PIROGOV

PIROGOV Nikolai Ivanovich (1810-1881), famous surgeon. Born in Moscow into the family of a provisioning official. At the age of 14, P. entered the medical faculty. Upon completing his course in 1827, he chose surgery as his specialty and, as one of the best students, was sent for advanced studies to Dorpat. P. absorbed the foundations of vulgar materialism, empirical-experimental positivism, and emotional atheism, without which no scientific-medical work was conceivable. Shunning parties, P. as a student avoided politics as well. Even the storm of the December uprising passed by P. completely unnoticed by him. P. himself noted in his diary his then 'immaturity, inexperience, and childishly passive indifference to public affairs.' Naturally, under such conditions, all the creative forces of his great mind, 'illuminated by the light of natural science,' were directed to his specialty. Arriving in Dorpat, under the guidance of Meyer, P. 'threw himself headlong into experimenting... I especially worked on the development of fasciae and their relations to the arterial trunks and pelvic organs. This subject was completely new at that time. Usually anatomists neglected the fasciae.' But P. was not a pure anatomist; he was an anatomical surgeon. Anatomy for him was a means of rationalizing operative technique. The fasciae discarded by pure anatomists, P. placed at the forefront of the science he created—surgical (not topographical) anatomy. In Dorpat, his first work on the assigned faculty topic about ligation of arteries was published, and his experimental work on ligation of the abdominal aorta was defended as his doctoral dissertation (1832). Going on a scientific mission to Berlin, Pirogov to his surprise 'found practical medicine almost completely isolated from the main real foundations of it: anatomy and physiology. Neither Rust, nor Graefe, nor Dieffenbach knew anatomy... Langenbeck was the only surgeon-anatomist.' Returning to Russia, P. legitimately considered himself the first candidate for the chair at Moscow University, but since on the way back he fell ill and was delayed in Riga for several months, in the meantime Professor Inozemtsev was appointed to the Moscow chair, which was a great blow to Pirogov. P. returned to Dorpat and here, on the proposal of the departing Meyer, was elected by the faculty as an extraordinary professor (1836) in the department of surgery, which he held until his move to Petersburg (1841). In P.'s life, this five-year period marked the highest flourishing of his scientific creativity. During this period, he published his classic work, later reprinted many times in several European languages, on the surgical anatomy of arterial trunks and fasciae ('Anatomia chirurgica truncorum arterialium atque fasciarum fibrosarum', Dorpat Liv.-Lpz., 1837-38; simultaneously a German edition was published), which opened a new era in the development of operative surgery. In 1837, P. was sent by the university to Paris, where the famous Velpeau greeted him with enthusiasm as an innovator and fellow surgeon in surgery. In 1841, Pirogov moved to Petersburg to the newly established chair of hospital surgery at the Medico-Surgical Academy, which had just then come under the jurisdiction of the Ministry of War, and held this chair until his retirement in 1856. At the same time, P. taught a course in pathological anatomy, performing over 11,000 autopsies in 14 years. In 1845, P. succeeded in establishing the Anatomical Institute at the Academy. In 1847, i.e., a year after Morton, P. was the first in Russia to apply ether anesthesia in the Petersburg hospitals, and soon also in field practice, during the siege of Salty in the Caucasus. Here, for the first time, he also applied the starched Sédillot bandage for fixing fractures of the extremities in wounded requiring transportation. In 1848, P. established a special department for cholera patients at his clinic and in 6 weeks managed to perform up to 800 autopsies of those who died from cholera. At the beginning of the Crimean War, P. hit upon the happy idea of replacing Sédillot's starch bandages with plaster ones, describing their preparation in a separate brochure 'Immovable Plaster Bandages' (SPB, 1854). In 1854, at the head of a detachment of surgeon-physicians, P. left for Sevastopol at the disposal of the commander-in-chief 'for the closest observation of the successful treatment of the wounded.' The military-command administration at every step put up obstacles to all his rationalizing innovations. 'It is not the work, not the labor—I am glad to strive—that is frightening, but these entrenched obstacles to doing something useful, obstacles that grow like the heads of the hydra: you chop one off, another appears.' From this harsh practical lesson, Pirogov derived the idea that formed the basis of all his field surgical practice: 'Not medicine, but administration plays the main role in the matter of aid to the wounded and sick on the theater of war.' From the negative experience of the Sevastopol defense, P.'s ideas about the paramount importance of the issues of sorting, evacuation, and dispersal of the wounded and sick arriving from the front also grew. Returning to St. Petersburg again to his work on anatomy, Pirogov came to the happy idea of studying the normal position of internal organs on frozen corpses, working through frozen tissues with chisel and hammer (sculptural anatomy). P.'s scientific authority and fame as a skilled surgeon grew unstoppably. With the move to SPB, a rich practice appeared, and his acquaintances and connections with circles of the large bourgeoisie, landowners, bureaucracy, and even court nobility expanded. Thus, for P. there necessarily came a period of 'double bookkeeping in the field of ideology'—materialism within the anatomical theater and operating room, and idealistic fawning before the priesthood in all family, official, and social relations. P. was only 45 years old, he was full of strength, energy, and ambition. Captivated by the general movement, P. wrote a bright pedagogical article 'Questions of Life,' which was passed by censorship only because the article was printed with the permission of Grand Duke Konstantin Nikolaevich in the 'Marine Collection' (1856, No. 9). The article made such a strong impression that P. was offered the post of trustee of the Odessa educational district, which he accepted, forever leaving surgical work. However, the immediate future showed the entire illusory nature of P.'s reformist intentions, which invariably encountered explicit or hidden resistance from the apparatus of royal power. It would be unfair to reject the great significance for his time of a number of Pirogov's innovative ideas and proposals in the field of pedagogy. He insisted on the connection of the school with life. 'We are accustomed to see,' wrote Pirogov, 'that upbringing and learning go by themselves, and life goes its own way, by itself... A school without life and outside life is absurd, and life sees that without a school it cannot make a single step forward.' As early as 1856, Pirogov¹ raised the question of the connection of polytechnic education with general education: 'Wishing to become true specialists, we must not forget that for this too, a general human education is necessary.' He stood for freedom of teaching from police supervision: 'Full freedom of scientific investigation and teaching, freedom of thought and speech, is absolutely required.' These advanced ideas were diluted by a series of the most conservative, and at times reactionary, theories. Thus, Lenin wrote about Pirogov: 'Pirogov in the 1860s agrees that one must flog, demanded that they flog not indifferently, not soullessly.' P.'s advanced ideas and persistence in implementing his convictions on this pedagogical front made him many enemies among the bureaucratic officials. On March 18, 1861, Pirogov was dismissed from his post as trustee of the Kiev district. Having gone to his estate Vishnyaki, Podolsk province, P. served for one year by election as a world mediator, and in 1862 he went abroad at the invitation of Minister of Public Education Golovin for 3 years as the leader of professorial scholarship holders. Here he wrote 'Letters from Heidelberg' on the university question, and also published in German (1864) and Russian a major work 'Fundamentals of General Field Surgery, Taken from Observations of Military-Hospital Practice and Memories of the Crimean War and Caucasian Expedition' (vols. 1-2, Dresden, 1865-66). In 1866, P. was finally dismissed 'from the tasks entrusted to him, both as to the fulfillment of various works in the educational and pedagogical field, and as to the guidance of persons sent abroad.' Thus the great scientist received his final wolf's passport. From 1866 until the end of his life, P. lived in his rural seclusion, engaged in extensive private practice and completely abandoning scientific work. During all this time, P. left his estate only twice: in 1870, at the invitation of the Red Cross to inspect hospitals on the theater of the Franco-Prussian War, and in 1877, for the same purpose, he made an expedition to Bulgaria. The fading period of Pirogov's life lasted a full 15 years and was marked by the final chords of the 'Diary of an Old Physician,' presenting a sad and pitiful picture of the political degradation of this great man.

Shortly before his death, P. wrote the following renegade words in his 'Diary' regarding the revolutionaries' handling of Alexander II on March 1, 1881: 'There is no difference between state murder and simple murder... Murder will not snatch the crown of immortality from Alexander II's head.' This is characteristic of P.'s social views and his attitude toward religion and autocracy. In his youth, during his student years, he went through a phase of fascination with atheism. He spoke such 'hellish' words about religion that he frightened his elderly mother, a minor official, into religious terror. But in his old age, he backtracked. In his discussions about faith and God, there is something midway between the fashionable Hegelian idealism of the time and deism. 'From my worldview, I conclude,' he wrote, 'that the existence of a supreme reason, and therefore a supreme creative will, I consider a necessary, inevitable (fatal) requirement (postulate) of my own reason; so that if I wanted to deny the existence of God now, I could not do so without going mad.' The thinker at the operating table, Pirogov forgot how, in the name of 'faith', sectarians were persecuted in his time, how religion became a faithful watchdog for Nicholas I. And he philosophizes: 'Faith is a pure abstraction of the soul: there are no worldly goals or tasks here; faith is necessary as the deepest need of the soul.' Liberal P., of course, cannot help but notice into what Christianity had turned in the era of kings and emperors. And he objects to the 'statization' of religion: 'A series of ecumenical councils establishes dogmas and formulas of dogmas, prescribes how and what to believe in order to be a Christian; freedom of conscience recedes to the background, making way for the deeply felt ideal of faith and the free flight of the soul desiring to draw close to it, are replaced by the symbolic rites of mystery, which played such a prominent role in polytheism, and so on. It finally came to the point that instead of the unattainably high ideal, which was to be the motive for all our deeds and moral aspirations, all these church rites and requirements came to the forefront.' But the compromising liberal P. is far from the decisive conclusion that Lev Tolstoy drew from these considerations in his time, and he falls to his knees before the ritualistic church and whispers about forgiveness: 'Is this a sin before God, if I, as a citizen and as a man, distinguish the dogmatic confession of Christ's teaching, which has taken on, so to speak, a state shell, from the spirit, ideal, and essence of the teaching itself... I still consider myself a son of the established church by birth and by submission, considering it unjust and illegal to leave its bosom.' These semi-idealist and semi-deistist considerations gave Professor of Theology at Moscow University Eletsky the right to count P. among his own. 'The positions listed,' proclaimed the protopresbyter in a speech at the unveiling of P.'s monument in Moscow on Devichye Pole, 'give grounds to guess in the late philosopher-idealist and deeply religious Christian person, who raised his theoretical philosophical views to the level of living convictions by consciously assimilating the basic points of Christ's teaching; and it was these convictions that left their mark on the social activities of the deceased and gave it a certain, exciting sincere sympathy, character.' The compromiser and peacemaker, Pirogov earned this Judas kiss. On May 24, 1881, Moscow University solemnly welcomed P. within its walls on the 50th anniversary of his medical activities. On November 23, 1881, P. died at his estate at the age of 72 from a cancerous tumor of the right palatine arch and was buried there. The 'Collected Works' of P. (only philosophical and journalistic works) were reprinted after the author's death (2nd ed., vols. I-II, St. Petersburg, 1886-87).