Ludvig Puusepp and the Institutional Origins of Surgical Neurology in Europe

Ludvig Puusepp is usually remembered through a single chronological claim: his 1910 appointment in St. Petersburg as the first holder of a professorship specifically designated for surgical neurology. However, this framing does not fully explain the academic, linguistic, and political settings that shaped his role in the early development of neurosurgery. This historical review reassesses Puusepp through primary and near-primary sources, including his German-language monographs, Folia Neuro-Chirurgica/Folia Neuropathologica Estoniana, archival biographical material, and institutional histories of St. Petersburg and Tartu/Dorpat. The historical analysis indicates that Puusepp’s early career materialized Vladimir Bekhterev’s model of surgical neurology in imperial St. Petersburg, where neurological diagnosis, localization, operative treatment, teaching, and clinic organization were conceived as a single program. His later work in Tartu/Dorpat developed this model within a Baltic academic environment historically connected to German-language scholarship and, after 1919, to independent Estonian medicine. His major writings should therefore be interpreted not merely as bibliographic achievements, but as tools of specialty formation. The Soviet occupation of Estonia disrupted the European-oriented academic conditions under which the Tartu school had operated. Puusepp’s legacy lies not only in chronological priority, but in his role as a trans-imperial institutional actor who linked St. Petersburg surgical neurology, Baltic-German academic culture, independent Estonian medicine, and the political rupture of early neurosurgical institutions.