Roots and routes of Soviet neurosurgery

Boleslav L. Lichterman
The Wellcome Institute for the History of Medicine, London, U.K.

Regular and purposeful neurosurgical interventions started in the end of the nineteenth century. Both surgical and neurological roots of the emerging speciality could be traced. The surgical roots of neurosurgery were the invention of anaesthesia, aseptics and antiseptics which made brain operations relatively safe and markedly reduced postoperative mortality. The neurological roots were the improvement of topical diagnosis in neurology and understanding the anatomy and physiology of nervous system. The first brain tumour was removed in Russia in 1896 in St. Petersburg and operating room at the neurology department of Russian Military Medical Academy was established in 1897 by the famous Russian neurologist and psychiatrist Vladimir Bekhterev (1857-1927). According to Bekhterev, neurology should become surgical speciality like gynaecology or ophthalmology and "neurologists will take knife in their hands and do what they should do". Bekhterev's pupil Ludwig Puusepp (1875-1942) became the first full-time Russian neurosurgeon ("surgical neurologist"). He headed the first neurosurgical department (not only in Russia but in the world) organised in 1908 in St. Petersburg until his emigration to Estonia in 1920. Due to the highly centralised pyramidal structure of Soviet healthcare most interesting and/or difficult cases all over former Soviet Union were concentrating in three Neurosurgical Research Institutes (Moscow, Kiev and Leningrad). Neurosurgery was developing here as complex speciality in connection with allied sciences (neuroradiology, neurootology, neuroophthalmology, neuropsychology etc.). The huge referral area made it possible to develop subspecialties like paediatric neurosurgery, vascular, skull base, functional neurosurgery by organising special departments within these Institutes. The set of provincial neurosurgical centres had also appeared in 1930-ies. In 1937 a special neurosurgical periodical called Voprosy neurochirurgii (Problems of Neurosurgery) was launched --seven years before Journal of Neurosurgery in the United States. According to the leading Soviet neurosurgeon N.N. Burdenko (1876-1946), neurosurgical interventions were viewed as experiments on humans in order to confirm the neurophysiological concepts of Pavlov and Bekhterev based on animal models. They had to follow three basic principles: anatomical availability, technical possibility and physiological permissibility. Increasing isolation from the West, lacking of proper training programs and resources resulted into gradual stagnation of this speciality.

Session V
Saturday, 21 June 1997, 8.00 - 8.20

Second Annual Meeting of the International Society for the History of the Neurosciences (ISHN) and 6th Meeting of the European Club on the History of Neurology (ECHN)

Leiden, The Netherlands