Ice Anatomy
Authors: Boleslav Lichterman
Journal: BMJ (2008)

Nikolai Pirogov (1810-1881) is considered to be the greatest Russian surgeon. He introduced the teaching of applied topographical anatomy in Russia, founded military surgery, implemented ether anaesthesia on the battlefield, suggested the use of plaster casts for fractures, and championed nursing care for the wounded during the Crimean War.

Born in Moscow, Pirogov graduated in medicine at the age of 18 and then spent two years in surgical clinics of continental Europe. In 1841 he was elected a professor of Imperial Medico-Surgical Academy in St Petersburg, where he stayed until his retirement in 1856.

An Illustrated Topographic Anatomy of Saw Cuts Made in Three Dimensions across the Frozen Human Body (Anatome topographica sectionibus per corporis humanum congelatum triplici directione ductis illustrate, often referred to in modern medical literature as “Ice Anatomy”) was published in Latin in four volumes. The volumes cover saw cuts of head, neck and spine, thorax, abdomen, and arms and legs. Pirogov wanted to investigate the “normal and pathological position of different organs and body parts by sections made in three main directions (transversal, longitudinal and anterioposterior) throughout all regions.” In order to reveal true representation of organs’ position Pirogov decided to freeze corpses below −18.75oC “to the density of the thickest wood” and then cut them by a special mechanical saw (similar to that used at furniture factories) into thin plates. A painter then transferred figures and contours of cuts onto paper ruled with squares, using a ruled glass. Pirogov suggested another method of frozen body investigation which he called the sculpture method: “Different internal organs such as stomach, heart etc, position of which had to be defined with previously unattainable accuracy, were chiseled out of adjacent frozen tissues with chisel and hammer similar to exposure of antique remains from lava in Herculaneum,” he wrote. 

“Ice Anatomy” apparently came to Pirogov’s mind at the meat market in St Petersburg in winter, where he noticed cuts across frozen pigs’ carcasses.

The original use of frozen sections for anatomical illustration is ascribed to Dutch anatomist Pieter de Riemer (1760-1831), but Pirogov’s atlas is striking because of its grandeur. It has 995 black and white pictures of saw cuts of the human body and four books of comments. It took eight years and the enormous sum of 35 000 silver rubles (more than £5500 in 1850s) to publish. The lithographs, printed from marble stones, strikingly resemble modern high resolution CT and MRI scans. Initially it was planned to print 300 copies, but circulation of each volume varied depending on availability of funds and the number of subscribers. By the turn of the 20th century the book became a rarity.

Pirogov was an icon for generations of Russian surgeons. Like Lenin he was embalmed after death. The mummy can be seen today in a village church in Pirogov’s estate Vishnya (now a museum) near Vinnitsa, Ukraine.

“Ice Anatomy” was reprinted in 1997 and translated from Latin into Russian and English for a limited edition of 500 copies. One set includes four volumes of pictures and two volumes of comments in a special case weighing about 20 kg—surely one of the heaviest medical books ever.