Cross-sectional representations of the central nervous system in Pirogov’s “Ice Anatomy”

ABSTRACT Russian surgeon Nikolay Ivanovich Pirogov (Pirogoff; 1810–1881) introduced the teaching of applied topographical anatomy in Russia. Pirogov’s monumental four-part atlas, Anatome topographica sectionibus per corporis humanum congelatum triplici directione ductis illustrate (An Illustrated Topographic Anatomy of Saw Cuts Made in Three Dimensions Across the Frozen Human Body), colloquially known as the “Ice Anatomy,” was published in Latin in folio in the 1850s. Pirogov sought to investigate “the normal and pathological positions of different organs and body parts using sections made in the three principal directions [anatomical planes] … throughout all regions.” To accomplish this, he froze cadavers “to the density of the thickest wood” and then cut them into thin plates with a special mechanical saw. His approach was reportedly inspired by his observations of butchers sawing across frozen pig carcasses at the meat market in St. Petersburg during winter. Pirogov systemically obtained full-size representations of more than 1,000 sections. A painter made a representative copy of the cross-sectional contours of each section, using ruled glass overlain on the sections. The final lithographs were of high artistic quality and execution, resembling modern high-resolution medical imaging (i.e., CT or MRI). Moreover, structures were serially sectioned and systematically illustrated along all three anatomical planes, something that had never previously been attempted. This allowed clinicians and anatomists to scrutinize the spatial relationships of structures from multiple perspectives and at a much more detailed level than was previously possible, although the cost, massiveness, and complexity of the completed work precluded wide dissemination.