There are many jokes about the work of surgeons. In many of them, representatives of this profession are ridiculed as irresponsible comedian butchers. However, in real life, a physician of this profile is engaged in very complex and responsible work involving a risk to life, not only of the patient, but also of the doctor himself. This is especially true for specialists in military field surgery. Let's find out what this specialty is, how it differs from others, and where doctors of this profile are trained.
What is called military field surgery
This phrase refers to medical discipline and the branch of surgery, which specializes in providing medical care to patients affected by military conflicts, most often directly in the process of hostilities.
As a rule, her interests include gunshot and fragmentation wounds, less often stabbed and cut.
What are the features of the work of a field surgeon
The treatment of victims in peacetime and wartime is significantly different, especially when it comes to surgical intervention.
In this regard, there are a number of differences.
- In the context of military operations, surgeons have to treat a huge number of patients in the shortest possible time. Therefore, field doctors need to be able to first sort their wards according to the severity of their injuries.
- Working in military mobile hospitals requires physicians to have physical stamina. Indeed, in addition to conducting treatment, sometimes they need to transport the wounded without the help of equipment. In addition, during direct combat, surgeons sometimes have to work day and night.
- The organization of medical assistance in war conditions directly depends on the state of affairs at the front (offensive, lull, retreat).
- In most cases, a military medic has a minimum of improvised means for making the correct diagnosis for a patient. In addition, he usually does not have much time for this (after all, such specialists, in most cases, work in combat conditions). So they have to rely on their knowledge and experience, and not on analyzes and instrument readings.
- When deciding on the type of medical care, the doctor focuses on saving life at the moment. Therefore, sometimes he is forced to ignore the further negative consequences of his treatment, choosing the lesser of evils. So, for example, during the Vietnam War, cyanoacrylate (superglue) is widely used in military surgery. Despite its toxicity, he coped well with sticking wounds, thereby saving patients from death from blood loss, making it possible to deliver them from the battlefield to hospitals, where they could be provided with more qualified help.
- All instruments and equipment of military doctors must be mobile and as simple as possible for transportation; in this regard, their functions (compared with hospital equipment) are reduced to the necessary minimum.
Where do you study this discipline?
Since the specifics of the work of a field surgeon during the fighting is somewhat different from that of his counterpart practicing in peacetime, in most countries of the world there are educational institutions for the training of relevant doctors. In Europe, they are called the Military Medical Academies (WMA).
Field surgery is also taught as an auxiliary discipline in ordinary general medical institutions. However, for those who want to concentrate precisely on this specialization, there are universities in Ankara (Turkey), Belgrade (Serbia), Kiev (Ukraine), St. Petersburg (Russian Federation) and Sofia (Bulgaria).
In addition to the above institutions, the basics of field surgery can be mastered at the US Military Medical University.
Stages of development
Having considered the meaning of the phrase “military field surgery”, as well as the features of the work of specialists in this field, it is worth studying its history.
To date, 4 historical stages of the development of this medical discipline have been identified.
- From ancient times to the XIX century.
- Field Surgery in the 19th Century (connected with the discoveries of N.I. Pirogov).
- First half of the 20th century (before the Second World War).
- From the middle of the 20th century up to this day.
The history of HPV in ancient times
Although surgery as an independent medical discipline during the period of hostilities was formed only in the 19th century, the phenomenon itself arose long before our era. In fact, the entire military history of the world includes a chronicle of assistance to its victims.
The first and longest period in military field surgery can be divided into 2 parts: before the invention of small arms and after.
In the first of them, after the battle, the soldiers remained, as a rule, stabbed or cut wounds and fractures. Therefore, ancient physicians specialized in their treatment. It is worth noting that the records about this are preserved in the documents of most ancient civilizations (Egypt, Greece, Rome, China, India and even Russia). Based on them it is known that the ancient military field surgeons began their work after the end of the battle. In addition, at that time, patients were not evacuated to field hospitals, but were treated on the spot. Needless to say, how high was the mortality rate of soldiers?
With the invention of gunpowder and firearms, the nature of injuries changed qualitatively, which required a different type of medical care. In this regard, medical scientists began to study the features of tissue damage due to bullet or shrapnel wounds.
In different centuries, doctors treated them differently. Until the 16th century it was believed that due to a gunshot damage, the body is poisoned by gunpowder. However, thanks to Ambroise Paré, this myth was dispelled, and his colleague Henri Ledran began to practice dissection and excision of such wounds, which is still relevant today. The experience of these French surgeons was safely assimilated in other European countries, including the Russian Empire.
In the latter, the famous military physician A. Charukovsky, based on the discoveries of Pare and Ledran and his own observations, made a detailed description of the features of gunshot wounds and gave fairly progressive (as at that time) advice on their treatment.
VPH in the XIX century.
Despite the active development of field surgery, until the XIX century. the methodology for its provision was not worked out and was unsystematic in nature, which catastrophically reduced the ability of doctors to save the wounded.
However, with the beginning of the XIX century. the number of protracted military conflicts has increased significantly (compared with past centuries). This required health workers to improve their skills.
The beginning of a new stage in the history of military surgery was facilitated by the Napoleonic wars. During their conduct in the army of the French emperor, 2 doctors managed to prove themselves - Pierre-Francois Percy and "ambulance father" Dominic Jean Larrey.
They began to practice the treatment of injured soldiers not after the battle, but directly during it. So, Percy organized special detachments of military doctors, and Larrey introduced the tradition of evacuating the wounded by orderlies during the battle. In addition, he created a system of mobile surgical infirmaries - “ambulances”.
The ideas of these French doctors subsequently began to be used in other countries. In the Russian Empire, based on them, Yakov Vasilievich Willie organized the system of work of military hospitals.
Contribution of Nikolai Ivanovich Pirogov
Subsequently, the Russian physician Nikolai Ivanovich Pirogov, who is rightfully considered the founder of military field surgery, made a tremendous contribution to the development of this branch of medicine.
It was he who not only coined the term, but also made a number of important discoveries that influenced the development of medicine as a whole. In addition to creating the first detailed anatomical atlas, he began to practice the euthanasia of the wounded by ether and anesthesia, which reduced the mortality from pain shock and gave the surgeon more time to perform manipulations.
Also, Nikolai Ivanovich began to practice the application of starch and gypsum dressings for the treatment of fractures and the use of antiseptics. All this reduced the number of amputations.
In addition to all of the above, this great doctor has developed the principle of sorting the wounded, which is still relevant today.
In addition to his practical contribution to field surgery, Pirogov wrote a number of theoretical works on the treatment of injuries of varying complexity, which are classics today.
Unfortunately, many of the most valuable ideas of Nikolai Ivanovich were not implemented everywhere until his death. The fact is that they demanded a change in the entire military health care system of the Russian Empire, for which for a long time its leadership simply did not want to allocate funds.
The development of HPV in the first half of the XX century.
After Pirogov’s discoveries for a long time, nothing new appeared in the methodology for helping soldiers on the battlefield. An exception can be considered the invention of a special type of tow and a sterile individual dressing bag by Friedrich Esmarch . The latter brought not only benefit, but also a lot of harm. Because of the belief in a false theory of the sterility of a gunshot wound, many injuries (requiring surgical intervention) were not treated, but were preserved with Esmarch's packages. As a result, many soldiers died due to the infection developing under the blindfold.
At the beginning of World War I, surgeons in the British and French armies began to actively practice surgical intervention in the treatment of most injuries. This was done to remove damaged tissue, which, decomposing, contributed to the onset of infection. The number of deaths from wounds began to decrease.
It is worth noting that in the development of military surgery at the beginning of the XX century. a huge role was played by the condition of roads. In Europe, where their quality was high, delivering the wounded to hospitals was much easier than in the Russian Empire. In it, despite the advanced ideas of Pirogov and his followers, for many years the system of military field surgery was not formed.
The situation has changed for the better thanks to Vladimir Andreevich Oppel. It was he who reformed Russian military field medicine, based on the best achievements of foreign and domestic colleagues.
Fortunately, the revolution of 1917 and the coming to power of the Communists did not prevent Oppel from continuing to develop this industry and organize educational institutions for the systematic training of specialists in this field.
His works in the early 30s. formed the basis of the Soviet military medical doctrine. On its basis, not only military field, but also general surgery developed in the future.
The fourth stage in the USSR and in post-Soviet countries
After World War II, the Soviet Union continued to participate in wars, albeit on a smaller scale. The experience gained by doctors in 1941-1945 was presented in a 35-volume edition, which influenced the evolution of surgery as a whole.
With the development of technology, military doctors were able to more quickly evacuate victims from the battlefield.
Because of this, after the end of the war in Afghanistan in 1989, the doctrine of field medicine was revised.
The Afghan conflict was useful for new discoveries. Among the famous physicians in this industry is Evgeny Konstantinovich Gumanenko. Field surgery in his face has gained theorist and practice.
He not only saved several thousand wounded with his own hands, having carried out complex operations in the field, but also wrote a lot of methodological manuals on this issue. He is the author of one of the most famous textbooks on military field surgery in the post-Soviet space. Gumanenko E.K. is also a historian of the discipline in question.
Overseas VPH in the USA after World War II
The iron curtain, which the USSR fenced off from the whole world after World War II, impeded the development of military field surgery in this country. So, in Europe and the USA, this industry has evolved much faster. From the beginning of the Vietnam War, the United States learned to quickly evacuate victims from the battlefield.
In addition, in European countries after the Second World War, active development of mobile equipment and instruments was carried out, which today facilitate the work of surgeons in the field. A whole series of hemostatic, blood substitute, painkillers was also invented - which can save hundreds of thousands of lives in war and peace.