Ludvig Puusepp
Encyclopedia
Ludvig Puusepp ' onMouseout='HidePop("28401")' href="/topics/Kiev">Kiev
– 19 October 1942, Tartu
) was an Estonia
n surgeon
and researcher
and the world's first professor of neurosurgery
.
to an Estonian
father and a Polish
-Czech mother. His father Martin Puusepp was a shoemaker who had migrated from Rakvere
, Estonia to St. Petersburg where he met and married Victoria-Stephania Goebel. Puusepp learned German
at home and Russian
in school; it was not until 1920 at age 44 that he learned the Estonian language
. He continued to study languages including French
, English
and Italian
.
, and performed his first neurosurgical operation in 1899. After he was awarded the Doctor of Medical Science in 1902, Puusepp joined the faculty in neurology at the Women's Medical Institute. From 1904-1905 he served as a medical officer in the Russo-Japanese war. Upon his return to St. Petersburg in 1907, he took the position of Assistant Professor at St. Petersburg Medical Military Academy in the Department of Nervous and Mental Diseases. He also taught medical students as a member of the faculty of the St. Petersburg Medical Military Academy. During this time, Puusepp and Bechterew performed an experimental surgical procedure—frontal leucotomy, cutting association fibers in the frontal lobes—on three patients with manic-depressive psychosis with the aim of reducing psychomotor agitation . Dissatisfied with the results, they ceased further attempts at psychosurgery.
Bechterew had become dissatisfied with the attempts of general surgeons to operate upon the nervous system and felt that neurology should become a surgical specialty like gynecology or ophthalmology: "neurologists will take a knife in their hands and do what they should do" . He established an operating room in the Department of Nervous and Mental Diseases and a curriculum which emphasized neurological diagnosis. When the St. Petersburg Psycho-Neurological Institute later that year established a Chair of Surgical Neurology, Bechterew's protege Puusepp was named to head the new division. This independent department for neurological surgery was the first in the world , and when Puusepp was named full professor in 1910, he was the world's first professor of neurological surgery. During his tenure in St. Petersburg he published over 100 research papers. Puusepp served in the Russian Army Medical Service at the start of World War I, but was discharged and returned to teaching and academic leadership in St. Petersburg after being wounded. In 1917 he published a Russian-language neurology text, Principles of Surgical Neurology.
, in the newly-independent Estonia, to begin the most productive chapter of his career. He was granted Estonian citizenship on August 6, 1920. He was appointed Professor of Neurology at the University of Tartu and Director of the Hospital of Nervous Diseases (established 1921). Puusepp performed the first brain tumor operation in Estonia on April 30, 1921, for a right-sided cerebellopontine angle mass . Over the next twenty years he developed a strong neurological and neurosurgical teaching and clinical service with its own operating rooms and neuroradiology support. His forward-thinking approach to organizing the treatment, research, and educational missions of the institute was articulated in a plan drawn up in the 1920s. Until 1940 the Tartu clinic remained the only specialty neurological center in the Baltics, attracting patients from Finland, Latvia and Lithuania. Physicians from across Europe, including from Spain and Yugoslavia, traveled to Tartu to train with Puusepp.
In Tartu, Puusepp continued to research, innovate and publish. He was a founding editor of Eesti Arst (Estonian Physician). A 726-page work, Die Tumoren des Gehirns, was published in 1929, and then translated for a Spanish edition in 1931. Puusepp founded the medical journal Folia Neuropathologica Estoniana. Published from 1923 to 1939, it incorporated work not only from other Tartu researchers but also from international authors including Marburg, Freeman, his mentor Bechterew, Walter Dandy
, Walker, Guillain, and Alajouaine
. The first volume of Die Neuropathologie chirurgische, a monumental 1400-page work, was released in 1931. The work remained unfinished due to the advent of World War II and Puusepp's failing health. His final work, Peaaju, tema töö ja tervishoid was published in Tartu in 1941.
Puusepp's contributions included published books on the surgery of brain tumors and the nervous system and papers on a diverse number of topics within neurosurgery including the description of Puusepp's sign—demonstrating abnormal reflex at the 5th toe --and Puusepp's operation for syringomyelia. He also refined the techniques of ventriculography, reviewed the surgical treatment of cerebral aneurysms, experimented with measuring intracranial pressure using a manometer, and investigated nerve compression due to herniated spinal disks. He was one of the founding members of the Estonian Neurological Society (Eesti Neuroloogide Selts) in 1922, and he later served as the association's president. Some authors have suggested that Puusepp, through the role he played in the advancement of the neurosurgical profession, was Harvey Cushing
's counterpart in the Eastern hemisphere.
. The current TÜ Kliinikum Närvikliinik is on Ludvig Puusepa street in Tartu.
Puusepp's health began to decline in the second half of 1940, and he died of carcinoma of the stomach on October 19, 1942 in Tartu. He is buried in Tartu at the Raadi cemetery
.
Kiev
Kiev or Kyiv is the capital and the largest city of Ukraine, located in the north central part of the country on the Dnieper River. The population as of the 2001 census was 2,611,300. However, higher numbers have been cited in the press....
– 19 October 1942, Tartu
Tartu
Tartu is the second largest city of Estonia. In contrast to Estonia's political and financial capital Tallinn, Tartu is often considered the intellectual and cultural hub, especially since it is home to Estonia's oldest and most renowned university. Situated 186 km southeast of Tallinn, the...
) was an Estonia
Estonia
Estonia , officially the Republic of Estonia , is a state in the Baltic region of Northern Europe. It is bordered to the north by the Gulf of Finland, to the west by the Baltic Sea, to the south by Latvia , and to the east by Lake Peipsi and the Russian Federation . Across the Baltic Sea lies...
n surgeon
Surgeon
In medicine, a surgeon is a specialist in surgery. Surgery is a broad category of invasive medical treatment that involves the cutting of a body, whether human or animal, for a specific reason such as the removal of diseased tissue or to repair a tear or breakage...
and researcher
Researcher
A researcher is somebody who performs research, the search for knowledge or in general any systematic investigation to establish facts. Researchers can work in academic, industrial, government, or private institutions.-Examples of research institutions:...
and the world's first professor of neurosurgery
Neurosurgery
Neurosurgery is the medical specialty concerned with the prevention, diagnosis, treatment, and rehabilitation of disorders which affect any portion of the nervous system including the brain, spine, spinal cord, peripheral nerves, and extra-cranial cerebrovascular system.-In the United States:In...
.
Early life
Ludvig Puusepp was born on 3 December 1875 in KievKiev
Kiev or Kyiv is the capital and the largest city of Ukraine, located in the north central part of the country on the Dnieper River. The population as of the 2001 census was 2,611,300. However, higher numbers have been cited in the press....
to an Estonian
Estonians
Estonians are a Finnic people closely related to the Finns and inhabiting, primarily, the country of Estonia. They speak a Finnic language known as Estonian...
father and a Polish
Poles
thumb|right|180px|The state flag of [[Poland]] as used by Polish government and diplomatic authoritiesThe Polish people, or Poles , are a nation indigenous to Poland. They are united by the Polish language, which belongs to the historical Lechitic subgroup of West Slavic languages of Central Europe...
-Czech mother. His father Martin Puusepp was a shoemaker who had migrated from Rakvere
Rakvere
Rakvere is a town in northern Estonia and the county seat of Lääne-Viru County, 20 km south of the Gulf of Finland.-History:The earliest signs of human settlement dating back to the 3rd-5th centuries AD have been found on the present theatre hill. Probably to protect that settlement, a wooden...
, Estonia to St. Petersburg where he met and married Victoria-Stephania Goebel. Puusepp learned German
German language
German is a West Germanic language, related to and classified alongside English and Dutch. With an estimated 90 – 98 million native speakers, German is one of the world's major languages and is the most widely-spoken first language in the European Union....
at home and Russian
Russian language
Russian is a Slavic language used primarily in Russia, Belarus, Uzbekistan, Kazakhstan, Tajikistan and Kyrgyzstan. It is an unofficial but widely spoken language in Ukraine, Moldova, Latvia, Turkmenistan and Estonia and, to a lesser extent, the other countries that were once constituent republics...
in school; it was not until 1920 at age 44 that he learned the Estonian language
Estonian language
Estonian is the official language of Estonia, spoken by about 1.1 million people in Estonia and tens of thousands in various émigré communities...
. He continued to study languages including French
French language
French is a Romance language spoken as a first language in France, the Romandy region in Switzerland, Wallonia and Brussels in Belgium, Monaco, the regions of Quebec and Acadia in Canada, and by various communities elsewhere. Second-language speakers of French are distributed throughout many parts...
, English
English language
English is a West Germanic language that arose in the Anglo-Saxon kingdoms of England and spread into what was to become south-east Scotland under the influence of the Anglian medieval kingdom of Northumbria...
and Italian
Italian language
Italian is a Romance language spoken mainly in Europe: Italy, Switzerland, San Marino, Vatican City, by minorities in Malta, Monaco, Croatia, Slovenia, France, Libya, Eritrea, and Somalia, and by immigrant communities in the Americas and Australia...
.
Early Career in Russia
Puusepp undertook medical studies at the St. Petersburg Medical Military Academy from 1894 to 1899. Puusepp began training in neurology under Vladimir BekhterevVladimir Bekhterev
Vladimir Mikhailovich Bekhterev was a Russian Neurologist and the Father of Objective Psychology. He is best known for noting the role of the hippocampus in memory, his study of reflexes, and Bekhterev’s Disease...
, and performed his first neurosurgical operation in 1899. After he was awarded the Doctor of Medical Science in 1902, Puusepp joined the faculty in neurology at the Women's Medical Institute. From 1904-1905 he served as a medical officer in the Russo-Japanese war. Upon his return to St. Petersburg in 1907, he took the position of Assistant Professor at St. Petersburg Medical Military Academy in the Department of Nervous and Mental Diseases. He also taught medical students as a member of the faculty of the St. Petersburg Medical Military Academy. During this time, Puusepp and Bechterew performed an experimental surgical procedure—frontal leucotomy, cutting association fibers in the frontal lobes—on three patients with manic-depressive psychosis with the aim of reducing psychomotor agitation . Dissatisfied with the results, they ceased further attempts at psychosurgery.
Bechterew had become dissatisfied with the attempts of general surgeons to operate upon the nervous system and felt that neurology should become a surgical specialty like gynecology or ophthalmology: "neurologists will take a knife in their hands and do what they should do" . He established an operating room in the Department of Nervous and Mental Diseases and a curriculum which emphasized neurological diagnosis. When the St. Petersburg Psycho-Neurological Institute later that year established a Chair of Surgical Neurology, Bechterew's protege Puusepp was named to head the new division. This independent department for neurological surgery was the first in the world , and when Puusepp was named full professor in 1910, he was the world's first professor of neurological surgery. During his tenure in St. Petersburg he published over 100 research papers. Puusepp served in the Russian Army Medical Service at the start of World War I, but was discharged and returned to teaching and academic leadership in St. Petersburg after being wounded. In 1917 he published a Russian-language neurology text, Principles of Surgical Neurology.
Later Career in Estonia
In 1920, Puusepp relocated from St. Petersburg to TartuTartu
Tartu is the second largest city of Estonia. In contrast to Estonia's political and financial capital Tallinn, Tartu is often considered the intellectual and cultural hub, especially since it is home to Estonia's oldest and most renowned university. Situated 186 km southeast of Tallinn, the...
, in the newly-independent Estonia, to begin the most productive chapter of his career. He was granted Estonian citizenship on August 6, 1920. He was appointed Professor of Neurology at the University of Tartu and Director of the Hospital of Nervous Diseases (established 1921). Puusepp performed the first brain tumor operation in Estonia on April 30, 1921, for a right-sided cerebellopontine angle mass . Over the next twenty years he developed a strong neurological and neurosurgical teaching and clinical service with its own operating rooms and neuroradiology support. His forward-thinking approach to organizing the treatment, research, and educational missions of the institute was articulated in a plan drawn up in the 1920s. Until 1940 the Tartu clinic remained the only specialty neurological center in the Baltics, attracting patients from Finland, Latvia and Lithuania. Physicians from across Europe, including from Spain and Yugoslavia, traveled to Tartu to train with Puusepp.
In Tartu, Puusepp continued to research, innovate and publish. He was a founding editor of Eesti Arst (Estonian Physician). A 726-page work, Die Tumoren des Gehirns, was published in 1929, and then translated for a Spanish edition in 1931. Puusepp founded the medical journal Folia Neuropathologica Estoniana. Published from 1923 to 1939, it incorporated work not only from other Tartu researchers but also from international authors including Marburg, Freeman, his mentor Bechterew, Walter Dandy
Walter Dandy
Walter Edward Dandy, M.D. was an American neurosurgeon and scientist. He is considered one of the founding fathers of neurosurgery, along with Victor Horsley and Harvey Cushing...
, Walker, Guillain, and Alajouaine
Théophile Alajouanine
Théophile Alajouanine was a French neurologist.Théophile Alajouanine was a student of Joseph Jules Dejerine and a colleague to Georges Guillain and Charles Foix...
. The first volume of Die Neuropathologie chirurgische, a monumental 1400-page work, was released in 1931. The work remained unfinished due to the advent of World War II and Puusepp's failing health. His final work, Peaaju, tema töö ja tervishoid was published in Tartu in 1941.
Puusepp's contributions included published books on the surgery of brain tumors and the nervous system and papers on a diverse number of topics within neurosurgery including the description of Puusepp's sign—demonstrating abnormal reflex at the 5th toe --and Puusepp's operation for syringomyelia. He also refined the techniques of ventriculography, reviewed the surgical treatment of cerebral aneurysms, experimented with measuring intracranial pressure using a manometer, and investigated nerve compression due to herniated spinal disks. He was one of the founding members of the Estonian Neurological Society (Eesti Neuroloogide Selts) in 1922, and he later served as the association's president. Some authors have suggested that Puusepp, through the role he played in the advancement of the neurosurgical profession, was Harvey Cushing
Harvey Cushing
Harvey Williams Cushing, M.D. , was an American neurosurgeon and a pioneer of brain surgery, and the first to describe Cushing's syndrome...
's counterpart in the Eastern hemisphere.
Honors
Puusepp traveled widely as an invited lecturer and visiting professor. He was awarded an honorary doctorate at the University of Padua (1922) and University of Vilnius (1929). In 1938 he was one of the first twelve Estonians granted membership in the Estonian Academy of Sciences . He was also a corresponding member of the Portuguese Academy of Sciences and of the French Academy of Surgery. After Estonia was incorporated into the USSR in 1940, Puusepp was awarded the title of Merited Scientist. A granite and bronze monument designed by Endel Eduard Taniloo was erected in 1982 in west Tartu at MaarjamõisaMaarjamõisa
Maarjamõisa is a neighbourhood of Tartu, Estonia. It has a population of 354 and an area of .-References:...
. The current TÜ Kliinikum Närvikliinik is on Ludvig Puusepa street in Tartu.
Family
Puusepp married Maria Kotšubei in 1906. After her death in 1929, he married Maria Küppar, and in 1932 their only daughter Liivia (who would become a neurosurgeon herself) was born.Puusepp's health began to decline in the second half of 1940, and he died of carcinoma of the stomach on October 19, 1942 in Tartu. He is buried in Tartu at the Raadi cemetery
Raadi cemetery
The Raadi cemetery) is one of the oldest and largest cemeteries in Tartu, in Estonia, dating from the 18th century. Many prominent historical figures from the history of Estonia are buried here. It is also the largest burial ground of the Baltic Germans in Estonia after the destruction of Kopli...
.
Works
- О влиянии рентгеновских лучей на возбудимость мозговой коры. Отчеты научных собраний врачей С.-Петербургской клиники душевных и нервных болезней за 1897–1898 гг. С.-Петербург: 1899.
- О мозговых центрах, управляющих эрекцией полового члена и семяотделением. С.-Петербург: 1902. ; 180 pp., 3 plates
- Экспериментальное психологическое исследование умственной работы школьников-онанистов по сравнению с нормальными. Юбилейный сборник Трудов по психиатрии и невропатологии, посвящённый В.М. Бехтереву. Том второй. С.-Петербург: 1903.
- Нервно-сосудистый отек кожи. С.-Петербург: V. S. Ettinger, 1907. ; 23 pp.
- Травматический невроз военного времени: клинический очерк на основании собственных наблюдений. Петроград: Практическая медицина, 1916.
- Основы хирургической невропатологии в 4-х частях. Т. 1: Периферическая нервная система. Петроград: 1917. ; 38 pp.
- Der Blutkreislauf im Gehirn beim Koitus. Dorpat: 1922?.
- Noorus ja eluväärtus: (noorsoo enesetapmiste andmetel). s.n.: 1926.
- Symptomatologie et traitement chirurgical des lésions de la moelle épinière. J. G. Krüger, 1926; 39 pp.
- (With Endel Kirsimägi): Hüpnoos ja suggestioon arstiteaduses ja seltskondlikus elus. s.n.: 1927.
- К вопросу об оперативном удалении опухолей спинного мозга. Ленинград : Государственное издательство, 1928
- Die Tumoren des Gehirns; ihre Symptomatologie, Diagnostik und operative Behandlung auf Grund eigener Beobachtungen. Tartu: 1929.
- К вопросу о доброкачественных кистовидных опухолях париетальной доли. Эстония, 193?
- Los tumores del cerebro: Su sintomatologia, diagnóstico y tratamiento operatorio. Barcelona: Salvat Editores, 1931. ; 661 pp.
- Über die Entwicklung der chirurgischen Neuropathologie während der letzten 10 Jahre, nach den Daten der Nervenklinik der Universität Tartu-Dorpat. [Tartu], [1932]
- Chirurgische Neuropathologie. Bd. 1, Die peripherischen Nerven. Tartu (Dorpt): Krüger, 1932.
- Chirurgische Neuropathologie. Bd. 2, Das Rückenmark. Tartu (Dorpat): Krüger, 1933.
- Über Hirnmeningiome in Einzeldarstellungen : (Symptomatologie, Diagnostik und operative Behandlung auf Grund eigener Beobachtungen). Tartu: J. Mällo, 1935.
- Chirurgische Neuropathologie. Bd. 3. T. 1, Das Gehirn. Tartu: Krüger, 1939.
- Peaaju, tema töö ja tervishoid. Teaduslik Kirjandus, 1941. ; 70 pp.