Nikolay Ivanovich Pirogov

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The Author(s) 2016 Nikolay Ivanovich Pirogov (1810–1881): Reprints and permissions: sagepub.co.uk/journalsPermissions.nav A pioneering Russian surgeon DOI: 10.1177/0967772016633399 and medical scientist journals.sagepub.com/home/jmb Inge F Hendriks, James G Bovill, Peter A van Luijt and Pancras CW Hogendoorn Abstract Nikolay Pirogov qualified as a physician from Moscow University in 1828 and then studied surgery and anatomy at University of Dorpat. He developed new surgical techniques, including the eponymous osteoplastic foot amputation. His application of scientifically based techniques extended surgery from a craft to a science. During the Crimean War he initiated the deployment of women as nurses and used triage for dealing with mass casualties. His textbook on field surgery became the standard reference on the subject and his principles remained virtually unchanged until the Second World War. Pirogov died on 5 December 1881 at his estate in Vishnya. Keywords Pirogov, surgery, field surgery, foot amputation, applied anatomy, topographical anatomy, Russia (pre-1917) Introduction field with great practical significance for surgery and Nikolay Ivanovich Pirogov1 (Figure 1) was one of the enhanced his reputation as a distinguished surgeon most talented Russian surgeons and medical scientists of the 19th century and among the greatest military Department of the Executive Board, Leiden University Medical Centre, surgeons of all times. He devised a number of surgical The Netherlands operations, of which the eponymous osteoplastic foot Corresponding author: amputation is the best known. He was passionate about Inge F Hendriks, Department of the Executive Board, Leiden University the importance of anatomy for surgeons. His work on Medical Centre, Albinusdreef 1, 2333 ZA Leiden, The Netherlands. topographical anatomy laid a firm foundation for that Email: [email protected] Hendriks et al. 11 anatomist, Professor Loder, who encouraged him to study anatomy seriously. The physician Professor Mudrov also made a deep impression; he taught students to treat not only the disease or the causes of disease but also the whole patient. Putting the patient’s interest central became the cornerstone of Pirogov’s approach to his patients throughout his professional career. Pirogov qualified as a physician in May 1828, only 17 years old.3 Professor Mukhin, then dean of the faculty of Medicine, encouraged him to enter as a can- didate for the prestigious postgraduate international institute of the Baltic-German University of Dorpat (now Tartu in Estonia).3,5 Only 20 Russian students, from all disciplines of the five Russian universities, were admitted to Dorpat each year. Pirogov passed the entrance examination and, on a scholarship spon- sored by the Russian Government, began his training in Dorpat in July 1828. His first choice of subject, physiology, was not available in Dorpat so instead he chose to specialize in surgery and anatomy under the mentor- ship of Professor Johann Christian Moier, a student of the famous Italian anatomist Antonio Scarpa. Pirogov combined his practical work as a surgeon with theoretical and experimental anatomical research. Figure 1. Portrait of Nikolay Ivanovich Pirogov, 1836, by an In 1829, the Medical Faculty freed him from compul- unknown photographer. Military Medical Museum, Saint sory attendance at some lectures, so that he could work Petersburg, Russian Federation (OF 21290, reproduced with on his doctoral thesis, the feasibility of treating aneur- permission). ysms of the inguinal artery by ligation of the abdominal aorta.3,6 Pirogov realized that a detailed knowledge of and anatomist. Several anatomical structures are the anatomy of the region, in particular of the vascular named after him, including the Pirogov angle (the junc- system, would be essential for his investigation, and tion of the internal jugular and subclavian veins), the conducted a series of animal experiments to determine Pirogov aponeurosis and the Pirogov triangle, an area the topography of the relevant blood vessels, with located between the mylohyoid muscle, the intermedi- particular attention to the abdominal aorta. He then ate tendon of the digastric muscle, and the hypoglossal investigated how animals responded to a gradual nerve. He extended surgery from a craft to a science, tightening of a ligature around the aorta, stimulating equipping doctors with scientifically based techniques the development of an improved collateral circulation. of surgical intervention. He was the first to prove the feasibility of this technique, which achieved a gradual obliteration of From childhood to professor of surgery the aorta while avoiding paralysis of the hind limbs and pelvis. Finally, he carried out a number of oper- Nikolay Ivanovich Pirogov was born on 13 November ations in which he ligated the abdominal aorta 18102 in Moscow. From an early age, he showed of patients with aneurysms of the inguinal artery. evidence of exceptional talent. A family friend, Efrem He completed his studies at Dorpat and received his Osipovich Mukhin, Professor of Anatomy and doctorate after defending his thesis on the 27 August Physiology at the Medico-Surgical Academy and later 1832 (Figure 2).7 His thesis was shortly thereafter pub- Professor of Physiology, Forensic Medicine, and lished in German. Medical Police at the Moscow University, was aware In May 1833, Pirogov went to Berlin to broaden his of his interest in medicine and suggested that he enter knowledge of anatomy and surgery at the Charite´ Moscow University as a medical student.3,4 University Hospital. Among his tutors were Friedrich Young Nikolay passed the university entrance exam- Schlemm, professor of anatomy and Johann Friedrich ination and began his studies a few weeks before his Dieffenbach, professor of surgery specializing in skin 14th birthday, when the accepted admission age was 16 transplantation and plastic surgery. Pirogov spent the years. One teacher who inspired Pirogov was the summer of 1834 at the University of Go¨ttingen where 12 Journal of Medical Biography 26(1) Figure 2. The front cover of the doctoral thesis by Nikolay Ivanovich Pirogov, University of Dorpat, 1832. he attended lectures by Konrad Langenbeck, famous someone who is familiar with the body, the position of for his speed and precision as a surgeon. He taught the organs in their unaltered state and the painful Pirogov how to achieve the most efficient movements changes, should operate on a person...’’7 and without during surgery and how to use a scalpel ‘‘...do not pres- a thorough knowledge of anatomy and physiology, sur- sure the scalpel but move it slowly, playing it as a bow gery could never rise to the level of a science but would over the violin...’’3 remain a craft.6,7 From his time in Berlin and Go¨ttingen, Pirogov was Pirogov left Berlin in May 1835 to travel to Saint amazed to discover that even the great German sur- Petersburg, but during the trip, he contracted typhus geons had little knowledge of anatomy or physiology. and was forced to stay in Riga until September of that Fortunately, Professor Schlemm of the Charite´ year. On his delayed journey to Saint Petersburg, he Hospital in Berlin was convinced of the importance of visited his former mentor, Professor Moier, in anatomy for a surgeon and gave Pirogov the opportun- Dorpat, from whom he learned that the chair of surgery ity to dissect hundreds of cadavers for his anatomical at Moscow University had gone to a former fellow stu- research. For Pirogov knowledge of anatomy was dent, Fedor I. Inozemtsev. This was a bitter disappoint- essential for a surgeon ‘‘... It is advisable that only ment for Pirogov who had hoped that he might be Hendriks et al. 13 Figure 3. A series of drawings showing stages in the restoration of the nose by a skin graft taken from the forehead following rhinoplasty, according to the method of N.I. Pirogov. Figures 1 and 6 illustrate the final result; Figures 3–5, the technique of forming the skin flaps; and Figure 2, how the flaps are attached using pins. From the Doctoral thesis Quaedam ad rhinoplasticen, Dorpati Livonorum, 1836 of G.H. Schultz, a student of Pirogov. appointed as professor at his Alma Mater. He decided mache to demonstrate the Indian rhinoplastic method as to remain in Dorpat and Professor Moier, who was modified by Dieffenbach (Figure 3).

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