by Academician Anatoly GRIGORYEV, RAS Vice-President, Noravard GRIGORYAN, Dr. Sc. (Med.), Chief Research Assistant of the RAS Institute of History of Natural Sciences and Technology named after Vavilov

The Miraculous Doctor (1897) is the name of a story by the famous Russian writer Alexander Kuprin dedicated to the physician Nikolai Pirogov. This year we celebrate the 200th birth anniversary of this eminent Russian surgeon and anatomist, teacher, public figure, father of field surgery, inventor of a number of effective treatment methods and author of fundamental medical papers, including The Topographical Anatomy atlas of worldwide fame. His scientific and pedagogical heritage has not lost its significance-namely, his concept of the development of secondary and high school is topical even in the 21st century.

THE ROAD TO SCIENCE

Nikolai Pirogov was born on November 13, 1810, in Moscow and was the 13th child in a large family. His father Ivan Ivanovich worked as a treasurer at the Moscow Provisions Depot, and his mother-Yelizaveta Ivanovna-dedicated herself to the upbringing of 14 children.

The future surgeon studied at home. At the age of 12, he entered one of the best private boarding schools of the capital-there he studied arithmetic, algebra, geography, logic, Russian, French and other subjects. In 1824, when he was 14, Pirogov, with the assistance of Yefrem Mukhin, Professor of the Moscow University, author of the first in Russia textbook in surgery, entered the Department of Medicine of this well-known educational establishment.

As a student, Pirogov assessed the system of medical education as follows: "I passed the exam for a physician's degree without a single operation on a cadaver observed or made. The similar situation was in some remote universities of Europe, where anatomy was taught using figures and dummies, not cadavers". At the same time he gratefully recalled: "Science in Moscow, despite its back-

wardness and superficiality, had something that did not leave me in peace and pushed forward".

In 1828, Pirogov graduated from the university and was assigned to the Derpt University (Tartu, Estonia) to train for the professor's activity. He wanted to practice in physiology, as, compared with other medical sciences, it was most closely associated with anatomy, which he knew well. Finally, he chose anatomy and surgery.

Pirogov wrote his thesis under guidance of professor Ivan Moyer, and in 1832 defended it to be qualified as Doctor of Medicine. The anatomic and physiological research work of the applicant Is the Bandage of Abdominal Aorta in Case of Groin Aneurysm–Easy and Safe Operation ? was dedicated to pathologies of blood circulation.

In the next two years the Russian doctor visited famous German clinics. In 1835, Pirogov left Göttingen for Russia to become the Head of the Chair of Surgery at the Moscow University. But on the way to Moscow he got seriously ill and was forced to reconsider his plans. Having recovered, he worked for some time at the surgical clinic of the Dept University; in 1836 Pirogov accepted Moyer's proposal, who highly appreciated the talent of his young colleague, and substituted Moyer at the Chair of Theoretical Operative and Clinical Surgery of the same university for 4 years. In 1837, the 27-year-old doctor published the work The Surgical Anatomy of Arterial Trunks and Fascias* and soon was awarded a prestigious prize–the Demidov Award of the St. Petersburg Academy of Sciences. In this work Pirogov formulated objectives and tasks of the scientific discipline he was interested in.

The same year, The Annals of the Surgery Department of the Dept University Clinic was published. In this paper the scientist, in addition to purely scientific aspects, formulated an important ethic idea: a teacher of the university should be self-critical, and admit his mistakes. Academician Ivan Pavlov**, eminent physiologist, Nobel Prize winner of 1904, who supported this idea, said at the joint meeting of medical societies of St. Petersburg dedicated to the 25th death anniversary of Nikolai Pirogov: "No chance to come across such a pitiless, open self-criticism in medical literature. What does it mean–to be a doctor for a patient who puts his life into your hands, for a student you teach? You have only one way out, one virtue–the truth, unconcealed truth."

In 1841, Pirogov was invited to the St. Petersburg Academy of Medicine and Surgery to head the Chair of Clinical Surgery, Pathological and Surgical Anatomy. He held this position up to 1856: a brilliant manager, Pirogov managed to establish a clinic of hospital surgery as a final stage of medical education. Right from the first days of his managerial activity, both the Chair and the clinic turned into an educational center for national surgeons, a real Pirogov's school.

In 1846, Pirogov together with Academician Karl Ber, natural scientist, founder of embryology, established the Anatomical Institute under the Medico-Surgical Academy specializing in anatomic and physiological studies. The same year he was elected Corresponding Member of the St. Petersburg Academy of Sciences.

THE SPECTRUM OF INTERESTS

Pirogov was a pioneer in medicine and pedagogics, education and science management, scientific enlightenment. For half a century, from 1832 to 1881, he published fundamental works in experimental, clinical, hospital, field, pathological, surgical and topographical anatomy, preventive medicine, wrote publicistic articles on the problems of education and enlightenment, autobiographical essays.

* Fascias–membranes covering muscles, tendons, etc. They represent a part of the so-called soft skeleton and are formed by a thick fibrous connecting tissue.–Ed.

** See: Yu. Natochin, "Pavlov... Science... Russia", Science in Russia, No. 6, 2004.–Ed.

Research results obtained by the scientist, especially in topographical anatomy, field and operative surgery, were soon acknowledged worldwide. Here is one of the evidences. During his visit to Paris, where he intended to get acquainted with the works of French physicians, Pirogov found professor Alfred Velpeau, head of the School of Surgery, looking through his atlas. When the well-known French professor found out that his Russian guest was going to study at his school, he said: "It is you who should teach me".

"As a young man, Pirogov went abroad where he did not behave as a shy student but as a strict critic of his foreign teachers and learned what he really found interesting", noted Academician Pavlov.

In 1847, in the field hospital in Daghestan, the scientist for the first time used an ether narcosis to anaesthetize surgical operations and a starch bandage in case of bullet wounds. When he understood that this method of fixing extremities was not efficient, he replaced it by a plaster one. This is how he started to work as a field surgeon.

In 1851, Pirogov published The Pathological Anatomy of Asiatic Cholera and The Atlas of Cuts (description of forms and location of organs)–fundamental works proving scientific nature of topographical anatomy. For these works, as well as for the aforesaid Surgical Anatomy..., Pirogov was granted Demidov Award.

In 1854, he established (first in the world) a community of the Sisters of Mercy. It was Pirogov who did a lot to introduce this type of medical care in the army. In his article The Historical Review of the Community of Exaltation of the Cross of the Sisters of Mercy at Hospitals of the Crimea and the Kherson Province from December 1, 1854 to December 1, 1855, he summarized the results of work performed by his "ardent assistants".

From October 1854 to December 1855, Pirogov participated in the Crimean War* (this period of his life will be described later) as a field surgeon and an attending physician, and in July 1856, six years after his return to St. Petersburg, the scientist resigned from the Chair and the Clinic at the Academy of Medicine and Surgery. Running ahead, let us point out that fifteen years later he once again participated in the center of hostilities (Franco-Prussian War, 1870-1871) and 6 years after–in the Russo-Turkish War (1877-1878).

From 1857 to 1859, he was a trustee of the Odessa Educational District, and 2 years later supervised the Kiev Educational District. Bidding farewell to students of the University of St. Vladimir, he presented his photo with an inscription to the students: "I love and respect youth as I remember my young years".

When the scientist retired, he settled down in a small estate in Ukraine and began to summarize his huge medical experience. In 1865-1866, he published The Fundamental Principles of General Field Surgery in two parts, which has become a reference book for many generations of field doctors.

In the afternoon of his life, from November 1879 to October 1881, Nikolai Ivanovich wrote The Diaries of Old Doctor "an essay written exceptionally for myself but with an ulterior motive that someone would read it one day".

On May 24-26, 1881, Pirogov celebrated 50th anniversary of his medical and scientific activities in Moscow. In his speech delivered at the assembly hall of the Moscow University, he expressed his gratitude to Emperor Alexander III for his telegram of greetings assessing it

* The Crimean (Eastern) War (1853-1856), originally the Russo-Turkish War for dominance in the Middle East. From February 1854, Turkey formed an alliance with Great Britain, France and Sardinian Kingdom (from 1855).–Ed.

"as a sign of greatest attention to his long professional activity". He was awarded title of an Honorary Citizen of Moscow, which Pirogov perceived as a high moral reward. "Indeed,–he said,–there is nothing more honorable than a title awarded by the motherland to one of her sons for work in the field of education, science and civic spirit and not for feats of arms, not for material benefits".

FROM SURGERY TO "PROBLEMS OF LIFE"

The Crimean War was a turning point in the professional activity of Pirogov as a surgeon. He worked for 12-14 hours a day, used his knowledge and experience to cure the wounded and sick soldiers, and lived a life of a simple soldier. One of his contemporaries wrote: "Russian soldiers will never forget proficiency and soft heart of Doctor Pirogov". It was there, in Sevastopol, where he for the first time offered and organized his renowned system of sorting the wounded into 5 categories depending on the severity of injuries. Before this, dressing stations were a real chaos, especially after heavy battles. The realization of Pirogov's idea made it possible to put the situation in order and render medical aid faster, facilitating the sufferings of the wounded.

With a sore heart observed Nikolai Ivanovich the rugged life of soldiers at hospitals, abuses and indifference of military administration, social ulcers that were "gnawing" Russia.

Pirogov's Letters from Sevastopol tell us much about his state of mind. In one of the letters dated April 29, 1855, Pirogov wrote to his wife in St. Petersburg: "Dear Sasha! When you see with your own eyes how little is done for the country only because of simple love to it, and its honor you will necessarily try to avoid evil for at least not to be its silent witness... I do not want to see disgrace of my home country, Sevastopol seized, I do not want to hear that it can be seized... However, you can do almost nothing in such situation... Each time... you see not Russian people who have unanimously agreed to die to save the motherland, but a chaos of ideas and opinions, i.e. complete misunderstanding of what is going on. We are blaming each other in silly things and leave everything to the mercy of fate... If you look at this mixture of our mediocrity, lack of talent, one-sidedness and meanness, no matter how much you believe in God and courage of the Russian army, you will certainly become concerned about the fate of Sevastopol, and consequently, the Crimea as a whole... The only thing we have to pray for is the same confused persons among our enemies."

"I arrived and saw,–continued Pirogov,–my patients with cut off legs lying in dirt like pigs. No doubt I will report on this to the Commander-in-Chief, even if the whole world becomes angry at me. I can imagine how a lot of top officials I attack as Sevastopol is attacked will be happy when I leave..."

According to the letter, Pirogov could not remain indifferent to what he saw. The scientist was an ardent advocate of a complete renewal of the country, and after his return to St. Petersburg, as we have already mentioned, he left the Chair and the Clinic at the Academy of Medicine and Surgery and wrote an article with a typical title The Problems of Life (1856). (This sudden change in his activities took place when Nikolai Ivanovich was only 46, i.e. in the prime of life). This article was published 154 years ago in the Marine Digest, but is topical even today.

The article begins with the following dialog: "What are you preparing your son for?"–someone asked me. "To be a man",–I answered. "Don't you know there are no men on earth: it is something abstract and unnecessary for our society. We need merchants, soldiers, mechanics, sailors, doctors, lawers, not men... It that so?"

Pirogov steadily substantiated the absurdity of class-specified education, showed a great gap between school and life. The article criticized the existing system but

nevertheless was permitted by censors and published due to the support of Grand Duke Konstantin Romanov, Minister of the Navy. Minister of Education Abraham Norov (Academician from 1851) highly appreciated the article and ordered to print it in the official organ of the Ministry to make known to public at large.

The article was written in the epoch-making period: defeat of Russia in the Crimean War, end of the reign of Nikolai I, awakening of public and national consciousness, hope for renewal of Russia. "We felt more free than before: literature and society faced new problems, posed new requirements to life"–this is how the physiologist Ivan Sechenov* (Honorary Member of the St. Petersburg AS from 1904) described that period.

Pirogov described the 19th century as mostly practical, "material, almost mercantile". The scientist believed that it was absolutely necessary to change the system of upbringing and education in the interests of a personality and public at large. The main objective was to create a man with high moral, human and civic ideals, which first of all required initial humanitarian training. "Don't hurry with your applied reality. Let the internal man become mature and strong..." Vocational training should go after initial complete development of moral, spiritual and physical potentialities of man, his talents.

UNIVERSITY EDUCATION

On June 18, 1863, a new charter was approved according to which universities were recognized autonomous and could develop independently taking into account local conditions and requirements, could determine the number of professors required, incite students for independent scientific studies, promote moral influence of teachers. Together with other reforms-the abolition of serfdom (1861), establishment of country councils (1864), Public Court (1865)–the new university charter ensured rapid development of education and science in Russia. Fundamental discoveries made by chemists Dmitry Mendeleev (Corresponding Member of St. Petersburg AS from 1876) and Alexander Butlerov (Academician from 1871), physicians Nikolai Pirogov and Sergei Botkin, biologists Ivan Sechenov and Ilya Mechnikov (Honorary Member of St. Petersburg AS from 1902, Nobel Prize winner of 1908) were recognized worldwide. Sechenov wrote: "Russian scientists successfully completed tasks posed by the reform... as science has always and everywhere been the most reliable test to check the cultural level of the race".

In The Executive Summary on the Progress of Education in the Novorossiysk Territory and on the Urgent Necessity to Restructure Educational Establishments (1857), Pirogov clearly demonstrated the necessity of two compulsory levels of common education–the first one is intended for gradual development of mental abilities of students and preparing them for independent activities; the second level comprises vocational training in this or that sphere of knowledge and mastering of practical skills for the benefit of the society. According to Pirogov, versatile and independent mind could be formed only if both educational levels are available. He believed that only a country where laws and other conditions do not break the strict sequence of this process could be proud of its children.

The University Charter of 1863, published in compliance with the instructions of the Ministry of Education, reads: "Many Russian and foreign professors expressed their attitude toward this project, but the standpoint stated by Nikolai Pirogov, Member of the Main Administration for Educational Establishments, is the most profound and socially-oriented. We can hardly find another such expert in the educational reform as

* See: A. Grigoryev, N. Grigoryan, "He Started Russian Physiology", Science in Russia, No. 4, 2009.–Ed.

our famous author of the Problems of Life... Pirogov's point of view, though a bit idealistic, is worth of special attention."

About 85 pages of comments and addenda were prepared by Pirogov for the draft charter. "Many people will think that I do not defend financial soundness of our universities in a proper way... That is so as I do not think it is the only condition... I am more interested in relations between universities and the state, society and science. It is impossible to form a true opinion on the significance of universities if we do not determine these relations... We neither can rely only on the improvement of financial situation nor be sure that rich libraries, museums, well equipped laboratories would awake interest in science. They are really valuable when they appear in university life as a consequence, not as a cause of scientific activity. The spirit of science can create great things with little means."

In his articles dedicated to the educational reform, Pirogov pursued the following idea: science and education are primary values of a country. It would be wrong to believe that only material means can enhance morality and convictions acquired in the course of education and through public views on science and life.

It is indicative that these problems posed by Pirogov in late 1850s-early 1860s turned out to be of acute importance and public interest in the 1870s in Europe. Academician-Secretary of Berlin Academy of Sciences Emil du Bois-Reymond (Foreign Corresponding Member of St. Petersburg AS from 1892) dedicated his public speech History of Culture and Natural Science delivered in Cologne on March 21, 1877, to close relations between culture and science. Disregard of fundamental science and culture results in detaching education from scientific and cultural environment. Art and literature become servants of the rude and inconsistent taste of the crowd. This is how spiritual efficiency runs low. According to Emil du Bois-Reymond, strengthening of classical education was an urgent necessity.

"HE TAUGHT US TO LEARN"

In 1862-1866 Pirogov successfully worked as a schoolmaster. Under his guidance more than 60 young scientists started work as professors at European universities, mainly in Germany. Among them were mathematicians Alexander Korkin and Vasily Imshenetsky (Academician from 1881), physicist Mikhail Avenarius (Corresponding Member of St. Petersburg AS from 1876), chemist Alexander Verigo, biologists Ilya Mechnikov, Nikolai Kovalevsky, Alexander Babukhin and Ivan Dogel, historian Vladimir Gerye (Corresponding Member of St. Petersburg AS from 1902), literary critic Alexander Veselovsky (Academician from 1877).

In his letters from Heidelberg (1863-1866) Pirogov wrote about an extremely rapid development of natural sciences and medicine in Germany, where the mood of abstract theorizing was predominant for a long time. Pirogov attributed this fact to the personality of naturalist and physiologist Johannes Müller (foreign Corresponding Member of St. Petersburg AS from 1832), whose breadth of views made it possible to prepare students, who later on headed chairs of anatomy, physiology, zoology, experimental pathology, pharmacology and ophthalmology. Pirogov had the same gift: according to the surgeon Academician Nikolai Burdenko, he was a brilliant teacher.

There exist a number of little-known literary works dedicated to Pirogov, in particular, recollections of Nikolai Kovalevsky, founder of the Kazan School of Physiology and one of the future professors of the Pirogov school. The meetings with the famous surgeon remained in his memory for the whole of his life. Kovalevsky recollected: "Examining new preparations and textbooks, leading lively scientific discussions with our foreign teachers and with us, students, he always found something new for himself, which he immediately criticized taking into account his own experience, his own positive knowledge. Pirogov infected us with his passion for learning, he assimilated knowledge not by way of simple addition but critically compared new data with what he knew for sure, he taught us to learn."

In early 20th century, in a speech made at a joint meeting of St. Petersburg Medical and Biological Societies, dedicated to the memory of the prominent Russian citizen, Ivan Pavlov expressed his opinion: People like Pirogov with "an amazingly clear understanding of true sense of life, its diversified aspects, have a really educating and guiding influence on us if we constantly, step by step, keep track of their lives." Pirogov's life is an outstanding example of self-sacrificing service to the noble ideals.