The Classic

Abstract

Nikolai Ivanovich Pirogoff (Fig. 1) was one of the greatest surgeons of the 19th Century. He is not well known in the English-speaking world since his contributions to the surgical literature were written in Latin, Russian, French, and German and have not been translated into English. His eponym is attached to an osteoplastic amputation of the foot in which the heel pad is affixed to the distal tibia utilizing a portion of the os calcis to form an end-bearing stump. In Russia, he had an enormous influence on medical practice and education. Pirogoff was born in Moscow, the 13th child in his family. After a private primary education, he was admitted to the University of Moscow to study medicine. Then, as now, universities were centers of liberalism and opposition to conservative governments. It was during his student days that Pirogoff developed a progressive point of view. The standard of medical education at the University of Moscow at that time was very poor. After graduation, he was selected for further training at the University of Dorpat in Estonia where the teachers were mostly German. He stayed there for five years and during these years he studied anatomy and experimental surgery. He then had the opportunity to study for two additional years in Berlin and Gottingen. Upon his return to Russia in 1835, Pirogoff hoped for an appointment as Professor of surgery at the University of Moscow but was forced to accept a similar but less prestigious position at Dorpat. He stayed in this position for five years with only a leave of five months for study in Paris in the clinic of Velpeau. In 1840, he became Professor of Surgery at the Medico-Chirurgical Academy in St. Petersburg. During the next few years, he established a reputation as the leading surgeon in the community as well as an outstanding teacher. With a mind always open to new ideas, he was one of the earliest European surgeons to adopt the use of ether anesthesia. In 1847, he described the administration of ether per rectum to produce anesthesia. During the war in the Crimea, Pirogoff was made the Surgeon General in charge of the medical establishment in Sevastopol. With the help of the Grand Duchess Elena Pavlovna, he was able to introduce female nurses into the military hospitals at the same time Florence Nightingale was doing so in the British military hospitals. The collaboration of Pirogoff and the Grand Duchess laid the groundwork for the establishment of the Russian Red Cross. Pirogov was the first surgeon to use plaster of paris dressings for the treatment of fractures in the treatment of war casualties. On the basis of his experience, he believed that open fractures should be immobilized in plaster of pans dressings as quickly as possible and before evacuation to the field hospitals. The results of his work in the Crimea were incorporated in his book, Principles of General Military Field Surgery. The period immediately after the Crimean war was one of frantic activity. During this period, Pirogoff published the description of his osteoplastic amputation (1854), a three-volume book on clinical surgery (1851–54), and his important atlas of cross-sectional anatomy (1852–1859). This latter work, based on sections taken through frozen cadavers, was introduced as a teaching tool. It opened a new approach to the visualization of anatomic relationships and was widely adopted. Cross-sectional anatomy participated in the general decline of interest in gross anatomy on medical school cumcula, but the introduction of computed tomography and nuclear magnetic resonance scans has revived interest in this aspect of gross anatomy. In 1856, tired of the political battles and intrigues of the medical school, Pirogoff resigned his position and became the Inspector of Education of Southern Russia. In this role, he traveled extensively and made a valiant effort to improve the educational system under his direction. Retiring five years later, he spent the next five years living in Berlin and Heidelberg. Upon returning to Russia, his liberal, western views were out of step with the trend toward conservatism following the assassination of Alexander 11, and he retired. He died of a cancer of the mouth.