Where was he wounded? Pushkin's death - interesting facts. My idea of ​​the diagnosis

For more than a century and a half, the wound and death of Alexander Pushkin have been discussed in the press, including medical press. Let's try to look at the gunshot wound and the actions of our colleagues in 1837 from the perspective of modern surgery.

Discussions continue

It seems to me that the ongoing discussions related to the death of A. S. Pushkin are due to the personality of the deceased patient; circumstances surrounding injury and death; lack of certainty regarding the nature of the injury, autopsy data and cause of death; inconsistency of medical assessments during treatment in subsequent years; accusations from society against attending physicians for allegedly making mistakes (including intentional ones). Accusations against doctors continue to this day. In 1944, the writer Vladimir Nabokov, in an article dedicated to N.V. Gogol, wrote the following: “15 years earlier (before Gogol’s treatment - I.G.), doctors treated Pushkin, wounded in the stomach, like a child suffering from constipation. At this time, mediocre German and French doctors were still in charge, and the wonderful school of great Russian doctors was just beginning.”
The most fruitful year for discussion was 1937, when articles by many well-known scientific specialists were published. Accusations of deliberate actions by doctors who treated the poet were contained, for example, in articles by Dr. G. D. Speransky and journalist V. Zakrutkin from Rostov-on-Don. The latter agreed to the point that he directly wrote: “He (N.F. Arendt. - I.G.) knew that Pushkin’s death would please the Tsar.”

In 1966, the newspaper Nedelya published an article by Pushkin scholar B. S. Meilakh, “Duel, wound, treatment of Pushkin,” which also condemned the incorrect actions of the doctors who treated the poet, and even proposed holding a “trial of history” with the participation of specialists!
In 1987, and again in the Nedelya newspaper, journalist A. Gudimov published the article “After the duel. The story of one mistake that has not yet been corrected.” This article provides an interesting fact that provides, to some extent, an answer to the forecast about Pushkin’s survival if he received a similar injury in the 20th century. In 1937, a certain A. Sobol, near the Pushkin monument in Moscow, inflicted a gunshot wound on himself in the area where the great poet was wounded. The victim was taken to the Sklifosovsky Institute, where he died, despite modern medical measures.

Perhaps, of all the materials that have been published over the past years, the chapter devoted to Pushkin’s wounding in the book by Sh. I. Uderman “Selected Essays on the History of Russian Surgery of the 19th Century” (Publishing House “Medicine”, L., 1970) aroused my greatest confidence ). The author uses and cites many documents and letters, published statements about the long-standing tragedy and, without imposing his point of view, allows him to judge what happened for himself.

Diary of medical history

Based on the documents I have read, we can talk about four diagnostic options: 1) Gunshot wound of the abdominal cavity with damage to the pelvic bones and femoral vein, complicated by external-internal bleeding. 2) Gunshot wound of the abdominal cavity, intestines and pelvic bones, complicated by external-internal bleeding and peritonitis. 3) Gunshot wound of the abdominal cavity with damage to the pelvic bones and the development of gas gangrene. 4) Gunshot injury to the abdominal cavity, pelvic bones, complicated by thrombosis of large pelvic veins.
Supporters of all versions fully agree that the gunshot wound damaged the abdominal cavity and pelvic bones. The controversy concerns the complications caused by the injury and the cause of death associated with this complication.

Four points of view have been expressed on complications and cause of death:

● bleeding and blood loss;
● peritonitis (inflammation of the peritoneum);
● blockage and inflammation in large veins, that is, thrombophlebitis;
● gas gangrene developed at the wound site.

There are three points of view on the implementation of therapeutic measures: 1) The treatment was carried out correctly and corresponded to the level of development of medicine, and in particular, surgery of that time. 2) The treatment was carried out incorrectly and even deliberately incorrectly, since there were instructions from the Tsar and Benckendorff. 3) The treatment was carried out correctly, but mistakes were made that influenced the outcome of the treatment.

In order to formulate your professional understanding of both the diagnosis and the treatment being carried out, it is advisable to provide a diary of the medical history left to us by contemporary eyewitnesses.

Pushkin received a gunshot wound during a duel with Dantes on January 27, 1837 at 16:00. The place of the duel was located seven and a half miles from the house where the poet lived.

Dantes shot first from a distance of 11 steps (about 8 meters).

The diameter of the bullet is 7–8 mm, it hit the right iliac region, 5.8 cm medially (?) from the anterosuperior iliac spine.

Immediately after being wounded, Pushkin fell forward on his left side, but then stood up and wanted to fire his shot. He shot while sitting and caused a slight wound to the enemy in the arm. After his shot, Pushkin again fell face down into the snow, and was unconscious for several minutes, his face and hands were pale, with a “widened look.” Gradually he regained consciousness. I could not move independently.

The poet is dragged by the overcoat to the sleigh, his clothes are bloody, and there is also blood on the snow trail. He is carried by hand and placed in a sleigh, and then the sleigh is dragged to the road and transferred to a carriage.

They take you sitting for an hour. I am worried about severe pain in the area of ​​the wound, excruciating nausea, short-term loss of consciousness, due to which I had to stop. They carried me into the house by hand.

January 27, 18–19 hours (2–3 hours after the wound). Somewhat excited, he himself changed into clean underwear, bleeding from the wound continues. Pronounced thirst, willingly drinks cold water. The pulse is frequent, weak, extremities are cold.

January 27, 19–23 hours (3–7 hours after injury). Abdominal pain increases. Periodically falls into oblivion.

January 27, 23 hours, until 3 hours January 28 (7–11 hours after the wound). Periodically screams from stomach pain.

January 28, 3–7 hours (11–15 hours after injury). The pain in his stomach increases sharply, so much so that he wants to shoot himself. N. F. Arendt gives an enema (“cleansing”) after which the condition sharply worsens: “wild gaze”, eyes seem to be popping out of their sockets, cold sweat, cold extremities, pulse cannot be detected. Pushkin groans, but his consciousness remains, he says goodbye to his wife and children.

January 28, 7–11 a.m. (19 hours after injury). The condition is serious, he takes henbane extract with calomel, bloating persists, but the pain has decreased, the extremities are cold, the pulse is barely palpable, consciousness is preserved.

January 28, 11–12 hours (19–20 hours after the wound). Arendt gives opium drops. Pushkin calms down somewhat and talks with Arendt.

January 28, 12–14 hours (20–22 hours after injury). He feels better, his hands are warmer, his pulse can be detected and its quality has improved, and “softening poultices” have been applied to his stomach. Pushkin became more active, he himself helps to put “poultices”.
January 28, 14–17 hours (22–25 hours after the wound). He suffers less, but his condition remains serious. Dahl came and wrote down: “The pulse is extremely small, weak and frequent.” Uses cherry laurel water with calomel. Pushkin is more or less calm, but there is a fear of death.

January 28, 17–18 hours (25–26 hours after injury). Slight general fever. Pulse 120, full, hard. Anxiety increased. Dahl believes that inflammation has begun to form. They placed 25 leeches on my stomach.

January 28, 19–23 hours (27–31 hours after injury). State of weakness. The fever subsided, the stomach and skin evaporation subsided. The pulse became smoother and softer. They gave me castor oil. I can’t sleep, the feeling of melancholy, the pain continues. Frequent intermittent breathing. Moans quietly. Consciousness is preserved.

January 28, 24 hours until 12 noon January 29. (32 – 44 hours after injury). The pulse drops every hour. General exhaustion (adynamia - I.G.). The face has changed, the hands have cooled, the feet are warm. Due to weakness he has difficulty speaking. Feeling of longing.

January 29, 12–14. 45 (44–46 hours 45 minutes after injury). My hands were cold up to my shoulders. Frequent, jerky breathing is replaced by drawn-out breathing. State of oblivion, dizziness, confusion. Visual hallucinations. Enlightenment with a clear mind. Said: “It’s hard to breathe.”

A total of 46 hours and 15 minutes have passed since the injury.

The autopsy of A. S. Pushkin’s body was performed at home by doctors I. T. Spassky and V. I. Dahl.

My idea of ​​the diagnosis

Open gunshot fracture of the right ilium and sacrum, damage to the pelvic muscles and pelvic vessels. External-internal bleeding (approximate blood loss is about 2 liters of blood). Septic peritonitis. The amount of damage and complications is quite sufficient for death at the level of medicine of the first third of the 19th century.

How was the treatment carried out?

Therapeutic measures: cold lotions on the stomach in the first hours; cold drink; enema; henbane extract with calomel inside; drops of opium tincture inside; “softening” (warm) poultices for the stomach; leeches to the stomach; castor oil (inside).

In the very first hours, Pushkin was told that the wound was fatal.

Who took part in the treatment of A.S. Pushkin?

The first to examine Pushkin, about two hours after the injury, were Professor B.V. Scholz, a famous obstetrician-gynecologist, and Doctor of Medical Sciences K.K. Zadler. Scholz, answering A. S. Pushkin’s question about whether his wound was fatal, replied: “I consider it your duty not to hide this, but we will hear the opinions of Arendt and Salomon, for whom we have been sent.” Scholz only changed the bandage on the wound and did not take part in the treatment.

Nikolai Fedorovich Arendt. At the time of Pushkin’s injury, he was 51 years old; he had been the personal physician of Emperor Nicholas I since 1829. He enjoyed great authority in society and medical circles. Arendt supervised the entire treatment of Pushkin from the moment of his arrival until his death.

Academician Ivan Timofeevich Spassky, 42 years old. An excellent and very authoritative doctor, the family doctor of the Pushkin family. Almost all the time (with the exception of a few hours of rest, when he was replaced by the doctor of medicine E.I. Andrievsky), he was with the wounded Pushkin, carrying out the orders of N.F. Arendt. Together with V.I. Dahl, he performed an autopsy on the body of A.S. Pushkin.

Vladimir Ivanovich Dal, 36 years old, graduate of Dorpat University. He defended his doctoral dissertation in surgery and successfully participated as a surgeon in the Turkish War of 1828. They wrote about him as a jack of all trades and a deft operator. He took part in the treatment of A. S. Pushkin from noon on January 28, followed the instructions of N. F. Arendt, participated in the autopsy of Pushkin’s body, kept a medical history diary, and wrote an autopsy report.

Professor Khristiin Khristianovich Salomon, 41 years old. An excellent surgeon, one of the first in Russia to use ether anesthesia. During the treatment of Pushkin, he spoke only once, advising N. F. Arendt during the first examination of the wounded Pushkin.

Doctor of Medicine Efim Ivanovich Andrievsky, 51 years old. A well-known and respected doctor in St. Petersburg. He remained with the wounded man during I. T. Spassky’s short rest.

Academician Ilya Vasilievich Buyalsky, 48 years old. One of the largest domestic surgeons. Consulted N. F. Arendt regarding Pushkin’s injury.

Thus, we can say that the entire flower of Russian medicine of that time took part in the treatment of A.S. Pushkin.

Evaluation of treatment measures

From the point of view of modern medicine, opium was used late. According to I.T. Spassky, who was on duty at Pushkin’s bedside, he was afraid to prescribe opium, since Pushkin fell into oblivion, and opium could hasten the death. The enema used by N. F. Arendt caused shock in the wounded man and sharply worsened his condition. The doctor, when prescribing an enema, did not expect injury to the sacral bone, and the enema was at that time one of the most common therapeutic procedures for peritonitis, which was suspected in Pushkin. Dr. Malis in 1915 accused doctors of using enemas, and Dahl of wanting to shield his colleagues from using them.

Prescribing simultaneously two drugs, opium and calomel, according to two famous domestic surgeons V.A. Shaak and S.S. Yudin, was inappropriate, since their action is antagonistic. However, according to pharmacologists, in the doses in which these drugs were given to A.S. Pushkin, they should have strengthened each other.
Dr. Rodzevich in 1899 reproached the attending physicians for prescribing leeches, which weakened the patient’s condition. We can agree with him, but for that time the use of leeches was the main thing in the treatment of peritonitis.

A number of publications expressed complaints against Professor Scholz for a truthful answer to A.S. Pushkin’s question about the unfavorable outcome of the injury. I think that in those days, telling the truth to a patient about his illness and outcome was the norm of behavior, as is the case today in most countries.

And, finally, there were statements about the useless probing of the wound, allegedly performed by Dr. Zadler. There is no documented evidence of this manipulation.

Conclusion

I believe that from the perspective of the development of medicine in the first half of the 19th century, A.S. Pushkin was treated correctly, although some confusion among doctors was visible, due to the personality of the patient.

Published in abbreviation. The full text was published in the book by I.N. Grigovich "Time to collect stones." - Petrozavodsk University Publishing House, 2002.

"Lyceum" No. 2 2003

It is easiest to determine the location of a wound when shooting with a bullet, therefore, in large animals such as elk, deer, wild boar, and bear, especially in long-legged ungulates. When shooting with buckshot, especially shot, it is much more difficult to determine where an animal or bird is wounded for the reason that they can receive several minor wounds. In the same way, the wound is significantly complicated and becomes much more severe when fired with an express, especially explosive, bullet, which knocks down the animal even if it does not hit a particularly lethal place. Usually the animal falls as if struck by thunder, killed on the spot when the charge hits the heart or spinal cord.

An experienced hunter will always be able to determine whether an animal (and a bird) is wounded and where exactly, even if no blood is seen, by the following signs:

If an animal falls after a shot and, jumping up, quickly leaves, this means that the bullet (or buckshot) only stunned the animal, hitting it either in the vertebra, sliding along the forehead, or in the lower part of the horn.

If the animal makes a big leap with its front legs or hind legs, or all four, it is wounded in the lungs or liver. At the same time, he speeds up his run, separates from the herd (hoofed animals), pokes into the bushes, but soon slows down and falls dead, 100 steps away or more. If the lungs are slightly injured, the animal moves on and should not be immediately pursued.

An animal wounded in the stomach shudders violently and quickly leaves, but soon slows down and runs hunched over.

Wounded in the front leg, he falls, but immediately jumps up and runs on three legs very quickly. In the back - he settles on his butt, but immediately jumps up and leaves, but not quickly.

In wolves and foxes, it is more difficult to determine the location of the wound than in large, especially hoofed animals. The mortally wounded wolf and fox poke their noses into the ground. Those wounded in the stomach or butt quickly turn around and bite the wounded area. If a wounded fox squeals, it means that its leg bone is broken. An uninjured fox sometimes rolls over and swings the pipe several times.

A hare wounded in the back or the back of the head begins to somersault, and in the lungs it jumps high to the side.

A wounded bird usually shudders and flaps its wings incorrectly, flies away from the flock and lands separately. Wounded in the head - rises up; to the back of the back - flies with legs down; in the legs - too; into the wing - flies along an inclined line with convulsive movements of the wings.

The bloody trail of an animal can always indicate much more accurately where the shell hit.

A very bloody trail at first, getting smaller and finally stopping, means that the bullet hit the soft parts of the backside, neck or chest, i.e. a minor wound.

If a bullet hits the leg, then there is a lot of red blood on the right or left side of the mark. This means a slight wound.

Light blood splashed on the sides, on the contrary, serves as a sign of a serious wound, since this means that the bullet hit the lungs and the animal is coughing it up.

There is blood on both sides - the wound is through. Such a wound is less severe than if blood (black) flows only on one side, since this means that the bullet remains in the animal.

Dark blood in small quantities and dried - the bullet hit the chest and touched the insides.

Dark, almost black, blood mixed with feces is evidence that the bullet entered the intestines.

Blood alternating on the right or left side means the bullet hit the head or the front of the neck.

The blood all over the trail in chunks of almost black color shows that the animal was very seriously wounded in the main internal organs and that blood poured down its throat.

In addition, the position of the wound can be recognized by the height of the bloody branches in the path of the animal. Also, from the bed of a wounded animal, it is not difficult to find out where the bullet hit, because the blood coming out of the wound indicates on the bed exactly where it hit. The irregularity of the track, even without blood, can serve as evidence of the wound of the beast, which is why it is necessary to carefully examine the track along the white throne: an animal wounded high in the shoulder blade throws up one of its front legs, draws it across the snow, runs unevenly and loses its run, widens hooves (elk and other hoofed animals). Finally, in winter, one can conclude that the animal is injured based on the location of the buckshot in the snow, in relation to the track. It is also necessary to look to see if there is any fur in the place (in the snow) where the animal was at the time of the shot, because the bullet, having hit the animal, cuts off the fur, which falls to the ground.

On April 28, 1813, in the city of Bunzlau (Prussia), Field Marshal General, the first full holder of the Order of St. George, commander-in-chief of the Russian army during the Patriotic War of 1812, Mikhail Illarionovich Kutuzov, died.

The commander's father, Illarion Matveevich, was a major military engineer, lieutenant general, and senator. He took part in the Russian-Turkish War of 1768-1774, commanding engineering and mining detachments of the Russian army. His son Mikhail was educated at home from the age of 7. In June 1759 he was sent to the Noble Artillery and Engineering School. In February 1761 he graduated with the rank of engineer-ensign and was left at the school to teach mathematics to students. His service to the Motherland lasted more than 50 years. Mikhail Illarionovich not only took part in hostilities, he was also a diplomat and military governor.

In 1774, in a battle near the village of Shuma near Alushta, the Turks killed 300 people, the Russians lost 32 people. A large number of wounded on both sides. Among the wounded was Lieutenant Colonel Kutuzov: “This staff officer received a wound from a bullet, which, having hit him between the eye and temple, came out in the same place on the other side of the face.” The bullet hit the commander in the left temple, exited near the right eye, but did not hit him. He was operated on. Doctors considered the wound fatal. However, Mikhail Illarionovich recovered, although the recovery process was long.

On August 18, 1788, during the siege of the Ochakov fortress, Kutuzov was again seriously wounded in the head. A rifle bullet hit Mikhail Illarionovich in the cheek, approximately in the same place where he was wounded in 1774. The bloodied and bandaged commander continued to give orders. From heavy loss of blood he felt weak and was carried from the battlefield. In a letter to the Austrian Emperor Joseph, Prince de Ligne wrote: “Yesterday they shot Kutuzov in the head again. I believe he will pass away today or tomorrow.” Contrary to predictions, Mikhail Illarionovich survived and served his Fatherland faithfully for many more years.

Currently, modern historians have two versions about the commander’s injury. These versions are not new. In 1813, a collection of documents “The Life and Military Exploits of Field Marshal General His Serene Highness Prince Mikhail Illarionovich Golenishchev-Kutuzov of Smolensky” was published. The first version of the commander’s injury is stated there: “... the bullet entered the cheek and went right through to the back of the head...” A.V. Suvorov wrote: “... the bullet hit him in the cheek and flew out into the back of the head. He fell. Everyone expected the wound to be fatal. But Kutuzov not only remained alive, but even soon entered the military ranks.”

In 1814, the first biographer of the commander, F. Sinelnikov, published a multi-volume biography of Kutuzov. In it, he outlined the second version of the wounding of Mikhail Illarionovich: “The bullet went right through from temple to temple behind both eyes. This dangerous end-to-end breakthrough of the most delicate parts and the most important in position of the temporal bones, eye muscles, optic nerves, past which the bullet passed by a hair's breadth and past the brain itself, after healing, did not leave any other consequences, except that one eye was slightly askew.”

Specialists from the Military Medical Academy and the Military Medical Museum M. Tyurin and A. Mefedovsky wrote an article “On the wounds of M.I. Kutuzov,” published in 1993. They analyzed the surviving materials and confirmed the second version about the commander’s injury. Both the first and second wounds were extra-cerebral, otherwise, of course, he would not have been able to serve in the army for almost 40 years.

Here is the diagnosis of modern researchers about the commander’s wound: a double tangential open non-penetrating cranial wound, without violating the integrity of the dura mater; compression-concussion syndrome, increased intracranial pressure.

In 1804, Russia joined the coalition of countries participating in the fight against Napoleon. In 1805, two Russian armies were sent to Austria, one of which was commanded by Mikhail Illarionovich. At the Battle of Austerlitz, Russian and Austrian troops were defeated by Napoleon, and Kutuzov was wounded in the cheek. The third time...

Among Alexander I's entourage, Mikhail Illarionovich had many ill-wishers who could not forgive him for the surrender of Moscow to Napoleon, the chosen tactics of action, and the slowness, in their opinion, in the fight against the enemy. After Napoleon was expelled from Russia, Kutuzov's powers began to decline. Although the commander was awarded the Order of St. George, 1st degree, “For defeats and expulsion of the enemy outside Russia.”

Kutuzov died on April 28, 1813. The possible cause of death was pneumonia. On April 6, 1813, the commander and Emperor Alexander I, on the way to Dresden, arrived in the city of Bunzlau. It was sleeting and raining, Kutuzov was driving in an open droshky and caught a cold. The next day his condition worsened. The emperor went to Dresden alone. Kutuzov could still read reports and give orders. But his strength was running out...

Modern military historian A. Shishkin writes: “The imperial physician Billie and the local doctor Bislizenus, the next day after death, performed an autopsy and embalming of the body of the deceased, which was placed in a zinc coffin, at the head of which they placed a small cylindrical silver vessel with an embalmed the heart of the Savior of the Fatherland." On June 11, the funeral ceremony of the commander took place in the Kazan Cathedral. The coffin was lowered into a specially prepared niche in the central hall of the Kazan Cathedral.

Andrey VUKOLOV, historian.
Moscow.

How often during the times of Tsarist Russia, disputes among people of the noble class were resolved by a duel! And this is all - despite the decree of Peter I of January 14, 1702 banning this kind of fights for the sake of preserving honor and dignity (as if there were no other options to talk “like a man”). However, such a burden fell on the lot of the hot-blooded young people of the “Golden Age”.

Which “victim” do we remember first? Naturally, Alexander Sergeevich Pushkin. And, naturally, almost everyone familiar with his fate had the question: “Was it possible to save him?” What would a modern doctor say about Pushkin’s case, how would he describe the condition and what treatment would he prescribe? Let’s figure this out - using the wonderful work of Mikhail Davidov “The Duel and Death of A.S. Pushkin through the eyes of a modern surgeon."

Over the centuries, many inquisitive minds have studied the numerous documents remaining after the duel, related both to the notes of eyewitnesses and to the notes of the great poet’s healers, among whom were the best doctors of St. Petersburg.

Here is what they write about Alexander Sergeevich’s health and his lifestyle: “At the time of his injury in a duel, Alexander Sergeevich was 37 years old, had average height (about 167 cm), a regular physique without signs of obesity. As a child, he suffered from colds and minor soft tissue bruises. In 1818, for 6 weeks, Alexander Pushkin suffered a severe infectious disease with a prolonged fever, which the attending physicians called “rotten fever.” Over the next two years, relapses of fever appeared, which completely stopped after treatment with quinine, which gives reason to assume that Pushkin suffered from malaria...

The poet led a healthy lifestyle. In addition to long walks on foot, he rode a lot, successfully practiced fencing, swam in the river and sea, and used ice baths for hardening.
We can conclude that by the time of the duel Pushkin was physically strong and practically healthy.”

The day of the duel was approaching...

Wednesday morning, January 27, 1837 (or February 8, new style). “I got up cheerfully at 8 o’clock - after tea I wrote a lot - an hour before 11. From 11 lunch. - I walked around the room unusually cheerfully, sang songs - then I saw Danzas through the window (note: second), greeted him joyfully at the door. - We entered the office and locked the door. - A few minutes later he sent for pistols. - After Danzasa left, he began to get dressed; washed all over, everything was clean; ordered the bekesh to be served; went out onto the stairs, returned, ordered a large fur coat to be brought into the office and walked on foot to the cab driver. “It was exactly at 1 o’clock.” (from the notes of Pushkin’s friend, poet V.A. Zhukovsky, about Alexander Sergeevich’s last day before the duel)

... The place of the duel. “Wrapped in a bear fur coat, Alexander Sergeevich sat in the snow and looked at the preparations with detachment. What was in his soul, only God knows. At times he showed impatience, turning to his second: “Is everything finally over?” His opponent, Lieutenant Dantes, a tall, athletic man, an excellent marksman, was outwardly calm. The psychological state of the opponents was different: Pushkin was nervous, in a hurry to end everything as quickly as possible, Dantes was more collected, calmer.”

...It was 5 o'clock in the evening.

“The seconds marked the barriers with their overcoats, loaded their pistols and took the opponents to their starting positions. There they were given weapons. The tension reached its climax. The deadly meeting of two irreconcilable opponents has begun. At a signal from Danzas, who drew a semicircle in the air with his hat held in his hand, the rivals began to approach each other. Pushkin quickly walked towards the barrier and, turning his body slightly, began aiming at Dantes’ heart. However, it is more difficult to hit a moving target, and, obviously, Pushkin waited for the opponent to finish approaching the barrier and then immediately fire a shot. Cold-blooded Dantes unexpectedly shot on the move, not reaching 1 step from the barrier, that is, from a distance of 11 steps (about 7 meters). It was convenient for him to aim at Pushkin, who was standing still. In addition, Alexander Sergeevich had not yet completed the classic half-turn, adopted during duels in order to reduce the sighting area for the enemy, his hand with the pistol was extended forward, and therefore his right side and lower abdomen were completely unprotected.” It was this position of Pushkin’s body that caused the peculiar wound channel.

Bright flash. Pushkin was blinded for a moment and at the same second felt a blow to his side and something shooting forcefully into his lower back. The poet’s legs could not withstand such a sharp impact and the weight of his own body, he collapsed on his left side face-first into the snow, briefly losing consciousness. However, as soon as the seconds and Dantes himself rushed to look at the consequences of the shot, Pushkin woke up and sharply shouted that he still had enough strength to make his shot. With an effort, he rose and sat down, briefly noticing with his blurred gaze that his shirt and overcoat were soaked with something scarlet, and the snow under him had turned red. I took aim. Shot.

the vest in which Pushkin shot himself

“The bullet flying from the seated Pushkin to the tall Dantes, who was standing with his right side forward, along a trajectory from bottom to top, was supposed to hit the Frenchman in the area of ​​the left lobe of the liver or the heart, but pierced his right hand, with which he covered his chest, causing a through bullet wound to the middle third of the right forearm, changed direction and, causing only a contusion of the upper part of the anterior abdominal wall, went into the air. Dantes’s wound, therefore, turned out to be not severe, without damage to bones and large blood vessels, and subsequently healed quickly...” What happened then?

Help for the poet and transportation.

According to Danzas’s recollections, at the site of the duel, blood flowed “like a river” from Pushkin’s wound; it soaked his clothes and stained the snow. He also noted the pallor of the face, hands, and “widened gaze” (dilated pupils). The wounded man regained consciousness on his own. The gravest mistake of the poet’s second was that he did not invite the doctor to the duel, did not take the means for bandaging and medicine, therefore, no one did first aid and at least a small bandage. Danzas justified this by the fact that “he was taken as a second several hours before the duel, time was running out, and he did not have the opportunity to think about first aid for Pushkin.”

Pushkin, while conscious, could not move independently due to shock and massive blood loss. There was no stretcher or shield. “The patient with a damaged pelvis was lifted from the ground and first “dragged” to the sleigh, then they were laid on an overcoat and carried. However, this turned out to be impossible. Together with the cab drivers, the seconds dismantled the fence made of thin poles and brought up the sleigh. All the way from the place of the duel to the sleigh there was a bloody trail in the snow. The wounded poet was put in a sleigh and driven along a shaking, bumpy road.” What did you achieve in this way? That's right, worsening shock.

The volume of blood loss, according to the calculations of doctor Sh.I. Uderman, amounted to about 2000 ml, or 40% of the total volume of blood circulating in the body. Nowadays, gradual blood loss of 40% of the volume is not considered fatal, but then... All means for restoring lost blood masses have not yet been developed.
It is impossible to imagine the degree of anemia in Pushkin, who did not receive a single milliliter of blood. Undoubtedly, blood loss sharply reduced the adaptation mechanisms of the poor organism and accelerated the death outcome from the septic complications of the gunshot wound that later developed.

At home…

“Already in the dark, at 18 o’clock, the mortally wounded poet was brought home. This was another mistake by Danzas. The wounded man had to be hospitalized. Perhaps, on the way, the poet really expressed a desire to be taken home. But he, periodically being in an unconscious state, in deep faints, for some time having difficulty getting out of them, was still not capable of a clear assessment of what was happening. That Pushkin was hopeless and they did not operate on him cannot serve as an excuse for the second, because Danzas could not have known this on the way. Observing severe bleeding, frequent fainting and the serious condition of the wounded man, Danzas didn’t even have to ask Pushkin where to take him, but make the right decision himself and insist on it!” - says Davydov.

Finding a surgeon in evening St. Petersburg is not an easy task. However, Fate itself intervened - Danzas met Professor Scholz on the street. Yes, he was not a surgeon, but an obstetrician, but it was still better than nothing. He agreed to examine Alexander Sergeevich and soon arrived with surgeon K.K. Zadler, who by that time had already managed to help Dantes! (such a vicissitude: he was slightly wounded, but help “came” earlier).

“Professor of Obstetrics Scholz, after examining the wound and dressing it, had a private conversation with the wounded man. Alexander Sergeevich asked: “Tell me frankly, how did you find the wound?”, to which Scholz replied: “I cannot hide to you that your wound is dangerous.” To Pushkin’s next question whether the wound was fatal, Scholz answered directly: “I consider it your duty not to hide this, but we will hear the opinions of Arendt and Salomon, for whom we have been sent.” Pushkin said: “Thank you for telling me the truth as an honest man... Now I’ll take care of my affairs.”

Finally (less than a few hours had passed), the seriously wounded poet was deigned to be visited by the urgently invited life physician N.F. Arendt and the Pushkin family’s home doctor I.T. Spassky.
Then many doctors took part in the treatment of the wounded Pushkin (H.H. Salomon, I.V. Buyalsky, E.I. Andreevsky, V.I. Dal), but behind the scenes it was Arendt, as the most authoritative among them, who supervised the treatment. Everyone listened to his opinion.

Some researchers believe that the actions of Arendt and Scholz, who told Pushkin about the incurability of his illness, contradicted medical ethics, because they contradicted the principle developed over centuries according to one of the rules of Hippocrates. It reads: “Surround the sick person with love and reasonable consolation; but most importantly, leave him in the dark about what awaits him, and especially about what threatens him.” It must be said that there are still disagreements between doctors in matters of deontology, but the patient still has the right to know about his diagnosis, no matter how disappointing it may be.

“Arendt chose a conservative tactic for treating the wounded, which was approved by other famous surgeons, H.H. Salomon, I.V. Buyalsky and all the doctors, without exception, who took part in the treatment. No one offered to operate, no one tried to pick up a knife themselves. For the level of development of medicine at that time, this was a completely natural solution. Unfortunately, in the 30s of the 19th century, those wounded in the stomach were not operated on. After all, science did not yet know asepsis and antiseptics, anesthesia, X-rays, antibiotics and much more. Even much later, in 1865, N.I. Pirogov in “The Beginnings of General Military Field Surgery” did not recommend opening the abdominal cavity to those wounded in the abdomen in order to avoid the development of inflammation of the peritoneum (peritonitis) and death.”

Wilhelm Adolfovich Shaak in the article “Wound of A.S. Pushkin in modern surgical coverage” from the Bulletin of Surgery in 1937 accuses doctors of giving the patient an enema, giving a laxative and prescribing oppositely acting drugs (calomel and opium). However, in the surgical manual of Professor Helius, published in 1839, measures such as poultices, castor oil, calomel, enema were recommended for the treatment of wounded in the abdomen, that is, in the 30s of the 19th century, these remedies were generally accepted for the treatment of such diseases.

From the chronicles:

“At 19:00 on January 27, the wounded man’s condition was serious. He was agitated, complained of thirst (a sign of ongoing bleeding) and asked for a drink, and was tormented by nausea. The pain in the wound was moderate. Objectively noted: the face is covered with cold sweat, the skin is pale, the pulse is frequent, weak, and the extremities are cold. The bandage that had just been applied was quite intensively soaked in blood and was changed several times.

On the first evening after the wound and on the night of January 28, all treatment consisted of cold drinks and applying ice packs to the stomach. Doctors tried to reduce bleeding with these simplest means. The patient's condition remained serious. Consciousness was mostly clear, but short-term periods of “forgetfulness” and unconsciousness arose. He drank cold water willingly. Complaints of thirst, nausea, gradually increasing abdominal pain. The skin remained pale, but the pulse became slower than in the first hours after the injury. Gradually the bandage stopped getting wet with blood. At the beginning of the night they became convinced that the bleeding had stopped. The tension between doctors and caregivers eased somewhat.

“At 5 o’clock in the morning on January 28, the pain in the abdomen intensified so much that it was no longer bearable. They sent for Arendt, who arrived very quickly and, upon examining the patient, found obvious signs of peritonitis. Arendt prescribed, as was customary at that time, a “lavage” to “ease and empty the intestines.” But the doctors did not assume that the wounded man had gunshot fractures of the iliac and sacral bones. Turning on the side to perform the enema caused, quite naturally, some displacement of the bone fragments, and the liquid introduced through the tube filled and expanded the rectum, increasing pressure in the pelvis and irritating damaged and inflamed tissue. After the enema, the condition worsened, the intensity of the pain increased “to the highest degree.” The face changed, the gaze became “wild”, the eyes were ready to jump out of their sockets, the body was covered in cold sweat. Pushkin could hardly restrain himself from screaming and only let out moans. He was so irritated that after the enema he refused any treatment offered for the entire morning.”

“On the afternoon of January 28, the wounded man’s condition remained serious. Abdominal pain and bloating persisted. After taking henbane extract and calomel (mercury laxative), there was no relief. Finally, at about 12 o’clock, as prescribed by Arendt, they gave opium drops as an anesthetic, after which Alexander Sergeevich immediately felt better. The intensity of the pain decreased significantly - and this was the main thing in improving the condition of the hopeless patient. The wounded man became more active and cheerful. Hands warmed up. The pulse remained frequent and weakly filled. After some time, the gases passed and spontaneous free urination was noted.”

“By 18:00 on January 28, a new deterioration in the condition was noted. A fever appeared. The pulse reached 120 beats per minute, was full and hard (tense). The abdominal pain became “more noticeable.” My stomach is bloated again. To combat the developed “inflammation” (peritonitis), Dahl and Spassky (with the consent and approval of Arendt) placed 25 leeches on the stomach. Pushkin helped the doctors, caught and administered leeches with his own hand. After using leeches, the fever decreased.”

From the use of leeches, the patient lost, according to Uderman's calculations, about another 0.5 liters of blood and, thus, the total blood loss from the moment of injury reached 2.5 liters (50% of the total volume of blood circulating in the body). There is no doubt that by the time leeches were prescribed, severe anemia had already occurred. The improvement turned out to be fleeting, and soon Alexander Sergeevich became even worse.

From the description of the poet’s friends, “the face has changed, its features have sharpened (“the face of Hippocrates,” typical of inflammation of the abdominal cavity). A painful grin of teeth appeared, lips twitched convulsively even during short-term oblivion. There were signs of respiratory and cardiovascular failure. Breathing became frequent, jerky, there was not enough air (shortness of breath). The pulse was barely noticeable."

Despite the severity of the condition, there was no doubt about it, the treatment tactics remained unchanged. The patient was still given cherry laurel water, calomel and opium.

Last hours

“On the morning of January 29, the condition became critical, pre-agonal. “General exhaustion took over.” Doctor Spassky, who came to the apartment early in the morning, was amazed at the sharp deterioration in the patient’s condition and noted that “Pushkin was melting away.” A council of doctors consisting of Arendt, Spassky, Andreevsky and Dahl unanimously agreed that the agony would soon begin. Arendt stated that Pushkin would live no more than two hours. ... The patient’s pulse dropped from hour to hour and became barely noticeable. The hands were completely cold. Frequent, jerky breathing movements were interrupted by pauses (Cheyne-Stokes breathing).”

At 14:45 on January 29, 1837 (February 10, new style), having breathed his last, Pushkin died. Doctor Efim Ivanovich Andreevsky closed the eyes of the deceased.

So what kind of wound did Pushkin have? Read about the autopsy data and anatomy of the wound canal in the article.

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