S..S. YUDIN= Ay STUDY. IN
FRUSTRATION

HENRY SWAN, M.D., D.Sc., F.A.C.S.
Denver Colorado

From the Department of Surgery and Clinics,
Colorado State University, Fort Collins, Colo.

Reprinted from

SURGERY
St. Louis

 

Vol. 58, No. 3, Pages 572-585, September, 1965

(Copyright © 1965 by The C. V. Mosby Company )
(Printed in the U. S. A.)

 

 
S. S. Yudin: A study in frustration

he room was little enough, and _ it
seemed almost anticlimactic to look around
at the high, dingy ceiling and dirty walls,
but little relieved by light from the tall-
paned windows. The room wasn’t very im-
pressive, for such an important place—the
office of the Commissar of Public Health—
but then, there were only about twenty
people gathered for the meeting, and they
were all standing.

It was July of 1943, and the trek had
been a gruelling one. Bucket seats for hours
at a time cut in on the hamstrings; and the
cabins were cold aloft, then burning hot on
the military aerodromes at Castel Bonito,
Cairo, and Teheran. The DC-3 had lum-
bered surely, but with exasperating indo-
lence, across the deserts where just last year
the armies of Rommel and Montgomery had
surged and ebbed. The Commission—dis-
tinguished, if not youthful—was ill-trained
for the ordeal. From Cairo to Teheran the
Liberator flew at 13,000 feet and Elliott
Cutler had Cheynes-Stokes respiration; Gor-
don Taylor became cyanotic; and Wilder
Penfield had scintillating scotoma, homony-
mous hemianopsia, and migraine headache
(self-diagnosis) .

Even after the members had been settled
in the National Hotel in Moscow, Rock
Carling and Loyal Davis had persistent diar-
rhea and abdominal pain. The trip in the
dilapidated springless cars to visit hospitals
on the front, 270 kilometers away at Vyazma,
had been a two-day ordeal in the rain, while
the “higher-ups” had sparred on the subject
of protocol and agenda. The Commission
had wished to make the presentation at a
glittering medical gathering, with pomp

572

HENRY SWAN, M.D., D.Sc., F.A.C.S.
DENVER, COLO.

From the Department of Surgery and Clinics,
Colorado State University, Fort Collins, Colo.

appropriate to the possible portent of the
occasion, but the Commissar had decreed,
for reasons best known to himself, that
the ceremony should take place before a
hand-picked group in his office. Nicolai
Nilovic Burdenko, Chief Surgeon of the Red
Army, had explained that it was because a
battle was in progress and there were not
many outstanding surgeons left in Moscow
“worthy of participating in such a ceremony.”
In actuality, it appeared that there were only
twelve worthy to attend the awarding of
Honorary Fellowships in the American and
Royal Colleges of Surgeons to two Soviet
Surgeons, even though it was the first time
that the American Fellowship had ever been
conferred outside of the confines of the
United States.

After Gordon Gordon-Taylor and Regi-
nald Watson-Jones had presented the English
Fellowships, Elliott Cutler had said,

This gathering is momentous. We doctors now
signify to the solidarity and common purpose of
a majority of living peoples. The occasion justi-
fies the hope that this junction of our races is
but the beginning of a friendly and cooperative
liaison for all time. . . .

The second investiture had been com-
pleted, and now the lean, ascetic recipient
with the receding forehead and prominent
spectacles was responding with animation,
his long, tapered fingers gesticulating to em-
phasize his comments, which were delivered
in English with an accent that seemed more
French than Russian.

You will easily understand my animation when,
immediately after one high honor, the surgeons
of a second great allied country, U. S. A., bestow
on me another.
Volume 58
Number 3

I know a little of your beautiful country. I am
proud of my personal acquaintance—and even
friendship—with George Crile, Howard Kelly,
the brothers Mayo, and other American surgeons
of world fame.

By the way, it is an astonishing fact that this
day of my decoration by the Allies completely
coincides with the day I was severely wounded
by a German shell on the eve of July 15, 1915.

For the second time in the same quarter of a
century our nations are united in their hard
efforts to save their countries and the world’s
civilization. . . . Victory will be ours. Nobody
has any doubts about it, even our enemies. Let
our scientific relations, which have begun in time
of such strained military needs, get stronger and
flourish more and more after this victory and
the won peace.

In times of struggle, surgery is as necessary
for victory as arms, transport, and all kinds of
supplies. But when the last gun of the enemy will
cease and the released humanity will turn with
hope to the restoration of great destroyments
caused by the war, we surgeons will have to heal
the wounds and injuries of hundreds of thousands
of people, who have won for us this victory.

Your high election of me as Honorary Fellow
of the American College of Surgeons will serve
as a new additional stimulus for further develop-
ment of my scientific work in surgery. . . . Once
more, I deeply and sincerely thank you.

With the gracious permission of the Com-
missar of Public Health, Sergei Sergevitch
Yudin then posed for a photograph—in his
academic gown and holding his two hoods
—between mufti-clad Elliott Cutler and Gor-
don-Taylor. But the fate of the picture was
prophetic: It was never seen by any member
of the Commission or any physician outside
the U.S.S.R. The promised opening of a
path of communication offered by this meet-
ing of distinguished Allied surgeons had, like
the unseen photograph, failed to materialize.
The follow-up never took place, and Russian
surgery disappeared behind the Iron Curtain
of official decree. Vice-Commissar Kolesnikov
was realistic when, after the presentation, he
told Loyal Davis that he thought it very de-
sirable to exchange medical information, but
that he would “have to take it up at a higher
level.” Meanwhile, Yudin had already left
for the front to operate with his famous
“femur brigade.”

Like most imaginative, pioneering men,

Swan: Study in frustration 573

Yudin’s life had been marked by opposition,
misunderstanding, and persecution. Revolu-
tionary Russia was bound to be cruel to an
individualist of such talent. Born of affluent
parents in Moscow in 1891, his early years
must have been exciting and happy as his
inexhaustible energy and boundless curiosity
responded to the cultural milieu of Czarist
Moscow and St. Petersburg. He entered
Moscow University School of Medicine at
the age of 22, and while there, married a girl
of considerable wealth. While preparing for
his surgical career, Professor Gubarey, a rest-
less gynecologist with a flare for surgery and
the designing of surgical instruments, was
perhaps his most important influence.

Before completing his medical education,
however, he entered the armed services at
the outbreak of war in 1914 and was
wounded three times, the last time severely
(July 15, 1915): shrapnel, entering the
spine, left him paralyzed for many months.
Just as he was recovering, the October Revo-
lution of 1917 burst into his world. When the
smoke cleared, Russia was out of the war,
he and his wife had been stripped of their
possessions, and he, a Zemstvo physician
subject to assignment by the State, found
himself at the Zakharino Sanatorium on the
outskirts of Moscow.

There he taught himself surgery, exploring
ways and means of performing more and
more extensive thoracoplasties for chronic
empyema.

His next assignment, in 1922, took him to
a small hospital at the textile town of
Serpukhovski, where the facilities were medi-
ocre but the clinic load was great. There he
turned his attention to a variety of problems
—and made certain that he presented his
results as frequently as possible to the con-
ferences of the Moscow Surgeons’ Society.
Surgical reports flowed from his pen: radical
gastrectomies for ulcer; a hemipelvectomy
for sarcoma (performed on a woman who
subsequently bore a living child) ; plastic
formation of neovaginas; and a book on local
anesthesia (which won the Rein’s prize as
the best publication on surgery in the
U.S.S.R. for 1924-25). His mastery of his
574 Surgical history

   

Surgery
September 1965

Fig. 1. Portrait of “S. S.,” busy at his desk, with the long facile fingers—of
which he was so justifiably proud—prominently displayed. (From a photograph
given by Yudin to Gordon-Taylor.8 From Annals of the Royal College of Surgeons

of England.)

art was expanding rapidly; and recognition
of that mastery was growing. He was elected
to membership in the Russian Surgical As-
sociation and in 1926 he was sent to the
United States, although his wife was not
allowed to accompany him. There he visited
Babcock, Crile, Cushing, Kelly, and the
Mayos, and wrote of his experiences in a
series of letters published under the title, “A
Guest of American Surgeons.’ Thus, when
Krasintsev, Chief Surgeon of the Sklifosovski
Institute (central emergency hospital of Mos-
cow) died in 1928, available was an energetic
surgeon of great versatility and wide renown
who, although not a party member, had not
as yet run afoul of officialdom. He accepted
this important assignment with enthusiasm.
The Sklifosovski had originally been a
sanitorium called the Sheremetief Hospital,
but after the Bolshevik victory in 1917 it
had been renamed and converted to serve
as the central emergency hospital of Moscow,
a role it has performed ever since. Thus, in
1928, a tremendous volume of traumatic

and emergent surgical cases were selectively
funneled into the operating suite of the new
director—and a more versatile and imagina-
tive recipient would be hard to visualize.
Only think of having all those in a large
metropolitan city who had suffered a bad
accident, bleeding ectopic pregnancy, frac-
tured hip, burned esophagus, perforated or
bleeding ulcer, or severe head injury brought
to your hospital admission room in an unend-
ing stream! (What a Chairman for the
A.C.S. Committee on Trauma he would have
made!)

“S. 8.” did not waste this surgical oppor-
tunity. His first step was administrative. He
enlarged his “trap” by careful organization
of the city into six districts, with an outlying
collecting station where patients were first
sorted and given first aid and supportive
treatment before being sent into “Mother”
Sklifosovski. Communications were stressed,
and a telephone network was established with
the master switchboard near the beautiful
mural-laden dome of the old chapel (built
Volume 58
Number 3

in 1803 by a Count in memory of his mistress,
who had died in childbirth) which was now
the entrance to the new hospital. This
switchboard controlled with precision the am-
bulances, the distribution of emergency phy-
sicians, and the inexorable flow of the most
difficult and demanding cases to the operat-
ing rooms of S. S.* It is probably fair to
state that the treatment of acute, emergent
surgical conditions in a large city has never
been equaled in the world. (And S. S., with
his burning drive, operated day and night!)
In 1943, the Commission was overwhelmed
by this tremendous organizational accom-
plishment and the virtuosity of its director.

What, specifically, were some of the surgi-
cal contributions from this vast experience?
To mention a few:

GASTRIC SURGERY

Yudin was an early advocate of gastric
resection in the treatment of the complica-
tions of peptic ulcer. He advocated and
practiced definitive gastric resection in the
treatment of acute perforation of a duodenal
ulcer, a plan repopularized by De Bakey a
quarter of a century later. One morning in
1943, Gordon-Taylor watched him perform
four gastric resections (partial and_ total)
under spinal anesthesia (twelfth thoracic) ,
in time to join his wife as host of a luncheon
at the hospital, spiced with vodka, caviar,
and blintzes (bar-le-duc and whipped sour
cream rolled in crépes). In 1943 his total
experience in gastric resection had exceeded

*All telephone calls come into a central telephone room
at this Institute, where there are many switchboards and
an elaborate system of intercommunication and directing
officials. Apparently, patients, doctors, police or friends
may call in and state facts. Ambulances go out im-
mediately, either from the Central Institute or from
nearest hospital, to the patient after the information is
relayed to that hospital. If a doctor is unnecessary he
does not go in the ambulance, but if there has been
an accident or if the case is questionable, the ambulance
contains a doctor, nurse, and driver. As the message
leaves the telephone control room in writing, a time
clock is started and officials in the room know when the
ambulance departs, for, as they leave, the doctor, nurse,
and driver all press separate buttons which flash a light
on in the central telephone room. A check list is also
kept by the director of the time consumed by each
operator per case, and the number of cases per day. Al-
so the director in a separate room can plug into any
line and listen to incoming and outgoing calls.

Swan: Study in frustration 575

5,500 cases, including a total gastrectomy in
1937 performed on his own mother for carci-
noma (a patient whom he introduced to the
Commission more than five years later) .

ESOPHAGEAL RECONSTRUCTION

Surely his greatest contribution to world
surgery was the solid establishment of basic
techniques for the construction of an ante-
thoracic, substernal neoesophagus with a
pedicled jejunal transplant. Nowhere in the
world but at the Sklifosovski could this have
been done so definitively. Throughout the
bitter, frigid heartland of the Russian pla-
teau, the peasants lived in chinked log cabins
which usually had a single, double-paned
glass window. After months of incarceration
in the humid miasma of too many people in
too small a room, one can easily understand
the importance of an opening—a window to
see through, not one frosted between the
panes to gray obscurity. The solution was a
hydroscopic agent between the panes, and
what was available was concentrated sul-
furic acid, made by the Czar’s former
munitions plants. So, every log cabin in
Russia had a glass of crystal-clear, waterlike
acid sitting in the window sill, where child
and adult alike could inadvertently drink to
the death of his esophagus (much as for
years most houses in America had a box of
lye in the laundry, although it was not so
inviting to the thirsty). And to the Sklifosov-
ski came those who survived the first terrible
ordeal, emaciated, unable to eat or perhaps
even swallow their saliva, for salvation. S. S.
learned how to preserve an adequate blood
supply to the jejunal flap by careful section
of the arcades as visualized by transillumina-
tion; how to prepare a _neck-to-abdomen
tunnel behind the sternum with a specifically
devised spade-like instrument with a long
handle, plunged fearlessly and rapidly up-
ward without anesthesia, since the abdomen
had been entered with local infiltration and
ganglion blockage; and how to stage the pro-
cedure, doing the jejunogastric anastomosis
at the first step, but leaving the esophago-
jejunal one until two weeks later, when the
blood supply of the jejunal end would be
576 Surgical history Surgery

September 1965

 

Fig. 2. A, Yudin’s specially devised spade for the preparation of the retro-
sternal tunnel. B, The creation of a skin tube to connect esophagus to
upper end of jejunal transplant for final stage of esophageal reconstruction.
(From Yudin: Surg. Gynec. & Obst. 78: 561, 1944.)
Volume 58
Number 3

stabilized and the fascial planes in the neck
had sealed a barrier to spreading infection.
And, remarkably, S. S. reasoned out these
steps in advance, with his characteristic bril-
liant decisiveness. In 1943 he reported to the
Commission on his first 88 cases, with only
two deaths (at that time, practically the
entire world experience with such a pro-
cedure)! He then performed four demon-
stration operations in their presence in one
morning, doing the second stage of number
89 and the first stage of numbers 90, 91, and
92. By 1947, he had done 350!

BLOOD TRANSFUSION
AND BANKING

With so much major trauma to deal with,
S. S. early became impressed with the thera-
peutic benefits of blood transfusion in a
period (the late 1920’s) when the scientific
energy of the western world was just be-
ginning to study the potential of bovine
plasma and gelatin as blood substitutes. The
techniques for preservation of blood had not
yet evolved, but S. S., avidly searching the
available literature, seized on the report of
V. N. Shamov, a physiologist working in
Kharkov, who in 1928 stated that the blood
of dogs that had been suddenly killed did
not clot, and that it could be conveniently
transfused into other dogs after storage for
several days. (The fact that blood in sud-
denly killed animals does not clot had been
observed and reported by John Hunter 150
years earlier, and Shamov just might have
known that—in spite of Russia’s official sup-
pression of all forms of foreign communica-
tion—because he had worked in the United
States for 6 months in 1918.) Why this
should be true was not known to Hunter,
Shamov, Yudin, or, for that matter, to any
hematologist today.

In his experiments, S. S. saw a possible
solution to the need for blood. Many accident
victims in the rough, hustling city were either
picked up dead or were dead on arrival at
the hospital. There were many, many poten-
tial donors available. In 1930, the first unit
of cadaver blood was transfused at the
Sklifosovski. Within a short time, the first

Swan: Study in frustration 577

practicing blood bank in the world was or-
ganized and running full blast.* By 1935 the
annual harvest was about 800 liters from
cadavers, with a 25 percent rejection rate
because of positive Wassermann reactions,
bacterial infection, or tuberculosis. By 1943,
sulfonilamide was being used as a preserva-
tive; but by this time too, citrated whole
blood was being used extensively in the
Red Army medical installations, drawn with
excellent techniques and good laboratory
control at the rate of 2,000 pints a day in
Moscow alone, transported to the front-line
hospitals in insulated four-unit boxes, and
stored there in ice block houses for use up
to three weeks later. In Moscow, the Central
Institute for Blood and Transfusions under
Professor Bagdassarov, with 79 substations
throughout Russia, was bleeding 600 donors
a day who had been lured to contribute by
a special food ration and some rubles (al-
though 85 percent of the latter was expected
to be put back into a government airplane
construction fund). The name of the donor
was placed on each ampule, and was often
the source of romance, since in the Russia
of 1943 blood donors were mostly women,
and the severely injured soldiers often wound
up for their reconstructive surgery in base
hospitals in the big city. At this time the
American Red Cross Blood Procurement
Program was just being considered, and the
Second Auxiliary Surgical Group was giving
the wounded G.I. in Sicily lyophilized plasma
(and a fair chance at hepatitis). Cutler and
Davis, in the report based on observations of

*Blood banking was entirely a Russian invention. In
1926 the Central Institute of Hematology and Transfu-
sions had been established in Moscow. In 1930, the
Sklifosovski Cadaver Blood Bank and the Ukranian In-
stitute of Blood Transfusion at Kharkov were established.
The next year the Leningrad Blood Transfusion Station
went into service, and Filatov and Depp were soon able
to report the administration of 1,529 transfusions. In
1932, a mobile blood transfusion unit was established in
Paris; in 1934, Tenconi and Palozzo described 41 trans-
fusions of citrated blood in Buenos Aires. Meanwhile,
transfusion stations had opened in Kiev, Tbilsi and Baku.
In 1936, Bagdassarov could report 6,345 citrated trans-
fusions, in Moscow, and in this year began the Barce-
lona Blood Transfusion Service for the Republican Army
in Spain. Before this war was finished, over 9,000 L. of
cold blood stored in hermetically sealed containers had
been transfused. In 1937, Fantus established a blood bank
at Cook County Hospital in Chicago.
578 Surgical history

Russian military medicine, made Recommen-
dation 3(c) to the Office of the Chief Sur-

geon, European Theater:

FACILITIES FOR
BLOOD TRANSFUSION

The attached report emphasizes the great
amount of blood used in the Russian Army and
its easy availability. Though this doubtless wasted
some blood, it made certain that every wounded
man could get blood if that was desirable. We
should establish a system making blood as well as
plasma available to our forward hospitals.

Gordon-Taylor wrote in 1954 that, among
other things, the name of Yudin would
probably “be linked with the macabre ex-
periment of transfusions of corpse blood.”
But, Watson-Jones made a better interpreta-
tion when he said, ‘““He made a cadaveric
blood bank long before anyone else talked of
banks.” Let us help, in this report, to put
the credit squarely where it clearly belongs.

 

 

Surgery
September 1965

Sergei Yudin established the first working
blood bank in the world (1930), worked
out the techniques of collection, storage, and
administration, and proved its worth. If he
had made no other notable contribution, this
alone should assure him a niche in Medicine’s
Hall of Fame.

WAR SURGERY

In icy Moscow, fractured hips were com-
mon enough and had become a matter of
special interest to S. S. He had pursued this
interest in bone injury during the Finnish
War, where it is said that he personally cared
for 2,000 compound fractures of the femur
before the war with Germany began. He had
accepted—in general and without iron-clad
commitment—the basic tenets concerning the
use of skin-tight plaster of paris first urged
by Piragov in 1865 as a result of his experi-
ences in the Crimean War. This method was

 

 

 

 

 

 

 

 

 

 

 

Fig. 3A. The table specially devised by Yudin for the “conveyor line” technique in the treat-
ment of lower extremity war fractures near the front by a “femur brigade.”
Volume 58
Number 3

widely used in the Red Army hospitals in
the treatment of all compound extremity
wounds. But Yudin added two important
principles: (A) the really wide and complete
excision of all devitalized tissue, leaving the
wound open, and, if need be, holding it open
by suturing the skin edges to the underlying
fascia (this, even if the wound were 5 to
10 days old when first seen); and (B) the
excision rather than drainage or removal of
bone fragments in joint wounds (including
knee and even hip). His results with these
methods were spectacular and made a tre-
mendous impression on the Commission, who
were also seeing for the first time the active
practice of secondary wound closure—7 to
12 days after first debridement. By 1944,
while the U. S. Field Hospital platoons leap-
frogged each other to stay at the level of

Fig. 3B. Steps in the treatment of lower extremity fractures: (1) spinal anesthesia on stretcher;

(2) initial cleansing on fracture table; (3) ready for operation. (From Yudin: Surg. Gynec.

& Obst. 78: 1, 1944.)

Swan: Study in frustration 579

Division Casualty Clearing Stations on the
mobile French front, the U. S. Medical Corps
had adopted the first principle (adequate
wound excision) ; no longer had need of the
second (joint excision) because of a growing
supply of penicillin; and was just beginning
to learn the value of the third (delayed pri-
mary or secondary closure). But Yudin,
despite his coronary attack the previous year
in 1942 (during his convalescence he wrote
three books to serve as manuals for military
surgeons on “The Treatment of Complex
Fractures,” “Military Field Surgery,’ and
“The Treatment of War Wounds with
Sulfonamides”) was now, at the time of the
Commissions visit, not only managing the
Sklifosovski and operating long hours on
civilian and military trauma patients, but
was also running his own “Flying Femur

 

 
580 Surgical history

Brigade.” By this he meant the following:
In a forward hospital, a good fracture sur-
geon needed eight assistants and three tables
going, one for careful wound cleansing, one
for the actual operation, and one for the ap-
plication of the cast, the three teams rotating
from table to table in turn. Thirty-two cases
could thus be handled by one surgeon in 16
hours, he said. This is what S. S. was doing
on his “days off” from the Sklifosovski in

Surgery
September 1965

1943, and why he left the Commissar’s office
on July 15 right after the ceremony, while
Davis and Carling were discussing “com-
munication” with Kolesnikov.

But whereas the Sklifosovski period was
firmly establishing his professional stature,
one wonders if this same activity was not
undermining his political acceptability and
personal security. It is easy to visualize the
constant friction between this brilliant, de-

 

Fig. 4A. Steps in the technique of wound excision and suture of the skin
to fascia preparatory to the application of plaster of paris for fracture of
the lower femur. (From Yudin: Surg. Gynec. & Obst. 78: 1, 1944.)
Volume 58

Number 3

cisive, energetic, individualistic administrator
and the frustrating restrictions, exasperating
indecision and procrastination, the buck-
passing, the infuriating, meddlesome orders
from the Commissar’s office, and the de-
mands for performance when the wherewith-
all to achieve it was withheld (a circumstance
so characteristic of bureaucracy in general
and totalitarian hierarchy in particular).
That his inner thoughts of resentment and
his overt acts of rebellion were well known
to officialdom can be assumed with confi-
dence, when it is remembered that one of his

 
  

mn. adductores

 

nischiadieus

whiceps ftonor. yo achimeindron.

Fig. 4B. Technique for hip fracture.

  
   

Swan: Study in frustration 581

assistants at the operating table in the
Sklifosovski was a woman—the wife of a
Vice-Commissar! One must assume that
gradually his name rose higher and higher
on the list of those who should be removed
from position of authority. But his talent and
stature temporarily held back official action.
Here was a man who had been elected to
the Georgia Society of Surgeons, was an
honorary member of the N.I. Piragov So-
ciety of Surgeons (Russia’s elite), an “Ac-
complished Scientist’ of the Academy of
Medical Sciences, twice laureate of the Star
582 Surgical history

of Stalin, and Professor at the Central In-
stitute for Medical Advancement.

He was certainly Russia’s best-known sur-
geon abroad. Indeed, he had cultivated this
aspect of his life with characteristic vigor.
He spoke French, German, and English. He
had wangled the trip to the U.S.A. in 1926,
and made sure everyone knew about it by
his travel letters. He succeeded in getting
another trip abroad in 1932, going to En-
gland, France, and Spain. He began cor-
respondence, as a result of these contacts,
with many distinguished European surgeons.

This latter trip saw the repetition of a
pattern of effort to make his voice heard
abroad which had occurred before and would
repeat itself in later years. In 1926 he had
left two manuscripts in the United States
for publication in Surgery, Gynecology, and
Obstetrics. When in Paris, in 1932, he hur-
riedly wrote the manuscript for his classic
monograph, “Le transfusion du sang de
cadavre a l’Homme,” which was published
by Masson et Cie in 1933. Why would the
Director of the Sklifosovski have to sur-
reptitiously and hurriedly write a book in a
foreign capital for publication in a foreign

Surgery
September 1965

language by a foreign publishing house? Be-
cause he understood that if the world were
to know of his work, it would never learn
through the very limited and nationally re-
stricted journals of Russian medicine; and
he knew that if he tried to forward a manu-
script to a Paris editor, it would go “through
channels,” and probably never get there.

One notices that Mrs. Yudin was never
allowed to accompany her husband on his
foreign journeys; rather, she was kept home
in Moscow under surveillance as hostage to
Sergei’s good behavior abroad and sure re-
turn. His tricky evasion of official censorship
while in Paris was probably viewed with
bureaucratic dismay. In any event, he was
never again allowed to leave Russia.

By 1943, Yudin was surely in the political
doghouse. Despite his official importance and
tremendous professional stature (Russia’s
best), he held the rank of Colonel in the
Red Army Consultants, a rank which was
never raised. He confided to Gordon-Taylor
that the reason he always took his wife with
him to the front line hospitals as a member
of his “femur brigade” was his haunting
fears for what might happen to her in his

 

Fig. 5. “S. S.” injecting spinal anesthesia at the level of the twelfth thoracic
vertebra preparatory to performing the first stage of a jejunal transplant
for esophageal reconstruction. (From Gordon-Taylor: J. Bone & Joint Surg.
36B: 503, 1954.)
Volume 58
Number 3

absence, “reckoning her danger less in the
forward area than in the capital city of the
U.S.S.R.” He had reason to worry. When
the onward rush of the German attack swept
to within 70 kilometers of Moscow’s gates, his
resistance to party officials in matters relating
to the administration and the surgery of his
hospital would have led at that time, save
for Stalin’s interception, to the liquidation of
this great patriot and master surgeon. The
lines of this internal war were clearly drawn,
and only Russia’s immediate need of him and
the bright light of his public image held
back the pen of banishment. Instead, they
gave him the Order of Lenin for “face,”
but the future was foreseeable.

The very Mission of 1943, itself, had been
a move of Yudin’s. It was known to Davis
and Gordon-Taylor that Yudin and Sir
Archibald Clark Kerr, the British Ambas-
sador to Russia, were good friends and had
secretly (secretly?) met many times at night.
It was at Yudin’s urging that Clark Kerr
laboriously organized the Mission, wangling
Russian official approval, getting the English,
American, and Canadian representatives
picked and properly credentialed by their
respective Research Councils and the appro-
priate Fellowship awards granted by the
Councils of the American and Royal College
of Surgeons, and then arranging the com-
plexities of the transportation. The Commis-
sion would be approved only if all members
were full professors, if it were oriented
around National Research Institutes, and if
the Russian surgeons (Burdenko and Yudin)
would be honored. Wilder Penfield had also
been urging the Commission through the
American Ambassador to Britain, Winant,
and had helped in achieving the organiza-
tional details in America and Britain. It was
an extraordinary hegira.

And, true to form, Yudin made what
proved to be his last successful move to be
heard abroad. On the night of July 22, with
the Commission working hard on the problem
of transportation home, S. S. dropped by
Loyal Davis’s room in the National Hotel.
Talk turned to the possibilities and urgent
need of a Second Front, whereupon Davis

Swan: Study in frustration 583

elaborated on the many things Britain and
the United States were doing for the Soviet
Union. Yudin said he knew it, but the
Russian people did not know it, for the press
was not free. He spoke wistfully and hope-
fully of the changes that would occur after
the war. Then he gave Davis two manu-
scripts. “The Treatment of War Fractures
of Femur,” containing the principles of wide
wound excision and early, skin-tight plaster
fixation, was published in Surgery Gyne-
cology and Obstetrics (78:1, 1944) ; “Surgi-
cal Construction of 80 Cases of Artificial
Esophagus” was published in the same
volume. These papers presented to the En-
glish-speaking surgical world its first glimpse
of the extraordinary contribution which this
masterful surgeon had made to the surgery
of esophageal replacement. His next foreign
publication appeared 10 years later, but he
never saw it. It was hurriedly submitted after
the announcement of his death!

So the Commission finally returned to
their respective jobs and posts, and nothing
had changed. Communication between the
Western powers and Russia dwindled to a
trickle. On V.E. Day, the Iron Curtain fell
with a clang, and what transpired in the
world of Sergei Yudin could only be con-
jectured.

There was foreboding across the continent.
Beginning in 1947, letters from Gordon-
Taylor and other correspondents were no
longer answered. Nor were they returned.
Just silence. In 1948, the name of Yudin
no longer appeared on the editorial board of
Vestnik Khirurgii, and the darkness was com-
plete.

Years passed by. Had S. S. been liqui-
dated? Or had he been, like the physiologist
Shamov, sentenced to the labor battalions
in Siberia? We will never know. We only
know that in the London Times of June,
1954, appeared his obituary, based on a
Moscow release in the Medicinski Rabotnik
(Medical Worker). Gordon-Taylor believed
that Yudin had been brought back from
Siberia dying, although the Soviets issued a
statement that he had been seriously hurt in
an airplane accident. At long last, however,
5984 Surgical history

the mystery was over. Sergei Sergevitch
Yudin was indeed dead.

But officialdom was not yet ready to cease
fire at this surgical martyr. The following is
what the editors of the Great Soviet Encyclo-
pedia® were permitted to say about the
greatest Soviet surgeon since Piragov.

Yudin, Sergei Sergeyevitch, 1891-1954
Soviet surgeon, Member of the U.S.S.R. Acad-
emy of Medicine since 1944. He graduated from
Moscow University in 1915. Served as an army
doctor, and held several important medical posts,
including the Sklifosovski Institute of Moscow,
where he was Chief of the Surgical Clinic.
From 1931, he was a professor of the Central
Institute for Medical Advancement, and was con-
sidered a great authority in surgery. He wrote
many books on the subject. Yudin received the
Lenin Prize and several other decorations and
medals.

Isn’t that a dandy!

But, in the minds and hearts of those who
knew him best—Gordon-Taylor, B. Petrov,
Watson-Jones, and many others—his dy-
namic and inspiring personality will endure.
Here was a cosmopolite, trapped in a hostile
world yet undaunted in spirit, a perpetual
monument to what is creative and humane
in mankind.

Gordon-Taylor’s tribute was from the
heart:

His personality was captivating: he was poet,
writer, fisherman, dilettante and lover of all things
beautiful, a perfervid patriot. It is good to have
known “S. S.”: Let us hope that his passing was
easy, and that his own devout wish may come
to fruition: ‘‘We have become united in the war;
let us see to it that we become united in the
peace.”

And as Boris Petrov said,

He did not stop before obstacles, he was not
given to despondency and melancholy; he never
complained. With his whole being he was living
for the future, always amidst a multitude of plans,
always burning with optimism. Not all his dreams
came true. ...

The author wishes to thank particularly: Dr.
David Schechter, who stimulated the preparation
of this interpretation of Yudin’s life and who pre-
pared the initial bibliography; Dr. Loyal Davis,
who generously made available his personal rec-
ords, which were invaluable in the reconstruction

Surgery
September 1965

of the Soviet surgical scene at the time of the
Surgical Mission to Moscow in July of 1943; and
Professor Boris A. Petrov, Yudin’s successor at
Sklifosovski, who also provided friendly stimulus
and an English translation of his tribute to
S. S. in the Festschrift volume of Khirurgiia, 1961.

REFERENCES
Articles about Yudin

1. American college of surgeons confers hon-
orary fellowships on distinguished Russian
surgeons, Bull. Am. Coll. Surgeons, Sept., p.
258, 1943.

2. Anonymous: Sergei Sergevitch Yudin, Hon.
F.R.C.S., Hon. F.A.C.S. Obituary, Brit. M. J.
2: 52-1954.

3. Anonymous: Yudin, Sergei Sergevitch, 1891-
1954. The great Soviet encyclopedia, ed. 2,
Vol. 49, p. 360.

4. Cutler, Elliott C., and Davis, Loyal: Report
of surgical mission to Russia to Chief Surgeon,
European Theatre of Operations, Aug. 7,
1943.

5. Davis, Loyal: Personal communication.

6. Davis, Loyal: Personal diary, June 28 to
July 29, 1943.

7. Davis, Loyal: Report to the National Re-
search Council upon the surgical mission to
the Soviet Union Aug. 1, 1943.

8. Gordon-Taylor, Gordon: The late Sergei
Sergevitch Yudin, Hon. F.R.C.S., Ann. Roy.
Coll. Surgeons England 15: 200, 1954.

9. Penfield, Wilder: Personal communication.

10. Petrov, B. A.: Sergei Sergevitch Yudin,
Khirurgiia Medgiz Moscow 10: 3, 1961.
(Festschrift in honor of Professor S. S. Yudin
on the seventieth anniversary of his birth.)

11. Thorek, Max: Surgeons and events. Sergei
S. Yudin, J. Internat. Coll. Surgeons 7: 446,
1944.

12. Watson-Jones, Reginald: Personal communi-
cation.

13. Watson-Jones, Reginald: Sergei Yudin, Hon.
F.R.C.S. (Eng.), Moscow, 1891-1954, J. Bone
& Joint Surg. 36B: 503, 1954.

Selected references from Yudin’s writings.

14. Tlio-abdominal amputation in a case of sar-
coma; recovery; pregnancy and birth of a
living child, Surg. Gynec. & Obst. 43: 668,
1926.

15. The Baldwin operation for the formation of
an artificial vagina; report of six cases, Surg.
Gynec. & Obst. 44: 530, 1927.

16. Local anesthesia in extensive operations of
the stomach, Vestnik Khir. 22: 25, 1930;
also, Lyon chir. 27: 705, 1930.

17. New series of perforated ulcers of the stom-
ach and duodenum, J. chir. 38: 159, 1931;
also Rev. Cir. Buenos Aires 10: 285, 1931.
Volume 58
Number 3

18.

19.

23.

24.

29.

26.

Zags

28.

Technique of subtotal gastrectomy, Sovet.
khir. (no. 5) 6: 587, 1934,

One thousand cases of perforated gastro-
duodenal ulcers, Sovet Khir. (no. 6) p. 25,
1935 (and Petrov, B. A.).

Surgical treatment of profuse gastroduodenal
hemorrhages, Vestnik Khir. 42: 78, 1936.
One hundredth anniversary of the birth of
Nikolai Vasilevich Sklifosovski, Sovet. khir.
(no. 6) p. 935, 1936.

Transfusion of cadaver blood, J. A. M. A.
106: 997, 1936; also, Presse med. 44: 68,
1936.

Method of handling duodenal stump in case
of large ulcer penetrating deeply into pan-
creas, Sovet. khir. 9: 454, 1936.

Partial gastrectomy in acute perforated peptic
ulcer; Observation on diagnosis and _treat-
ment of 426 new cases, Surg. Gynec. & Obst.
64: 63, 1937:

Transfusion of stored cadaver blood; Practical
considerations; the first thousand cases, Lancet
22.361; 71937,

Continuous drip transfusion of massive doses
of cadaver blood, Vestnik Khir. 55: 103,
1938.

Primary resection in cases of perforated
gastric and duodenal ulcers, Vestnik Khir.
992-260, 1988:

Acute ileus at Sklifosovski Institute during
1928-1938, Vestnik Khir. 56: 410, 1938.

30.

aT;

33.

34.

35.

36.

37.

38.

39.

Swan: Study in frustration 585

Complications after operations for peptic
ulcer, Navy Khir. Arkhiv. 43: 99, 1939.
New methods for the surgical treatment of
profuse gastroduodenal hemorrhage, Acta
Med. U.R.S.S. 3: 359, 1940.

Role of sulfanilamide preparations in military
medicine, Klin. Med. 19: 18, 1941.
Treatment of gunshot fractures of limbs, Brit.
M. J. 2: 567, 1943; also Dia Med. 16: 750,
1944.

Treatment of war fractures of femur, Surg.
Gynec. & Obst. 78: 1, 1944; also Am. Rev.
Sov. Med. 1: 197, 1944; also Prensa Med.
Argent. 33: 641, 1946.

Observations on military field surgery, Mos-
cow, Narkomzdravy. SSSR, Medgiz, p. 646,
1943.

How to lower postoperative mortality in war
injuries of abdomen, Bull. War Med. 4: 446,
1944.

Refrigeration anaesthesia for amputations,
Anesth. & Analg. 24: 216, 1945; also, Am.
Rev. Sov. Med. 2: 4, 1944.

The surgical construction of 80 cases of
artificial esophagus, Surg. Gynec. & Obst.
78: 561, 1944.

Twenty-five years’ experience with surgery
of gastric and duodenal ulcer, Sovet. Med.
11: 5, 1947.

Transpleural plastic reconstruction of esopha-
gus using small intestine, Vestnik Khir. 74:
25, 1954.