at that time, Pirogov was talking about "capillaroscopicity", and not about the hygroscopicity of the dressing material, believing that the better it cleans and protects the wound, the more perfect it is. He recommended English lint, cotton wool, cotton, peeled tow, rubber plates, but required a mandatory microscopic examination - a check for purity.
Not a single detail escapes Pirogov the clinician. His thoughts about the "infection" of wounds essentially anticipated the method of D. Lister, who came up with an antiseptic bandage. But Lister sought to close the wound hermetically, and Pirogov proposed "through drainage, carried out to the bottom and through the base of the wound and connected to constant irrigation." In his definition of miasms, Nikolai Ivanovich came very close to the concept of pathogenic microbes. He recognized the organic origin of the miasma, the ability to multiply and accumulate in overcrowded medical institutions. "Purulent infection spreads ... through the surrounding wounded, objects, linen, mattresses, dressings, walls, floors, and even sanitary personnel." He proposed a number of practical measures: patients with erysipelas, gangrene, and pyemia should be transferred to special buildings. This was the beginning of the departments of purulent surgery.
Having studied the results of primary amputations in Sevastopol, Nikolai Ivanovich concluded: “Amputations of the hip do not give the best hope for success. Therefore, all attempts at saving the treatment of gunshot wounds, hip fractures and injuries of the knee joint should be considered a true progress in field surgery. The reaction of the body to injury is of no less interest to the surgeon than treatment. He writes: “In general, trauma affects the whole organism much deeper than is usually imagined. Both the body and the spirit of the wounded become much more susceptible to suffering ... All military doctors know how strongly the state of mind affects the course of wounds, how different the mortality rate is between the wounded among the defeated and the winners ... "Pirogov gives a classic description of shock, which is still quoted in textbooks.
The great merit of the scientist is the development of three principles for the treatment of the wounded:
1) protection from traumatic effects;
2) immobilization;
3) anesthesia during surgical interventions in the field. Today it is impossible to imagine what and how can be done without anesthesia.
In the scientific heritage of N. I. Pirogov, works on surgery stand out very clearly. Historians of medicine say so: "before Pirogov" and "after Pirogov." This talented person solved many problems in traumatology, orthopedics, angiology, transplantology, neurosurgery, dentistry, otorhinolaryngology, urology, ophthalmology, gynecology, pediatric surgery, and prosthetics. All his life he convinced that it is not necessary to lock oneself within the framework of a narrow specialty, but to endlessly comprehend it in an inextricable connection with anatomy, physiology and general pathology.
He managed to selflessly work 16 hours a day. It took almost 10 years to make preparations for the 4-volume atlas of topographic anatomy alone. At night he worked in the anatomical theater, in the morning he lectured to students, during the day he operated in the clinic. His patients were both members of the royal family and the poor. Healing the most seriously ill patients with a knife, he achieved success where others gave up. He popularized his ideas and methods, found like-minded people and followers. True, Pirogov was reproached for not leaving a scientific school. The well-known surgeon Professor V.A. interceded for him. Oppel: "His school is all Russian surgery" (1923). It was considered honorary to be the pupils of the greatest surgeon, especially when this did not lead to disastrous consequences. At the same time, the sense of self-preservation, quite natural for homo sapiens, obligated many to give up this honorary privilege in case of personal danger. Then came the time of apostasy, eternal as the human world. So did many Soviet surgeons, when in 1950 the publishing house of the USSR Academy of Sciences published an abridged version of N.I. Pirogov, devoid of the former core, which consisted in the spiritual heritage of the "first surgeon of Russia." None of the apostates spoke in defense of the mentor, caring more about themselves and retreating from the legacy of the founder of the Russian surgical school.
There was only one Soviet surgeon who saw it as his duty to protect Pirogovo's spiritual heritage. A worthy student and follower of N.I. Pirogov showed himself Archbishop Luka (Voyno-Yasenetsky) in the Crimean period of hierarchical and professorial activity. At the turn of the 50s of the last century in Simferopol, he wrote a scientific and theological work entitled "Science and Religion", where he paid considerable attention to the spiritual heritage of N.I. Pirogov. For many years, this work remained little known, like many of the achievements of Professor V.F. Voyno-Yasenetsky in his medical and scientific activities. Only in recent decades, "Science and Religion" by Archbishop Luke becomes public property.

Valentin Feliksovich Voyno-Yasenetsky, Archbishop Luke (1877 - 1961) - a great Russian surgeon and clergyman

What new can you learn about N.I. Pirogov, reading “Science and Religion” nowadays, a work of half a century ago, when many Soviet surgeons, for many reasons, including out of a sense of self-preservation, refused to recognize the spiritual heritage of the “first surgeon of Russia”?
“The works of the brilliant humanist doctor Professor N.I. Pirogov, - Archbishop Luke wrote here, - both in the field of medicine and in the field of pedagogy are still considered classic. Until now, in the form of a weighty argument, references are made to his writings. But Pirogov's attitude to religion is diligently hidden by modern writers and scientists. Further, the author cites "silenced quotations from Pirogov's writings." These include the following.
“I needed an abstract, unattainable high ideal of faith. And taking up the Gospel, which I myself had never read before, and I was already 38 years old, I
I found this ideal for myself.
“I consider faith to be the psychic ability of man, which, more than any other, distinguishes him from animals.”
“Believing that the basic ideal of Christ’s teaching, due to its inaccessibility, will remain eternal and will forever influence souls seeking peace through an inner connection with the Divine, we cannot doubt for a minute that this judgment is destined to be an inextinguishable beacon on a winding the path of our progress."
“The unattainable height and purity of the ideal of the Christian faith makes it truly blessed. This is revealed by an extraordinary calmness, peace and hope, penetrating the whole being of the believer, and short prayers, and conversations with oneself, with God, ”as well as some others.
It was possible to establish that all the “hushed up quotes” belong to the same fundamental work by N.I. Pirogov, namely “Questions of life. Diary of an old doctor, written by him in 1879-1881.
It is known that the most complete and accurate (in relation to the original Pirogov manuscript) was the Kiev edition of “Questions of Life. Diary of an old doctor”, which was released on the occasion of the 100th anniversary of the birth of N.I. Pirogov (1910), and therefore, in pre-Soviet times.
The first Soviet edition of the same Pirogov work entitled “From the Old Doctor’s Diary” was published in the collection of works by N.I. Pirogov “Sevastopol Letters and Memoirs” (1950) The contents of the first Soviet edition testifies that, compared with the publications of the pre-Soviet era (1885, 1887, 1900, 1910, 1916), it became the only one from which, for censorship reasons, several large sections. These included not only the philosophical section, which was part of the first part of Pirogov's memoirs, which he called "Questions of Life", but the theological and political sections given in the "Diary of an Old Doctor", representing the second part of this work. In particular, those “hushed up quotations” that were mentioned by Archbishop Luke in his scientific and theological work entitled “Science and Religion” belonged to the theological section. All these censorship exceptions were partially restored only in the second Soviet edition of Vopros Zhizn. Diary of an old doctor "N.I. Pirogov (1962), which saw the light after the earthly days of Archbishop Luke ended.
Thus, Nikolai Ivanovich Pirogov is not only the priceless past of our medicine, but its present and future. At the same time, it is important to emphasize that the activities of N.I. Pirogov does not fit only within the framework of surgery, his thoughts and beliefs go far beyond its limits. If in the 19th century there was a Nobel Prize, then N.I. Pirogov would certainly become its repeated laureate. On the horizon of the world history of medicine, N.I. Pirogov is a rare personification of the ideal image of a doctor - an equally great thinker, practitioner and citizen. So he remained in history, so he lives in our understanding of him today, being a great example for all new and new generations of doctors.

Monument to N.I. Pirogov. I. Krestovsky (1947)

Nikolai Ivanovich Pirogov(November 13; Moscow - November 23 [December 5], v. Vishnya (now within the boundaries of Vinnitsa), (Podolsk province) - Russian surgeon and anatomist, naturalist and teacher, creator of the first atlas of topographic anatomy, founder of Russian military field surgery, founder of the Russian school of anesthesia Privy advisor .

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  Nikolai Ivanovich was born in 1810 in the family of the military treasurer, Major Ivan Ivanovich Pirogov (1772-1826), in Moscow, the 13th child in the family (according to three different documents stored in the Dorpat University, N. I. Pirogov was born on two years earlier - November 13, 1808). Mother Elizaveta Ivanovna Novikova belonged to an old Moscow merchant family. He received his primary education at home, 1822-1824. studied at a private boarding school, which he had to leave because of the deteriorating financial situation of his father. In 1824, he entered the medical faculty of Moscow University as a student of his own (in the petition he indicated that he was 16 years old; despite the need for a family, Pirogov’s mother refused to give him to state students, “it was considered as if something humiliating”). He listened to the lectures of H.I. Loder, M. Ya.

  In 1828 he graduated from the course with a degree in medicine and was enrolled in the pupils, opened at the University of Derpt for the training of future professors of Russian universities. Pirogov studied under the guidance of Professor I.F. Moyer, in whose house he met V.A. Zhukovsky, and at Dorpat University he became friends with V.I.Dal. In 1833, after defending his dissertation for the degree of Doctor of Medicine, he was sent to study at the University of Berlin along with a group of 11 of his comrades from the Professorial Institute (among them F. I. Inozemtsev, D. L. Kryukov, M. S. Kutorga, V. S. Pecherin , A. M. Filomafitsky , A. I. Chivilev) .

  After returning to Russia (1836), at the age of twenty-six, he was appointed professor of theoretical and practical surgery at Dorpat University. In 1841, Pirogov was invited to St. Petersburg, where he headed the Department of Surgery at the Medical-Surgical Academy. At the same time, Pirogov led the Clinic of Hospital Surgery organized by him. Since Pirogov's duties included the training of military surgeons, he began to study the surgical methods common in those days. Many of them were radically reworked by him; in addition, Pirogov developed a number of completely new techniques, thanks to which he managed more often than other surgeons to avoid amputation of limbs. One of these techniques is still called "Operation  Pirogov"

  In search of an effective teaching method, Pirogov decided to apply anatomical studies on frozen corpses. Pirogov himself called this "ice anatomy". Thus was born a new medical discipline - topographic anatomy. After several years of such anatomy study, Pirogov published the first anatomical atlas entitled "Topographic anatomy, illustrated by cuts made through the frozen human body in three directions," which became an indispensable guide for surgeons. From that moment on, surgeons were able to operate with minimal trauma to the patient. This atlas and the technique proposed by Pirogov became the basis for the entire subsequent development of operative surgery.

  In 1847, Pirogov left for the active army in the Caucasus, as he wanted to test the operating methods he had developed in the field. In the Caucasus, he first applied dressing with bandages soaked in starch; starch dressing proved to be more convenient and stronger than previously used splints. At the same time, Pirogov, the first in the history of medicine, began to operate on the wounded with ether anesthesia in the field, having performed about 10 thousand operations under ether anesthesia. In October 1847, he received the rank of actual State Councilor.

  In 1855, Pirogov was elected an honorary member of the Moscow University. In the same year, at the request of the St. Petersburg doctor N.F. Zdekauer, N.I. Pirogov, who at that time was the head teacher of the Simferopol gymnasium D.I. consumption); stating the satisfactory condition of the patient, Pirogov declared: “You will outlive both of us” - this predestination not only instilled confidence in the future great scientist in the favor of fate, but also came true.

  Crimean War

  Operating on the wounded, Pirogov for the first time in the history of Russian medicine used a plaster bandage, giving rise to a savings tactic in the treatment of limb injuries and saving many soldiers and officers from amputation. During the siege of Sevastopol, Pirogov supervised the training and work of the sisters of the Exaltation of the Cross Community of Sisters of Mercy. It was also an innovation at the time.

  The most important merit of Pirogov is the introduction in Sevastopol of a completely new method of caring for the wounded. The method lies in the fact that the wounded were subject to careful selection already at the first dressing station; depending on the severity of the wounds, some of them were subject to immediate operation in the field, while others, with lighter wounds, were evacuated inland for treatment in stationary military hospitals. Therefore, Pirogov is justly considered the founder of a special area in surgery, known as military field surgery.

  For merits in helping the wounded and sick, Pirogov was awarded the Order of St. Stanislav, 1st degree.

  After the Crimean War

  Despite the heroic defense, Sevastopol was taken by the besiegers, and the Crimean War was lost by Russia. Returning to St. Petersburg, at a reception at Alexander II, Pirogov told the emperor about problems in the troops, as well as about the general backwardness of the Russian army and its weapons. The emperor did not want to listen to Pirogov.

  After this meeting, the subject of Pirogov's activity changed - he was sent to Odessa to the post of trustee of the Odessa educational district. Such a decision by the emperor can be regarded as a manifestation of his disfavor, but at the same time, Pirogov had already been assigned a life pension of 1849 rubles and 32 kopecks a year; On January 1, 1858, Pirogov was promoted to Privy Councilor, and then transferred to the position of trustee of the Kyiv educational district, and in 1860 he was awarded the Order of St. Anna, 1st degree.

  Pirogov tried to reform the existing education system, but his actions led to a conflict with the authorities, and the scientist had to leave the post of trustee of the Kyiv educational district. Pirogov remained in the position of a member of the Main Board of Schools, and after the liquidation of this board in 1863, he was under the Ministry of Public Education for life.

  Pirogov was sent to supervise Russian candidate professors studying abroad. “For his work when he was a member of the Main Board of Schools,” Pirogov was kept 5,000 rubles a year.

  He chose Heidelberg as his residence, where he arrived in May 1862. The candidates were very grateful to him; this, for example, was warmly recalled by the Nobel laureate I. I. Mechnikov. There he not only fulfilled his duties, often traveling to other cities where the candidates studied, but also provided them and their families and friends with any assistance, including medical assistance, and one of the candidates, the head of the Russian community of Heidelberg, held a fundraiser for the treatment of Garibaldi and persuaded Pirogov to examine the most wounded Garibaldi. Pirogov refused money, but went to Garibaldi and discovered a bullet not noticed by other world-famous doctors and insisted that Garibaldi leave the climate harmful to his wound, as a result of which the Italian government released Garibaldi from captivity. According to the general opinion, it was N.I. Pirogov who then saved the leg, and, most likely, the life of Garibaldi, who was convicted by other doctors. In his "Memoirs" Garibaldi recalls: "The outstanding professors Petridge, Nelaton and Pirogov, who showed generous attention to me when I was in a dangerous state, proved that there are no boundaries for good deeds, for true science in the family of mankind ... ". After this incident, which caused a furor in St. Petersburg, there was an attempt on the life of Alexander II by nihilists who admired Garibaldi, and, most importantly, Garibaldi's participation in the war of Prussia and Italy against Austria, which displeased the Austrian government, and the "red" Pirogov was relieved of his duties , but at the same time retained the status of an official and the previously assigned pension.

  In the prime of his creative powers, Pirogov retired to his small estate "Cherry" not far from Vinnitsa, where he organized a free hospital. He traveled from there for a short time only abroad, and also at the invitation of St. Petersburg University to give lectures. By this time, Pirogov was already a member of several foreign academies. For a relatively long time, Pirogov left the estate only twice: the first time in 1870 during the Franco-Prussian War, being invited to the front on behalf of the International Red Cross, and the second time in 1877-1878 - already at a very old age - he worked at the front for several months during the Russian-Turkish war. In 1873, Pirogov was awarded the Order of St. Vladimir, 2nd class.

  Russian-Turkish war 1877-1878

  Last days

  At the beginning of 1881, Pirogov drew attention to pain and irritation on the mucous membrane of the hard palate, on May 24, 1881, N.V. Sklifosovsky established the presence of cancer of the upper jaw. N. I. Pirogov died at 20:25. November 23, 1881 in the village. Cherry, now part of Vinnitsa.

  In the late 1920s, robbers visited the crypt, damaged the lid of the sarcophagus, stole Pirogov's sword (a gift from Franz Joseph) and a pectoral cross. In 1927, a special commission indicated in its report: “The precious remains of the unforgettable N.I. Pirogov, thanks to the all-destroying effect of time and complete homelessness, are in danger of undeniable destruction if the existing conditions continue.”

  In 1940, an autopsy of the coffin with the body of N.I. Pirogov was carried out, as a result of which it was found that the examined parts of the body of the scientist and his clothes were covered with mold in many places; the remains of the body were mummified. The body was not removed from the coffin. The main measures for the preservation and restoration of the body were planned for the summer of 1941, but the Great Patriotic War began and, during the retreat of the Soviet troops, the sarcophagus with the body of Pirogov was hidden in the ground, while being damaged, which led to damage to the body, which was subsequently restored and repeatedly re-embalmed . E.I. Smirnov played a big role in this.

  Officially, Pirogov's tomb is called the "church-necropolis", the body is located slightly below ground level in the crypt - the basement of the Orthodox church, in a glazed sarcophagus, which can be accessed by those wishing to pay tribute to the memory of the great scientist.

  Meaning

  The main significance of the activity of N. I. Pirogov is that with his selfless and often disinterested work he turned surgery into a science, arming doctors with scientifically based methods of surgical intervention. In terms of his contribution to the development of military field surgery, he can be placed next to Larrey.

  A rich collection of documents related to the life and work of N. I. Pirogov, his personal belongings, medical instruments, lifetime editions of his works are stored in the funds of the Military Medical Museum in St. Petersburg. Of particular interest are the two-volume manuscript of the scientist “Questions of life. Diary of an old doctor” and a suicide note left by him indicating the diagnosis of his illness.

  Contribution to the development of national pedagogy

  In the classic article "Questions of Life" Pirogov considered the fundamental problems of education. He showed the absurdity of class education, the discord between school and life, put forward the formation of a highly moral personality, ready to renounce selfish aspirations for the good of society, as the main goal of education. Pirogov believed that for this it was necessary to rebuild the entire education system based on the principles of humanism and democracy. The education system that ensures the development of the individual must be based on a scientific basis, from primary to higher education, and ensure the continuity of all education systems.

  Pedagogical views: Pirogov considered the main idea of ​​universal education, the education of a citizen useful to the country; noted the need for social preparation for life of a highly moral person with a broad moral outlook: “ Being human is what education should lead to»; upbringing and education should be in their native language. " Contempt for the native language dishonors the national feeling". He pointed out that the basis of subsequent professional education should be a broad general education; proposed to attract prominent scientists to teaching in higher education, recommended to strengthen the conversations of professors with students; fought for general secular education; urged to respect the personality of the child; fought for the autonomy of higher education.

  Criticism of class vocational education: Pirogov opposed the class school and early utilitarian-professional training, against the early premature specialization of children; believed that it hinders the moral education of children, narrows their horizons; condemned arbitrariness, the barracks regime in educational institutions, thoughtless attitude towards children.

  Didactic ideas: teachers should discard old dogmatic ways of teaching and apply new methods; it is necessary to awaken the thought of students, to instill the skills of independent work; the teacher must draw the attention and interest of the student to the reported material; transfer from class to class should be based on the results of annual performance; in transfer exams there is an element of chance and formalism.

  The system of public education according to N. I. Pirogov:

  Family

  First wife (since December 11, 1842) - Ekaterina Dmitrievna Berezina(1822-46), representative of an ancient noble family, granddaughter of the infantry general Count N. A. Tatishchev. She died at the age of 24 from complications after childbirth. Sons - Nikolai (1843-1891) - physicist, Vladimir (1846-after 11/13/1910) - historian and archaeologist

  Second wife (from June 7, 1850) - Baroness Alexandra von Bystrom(1824-1902), daughter of Lieutenant General A. A. Bistrom, great-niece of the navigator I. F. Kruzenshtern. The wedding was played in the potter's estate of the Linen Factory, and the sacrament of the wedding was performed on June 7/20, 1850 in the local Transfiguration Church. For a long time, Pirogov was credited with the authorship of the article “The Ideal of a Woman”, which is a selection from the correspondence of N. I. Pirogov with his second wife. In 1884, the work of Alexandra Antonovna opened a surgical clinic in Kyiv.

  The descendants of N.I. Pirogov currently live in Greece, France, the United States and St. Petersburg.

  Memory

  The image of Pirogov in art

  N. I. Pirogov is the main character in several works of fiction.

  • The story of A. I. Kuprin "The Miraculous Doctor" (1897).
  • Yu. P. Herman's stories "Bucephalus", "Drops of Inozemtsev" (published in 1941 under the title "Stories about Pirogov") and "Beginning" (1968).
  • Roman B. Yu. Zolotarev and Yu. P. Tyurin "Privy Councilor" (1986).

  Bibliography

  • Complete course of applied anatomy of the human body. - St. Petersburg, 1843-1845.
  • Anatomical images external view and position of organs in three main cavities of human body. - St. Petersburg, 1846. (2nd ed. - 1850)
  • Report about travel in Caucasus 1847-1849 - St. Petersburg, 1849. (M.: State publishing house of medical literature, 1952)
  • Pathological anatomy of Asiatic cholera. - St. Petersburg, 1849.
  • Topographic anatomy according to cuts through frozen corpses. Tt. 1-4. - St. Petersburg, 1851-1854.
  • - St. Petersburg, 1854
  • The beginnings of general military field surgery, taken from observations of military hospital practice and memories of the Crimean War and the Caucasian expedition. Ch. 1-2. - Dresden, 1865-1866. (M., 1941.)
  • university question. - St. Petersburg, 1863.
  • Grundzüge der allgemeinen Kriegschirurgie: nach Reminiscenzen aus den Kriegen in der Krim und im Kaukasus und aus der Hospitalpraxis (Leipzig: Vogel, 1864.- 1168 p.) (German)
  • Surgical anatomy of arterial trunks and fascia. Issue. 1-2. - St. Petersburg, 1881-1882.
  • Works. T. 1-2. - St. Petersburg, 1887. (3rd ed., Kyiv, 1910).
  • Sevastopol letters N.I. Pirogov 1854-1855 . - St. Petersburg, 1899.
  • Unpublished pages from the memoirs of N. I. Pirogov. (Political confession of N. I. Pirogov) // About the past: a historical collection. - St. Petersburg: Typo-lithography B. M. Wolf, 1909.
  • Questions of life. Diary of an old doctor. Edition of the Pirogov t-va. 1910
  • Works on experimental, operational and military field surgery (1847-1859) T 3. M.; 1964
  • Sevastopol letters and memoirs. - M.: Publishing House of the Academy of Sciences of the USSR, 1950. - 652 p. [Contents: Sevastopol Letters; memories of the Crimean War; From the diary of the "Old Doctor"; Letters and documents].
  • Selected pedagogical works / Entry. Art. V. Z. Smirnova. - M .: Publishing House of Acad. ped. Sciences of the RSFSR, 1952. - 702 p.
  • Selected pedagogical works. - M.: Pedagogy, 1985. - 496 p.

  Notes

  1. Kulbin N. I.// Russian biographical dictionary: in 25 volumes. - St. Petersburg. - M., 1896-1918.
  2. Pirogovskaya street // Evening courier. - November 22, 1915.
  3. Biographical dictionary of professors and teachers Imperial Yurievsky, former Derpt University for one years of its existence (1802-1902) Vol II. - S. 261
  4. , With. 558.
  5. , With. 559.
  6. When choosing candidates for the department of the same name at Moscow University, preference was given to F. I. Inozemtsev.
  7. Pirogov Nikolai Ivanovich on the site "Chronicle of Moscow University".
  8. Chronicle of the life and work of D. I. Mendeleev. - L .: Nauka, 1984.
  9. Sevastopol letters N.I. Pirogov 1854-1855 - SPb., 1907.
  10. Nikolay Marangozov. Nikolay Pirogov v. Duma (Bulgaria), November 13, 2003
  11. Gorelova L. E. Mystery N.I. Pirogov // Russian Medical Journal. - 2000. - V. 8, No. 8. - S. 349.
  12. Shevchenko Yu. L., Kozovenko M. N. Museum of N. I. Pirogov. - St. Petersburg, 2005. - S. 24.
  13. Long-term preservation of the embalmed body of N. I. Pirogov - a unique scientific experiment // Biomedical and Biosocial Anthropology. - 2013. - V. 20. - P. 258.
  14. Last shelter Pirogov
  15. Russian newspaper - Monument to the living for the salvation of the dead
  16. Location Tombs N.I. Pirogov on map Vinnitsa
  17. History of Pedagogy and Education. From the origin of education in primitive society to the end of the 20th century: Textbook for pedagogical educational institutions / Ed. A. I. Piskunova.- M., 2001.
  18. History of Pedagogy and Education. From the origin of education in primitive society to the end of the 20th century: A textbook for pedagogical educational institutions / Ed. A. I. Piskunova. - M., 2001.
  19. Kodzhaspirova G. M. History of education and pedagogical thought: tables, diagrams, reference notes. - M., 2003. - S. 125.
  20. He was a professor at Novorossiysk University in the Department of History. In 1910 he temporarily lived in

  (1810-1881) - a great Russian doctor and scientist, an outstanding teacher and public figure; one of the founders of surgical anatomy and anatomical and experimental direction in surgery, military field surgery, organization and tactics of medical support for troops; corresponding member Petersburg Academy of Sciences (1847), honorary member and honorary doctor of many domestic and foreign universities and medical societies.

  In 1824 (at the age of 14) N. I. Pirogov entered the medical department. Faculty of Moscow University, where among his teachers were the anatomist X. I. Loder, clinicians M. Ya. Wise, E. O. Mukhin. In 1828 he graduated from the un-t and entered among the first "professorial students" in the Derpt Professorial Institute, created to train professors from "natural Russians" who successfully graduated from the high fur boots and passed the entrance exams at the St. Petersburg Academy of Sciences. Initially, he intended to specialize in physiology, but due to the lack of this profile of special training, he chose surgery. In 1829 he received a gold medal from Derpt (now Tartu) University for the work done in the surgical clinic by prof. I.F. Moyer competitive research on the topic: “What should be borne in mind when ligating large arteries during operations?”, In 1832 he defended a doctorate, a dissertation on the topic: “Is ligation of the abdominal aorta with inguinal aneurysm easy and safe intervention. In 1833-1835, completing his training for a professorship, N. I. Pirogov was on a business trip in Germany, improved in anatomy and surgery, in particular in the clinic of B. Langenbeck. Upon his return to Russia in 1835, he worked in Dorpat at the clinic of prof. I. F. Moyer; since 1836 - extraordinary, and since 1837 ordinary professor of theoretical and practical surgery at Dorpat University. In 1841, N. I. Pirogov created and until 1856 headed the hospital surgical clinic of the St. Petersburg Medical and Surgical Academy; at the same time was Ch. doctor of the surgical department of the 2nd military land hospital, director of the technical part of the St. Petersburg Instrumental Plant, and since 1846 director of the Institute of Practical Anatomy created at the Medico-Surgical Academy. In 1846, N. I. Pirogov was approved as an academician of the Medical and Surgical Academy.

  In 1856, N. I. Pirogov left the service at the academy (“due to illness and domestic circumstances”) and accepted the offer to take the post of trustee of the Odessa educational district; from that time began the 10-year period of his activity in the field of education. In 1858, N. I. Pirogov was appointed trustee of the Kyiv educational district (in 1861 he resigned for health reasons). Since 1862, N. I. Pirogov was the leader of young Russian scientists sent to Germany to prepare for professorial and teaching activities. N. I. Pirogov spent the last years of his life (since 1866) on his estate in the village of Vishnya near Vinnitsa, from where he traveled as a consultant on military medicine to the theater of operations during the Franco-Prussian (1870-1871) and Russian-Turkish (1877 -1878) wars.

  The scientific, practical and social activities of N. I. Pirogov brought him world medical fame, undeniable leadership in domestic surgery and put him forward among the largest representatives of European medicine in the mid-19th century. The scientific heritage of N. I. Pirogov belongs to various fields of medicine. He made a significant contribution to each of them, which has not lost its significance until now. Despite more than a century ago, the works of N. I. Pirogov continue to amaze the reader with their originality and depth of thought.

  The classic works of N. I. Pirogov “Surgical anatomy of arterial trunks and fascia” (1837), “A complete course of applied anatomy of the human body, with drawings (descriptive-physiological and surgical anatomy)” (1843-1848) and “Illustrated topographic anatomy of cuts, carried out in three directions through the frozen human body” (1852-1859); each of them was awarded the Demidov Prize of the St. Petersburg Academy of Sciences and became the foundation of topographic anatomy and operative surgery. They outline the principles of layer-by-layer preparation in the study of anatomical regions and formations and present original methods for preparing anatomical preparations - sawing frozen corpses (“ice anatomy”, which was initiated by I. V. Buyalsky in 1836), carving individual organs from frozen corpses (“sculptural anatomy”), which together made it possible to determine the relative position of organs and tissues with an accuracy inaccessible with previous research methods.

  Studying the materials of a large number of autopsies (about 800) carried out by him during an outbreak of cholera in St. Petersburg in 1848, N. I. Pirogov established that with cholera, zhel.-kish is primarily affected. path, and made a correct guess about the ways of spreading this disease, indicating that the causative agent of the disease (according to the terminology of that time, miasm) enters the body with food and drink. N. I. Pirogov outlined the results of his research in the monograph “Pathological Anatomy of Asiatic Cholera”, published in 1849 in French. language, and in 1850 in Russian and awarded the Demidov Prize of the St. Petersburg Academy of Sciences.

  In the doctoral thesis of N. I. Pirogov, devoted to the technique of ligation of the abdominal aorta and elucidation of the reactions of the vascular system and the whole organism to this surgical intervention, the results of an experimental study of the characteristics of collateral circulation after surgery and ways to reduce surgical risk were presented. The monograph of N. I. Pirogov “About transection of the Achilles tendon as an operative-orthopedic remedy” (1840) also refers to the Derpt period, in which an effective method of treating clubfoot is described, biol, properties of a blood clot are characterized and it is determined to lay down. role in wound healing processes.

  N. I. Pirogov was the first among domestic scientists to come up with the idea of ​​plastic surgery (a trial lecture at the St. Petersburg Academy of Sciences in 1835 “On plastic surgery in general and about rhinoplasty in particular”), for the first time in the world put forward the idea of ​​bone grafting, publishing in 1854 . work "Osteoplastic elongation of the bones of the lower leg during exfoliation of the foot." His method of connecting the supporting stump during amputation of the lower leg due to the calcaneus is known as the Pirogov operation (see Pirogov amputation); he served as an impetus for the development of other osteoplastic operations. Proposed by N. I. Pirogov, Extraperitoneal access to the external iliac artery (1833) and the lower third of the ureter received wide practical application and was named after him.

  The role of N. I. Pirogov in the development of the problem of anesthesia is exceptional. Anesthesia (see) was proposed in 1846, and the very next year N. I. Pirogov conducted a wide experimental and wedge test of the analgesic properties of ether vapors. He studied their effect in experiments on animals (with various methods of administration - inhalation, rectal, intravascular, intratracheal, subarachnoid), as well as on volunteers, including himself. One of the first in Russia (February 14, 1847), he performed an operation under ether anesthesia (removal of the mammary gland for cancer), which lasted only 2.5 minutes; in the same month (for the first time in the world) he performed an operation under rectal ether anesthesia, for which a special apparatus was designed. He summarized the results of 50 surgical interventions carried out by him in the hospitals of St. Petersburg, Moscow and Kiev in reports, oral and written communications (including in the Society of Doctors of St. Petersburg and the Medical Council of the Ministry of Internal Affairs, in the St. Petersburg and the Paris Academies of Sciences) and the monographic work “Observations on the action of ethereal vapors as an analgesic in surgical operations” (1847), which were of great importance in promoting the new method in Russia and introducing anesthesia into wedge practice. In July-August 1847, N. I. Pirogov, seconded to the Caucasian theater of operations, first used ether anesthesia in the conditions of active troops (during the siege of the fortified village of Salty). The result was unprecedented in the history of wars: operations took place without the groans and cries of the wounded. In his “Report on a Journey through the Caucasus” (1849), N.I. Pirogov wrote: “The possibility of broadcasting on the battlefield has been undeniably proven ... The most comforting result of broadcasting was that the operations we performed in the presence of other wounded did not frighten but, on the contrary, they reassured them in their own fate.

  The activity of N. I. Pirogov played a significant role in the history of asepsis and antiseptics, which, along with anesthesia, determined the success of surgery in the last quarter of the 19th century. Even before the publication of the works of L. Pasteur and J. Lister, in his wedge, lectures on surgery, N. I. Pirogov made a brilliant guess that suppuration of wounds depends on living pathogens (“hospital miasm”): “Miasma, infecting, itself and reproduced by an infected organism. Miasma is not, like poison, a passive aggregate of chemically active particles; it is organic, capable of development and renewal. From this theoretical position, he drew practical conclusions: he allocated special departments in his clinic for those infected with "hospital miasms"; demanded "to completely separate the entire staff of the gangrenous department - doctors, nurses, paramedics and attendants, to give them dressings (lint, bandages, rags) and special surgical instruments special from other departments"; recommended that the physician "of the miasmic and gangrenous department pay special attention to his dress and hands." Regarding the dressing of wounds with lint, he wrote: “You can imagine what this lint must be like under a microscope! How many eggs, fungi and various spores are in it? How easily it becomes itself a means of transmitting contagions! N. I. Pirogov consistently carried out antiseptic treatment of wounds, using iodine tincture, solutions of silver nitrate, etc., emphasized the importance of gigabytes. measures in the treatment of the wounded and sick.

  N. I. Pirogov was a champion of the preventive trend in medicine. He owns the famous words that have become the motto of domestic medicine: “I believe in hygiene. This is where the true progress of our science lies. The future belongs to preventive medicine.”

  In 1870, in a review of the “Proceedings of the Permanent Medical Commission of the Poltava Provincial Zemstvo,” N.I. Pirogov advised the Zemstvo to pay special attention to honey. organizations for hygiene and sanitation. sections of its work, as well as not to lose sight of the food issue in practical activities.

  The reputation of N. I. Pirogov as a practical surgeon was as high as his reputation as a scientist. Even in the Dorpat period, his operations were striking in their boldness of conception and mastery of execution. Operations were carried out at that time without anesthesia, so they were sought to be performed as quickly as possible. Removal of the mammary gland or stone from the bladder, for example, N. I. Pirogov carried out in 1.5-3 minutes. During the Crimean War, at the main dressing station in Sevastopol on March 4, 1855, he performed 10 amputations in less than 2 hours. The international medical authority of N. I. Pirogov is evidenced, in particular, by his invitation for a consultative examination to the German Chancellor O. Bismarck (1859) and the national hero of Italy J. Garibaldi (1862).

  Of great importance not only for military field surgery, but also for a wedge, medicine as a whole were the works of N. I. Pirogov on the problems of immobilization and shock. In 1847, at the Caucasian theater of military operations, for the first time in military field practice, he used a fixed starch dressing for complex fractures of the limbs. During the Crimean War, he also for the first time (1854) applied a plaster bandage in the field (see Plaster technique). N. I. Pirogov owns a detailed description of the pathogenesis, a presentation of methods for the prevention and treatment of shock; the wedge described by him, the picture of shock is classical and continues to appear in manuals and textbooks on surgery. He also described a concussion, gaseous swelling of the tissues, singled out "wound consumption" as a special form of pathology, now known as "wound exhaustion".

  A characteristic feature of N. I. Pirogov - a doctor and teacher - was extreme self-criticism. Even at the beginning of his professorship, he published the two-volume work "Annals of the Derpt Surgical Clinic" (1837-1839), in which a critical approach to his own work and an analysis of his mistakes are considered as the most important condition for the successful development of honey. science and practice. In the preface to the 1st volume of the Annals, he wrote: "I consider it the sacred duty of a conscientious teacher to immediately publish his mistakes and their consequences in order to warn and edify others, even less experienced, from such errors." I. Pavlov called the publication of the Annals his first professorial feat: “... in a certain respect an unprecedented publication. Such ruthless, frank criticism of oneself and one's activities is hardly found anywhere in the medical literature. And this is a huge merit! In 1854, the "Military Medical Journal" published an article by N. I. Pirogov "On the difficulties of recognizing surgical diseases and on happiness in surgery", based on the analysis of Ch. arr. own medical errors. This approach to self-criticism as an effective weapon in the struggle for genuine science is characteristic of N. I. Pirogov in all periods of his versatile activity.

  N. I. Pirogov, a teacher, was distinguished by a constant desire for greater clarity of the material presented (for example, widespread demonstrations at lectures), the search for new methods of teaching anatomy and surgery, conducting a wedge, detours. His important merit in the field of honey. education is an initiative to open hospital clinics for 5th year students. He was the first to substantiate the need to create such clinics and formulated the tasks facing them. In the draft on the establishment of hospital clinics in Russia (1840), he wrote: “Nothing can contribute to the dissemination of medical and especially surgical information among students as an applied direction in teaching ... Clinical teaching ... has a completely different goal from practical teaching in large hospitals, and one alone is not enough for the full education of a practical doctor ..., a professor of practical medicine, a hospital one, directs the attention of listeners during his visits to a whole mass of identical painful cases, showing at the same time their individual shades; ... his lectures consist of a review of the main cases, comparing them, etc.; he has in his hands the means of advancing science.” In 1841, a hospital surgical clinic began to function at the St. Petersburg Medical and Surgical Academy, and in 1842, the first hospital therapeutic clinic. In 1846 hospital clinics were opened in Moscow un-those, and then in Kazan, Derpt and Kiev high fur boots with the simultaneous introduction of the 5th year of study for medical students. f-comrade. So an important reform of higher medical education was carried out. education, which contributed to the improvement of the training of domestic doctors.

  N. I. Pirogov's speeches on upbringing and education had a great public resonance; his article “Questions of Life”, published in 1856 in the “Sea Collection”, was positively evaluated by N. G. Chernyshevsky and N. A. Dobrolyubov. From the same year, the activities of N.N. Pirogov in the field of education, which was marked by a constant struggle against ignorance and stagnation in science and education, with patronage and bribery. N. I. Pirogov sought to disseminate knowledge among the people, demanded the so-called. autonomy of high fur boots, was a supporter of competitions that provide a place for more capable and knowledgeable applicants. He defended equal rights to education for all nationalities, large and small, and all estates, strove for the implementation of universal primary education and was the organizer of Sunday public schools in Kyiv. On the issue of the relationship between “scientific” and “educational” in higher education, he was a resolute opponent of the opinion that high fur boots should teach, and the Academy of Sciences should “move science forward”, and argued: “It is impossible to separate educational from scientific at the university. But scientific and without educational still shines and warms. And educational without scientific, - no matter how ... its appearance is alluring, - it only shines. In assessing the merits of the head of the department, he gave preference to scientific rather than pedagogical abilities and was deeply convinced that science is driven by the method. “Be a professor, at least a dumb one,” wrote N. I. Pirogov, “and teach by example, in fact, the real method of studying the subject - for science and for those who want to do science, it is more expensive than the most eloquent speaker ...” A. I. Herzen called N. I. Pirogov one of the most prominent figures in Russia, who, in his opinion, brought great benefits to the Motherland not only as its “first operator”, but also as a trustee of educational districts.

  N. I. Pirogov is rightly called the “father of Russian surgery” - his activities led to the entry of domestic surgery to the forefront of world medical science. sciences (see Medicine). His works on topographic anatomy, on the problems of anesthesia, immobilization, bone grafting, shock, wounds and wound complications, on the organization of military field surgery and the military medical service as a whole are classical and fundamental. His scientific school is not limited to direct students: in essence, all the leading domestic surgeons of the 2nd half of the 19th century. developed the anatomical and physiological direction in surgery based on the provisions and methods developed by N. I. Pirogov. His initiative in attracting women to care for the wounded, i.e., in organizing in-that sisters of mercy, played an important role in attracting women to medicine and contributed, according to A. Dunant, to the creation of the international Red Cross.

  In May 1881, the 50th anniversary of the versatile activity of N. I. Pirogov was solemnly celebrated in Moscow; he was awarded the title of honorary citizen of Moscow. After his death, the Ob-in of Russian doctors was founded in memory of N. I. Pirogov, who regularly convened the Pirogov congresses (see). In 1897, in Moscow, in front of the building of the surgical clinic on Tsaritsynskaya Street (since 1919, Bolshaya Pirogovskaya), a monument to N. I. Pirogov was erected with funds raised by subscription (sculptor V. O. Sherwood); in the State Tretyakov Gallery there is his portrait by I. E. Repin (1881). By decision of the Soviet government, in 1947, in the village of Pirogovo (former Cherry), where a crypt with the embalmed body of a great figure of Russian science was preserved, a memorial estate museum was opened. Since 1954, the Presidium of the USSR Academy of Medical Sciences and the board of the All-Union Society of Surgeons have been holding annual Pirogov readings. N. I. Pirogov are dedicated to St. 3 thousand books and articles in domestic and foreign press. The name of N. I. Pirogov is carried by the Leningrad (former Russian) surgical society, the 2nd Moscow and Odessa medical institutes. His works on general and military medicine, upbringing and education continue to attract the attention of scientists, doctors and educators.

  The museum is located in the Vishnya estate (at present, within the city of Vinnitsa), where N. I. Pirogov settled in 1861 and lived, intermittently, for the last 20 years of his life. In addition to the estate with a residential building and a pharmacy, the museum complex includes a tomb, in which the embalmed body of N. I. Pirogov rests.

  The proposal to create a museum in the Vishnya estate was first put forward in the early 1920s. Vinnitsa Scientific Society of Physicians. This proposal found support and development at the solemn meeting of the Pirogov Surgical Society (December 6, 1926), as well as at the I (1926) and II (1928) All-Ukrainian Congresses of Surgeons in the speeches of H. M. Volkovich, I. I. Grekov , N. K. Lysenkova. In 1939-1940. in connection with the approaching 135th anniversary of the birth of N. I. Pirogov People's Commissar-zdrav of the Ukrainian SSR and medical. the public again raised the issue of creating a memorial complex in the Pirogovo estate. It was supposed to carry out the main work in the summer of 1941. However, the war prevented the implementation of the developed plan.

  The organization of the museum began shortly after the liberation of Ukraine from the Nazi invaders (October 1944) in accordance with the decision of the Council of People's Commissars of the USSR to establish a museum in the estate of N. I. Pirogov and to take measures to preserve his remains. A huge merit in the organization of the museum belongs to Academician of the USSR Academy of Medical Sciences E. I. Smirnov, at that time the head of the Main Military Sanitary Directorate of the Red Army.

  The invaders caused great damage to the estate and the tomb. The coffin with the body of the scientist was on the verge of destruction. The commission appointed in May 1945, consisting of professors A. N. Maksimenkov, R. D. Sinelnikov, M. K. Dahl, M. S. Spirova, G. L. Derman and others, managed to slow down the process of tissue breakdown and restore the appearance of N. I. Pirogov. At the same time, repair and restoration work was carried out in the estate. The development of expositions was undertaken by the Leningrad Military Medical Museum (see). On September 9, 1947, the grand opening of the museum took place.

  The collection of museum exhibits reflects the medical, scientific, pedagogical, social activities of N. I. Pirogov. The museum presents the works of the scientist, memorial items, handwritten documents, anatomical preparations, surgical instruments, pharmacy equipment, recipes, photographs, paintings and sculptures. The number of exhibits exceeds 15,000. The museum's library contains several thousand books and magazines. In the garden and park of the estate, trees planted by N.I. Pirogov have been preserved.

  In recent years, a team of scientists and practitioners consisting of S. S. Debov, V. V. Kupriyanov, A. P. Avtsyn, M. R. Sapin, K. I. Kulchitsky, Yu. I. Denisov-Nikolsky, L. D. Zherebtsov, V. D. Bilyk, S. A. Markovsky, G. S. Sobchuk carried out restoration and restoration work in the tomb and reembalmed the body of N. I. Pirogov. For the restoration of the museum-estate of N. I. Pirogov and its use for the wide promotion of the achievements of domestic medical science and the practice of Soviet health care, a group of scientists and museum workers was awarded the State Prize of the Ukrainian SSR (1983).

  The museum is a scientific and educational base of the Vinnitsa Medical Institute named after V.I. N. I. Pirogov. More than 300 thousand people get acquainted with the expositions of the museum every year.

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

  Bibliography: Georgievsky A. S. Nikolai Ivanovich Pirogov and "Military Medicine", JT., 1979; G e with e l e-in and h A. M. Chronicle of the life of N. I. Pirogov (1810-1881), M., 1976; Gesele-in and h A. M. and Smirnov E. I. Nikolay Ivanovich Pirogov, M., 1960; Maximenkov A. N. Nikolay Ivanovich Pirogov. L., 1961; Smirnov E. I. Modern value of the main provisions of N. I. Pirogov in military field surgery, Vestn, hir., t. 83, No. 8, p. 3, 1959.

  Museum-estate of N. I. Pirogov- Bolyarsky H. N. N. I. Pirogov in the estate "Cherry" of the Vinnitsa district of the Podolsk province, Nov. hir. arch., v. 15, book. I, p. 3, 1928; Kulchitsky K. I., Klantsa P. A. and Sobchuk G. S. N. I. Pirogov in the estate of Cherry, Kyiv, 1981; Sobchuk G. S. and Klanz P. A. Museum-estate of N. I. Pirogov, Odessa, 1986; Sobchuk G.S., Kirilenko A.V. and Klantsa P.A. Monument of national gratitude, Ortop. and traumat., No. 10, p. 60, 1985; Sobchuk G. S., Markovsky S. A. and Klanza P. A. To the history of the museum-estate of N. I. Pirogov, Owls. health care, Jsft 3, p. 57, 1986.

  E. I. Smirnov, G. S. Sobchuk (museum), P. A. Klantz (museum).