A Surgeon is Born

25 November 1810

In war, people die from bullets and grenades, from bombs and missiles, but also from dysentery and typhus, not to mention infection of their wounds. And the further back in history we go, the more common it was for hapless soldiers to be done in by disease, in some cases before they ever reached the field of battle, in others, having survived the bullets and bombs, only to succumb to an infected scratch.

A wound, even one that today we would think of as rather harmless, would begin to fester, the infection would spread, and death would come simply because doctors did not yet know how to sterilize instruments or properly clean the spot where the bullet or bayonet had entered the body. And once the infection began, especially if it turned gangrenous, the only (and by no means certain) way to save the life of the wounded was to amputate, to cut off the arm or the leg and offer at least a chance to survive.

Before the use of anesthesia, the approach to amputation was simple: patients would be given a bullet to hold between their teeth, so that they wouldn’t scream or bite off their tongue, or they were given a glass of vodka, the higher the proof the better, so that the ensuing fog would at least somewhat drown out the agonizing pain. Sometimes, patients would just be hit over the head in the hope they would stay unconscious for the duration of the operation. Eventually, of course, they came to, and there was plenty of pain still to be endured, along with the likelihood of infection.

Generally speaking, there was nothing pleasant about medical treatment in the early nineteenth century, to say nothing of the more distant past. Back then, the military field hospital experience had a lot in common with the medieval torture chamber. But it would not be much longer before the situation improved, and that improvement had a tremendous amount to do with the 1810 birth of a remarkable human being in Moscow who not only saved thousands upon thousands of (mostly military) lives, but also saved soldiers from torments that, in the past, had been unavoidable.

Nikolai Pirogov began studying medicine at the age of 14. Despite extreme poverty (his mother and many siblings became destitute after his father’s death in 1824), he managed to master all the most intricate mysteries of anatomy and diagnostics known at the time. Sometimes he had to keep his overcoat on in the university lecture halls, pretending to be cold even when he was roasting, to conceal the fact that he was unable to afford the uniform that Russian university students wore back then.

Despite the many obstacles he faced, Pirogov’s fascination with medicine and his exceptional intelligence allowed him to become a doctor, a professor, a surgeon, and a medical revolutionary. The innovations he introduced into surgical practice were designed to cause minimal damage to patients, something that had not previously been considered a high priority. When he deemed amputation to be unavoidable, as it often was back then, he managed to perform it in a way that left as much of the damaged limb intact. Perhaps most importantly, he was the first surgeon (in the world, as far as we know) to use anesthesia in a field operation. At the time, the anesthetics that today we take for granted in dentistry and major surgery were only beginning to be hesitantly administered. Now, rather than being stupefied by vodka or biting a bullet, wounded Russian soldiers could undergo surgery in ether-induced oblivion. It is noteworthy that they benefited from this innovation before the country’s wealthy or patients in Moscow’s elite hospitals.

Pirogov’s first operation in a military field hospital using anesthesia was performed in 1846, in the Caucasus. On top of his medical talents, he was a capable organizer who could create the conditions for surgery under the most difficult circumstances and not far from the fighting. We do not know how many lives he saved – no doubt a huge number. But he did a great service even to those who did not survive surgery, since they were spared excruciating pain. This was one of his greatest achievements, just as important as his many scientific discoveries and the surgical techniques he developed.

Russia was involved in many wars over Pirogov’s career, so he had many opportunities to hone his techniques. His first experience was with the Caucasus War, and during the Crimean War he became chief surgeon in besieged Sevastopol. Under constant fire that turned a horrifying number of soldiers and officers into cannon fodder, he kept operating, anesthetizing, figuring out ways to avoid amputations, teaching nurses, and devising new ways of triaging the wounded, updating medical procedures that had mostly not changed for 150 years.

Russia lost the Crimean War, but Russian medicine came out victorious. Just as organizational innovations introduced by Florence Nightingale during the Crimean War marked a turning point in British medicine, Pirogov’s took Russian medicine to a new level.

After the Crimean War, Pirogov continued to operate and teach, both in Russia and abroad. Among his patients was the Italian General Giuseppe Garibaldi, whose limb he saved from amputation. Back in Russia, he set up a free clinic on his estate for the local peasants. At the request of the Red Cross, he traveled to the front lines of the Franco-Prussian War (1870-71), and then, already in his sixties, was asked by the tsar to serve during the Russo-Turkish War of 1877-78.

How many wounded warriors passed through his care over the course of all these wars? How many operations did he perform? Over the course of two months in 1877 alone, the elderly doctor, by then a world-renowned professor, covered more than 700 kilometers as he zigzagged across the area of military operations inspecting dozens of field hospitals, organizing treatment, and performing operations.

And when death came he greeted it as the medical scholar he was, determining his own diagnosis.

The respect and veneration that Pirogov commanded was so great that his pupils embalmed his body in order to provide future generations the opportunity to “behold his serene image.” Pirogov’s mausoleum, in what is now Vinnytsia, Ukraine, survived the turmoil of the Civil War and World War II, as well as the looting of his sword and cross. Pirogov’s body was interred to hide it from advancing Nazis, but then restored to its tomb and re-embalmed. It has survived decay to the present day.

Somehow, preserving Pirogov’s body in this way seems much more appropriate than the almost pagan treatment of Lenin’s embalmed body, eternally resting outside the Kremlin. There is something touching about a desire to preserve the body of a doctor who, in his lifetime, helped so many of the living to preserve their own.