What is military field surgery?

There are many anecdotes about the work of surgeons. In many of them representatives of this profession are ridiculed as irresponsible butchers-humorists. However, in real life, a physician of this profile is engaged in a very complex and responsible work, involving a risk to life, not only the patient, but also the doctor himself. This is especially true for specialists in military field surgery. Let's find out: what kind of specialty it is, how it differs from others, and where doctors of this profile are trained.

What is called military field surgery

This phrase is called 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 the hostilities themselves.

As a rule, the sphere of her interests includes gunshot and fragmentation wounds, less often chopped and cut.

What are the characteristics of the work of the military 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 conditions of military operations, surgeons have to treat a huge number of patients in the shortest possible time. Therefore, military field doctors need to be able to sort out their wards in the first place in terms of the severity of their wounds.
• Work in military movable hospitals requires physical endurance from physicians. After all, apart from the treatment, sometimes they need to transport the wounded without the help of technology. In addition, during a direct battle, surgeons sometimes have to work day and night.
• The organization of medical care in war conditions depends on the state of affairs at the front (offensive, calm, retreat).
• Military physician in most cases has a minimum of improvised means for the diagnosis of the patient. In addition, he usually has little time for this (after all, such specialists, in most cases, work in combat conditions). So they have to rely on their knowledge and experience, not on analysis and instrument reading.
• When deciding on the type of medical care, the doctor puts at the forefront the salvation of life at the moment. Therefore, sometimes he has to ignore the further negative consequences of his treatment, choosing the lesser of evils. So, for example, during the war in Vietnam, cyanoacrylate (superglue) is widely used in military field surgery. Despite its toxicity, he coped well with the adhesion of wounds, thereby saving patients from death from loss of blood, enabling them to be delivered from the battlefield to hospitals where they could be provided with more qualified help.
• All instruments and equipment of military doctors must necessarily be mobile and as simple as possible for transportation, in connection with this their functions (in comparison with hospital equipment) are reduced to the necessary minimum.

Where do they study this discipline

Since the specifics of the work of a military surgeon during military operations is somewhat different from that of his peer practicing in peacetime, in most countries the world has educational institutions for the training of relevant doctors. In Europe they are called the Military Medical Academy (WMA).

Military field surgery is also taught as an auxiliary discipline in general medical institutions. However, for those who want to concentrate 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 fundamentals of military field surgery can be learned at the US Military Medical University.

Stages of development

Having considered the meaning of the word combination "military field surgery", as well as the peculiarities of the work of specialists of this profile, it is worth studying its history.

To date, there are 4 historical stages in the development of this medical discipline.

1. From ancient times to the XIX century.
2. Military field surgery in the XIX century. (Connected with the discoveries of NI Pirogov).
3. First half of XX century. (Before the Second World War).
4. From the middle of XX century. up to this day.

History of the WWII in ancient times

Although as an independent medical discipline surgery in the period of military operations was formed only in the XIX century, the very phenomenon arose long before our era. In fact, the entire military history of the world includes the chronicle of rendering assistance to its victims.

The first and the longest period in military field surgery can be conditionally divided into 2 parts: before the invention of small arms and after.

In the first of these, after the battle, the soldiers usually had stab wounds or cut wounds and fractures. Therefore, ancient physicians specialized in their treatment. It should be noted that records of this have been preserved in the documents of most ancient civilizations (Egypt, Greece, Rome, China, India and even Russia). Proceeding from them it is known that ancient military field surgeons started their work after the end of the battle. In addition, at that time patients were not evacuated to field hospitals, but were treated directly on site. Needless to say, how high was the death rate of soldiers?

With the invention of gunpowder and firearms, the nature of wounds 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 fragmentation wounds.

In different centuries doctors treated them differently. Until the XVI century. It was believed that because of gunshot destruction the body is poisoned with gunpowder. However, thanks to Ambroise Paré, this myth was dispelled, and his colleague Henri Ledrand began to practice the dissection and excision of such wounds, which is still relevant today. The experience of these French surgeons was successfully mastered in other European countries, including the Russian Empire.

In the latter, the well-known military physician A. Charukovsky, based on the discoveries of Pare and Ledran and his own observations, carried out a detailed description of the characteristics 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 military field surgery, until the XIX century. The methodology of its rendering was not worked out and had an unsystematic character, which dramatically reduced the doctors' ability to save the wounded.

However, with the beginning of the XIX century. The number of protracted military conflicts has increased significantly (compared to past centuries). This required medical workers to improve their skills.

The beginning of a new stage in the history of military field surgery contributed to the Napoleonic wars. During their conduct in the army of the French emperor managed to show themselves 2 doctors - Pierre-Francois Percy and "father of first aid" Dominique Jean Larray.

It was they who began to practice the treatment of injured soldiers not after the battle, but directly during it. So, Percy organized special teams of military physicians, and Larry introduced the tradition of evacuating wounded orderlies during the battle. In addition, he created a system of mobile surgical hospitals - "ambulance".

The ideas of these French doctors subsequently began to be used in other countries. In the Russian Empire on their basis, Yakov Vasilyevich Willie organized a system of military hospitals.

Contribution of Nikolai Ivanovich Pirogov

In the future, a major contribution to the development of this branch of medicine was made by the Russian physician Nikolai Ivanovich Pirogov, who is rightfully considered the founder of military field surgery.

He not only came up with this term, but also made a number of important discoveries that influenced the development of medicine in general. In addition to creating the first detailed anatomical atlas, he began to practice lulling with ether and anesthesia, which reduced the death from pain shock and gave the surgeon more time for manipulation.

Also, Nikolai Ivanovich began to practice the imposition of starch and gypsum dressings to treat fractures and use antiseptics. All this reduced the number of amputations.

In addition to all of the above, this great doctor developed the principle of sorting the wounded, which is still relevant today.

In addition to the practical contribution to military field surgery, Pirogov wrote a number of theoretical works on the treatment of injuries of varying complexity, which today are classics.

Unfortunately, many of Nikolai Ivanovich's most valuable ideas were not implemented all over the world until his death. The fact is that they demanded a change in the entire military health system of the Russian Empire, for which for a long time its leadership simply did not want to allocate funds.

Development of WWR in the first half of the XX century.

After Pirogov's discoveries, for a long time nothing new appeared in the methods of helping soldiers on the battlefield. An exception can be considered the invention of Friedrich Esmarch special kind of harness and sterile individual dressing package. The latter brought not only good, but also much harm. Because of their belief in the false theory of the sterility of a gunshot wound, many injuries (requiring surgery) were not treated, but were preserved with the help of Esmarch's packs. As a result, many soldiers died because of the infection developing under the bandage.

At the beginning of the First World War, surgeons from the British and French armies began to actively practice surgical intervention in the treatment of most wounds. This was done to remove damaged tissues, which, decomposing, contributed to the onset of infection. The number of deaths from wounds began to decrease.

It should be noted that in the development of military field surgery in the early XX century. A huge role played by the state 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 progressive ideas of Pirogov and his followers, the system of military field surgery was not formed for many years.

The situation has changed for the better thanks to Vladimir Andreevich Oppel. It was he who reformed Russian military medicine based on the best achievements of foreign and domestic colleagues.

The revolution of 1917 and the coming to power of the Communists, fortunately, did not prevent Oppel from continuing the development of this industry and organizing educational institutions for the systematic training of specialists of this profile.

His writings in the early 30's. Formed the basis of the Soviet military medical doctrine. On its basis in the future, not only military field, but also general surgery developed.

The fourth stage in the USSR and in the post-Soviet countries

After the Second World War, the Soviet Union continued to participate in wars, however, of a smaller scale. The experience accumulated by doctors in 1941-1945, was outlined in the 35-volume edition, which influenced the evolution of surgery as a whole.

With the development of technology military physicians were able to more quickly evacuate the victims from the battlefield.

Because of this, after the end of the war in Afghanistan in 1989, the doctrine of military medicine was revised.

The Afghan conflict was useful for new discoveries. Among the well-known physicians in this industry is Evgeny Kumaninovich. Military-field surgery in his face gained theoretical knowledge and practice.

He not only personally saved several thousand wounded, having carried out the most complicated operations in the field, but also wrote a lot of methodological aids on this issue. He is the author of one of the most well-known in the post-Soviet space textbooks on military field surgery. E.Kumanenko is also a historian of the discipline in question.

Foreign WWH in the United States after World War II

The iron curtain, to which the USSR fenced off from the whole world after the Great Patriotic War, hindered the development of military field surgery in this country. So, in Europe and the USA this industry evolved much faster. Since the beginning of the war in Vietnam in the United States, they learned how to quickly evacuate the victims from the battlefield.

In addition, in the European countries after World War II, active development of mobile equipment and instruments was conducted, which today facilitate the work of surgeons in the field. Also, a whole series of hemostatic, blood-soothing, pain-relieving drugs was invented - which can save hundreds of thousands of lives in the military and peace time.