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0025-81051102097G.Pdf Med Pregl 2011; LXIV (1-2): 97-100. Novi Sad: januar-februar. 97 ISTORIJA MEDICINE HISTORY OF MEDICINE Zavod za hitnu medicinsku pomoć Kragujevac Istorija medicine History of medicine UDK 61(44):929 Larej Dominik-Žan ZABORAVLJENI VELIKANI MEDICINE — BARON DOMINIK-ŽAN LAREJ (1766–1842) FORGOTTEN GREAT MEN OF MEDICINE - BARON DOMINIQUE JEAN LARREY (1766–1842) Vladimir GAJIĆ Sažetak – Dominik-Žan Larej bio je francuski vojni hirurg koji se uzdigao do mesta glavnog hirurga velike Napoleonove armije. Mnogi napreci na polju hirurgije pripisuju se njemu: on je jedan od prvih koji je uspešno amputirao nogu iz kuka (1812. godine), bio je pionir u primeni larvi mušica u prevenciji infekcije rana, dao je prvi opis rovovskog stopala i patentirao je prvu pomoć ranjenicima na bojnom po- lju korišćenjem posebnih nosača koji su odmah iznosili povređene s bojišta. Larej je studirao medicinu u Parizu, a zatim je proveo kratko vreme u mornarici, pre nego što je nastavio svoje studije na pariskom koledžu za hirurgiju. Pridružio se armiji 1792. godine, i tamo pro- veo ostatak života, učestvujući u 60 bitaka i 400 drugih angažmana, i bio je triput ranjen. Tokom tog perioda, inicirao je moderne metode vojne hirurgije, poljskih bolnica i sistem vojnih bolničkih jedinica. Posle zapažanja brzine kojom se kreću kočije s francuskom letećom artiljerijom manevrišući kroz bojno polje, Larej ih je prilagodio u leteće sanitete za brz transport ranjenih i tretman s obučenim ekipama vozača, nosača i bolničara. Lari je takođe povećao mobilnost i poboljšao organizaciju poljskih bolnica efikasno kreirajući prethodnice modernih mobilnih poljskih bolnica. Promovisan je u barona 1809. godine. Ostao je veran Napoleonu, čak i posle njegove abdikacije 1814. godine i sledio ga je u njegovoj poslednjoj kampanji (kampanja 100 dana). U bici kod Vaterloa zarobljen je i osuđen na smrt, ali je spasen ličnom intervencijom pruskog komandanta Blihera. Mnogi istoričari ga svrstavaju u red s hemičarem Lavoazijeom (Antoine Lavo- isier) i lekarima Giljotinom (Joseph Guillotin) i Maraom (Jean Paul Marat). Ključne reči: Istorija medicine; Francuska; Hirurgija; Istorija 19. veka Per aspera ad astra Dominik Larej je rođen osmog jula 1766. godine u buržoaskoj porodici na samom jugu Francuske, u ma- lom mestu Boden (Beaudean), podno Pirineja. Vrlo brzo, njegovi roditelji se sele u Bordo (Bordeaux), ali, nažalost, vrlo brzo i umiru, nakon čega Larej ostaje siroče s nepunih trinaest godina. Brigu o njemu preu- zima njegov ujak Aleksis, koji je bio šef hirurgije u Tuluzu (Toulouse). Dominik je imao i starijeg brata Kloda-Fransoa Hilari Lareja (Claude-François Hilaire Larrey, 1774—1819), koji je takođe bio uspešan hirurg i pisac knjiga o hirurgiji. Dominik je proveo šest go- dina šegrtovanja kod svog ujaka, kad prelazi na školo- vanje u Pariz, kod čuvenog hirurga Dezola (Pierre Jo- seph Desault) u hotel „Dieu”, gde je usavršio debrid- man rana. Međutim, Francuska stupa u rat i mladi Lari se odaziva na poziv i prijavljuje se u mornaricu, gde biva dodeljen na službu na fregatu Vigilante, s ko- jom plovi sve do Severne Amerike. Zbog hronične morske bolesti brzo napušta mornaricu i vraća se na školovanje u drugu Dezolovu kliniku Les Invalides. Do 1790. godine, mladi lekar se već nametnuo kao stariji asistent glavnog hirurga u bolnici „Invalidi”, a ubrzo sreće i mladog Bonapartu, koji je tad bio ko- Slika 1. Mladi major Dominik-Žan Larej mandir artiljerijske brigade. Fig 1. Young major Dominique Jean Larrey Već 1792. godine, mladi Dominik stupa u armiju, organizacija medicinske službe, jer je velik broj vojni- tokom borbe s prvom koalicijom, preuzimajući polj- ka umirao pre nego što bi i stigao do poljske bolnice. sku bolnicu u činu majora (Slika 1). Tokom boravka Zapazio je izuzetna pokretljivost francuske artiljerije, na bojnom polju, shvata da je potrebna mnogo bolja pa mu je to poslužilo kao ideja za leteće sanitete — Adresa autora: Dr Vladimir Gajić, Zavod za hitnu medicinsku pomoć, 34000 Kragujevac, Zmaj Jovina 32, E-mail: [email protected] 98 Gajić V. Zaboravljeni velikani medicine Ambulance Volante. Ovi leteći saniteti bile su vagon- ske kočije s konjskom vučom, koje su skupljale po- vređene po bojnom polju, transportujući ih do prve poljske bolnice (slike 2 i 3). Ovi saniteti su poboljšali i sistem medicinskog snabdevanja. U njima je boravio doktor, bolničar, intendant, dobošar koji je nosio za- voje, neraspoređeni oficir sa 24 vojnika koji su sku- pljali povređene. Ubrzo je formirao ovakve leteće sa- nitete za celu francusku vojsku. Ovakav način organi- zacije brzo je bio prihvaćen i od ostalih armija u Evropi. Time je formirao preteču današnje hitne po- moći i postavio temelje doktrine vojne medicine [1-5]. Slika 3. Ambulance Volante – leteći sanitet iznutra Fig 3. Flying ambulance interior banja. Takođe je našao vremena da piše o tifusu, bu- boničkoj kugi, lepri i trahomu (koji se brzo proširio po Evropi pod nazivom egipatska oftalmija). Po povratku iz Egipta u avgustu 1799. godine, Napoleon mu daje titulu barona i postavlja ga za glavnog hirurga Carske imperijalne garde. Tokom pohoda na Španiju imao je, nažalost, mnogo prilika da studira amputaciju stopala. Da bi sprečili Napole- onovo napredovanje, Španci su često minirali pute- Slika 2. Ambulance Volante — leteći sanitet spolja ve, što je rezultiralo čestim povređivanjem donjih Fig 2. Flying ambulance exterior ekstremiteta. Kao stariji doktor na Korzici i u Špani- ji on je uvežbao i doveo do perfekcije svoju tehniku U izveštaju s bojnog polja, tokom pohoda na Ita- amputacije stopala, kao i tretman stopala od smrzo- liju, 1797. godine zapisao je: tina. Ovo iskustvo mu je kasnije dobro došlo tokom „Oni koji su teško povređeni, trebalo bi da budu katastrofalnog pohoda na Rusiju. prvi pregledani bez obzira na čin i položaj. Oni koji Tokom 1812. godine, Larej je pratio smrzotine voj- su manje povređeni mogu čekati na zbrinjavanje, oni nika i primetio je da oni s ukočenim smrzotinama koji su teško povređeni treba da budu prvi operisani skoro i ne osećaju bol tokom amputacije. Štaviše, po- i previjeni, nasuprot onima koji ne mogu preživeti sle amputacije bol se smanjivao sa stavljanjem patrlja- mnogo sati, a retko sledeći dan.” (Larrey DJ: Surgi- ka u sneg i led. Larejeve veštine prilikom amputacije cal memoris of the Campaigns of Russia, Germany jesu one koje se još uvek pamte i prepričavaju. Kaže and France; Philadelphia: Carey, Lea 1832) i time se da je za vreme Borodinske bitke lično izveo oko postavio osnove moderne trijaže pacijenata. 200 amputacija u roku od 24 sata. U bici na Berezini, Štaviše, njegova briga za pacijente na obe zaraće- tokom katastrofalnog povlačenja, izveo je još oko 300 ne strane postalo je etičko načelo za koje bi Larej amputacija. Zbog toga je bio duboko poštovan od ko- trebao da bude nagrađen. Ove revolucionarne ideje lega doktora i oficira. On je prvi amputirao nogu iz pomogle su nekim drugim ljudima prilikom osniva- kuka 1803. godine. Takođe je interesantan podatak da nja organizacije Crvenog krsta. Tokom kratkog mira je 1810. godine izveo uspešnu mastektomiju kod jed- posle italijanske kampanje, postaje profesor hirurgije ne žene i to bez anestezije [9-12]. u vojnoj bolnici u Val de Graseu (Val-de-Grace), gde se i danas nalazi njegova statua [3,6-8]. Odanost Napoleonu Vojničko doba Od egipatskog pohoda, preko bitke kod Austerli- ca (1805), pa sve do ruskog pohoda (1812), baron La- Dominik Larej je dao velik doprinos medicini, pa rej pratio je Napoleona kroz sve njegove ratne poho- ga Napoleon imenuje za glavnog šefa svih medicin- de. Pri tome je učestvovao u preko 60 većih bitaka i skih trupa tokom priprema za egipatsku kampanju 400 manjih angažmana. Za to vreme je bio triput ra- (1798—1799). Tokom egipatskog pohoda, Larej neu- njavan. Kad je Napoleon abdicirao, i baron Larej se morno radi, pa formira vojne bolnice u Egiptu, Su- povukao, da bi se ponovo vratio u Napoleonoj za- danu, Siriji i Palestini. Zapisano je da su uprkos teš- dnjoj kampanji (takozvana kampanja 100 dana). kom terenu njegovi leteći saniteti uspevali da sakupe Tada je učestvovao u bici kod Vaterloa, gde je zaro- povređene za manje od 15 minuta od momenta ra- bljen i osuđen na smrt. Tokom bitke je prepoznat, pa njavanja. Ovde nije pokazao samo veliku uspešnost je engleski vojskovođa vojvoda Velington (Duke of u adminstrativnom organizovanju, već je i lično Wellington) naredio svojim vojnicima da ne pucaju izveo preko 70 amputacija i nekoliko trepanacija lo- na stranu gde se nalazi Larej, znajući za njegove Med Pregl 2011; LXIV (1-2): 97-100. Novi Sad: januar-februar. 99 je nekoliko knjiga koje su doživele mnoga izdanja i prevode na mnoge jezike. Objavio je sledeće knjige: Mémoire sur l’ophthalmie régnante en Égypte. Cairo, An IX (1800—1801); Relation historique et chirurgicale de l’expédition de l’armée d’Orient en égypte et en Syrie. Paris 1803, prevedena na engleski i nemački; Dissertation sur les amputations des membres à la suite des coups de feu, étayée de plusieurs obser- vations. Novo izdanje, 1808; Mémoires de chirurgie militaire, et campagnes. 4 volumes, Paris, J. Smith and F. Buisson, 1812—1817. Za sobom je ostavio sina, barona Feliksa Ipolita Lareja, koji je takođe bio uvaženi hirurg. Nažalost, zbog svojih političkih opredeljenja o nje- Slika 4. Statua barona Lareja u Val de Graseu mu se neopravdano malo zna, mada ga mnogi istori- Fig 4. Baron Jean Larrey statue in the Val-de-Grace čari svrstavaju u red s hemičarem Lavoazijem (Antoi- ne Lavoisier) i lekarima Giljotinom (Joseph Guillotin) etičke postupke da spasava živote svih vojnika, bez ob- i Marom (Jean Paul Marat). Koliko ga je Napoleon ce- zira na kojoj se strani bore. Kada je zarobljen i čekao na nio govori to što mu je u nasledstvo ostavio 100 000 izvršenje smrtne kazne, prepoznali su ga njegovi učeni- zlatnih franaka s posvetom: „Ako vojnici ikom treba ci, lekari iz Val de Grasea, koji su bili u pruskoj vojsci.
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