Sinusitis

Zilber clinical anesthesiology. Clinical physiology of general anesthesia

Anatoly Petrovich Zilber- graduate of the First Leningrad Medical Institute in 1954. The first official anesthesiologist of the Republican Hospital of Karelia (1957). In 1959 he created one of the first ITAR branches in the country. From this year until 2009 - chief anesthesiologist of the Ministry of Health of the KASSR. In 1966, he organized the first independent course in anesthesiology and resuscitation in the USSR (since 1989 - department) at Petrozavodsk State University, and became its head. The course worked according to the original program developed by A.P. Zilber.

Organizer of the first intensive respiratory therapy department in Russia (1989), then a respiratory center (2001). Author of the concept of critical care medicine (MCM) (1989). Currently, Anatoly Petrovich is the head of the Department of Critical and Respiratory Medicine, Doctor of Medical Sciences (1971), Professor (1973), Honored Scientist of the Russian Federation (1989), Academician of the Russian Academy of Medical and Technical Sciences (1997) and the Academy of Security, Defense and Law and Order of the Russian Federation (2007), Honorary Worker of Higher Professional Education of the Russian Federation (2000), Honored Doctor of the Russian Federation, People's Doctor of the Republic of Karelia (2001), Visiting Professor at Harvard and Southern California Universities (USA), Honorary Professor at Khorezm University (Uzbekistan, 2004), Honorary and full member of the Board of the Federation of Anesthesiologists and Reanimatologists of the Russian Federation (2000), Honorary Citizen of Petrozavodsk (2003), Chairman of the Ethics Committee under the Ministry of Health and Social Development of the Republic of Kazakhstan and Petrozavodsk State University.

Author of more than 450 published works, incl. 42 monographs, editor of translations of four manuals on the specialty: J. Duke “Secrets of Anesthesia.” M.: Medpress-inform, 2005. 552 pp.; "Guide to Clinical Anesthesiology", ed. B.J. Pollard. M.: Medpress-inform, 2006. 912 pp.; J.P. Rafmell, D.M. Neal, Cr.M. Viscomi "Regional anesthesia." M.: Medpress-inform, 2007. 272 pp.; P. Marino “Intensive care”. M.: GEOTAR-media, 2010. 900 p. Co-author of the first textbook for medical universities on resuscitation, “Resuscitation and Intensive Care.” M.: Publishing center "Academy", 2007. 400 p. Co-author (with V.I. Bragina) of the monograph “Humanitarian Culture of Medical Education” - the first book on this most important topic of modern education.

Organizer of Petrozavodsk annual educational and methodological seminars of critical care medicine (since 1964). Currently these are international seminars “Silber School. Open Forum”, held under the auspices of the Committee on European Education in Anesthesiology (CEEA) of the European Association of Anesthesiologists (ESA). A total of 50 (!) seminars were held on current issues in critical care medicine. Physicians who have participated in six SEEA seminars are entitled to take the European Diploma in Anesthesiology exam.

A.P. Zilber has repeatedly given lectures in different cities of Russia, as well as in Austria, Sweden, Finland, Israel, Hungary, the USA, Canada and other countries near and far abroad. Currently, using the capabilities of telecommunications, Anatoly Petrovich gives lectures for doctors not only in Russia, but also in other CIS cities. In 2013 alone, the professor gave more than 30 video lectures. A record was given to giving a lecture on problems of medical ethics and law in critical care medicine to 8 different audiences at once - from Moscow to Yerevan and Krasnoyarsk.

Area of scientific interests

Clinical Physiology and Critical Care Intensive Care;
clinical physiology of breathing;
promotion of the humanitarian foundations of training and practice of doctors;
study of the activities of doctors who became famous outside of medicine (so-called medical truthism).

No one in Russia, and perhaps in the world, knows as much about the non-medical activities of doctors as Anatoly Petrovich Zilber knows. He talks about them with pleasure and writes books called "Truent Doctors."

Awards

For his contribution to the development of medical science and practice in Russia, increasing the authority of Russian medicine in the world, A.P. Zilber was awarded the Order of Friendship (1998), Honor (2006), the Order of Hippocrates, medals “For outstanding achievements in resuscitation” (2004), “For strengthening the authority of Russian science" (2007), "A.L. Chizhevsky Gold Medal for professionalism and business reputation" (2008), Lomonosov Medal (2012), gold badge "Ibi Victoria ubi Concordia" ("Where there is agreement, there is victory") (2012), Memorial Medal named after Academician of the Russian Academy of Medical Sciences V.A. Negovsky - “For significant contribution to the development of anesthesiology and resuscitation, aimed at preserving and strengthening human health, and training highly qualified scientific personnel” (2013).

Order "Sampo" (2019)
Certificate of Honor from PetrSU (2016)
Certificate of honor from Petrozavodsk (2015)
Order of Honor (2006)
Honorary title Honorary Citizen of Petrozavodsk (2003)
Honorary title Laureate of the Republic (2001)
Honorary title People's Doctor of the Republic of Kazakhstan (2001)
Honorary title "Honorary Worker of Higher Professional Education of the Russian Federation" (2000)
Honorary title of 100 laureates of the year in Petrozavodsk (1999)
Order of Friendship (1998)
Honorary title Honored Scientist of the Russian Federation (1989)
Honorary title Honored Doctor of the Republic of Kazakhstan (1968)

Publications

Articles (16)

Zilber, A.P. Medical education: creativity or standard? (Etymological excursion [Text] / A.P. Zilber // History of the Medical Institute of PetrSU 2015-2019. - Petrozavodsk, 2019. - P.115-122.
Zilber, A.P. COMMENTARY ON THE ARTICLE by K.A. TOKMAKOVA ET AL. "ENGLISH FOR ANESTHESIOLOGIST AND RESUSCITATOLOGIST: A TRIBUTE TO FASHION OR NECESSITY?" [Text] / A.P. Zilber // Bulletin of Intensive Therapy named after. A.I. Saltanova. - Moscow, 2018. - No. 4. - P.88. (RSCI)
Zilber, A.P. Critical and respiratory medicine needs a humanitarian culture. [Text] / A.P. Zilber // Bulletin of intensive care. - Moscow, 2017. - No. 2. - P.8-11. - ISSN 1726-9806. (RSCI)
Zilber, A.P. How to develop the Federation of Anesthesiologists and Resuscitators of Russia? [Text] / A.P. Zilber // Bulletin of intensive care. - Moscow, 2016. - No. 1. - P.61-67. (RSCI)
Zilber A.P. History of the critical care medicine service (MCS) in Karelia. [Text] / A.P. Zilber, A.P. Spasova, V.V. Maltsev // Current problems of anesthesiology and resuscitation: collection of articles and abstracts. - Svetlogorsk, 2016. - P. 17 - 24. (RSCI)
Zilber, A.P. Iridium from the Greek “Iris” – rainbow [Text] / A.P. Zilber // History of the Medical Institute of PetrSU. - Petrozavodsk, 2015. - P.162-170.
Zilber, A.P. Rationalism in the management of patients with respiratory failure [Text] / A.P. Zilber // Ukrainian Pulmonological Journal. - Kyiv, 2013. - No. 2 (80). - P.20–25. - ISSN 2306-4927. (VAK)
Zilber, A.P. Do we need to find new anesthesia techniques? [Text] / A.P. Zilber // Bulletin of anesthesiology and resuscitation. - 2013. - No. 1. - P.70-71. (VAK, RSCI)
Zilber, A.P. Critical medicine as a modern but unnatural section of healthcare [Text] / A.P. Zilber // Bulletin of intensive care. - Moscow, 2012. - No. 1. - P.4-7.
Zilber, A.P. Correction of metabolism - p. 54-58, Artificial ventilation - p. 58-62, Shock lung syndrome - p. 266-269, Aspiration syndrome - p. 268-269, Hyperthermia and hyperthermic syndromes - p. 302-304, Amniotic embolism - p. 308-310. [Text] / A.P. Zilber // Handbook of anesthesiology and resuscitation. - Moscow: Medicine, 1982.

Biography

Zilber A.P. Clinical physiology in anesthesiology and resuscitation. - 1984. - 486 p.

Zilber A.P. Sketches of critical medicine. - 2006.

Zilber A.P. Ethical and legal problems of blood transfusion. A manual for doctors. - Ministry of Health of the Russian Federation, 2001.

Zilber A.P. Treatise on euthanasia. - Petrozavodsk: Peter. State University, 1998. - 464 p.

Zilber A.P. Ethics and law in critical care medicine. - Petrozavodsk: Petrozavodsk University Publishing House, 1998. - 560 p.

Famous sayings

if the doctor is familiar with modern ideas about the clinical physiology of blood, blood loss and blood transfusion, he will find alternative methods suitable for a particular patient and will do without donor blood transfusion

Notes

Categories:
Personalities in alphabetical order
Scientists by alphabet
Born on February 13
Born in 1931
Born in Zaporozhye
Doctors of Medical Sciences
Knights of the Order of Friendship (Russia)
Knights of the Order of Honor
Honored Scientists of the Russian Federation
Graduates of St. Petersburg State Medical University
Anesthesiologists of the USSR
Anesthesiologists of Russia
Scientists of Karelia
PetrSU teachers

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Head of the Department of Anesthesiology and Resuscitation of Petrozavodsk State University, Chief Anesthesiologist and Reanimatologist of the Ministry of Health of the Republic of Karelia; born 1931; graduated from the 1st Leningrad Medical Institute,... ... Large biographical encyclopedia- Laureates of the Stalin Prize in the field of science Main articles: Laureates of the Stalin Prize in the field of science, Laureates of the Stalin Prize for outstanding inventions Contents 1 List of laureates 1.1 1941 1.2 1942 ... Wikipedia

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GENERAL ISSUES IN ANESTHESIOLOGY

guidelines for 5th year students

Approved

Academic Council of KhNMU

protocol No. ______

from "____" ___________ 2009

Mikhnevich K.G., Khizhnyak A.A., Kursov S.V. etc. General issues of anesthesiology: Method. instructions for 5th year students. – Kharkov: KhNMU, 2009. – p.

Compiled by: assistant Konstantin Georgievich Mikhnevich

Professor Anatoly Antonovich Khizhnyak

Associate Professor Sergei Vladimirovich Kursov

assistant Viktor Aleksandrovich Naumenko

assistant Vitaly Grigorievich Redkin

assistant Nikolay Vitalievich Lizogub

List of abbreviations................................................... ........................................................ .....

1. Brief historical background.................................................... ...............................

2. Clinical physiology of general anesthesia.................................................. .......

3. Classifications of anesthesia.................................................... ....................................

3.1. Classifications of general anesthesia................................................................... ...............

3.2. Classification of local anesthesia................................................................... ..........

4. General anesthesia................................................................. ........................................................ ....

4.1. Single-component general anesthesia................................................................. .......

4.1.1. Stages of ether anesthesia (according to Guedel)................................................... .......

4.1.2. Brief characteristics of the most used general anesthetics.

4.2. Methods of administering inhalational anesthetics. Breathing circuits

4.3. Combined anesthesia................................................................ ......................

4.4. Multicomponent anesthesia................................................................. ...............

4.5. Protocol for general anesthesia.................................................................... ...

4.6. Complications of general anesthesia................................................................. ....................

5. Local anesthesia.................................................... ........................................................ .

5.1. Brief characteristics of local anesthetics....................................................

5.2. Terminal (contact) anesthesia................................................................. .......

5.3. Infiltration anesthesia according to Vishnevsky....................................

5.4. Regional anesthesia................................................................ ................................

5.4.1. Conduction anesthesia................................................................ ........................

5.4.2. Plexus anesthesia................................................................. ...............................

5.4.3. Spinal anesthesia................................................................ ...........................

5.4.4. Combined anesthesia using regional methods....

5.4.5. Complications of regional anesthesia.................................................................... ........

6. Features of general anesthesia in an outpatient setting.................................

LIST OF ABBREVIATIONS

Module 1. Anesthesiology and intensive care.

Topic 2. General issues of anesthesiology.

Relevance of the topic.

Anesthesiology and intensive care as an academic discipline is an integral part of clinical medicine, therefore studying the basic principles of this branch of science is an important aspect of training a doctor of any specialty. Study of anesthesiology and intensive care:

a) is based on students’ study of anatomy, histology, biochemistry, physiology, pathomorphology, pathophysiology, internal medicine, pediatrics, pharmacology and is integrated with these disciplines;

b) lays the foundation for students of anesthesiology and intensive care to study emergency and critical conditions that arise in the clinic of internal medicine, pediatrics, surgery, traumatology and orthopedics, neurosurgery, urology, obstetrics and gynecology and other branches of medicine where methods of pain management and intensive care are used, which provides for the integration of teaching these disciplines and the formation of the ability to apply knowledge in the process of further education and professional activity;

c) provides an opportunity to gain practical skills and develop professional skills in diagnosing and providing emergency medical care and conducting intensive care in certain pathological conditions and during patient monitoring.

General goal: to develop knowledge of the general principles and methods of anesthesia for surgical interventions.

Specific Goals:

1) master the classification of modern methods of anesthesia;

2) know the advantages and disadvantages of different methods of anesthesia;

3) be able to differentiate the clinical manifestations of different stages of anesthesia;

4) understand the main stages of anesthesia;

5) be able to identify complications of anesthesia, analyze their causes and decide on a method for eliminating them.

Brief historical background

Chronologically, anesthesiology was the first section of critical care medicine (MCM). The birthday of modern anesthesiology (and the ISS as a whole) is considered to be October 16, 1846, when at the Massachusetts General Hospital (Boston, USA), W. Morton performed successful ether anesthesia when surgeon J. Warren removed a neck tumor from the patient E. Abbott. In Russia, the first operation under ether anesthesia was performed by F. Inozemtsev on February 7, 1847 (a mastectomy was performed on the patient E. Mitrofanova). A great contribution to the development of ether anesthesia in Russia was made by N.I. Pirogov.

However, earlier attempts to carry out anesthesia with both ether and other substances (now we call them general anesthetics) are also known, but priority was left to Morton as a person who actively promoted this method of pain relief.

Unfortunately, earlier attempts at general anesthesia were often unsuccessful: either the anesthesia was inadequate or the patient died from it. Today, the reasons for these failures are clear, and they were associated either with the wrong choice of anesthetic, or with its incorrect dosage, as well as with ignorance of the deep mechanisms triggered by both anesthesia itself and surgery.

In 1879-1880, Russian doctor and researcher V.K. Anrep discovered the local anesthetic properties of cocaine (in experiments on frogs). These properties were first used in the clinic by Yaroslavl ophthalmologist I.N. Katsaurov (1884). Cocaine was applied in the form of a 5% ointment, under its influence a foreign body was removed from the cornea. In 1885, St. Petersburg surgeon A.I. Lukashevich used cocaine for regional anesthesia (cocaine was injected into the base of the fingers, anesthesia was obtained on the fingers themselves). In the same year, dentist J. Halstead performed conduction anesthesia of the mandibular nerve. Advances in local anesthesia continued with the development of A.V. Vishnevsky’s method of tight creeping infiltration with a solution of novocaine.

The emergence of new methods of pain relief gave a strong impetus to the development of surgery, as it became possible to carry out such complex and lengthy surgical interventions that were unthinkable without anesthesia. Now everyone is well aware that not a single more or less serious operation is possible without the participation of an anesthesiologist.

Clinical physiology of general anesthesia

The term “anesthesia” is usually used in two meanings: 1) as a state of the body; 2) as a set of measures carried out by an anesthesiologist to introduce the body into this state (in this sense, a more complete term sounds like “anesthesiological assistance”).

Anesthesia - an artificially induced reversible condition characterized by the presence of several components. This condition does not occur in nature, which is why it is called artificially induced. It is clear that this condition should be reversible, since the need for this condition disappears after surgery. The state of anesthesia is designed to protect the body from the necessary surgical trauma, ultimately aimed at healing the body. A state of anesthesia can be considered when at least several of the following components are present.

1 . Anesthesia (synonyms: switching off consciousness, or inhibition of the central nervous system, or narcotic sleep). "Narcosis" translated from Greek means "numbness." This component is provided by inhibition of the cerebral cortex, which eliminates the “presence of the patient” at his own operation*.

2 . Analgesia - turning off pain sensitivity. Turning off consciousness in itself does not protect the body from pain - this complex multicomponent condition. The path of the pain signal and the processes accompanying it can be briefly described as follows.

Having originated in the sensitive receptor, the pain impulse follows through the dorsal roots to the dorsal horns of the spinal cord, where it switches in a certain way to the motor neurons of the anterior horns, which is manifested by reflex movement. Most often these are reactions of the withdrawal type (the same scheme is used for the widely known knee-jerk reflex). ! The pain impulse follows further along the ascending nerve pathways and reaches numerous subcortical structures of the brain. At this level, various signal switches to effector neurons also occur, which forms more complex autonomic and humoral reactions (activation of the sympathoadrenal system, increased release of various hormones, neurotransmitters, etc.), designed to prepare the body to combat damaging (nociceptive) effects. This is manifested, for example, by arterial hypertension, tachycardia, peripheral vascular spasm, hyperventilation, mydriasis, etc. Consciousness is not involved in these reactions! During surgery, these reactions do not make sense, since the surgical trauma is inflicted purposefully and has the goal of healing the patient. The harm of these phenomena during surgery is obvious.

Next, the pain impulse reaches the limbic system, where a negative emotional connotation of the pain sensation is formed (feelings of anxiety, fear, depression, etc.). Consciousness is not involved in this process!

And only at the end of its path does the pain impulse reach the sensitive neurons of the cortex, which leads to awareness and localization of pain. Only after this the painful sensation is formed in full: the pain is conscious, localized, emotionally unpleasant, and the body is prepared to protect itself from the source of painful (and it is always damaging) irritation. Of course, such a mechanism for the formation of pain is the result of a long evolutionary path, and this mechanism is deeply physiologically based. Only during surgery does this mechanism make no sense and must be suppressed. From the above it is clear that it is impossible to do this by simply turning off consciousness.

3 . Anesthesia is the switching off of other types of sensitivity (primarily auditory, visual and tactile), since their preservation can also cause unnecessary reactions during surgery.

4 . Neurovegetative blockade (NVB). Unfortunately, it is not always possible to adequately provide analgesia, and then the nociceptive effect leads to undesirable neurovegetative and humoral reactions. Of course they should be warned. It can be said that NVB corrects the consequences of insufficient analgesia. In addition, surgery may be associated with a direct impact on reflexogenic zones (for example, traction of the mesentery activates vagal reactions), and reflexes from these zones also require suppression.

5 . Muscle relaxation is a component necessary solely for the convenience of the surgeon, since increased muscle tone can cause serious technical difficulties.

Not all surgical interventions require the presence of all these five components in full, but not a single long-term extensive operation can be performed without them. If consciousness is turned off during anesthesia, such anesthesia is called general (in medical vernacular, the term “anesthesia” is acceptable); if consciousness is not turned off, then such anesthesia, as a rule, will be local.

It is easy to see that providing all 5 components of anesthesia (as a state of the body) means the development of a typical critical condition in the patient (see the section on critical conditions and CPR), since the patient is deprived of the opportunity to fully control his functions (adaptive reactions are suppressed). In addition, muscle relaxation turns off the ventilation of the lungs. Thus, the anesthesiologist intentionally puts the patient into a critical state, however, nevertheless, this artificial critical state, unlike a natural one, is controllable (at least, it should be so). It may also be that the patient comes to the anesthesiologist already in a critical condition, which has developed as a result of injury or some other pathological process. In any case, a patient in a state of anesthesia needs intensive care (IT), and this gives the right to say that anesthesia care is IT associated with surgery.

Rice. 1. Classification of anesthesia.

Place of work: Academic degree: Academic title: Alma mater: Awards and prizes:

Anatoly Petrovich Zilber(born in 1931) - organizer of the first intensive respiratory therapy department in Russia (1989), then a respiratory center (2001). Author of the concept of critical care medicine (MCM) (1989). Doctor of Medical Sciences (1969), professor (1973), academician of the Russian Medical-Technical Academy (1997) and the Academy of Security, Defense and Law Enforcement of the Russian Federation (2007).

Honorary and full member of the Board of the Federation of Anesthesiologists and Reanimatologists of the Russian Federation, Honored Scientist of the Russian Federation, Honorary Worker of Higher Professional Education of the Russian Federation, People's Doctor of the Republic of Karelia, Knight of the Orders of Friendship and Honor.

Biography

Bibliography

Author of more than 400 published works, including 34 monographs. Being one of the founders of domestic anesthesiology and resuscitation, A.P. Zilber pays great attention to the study of the respiratory system, and his first monograph “Operating position and anesthesia” has the subtitle “Postural reactions of blood circulation and breathing in anesthesiology.” The subject of his research is the reaction of the respiratory system in any critical condition. For A.P. Zilber, the respiratory system is not only a structure that provides the entire body with the necessary amount of oxygen and relieves it of excess carbon dioxide. This is the most important life support system of the body, protecting it from “external and internal enemies”, creating the conditions necessary for the normal functioning of other vital organs. It is difficult to say what is more surprising in his works - the non-standard approach to the problems being studied or the unexpectedness of the findings and identified patterns. A clear proof of this is the professor’s main works on this topic: “Regional functions of the lungs. Clinical physiology of uneven ventilation and blood flow”, “Respiratory therapy in everyday practice”, “Respiratory failure” and, finally, “Respiratory medicine”(!). The main feature of these (and other) books by A.P. Zilber, which makes them books “for all times,” is their clinical and physiological focus and validity. This is probably why none of the fundamental provisions derived by A.P. Zilber from his research was refuted or, at least, reasonably rejected. Zilber A.P. Blood loss and blood transfusion. Principles and methods of bloodless surgery. - Petrozavodsk: Petrozavodsk State University Publishing House, 1999. - 114 p. - 5000 copies. - ISBN 5-8021-0057-5.

Zilber A.P. Clinical physiology in anesthesiology and resuscitation. - 1984. - 486 p.

Zilber A.P. Sketches of critical medicine. - 2006.

Zilber A.P.. - Ministry of Health of the Russian Federation, 2001.

Zilber A.P. Treatise on euthanasia. - Petrozavodsk: Peter. State University, 1998. - 464 p.

Zilber A.P. Ethics and law in critical care medicine. - Petrozavodsk: Petrozavodsk University Publishing House, 1998. - 560 p.

Famous sayings

if the doctor is familiar with modern ideas about the clinical physiology of blood, blood loss and blood transfusion, he will find alternative methods suitable for a particular patient and will do without donor blood transfusion

Jehovah's Witnesses proved useful to medicine […] They... forced doctors to reconsider the effectiveness of blood transfusions, prompted the search for alternative methods, and, finally, increased attention to the rights of patients. Thus, paraphrasing Voltaire, who ... wrote - “If God did not exist, he would have to be invented,” I would say - “If Jehovah’s Witnesses did not exist, they would have to be invented,” so that we would quickly get a correct idea of the acute blood loss and the role of blood transfusion

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Excerpt characterizing Zilber, Anatoly Petrovich

- Well, what, my Cossack? (Marya Dmitrievna called Natasha a Cossack) - she said, caressing Natasha with her hand, who approached her hand without fear and cheerfully. - I know that the potion is a girl, but I love her.
She took out pear-shaped yakhon earrings from her huge reticule and, giving them to a beaming and blushing Natasha, immediately turned away from her and turned to Pierre.
- Eh, eh! kind! “Come here,” she said in a feignedly quiet and thin voice. - Come on, my dear...
And she menacingly rolled up her sleeves even higher.
Pierre approached, naively looking at her through his glasses.
- Come, come, my dear! I was the only one who told your father the truth when he had a chance, but God commands it to you.
She paused. Everyone was silent, waiting for what would happen, and feeling that there was only a preface.
- Good, nothing to say! good boy!... The father is lying on his bed, and he is amusing himself, putting the policeman on a bear. It's a shame, father, it's a shame! It would be better to go to war.
She turned away and offered her hand to the count, who could hardly restrain himself from laughing.
- Well, come to the table, I have tea, is it time? - said Marya Dmitrievna.
The count walked ahead with Marya Dmitrievna; then the countess, who was led by a hussar colonel, the right person with whom Nikolai was supposed to catch up with the regiment. Anna Mikhailovna - with Shinshin. Berg shook hands with Vera. A smiling Julie Karagina went with Nikolai to the table. Behind them came other couples, stretching across the entire hall, and behind them, one by one, were children, tutors and governesses. The waiters began to stir, the chairs rattled, music began to play in the choir, and the guests took their seats. The sounds of the count's home music were replaced by the sounds of knives and forks, the chatter of guests, and the quiet steps of waiters.
At one end of the table the Countess sat at the head. On the right is Marya Dmitrievna, on the left is Anna Mikhailovna and other guests. At the other end sat the count, on the left the hussar colonel, on the right Shinshin and other male guests. On one side of the long table are older young people: Vera next to Berg, Pierre next to Boris; on the other hand - children, tutors and governesses. From behind the crystal, bottles and vases of fruit, the Count looked at his wife and her tall cap with blue ribbons and diligently poured wine for his neighbors, not forgetting himself. The countess also, from behind the pineapples, not forgetting her duties as a housewife, cast significant glances at her husband, whose bald head and face, it seemed to her, were more sharply different from his gray hair in their redness. There was a steady babble on the ladies' end; in the men's room, voices were heard louder and louder, especially the hussar colonel, who ate and drank so much, blushing more and more, that the count was already setting him up as an example to the other guests. Berg, with a gentle smile, spoke to Vera that love is not an earthly, but a heavenly feeling. Boris named his new friend Pierre the guests at the table and exchanged glances with Natasha, who was sitting opposite him. Pierre spoke little, looked at new faces and ate a lot. Starting from two soups, from which he chose a la tortue, [turtle,] and kulebyaki and to hazel grouse, he did not miss a single dish and not a single wine, which the butler mysteriously stuck out in a bottle wrapped in a napkin from behind his neighbor’s shoulder, saying or “drey Madeira", or "Hungarian", or "Rhine wine". He placed the first of the four crystal glasses with the count's monogram that stood in front of each device, and drank with pleasure, looking at the guests with an increasingly pleasant expression. Natasha, sitting opposite him, looked at Boris the way thirteen-year-old girls look at a boy with whom they had just kissed for the first time and with whom they are in love. This same look of hers sometimes turned to Pierre, and under the gaze of this funny, lively girl he wanted to laugh himself, not knowing why.
Nikolai sat far from Sonya, next to Julie Karagina, and again with the same involuntary smile he spoke to her. Sonya smiled grandly, but apparently was tormented by jealousy: she turned pale, then blushed and listened with all her might to what Nikolai and Julie were saying to each other. The governess looked around restlessly, as if preparing to fight back if anyone decided to offend the children. The German tutor tried to memorize all kinds of dishes, desserts and wines in order to describe everything in detail in a letter to his family in Germany, and was very offended by the fact that the butler, with a bottle wrapped in a napkin, carried him around. The German frowned, tried to show that he did not want to receive this wine, but was offended because no one wanted to understand that he needed the wine not to quench his thirst, not out of greed, but out of conscientious curiosity.

At the male end of the table the conversation became more and more animated. The colonel said that the manifesto declaring war had already been published in St. Petersburg and that the copy that he himself had seen had now been delivered by courier to the commander-in-chief.
- And why is it difficult for us to fight Bonaparte? - said Shinshin. – II a deja rabattu le caquet a l "Autriche. Je crins, que cette fois ce ne soit notre tour. [He has already knocked down the arrogance of Austria. I am afraid that our turn would not come now.]
The colonel was a stocky, tall and sanguine German, obviously a servant and a patriot. He was offended by Shinshin's words.
“And then, we are a good sovereign,” he said, pronouncing e instead of e and ъ instead of ь. “Then that the emperor knows this. He said in his manifesto that he can look indifferently at the dangers threatening Russia, and that the safety of the empire, its dignity and the sanctity of its alliances,” he said, for some reason especially emphasizing the word “unions”, as if this was the whole essence of the matter.
And with his characteristic infallible, official memory, he repeated the opening words of the manifesto... “and the desire, the sole and indispensable goal of the sovereign: to establish peace in Europe on solid foundations - they decided to send part of the army abroad and make new efforts to achieve this intention “.
“That’s why, we are a good sovereign,” he concluded, edifyingly drinking a glass of wine and looking back at the count for encouragement.
– Connaissez vous le proverbe: [You know the proverb:] “Erema, Erema, you should sit at home, sharpen your spindles,” said Shinshin, wincing and smiling. – Cela nous convient a merveille. [This comes in handy for us.] Why Suvorov - they chopped him up, a plate couture, [on his head,] and where are our Suvorovs now? Je vous demande un peu, [I ask you,] - he said, constantly jumping from Russian to French.