Letter to the Editor-in-chief

Dear Editor-in-chief,

We have read with interest the recent article by Igor Telichkin about Nikolay Ivanovich Pirogov and Bernhard Langenbeck. ¹ However, there are a number of inaccuracies, discrepancies and mistakes in the article that we feel need to be brought to the attention of your readers. As we read the article, it became clear that it has less to do with Pirogov and more to do with the Langenbeck family, and not only Bernhard. Indeed, we have the impression that information about Pirogov was added to distinguish this article from a similar article previously published by the author in the Russian journal Khirurgiia (Mosk). ²

The present article is in places confusing as to which Langenbeck the author is referring, in particular, the section devoted to Konrad (not Conrad) Langenbeck. How can Konrad have been a half-brother to Bernhard’s father and also his uncle? It would appear that the author is referring to two different Konrad’s! Indeed, Konrad Johann Martin Langenbeck was a much more famous surgeon than his nephew Bernhard, and it was Konrad who taught Pirogov during the latter’s time in Göttingen. We are not sure why the sections on Maximilian Adolf Langenbeck and Theodor Billroth have been included, they seem superfluous to us.

While much has been written about Nikolay Ivanovich Pirogov as a surgeon, the majority of authors have relied on at best second hand material, and very few authors have used original source material, i.e. the works written by Pirogov himself. In addition to publications in Russian, Pirogov also published in Latin, German and French. We realise that many of these publications are not readily available or easy to read for most medical historians, but we are disappointed that your Russian speaking author did not make use of information from original sources. There is not a single reference to the original published work of Pirogov in the whole paper. Two references (26 and 27) which appear to be identical, have NI Pirogov as one of the authors, but since that paper was published in 1910 and Nikolay Ivanovich Pirogov died in 1881, this is hardly likely to be him. ³

Dr Telichkin implied that Nikolay Pirogov was of Jewish origin, referring to a paper published in 1970. ⁴ We have been unable to verify this from any original sources. Indeed, all the evidence points to Pirogov having been raised by his family and especially his mother as a Russian Orthodox Christian. In his biography, Pirogov never mentions any Jewish roots but does refer to his Russian Orthodox upbringing and education. In his ‘Sevastopol letters’, he does refer to the Talmud Torah, a school in the city Odessa which he visited in his capacity as a superintendent of schools. But his report on the school by no means supports the idea that he had a Jewish background.

The statement that ‘When Pirogov left the Professorship (sic. in St. Petersburg) his former surgical pupils … were unable to continue and develop his ideas and views on surgical science’ is clearly without foundation. Despite his heavy workload, Pirogov dedicated himself to teaching. Indeed, one of his earliest tasks after his appointment in St. Petersburg was to make far-reaching changes to the medical curriculum, and all the other Russian Universities adopted his teaching methods. Further, one of his pupils became his successor at the Medico-Surgical Academy. After leaving St. Petersburg, he even travelled over a period of four years with groups of medical students to support and teach them when they spent time studying in Heidelberg in Germany.

Pirogov was much involved in both the Caucasian and the Crimean wars. However, contrary to the impression given by Igor Telichkin, he was not forced to become involved but did so at the express command of the Tsar because of his special talents. He was sent to the Caucasus to demonstrate the use of the recently discovered ether anaesthesia, of which he was the leading exponent in Russia. During the Crimean War, Pirogov was appointed by the Tsar as the overall head of the army medical services, something completely new in Russian history. His role was thus to work not only as a surgeon but more importantly to use his skills as an organizer of medical facilities. Pirogov, actively supported by Grand Duchess Elena Pavlovna, sister-in-law of Tsar Nicholas I, initiated the deployment of women to be trained as nurses and surgical assistants. This group of women became the foundation for what later became the Russian Red Cross.^5,6 His textbook describing his experiences during the Caucasian and Crimean conflicts became the standard reference for field surgery. ⁷ Indeed, Pirogov is considered by many to be the founder of field surgery. The principles of battlefield medicine established by him remained virtually unchanged until the outbreak of the Second World War.

The claim that Pirogov anticipated discoveries made by others is unfounded and made without any reference or example. One example that illustrates the enormous talent of this medical scientist is his use of frozen sections that allowed him to describe the topographical anatomy of the human body in a detail never before attempted. This formed the basis for his monumental work on topographical anatomy of the human body, and which represented the first use on a grand scale of frozen sections in anatomical illustrations.^8,9 Another example is his method for amputation of the foot, now known as the Pirogov amputation, and the world’s first osteoplastic surgery and which is still used in a modified form today. ¹⁰ There are many more examples which we could have shown.

In conclusion, Nikolay Ivanovich Pirogov is widely acknowledged as one of the greatest Russian surgeons and medical scientists of the 19th century and among the greatest of military surgeons of all time. He extended surgery from a craft to a science, equipping doctors with scientifically based techniques of surgical intervention. But his contributions reached beyond the boundaries of surgery, and we feel that the article by Telichkin fails to do him justice.