The Contribution of Professors and Graduates of the Medical Faculty Of

History of Medicine. 2015. Vol. 2. № 2. DOI: 10.17720/2409-5834.v2.2.2015.19h

The Contribution of Professors and Graduates of the Medical Faculty of the Imperial Moscow University in the Development of Zemstvo District Medicine in Russia Marina Y. Chernichenko I.M. Sechenov First Moscow State Medical University, the Ministry of Health of the Russian Federation 8 Trubetskaya St., building 2, Moscow 119991, Russia Abstract. The article deals with the participation of professors and graduates of the Imperial Moscow University faculty of medicine in the development of zemstvo district medicine in post-reform Russia. The focus is on the work of the founder of domestic hygiene F.F. Erisman, the founder of health statistics P.I. Kurkin, state and public ﬁ gure A.I. Shingarev, writer A.P. Chekhov, the founder of national gynecology in zemstvo district hospitals V.F. Snegirev, as well as focusing on scientiﬁ c research and discussion of zemstvo district medicine experiences and challenges at the Russian doctors’ congresses. The development of the ideas of zemstvo district medicine at the congresses of the N.I. Pirogov Memorial Society of Russian Doctors is analyzed – in particular, in the public medicine section. It examines in detail the value of the “Program to obtain information on the status of zemstvo district medicine in its gradual development” (1889), which resulted in the publication of seven volumes of the “Zemstvo District Medical Collection” summarizing the experience of zemstvo district medical facilities for 25 years, and later an important study by E.A. Osipov, P.I. Kurkin and I.V. Popov, “Russian Zemstvo District Medicine” (1899). It is concluded that the professors and graduates of the medical faculty of the Imperial Moscow University made an outstanding contribution to the organization and development of the zemstvo district medicine, which became one of the major achievements of Russian medicine – and which had no analogues in the world.

Keywords: Russian empire, zemstvo, zemstvo district medicine, Moscow University, medical faculty, history of medicine

For quotation: Chernichenko M.Y. The Contribution of Professors and Graduates of the Medical Faculty of the Imperial Moscow University in the Development of Zemstvo District Medicine in Russia. History of Medicine. 2015. Vol. 2. № 2. P. 196–203.

About the author Marina Y. Chernichenko – Director of the Museum of the History of Medicine, I.M. Sechenov First Moscow State Medical University (Moscow). E-mail: [email protected]

Following the abolition of serfdom in Russia, work anniversary party in 1881 in Moscow. This there was a series of provincial reforms. In 1864 idea was realized, thanks, in large part, to the “Regulations on the Governorate and District professors in the Medical School of Imperial Zemstvo Institutions” were completed and took Mos cow University (IMU). The dean of this eff ect, ushering in territorial self-government. department and the Honorary Chairman of the Zemstvos (rural councils) were created in First and Sixth Pirogov Congresses (Figure 1), provinces and districts. It as a system of agencies N.V. Sklifosovski, also played an important role consisting of elected representatives from every in organizing the association. The First Congress, class. Their main function was maintaining public taking place in Saint-Petersburg in 1885, took on education, national health and prisons. a nationwide character, which itself testifi es to the The Association of Russian Doctors in the keen need for medical consultation with doctors memory of N.I. Pirogov played a signifi cant role from diff erent regions for discussing topical in the growth of zemstvo (rural) medicine. The questions to allow for the growth of medical idea of creating an association, uniting1 doctors science and national healthcare. Over the course with various specialities from Moscow and St. of the congressional proceedings, ninety-eight Petersburg, was conceived by Pirogov at his 50th presentations were read, many of which were dedicated to questions facing rural medicine, despite the formal absence of a specialized 1 The article uses materials from the collection of the Museum of the History of Medicine at the Ministry of Health’s section on rural governments. The most relevant I.M. Sechenov First Moscow State Medical University. problems were addressed, including the rendering of surgical and ophthalmological help to the Received: 15.05.15 country-dwelling population, the construction of © Marina Y. Chernichenko rural pharmacies, the materiel provisions of rural

196 History of Medicine. 2015. Vol. 2. № 2 doctors, and the household and condition of medical conditions of their lives and institutions in the provinces (the work in rural areas. presence of infectious disease At the Second Congress wards, outpatient clinics, in 1887 in Moscow, an and the number of beds), independent section was the procedure for supplying formed to deal with the medicine, the conditions for question of social medicine. A admitting patients (on a paid temporary bureau was created, or unpaid basis), and statistical which developed and presented data on appeals for medical at the Third Congress in Saint- help by year. Petersburg in 1889 a “Program The researchers paid for Collecting Information special attention to data on on the State of Medicine in the organization of the rural Zemstvos and its Gradual medical districts, which Development” [1, p. 29]. was exceedingly important E.A. Osipov, F.F. Erisman, in situations of annual I.V. Popov, and N. Mikhailov epidemics. They collected Fig. 1.N. F. Sklifosovsky. were members of the bureau, information on the measures and over the course of the taken by rural district program they independently reviewed problems assemblies for epidemic prevention and control, at the provincial and district levels. One group of the organization of “smallpox vaccinations,” the such questions consisted of eight major blocks: implementation of sanitary surveys in particular the quality of medical assistance rendered to areas – especially factories and schools, the the population before the implementation of organization of instruction manuals for health the 1864 reforms, the formation and growth of personnel, as well as the implementation of local “zemstvo medical districts” and their condition legislation in the fi eld of healthcare. at the moment of the survey, medical records Separately, they studied statements from rural and sanitary statistics, medical personnel, physicians, the forms of patient records, and active governace of rural medical districts, and the cost nomenclatures of diseases. It was also expected of maintaining rural institutions. that they gather general information regarding The maximum possible information was the number of country doctors, paramedics, expected regarding each midwives, pharmacists, and point. First of all, the also the conditions of their quality of medical treatment work (the procedure for rendered to the population appointment and dismissal, before 1864 was evaluated: salaries, vacation, retirement, the number of beds available and pensions). in hospitals and “hospices” Similar information was in the districts, the number intended to be looked over of paramedical accident by the section of provincial wards and their locations and issues as well. Additional the condition, and provisions information was collected on of the facilities. the participation of provincial The Organization of zemstvos in medical-sanitary Zemstvo District Medicine work. studied these problems Thus, an overview of the deeply. They collected data rural medical system was on the medical assistance made available for the fi rst system (stationary, mixed, time in 25 years, allowing the and traveling), the number Fig. 2. F.F. Erisman. assessment of the eff ectiveness

197 Marina Y. Chernichenko of provincial doctors and institutions. In their workers’ health had never been completed. presentation at the Third Congress, members Erisman worked in the Moscow Province for of the bureau identifi ed the collection of twelve years. He managed not only to organize information not as “a dead picture of the current sanitary work at the highest level, but also to stage of zemstvo medicine in various parts of popularize both the practice of the country Russia,” but as “a critical, animated chronicle of doctor and hygiene as a science. F.F. Erisman living public aff airs” [1, p. 21]. On the basis of presided over eight provincial congresses and the collected data, it was suggested to outline the played an active role in each of them. further growth of medical assistance to provincial Erisman’s combination of teaching and populations and to take into account and correct district work raised complaints from the Mayor the mistakes of the past. The of Moscow, N.A. Alekseev. members of the bureau deemed In defense of his colleague, it necessary to continue the the excellent rural physician discussion on most important E.A. Osipov responded with questions concerning rural an open letter. He wrote “… medicine. It is telling that a the zemstvo work of F.F. was, “Diary of the Association of so to speak, a living practice at Russian Doctors in Memory the department of health, and of N.I. Pirogov” began from lastly… in large part due to its this presentation and the outstanding value has become bureau members program. so universally recognized [2]2. Establishing and developing The result of the “Program for rural medicine quickly became the Collection of Information on a priority. F.F. Erisman, who the Status of Zemstvo Medicine was elected Chairman of the in its Gradual Development” Congress, gave a speech at the was the release of the “Zemstvo fi rst general meeting on January Medical Collection”, which 3, 1889, in which he said, Erisman helped to complete. that “the Congress of Russian Fig. 3. S.S. Korsakov. From 1890 to 1893 seven doctors holds huge signifi cance volumes were published, each not only for us, physicians, but also for Russia included the practical experiences of rural medical as a whole, and, of course, mainly because the institutions for 25 years [3]. questions discussed at this Congress are not just An original continuation of this work, anecdotal, but pertaining to diff erent areas of summarizing the research, was released in the medicine and also general questions, questions form of a book by E.A. Osipov, P.I. Kurkin and of the possibility of improving the medical I.V. Popov under the title “Zemstvo Medicine and sanitary concerns in Russia, of the further in Russia.” The idea for creating such a study development of our treasure- that which has no was initiated by the Executive Committee of the analogue in Western Europe: our domestic, rural Twelfth International Congress of Physicians. medicine…” [1, p. 106]. These excellent doctors, including several F.F. Erisman, a professor in the Medical famous doctors of the Medical School of IMU School of IMU, an outstanding hygienist and (N.V. Sklifosovsky, I.F. Klein, A.Y. Kozhevnikov, public fi gure, worked for a long time in the V.K. Rot, and others) made the decision to Moscow Provincial Zemstvo (Figure 2). Under present the Organization of Zemstvo Medicine his leadership from 1879 to 1885, 1,080 industrial as one of the main achievements in domestic businesses with 114,000 workers in the Moscow medicine, since it had no analogues in Province underwent sanitary inspections. The international practice. As a result, a book was results were published in seventeen editions. This published in French in 1897 and was presented was a new dawn in hygienic science, insomuch as a similarly thorough, comprehensive examination 2 Hereinafter the original features are taken into account into the infl uence of work conditions on the when citing. 198 History of Medicine. 2015. Vol. 2. № 2 as a gift to foreign participants at the Congress. In 1899 it was published in Russian. The book included a statistical outline and a description of the sanitary situation in Russia, the general characteristics of operating rural medicine in the country, and a review of rural medical work in the Moscow Province. In the preface to the Russian edition two foundational characteristics of rural medicine were formulated: the rendering of medical assistance to the population free of charge (including the supply of free medications) and the close interconnectivity of therapeutic and sanitary tasks [4, p. VIII] . One of the authors of the study, P.I. Kurkin, graduate of the IMU Medical School (1886) and the division of natural sciences at the Faculty of Math and Physics at Saint Petersburg University (1882), chose for himself the path of a country physician. Immediately after fi nishing university he worked in the Mozhaysky and Surpukhovsky districts, then in 1895 he headed Fig. 4. One of the collections publishedbli h d bby ththe SSocietyi t the Medical-Statistical Department of the of Russian Doctors in Memory of N.I. Pirogov. Moscow Governorate’s Sanitation Bureau. He ran the permanent statistical committee under the auspices of the Association of Russian Physicians fi rst this journal was seen as a sort of messenger for for a long time. Kurkin became one of the founders the Board, but soon it was dominated by provincial of domestic sanitary statistics. His foundational medical topics, and it was subsequently renamed works are dedicated to the application of methods “Public Doctor.” of sanitary-statistical research in rural districts: At the Fifth Congress, taking place between “Infant Mortality in the Moscow Province and 1893 and 1894 in Saint Petersburg, a decision was its districts in 1883-1897” [5], “Zemstvo Sanitary passed within the confi nes of the Section of Social Statistics” [6], “Statistics of Morbidity in the Medicine to form a permanent commission on Population of the Moscow Governorate in the spreading knowledge, related to sanitation among Period 1883-1902” [7], and others. the population. K.M. Yazikov and A.V. Molkov, The main decision of the Third Congress former rural sanitary physicians and graduates of was the periodic publication of printed media the IMU Medical School, subsequently became on the question of domestic medicine [1, p. 24], chairmen of this commission. The result of and from 1895 the “Journal of the Association of the commission’s activities was a publication Russian Physicians in memory of N.I. Pirogov”3 of special brochures, popularizing sanitary was printed. The journal was released under the knowledge (Figure 4). Additionally, it was at this editing of Professor S.S. Korsakov4 (Figure 3) from congress when composition of the Association’s the Medical Department of IMU until 1900. The Management Board, located in Moscow, journal was distributed by subscription. Published was chosen. IMU professors F.F. Erisman, within were reports on the meetings of the Society’s S.S.Korsakov, and V.D. Shervinsky were elected Board, itineraries of upcoming Congresses, reports in the board while professors A.A. Bobrov, on activities undertaken by the Management N.F. Filatov, and P.I. Dyakonov were also chosen Board, and articles on the topic of medicine. At as candidates. The fi rst board meetings were held at the Hygienic Institute of IMU and at Erisman’s 5 3 The fi rst edition of the Journal was released March 29, 1895. apartment. 4 From 1888 to 1900 S.S. Korsakov was the director of the psychiatric clinic of IMU. 5 F.F. Erisman’s apartment was located on the territory of the

199 Marina Y. Chernichenko

orphans, means of fi ghting against the spread of syphilis, the organization of obstetrics, the organization of an education system with regards to the demands of zemstvos, and helping the mentally ill, invalids, and the chronic patients. Discussion of the problems facing zemstvo medicine was not limited to the Section of Social Medicine: presentations relating to zemstvos were read in every section. At subsequent congresses, it this became Fig. 5. Institutes of hygiene, general pathology and pharmacology a standard practice to hold a unifi ed of the department of medicine at IMU. section meeting. For example, at the Eleventh Congress, taking place in 1910 in Saint Petersburg, the Social The Section of Social Medicine was extremely Medicine Section joined with diff ering sections, popu lar, brought about discussion, and attracted such as the sections, for obstetrics, infectious and new lecturers. The professors’ tasks were to skin diseases, hygiene, and internal and childhood cultivate rural medicine, solve both old and new diseases [8]. problems, usher in new methods of treatment, As a whole, the Pirogov Congresses had an and, most important, to support free medical care enormous impact on the growth and formation for the population of the entire country to the of rural medicine. Thanks to the combined extent necessary among ordinary country doctors eff orts of physicians from all corners of the and prominent scientists alike. country, the improvement of medical facilities It is revealing that the program of the Section and assistance for people living in the countryside of Social Medicine was one of the most large- became a reality. Love for the Motherland and scale. Still developed in the Second Congress, new the sincere desire to fulfi ll their social debt – problems were constantly added as presentations these were the high ideals that drove together touched on new and relevant themes. the members of the congresses. Because of this, The basis of the programs consisted of eighteen it was not strictly scientifi c questions that came parts. Each covered very diff erent problems to the fore, but instead social, practical work. facing rural medicine: general organization, An excellent rural physician, active participant the areas of activity and allocation of responsibilities between provincial and district zemstvos, the development and application of principles of sanitary statistics, the development of a unifi ed form of zemstvo-medical record keeping for the entire country, building hospitals and outpatient treatment facilities, the development of methods of epidemic prevention and control, supporting population with medications, publishing necessary sanitary regulations, sanitation control for medical establishments, the fi ght against infant mortality, custody of Fig. 6. Colleagues from one of the district hospitals at the beginning Clinical town on Devichye Pole. of the 20th century.

200 History of Medicine. 2015. Vol. 2. № 2 in the Pirogov Congresses, deputy in the Second 1892-1893 there was an outbreak of cholera, and and Fourth convocations of the State Duma, and A.P. Chekhov took an active role in organizing Finance Minister of the temporary government, means to combat the spread of the epidemic in the A.I. Shingarev said about the work of country Melikhovo zemstvo medical sector. P.I. Kurkin physicians: “Our pride – zemstvo medicine and had this to say about Chekhov’s work here: “In sanitation organization – began and developed this diffi cult time of danger to the population a thanks only to the belief and energy of its citizen-doctor manifested himself in the form representatives” [9, p. 33] (Figure 6). of a famous author. Immediately, almost from A.I. Shingarev was the first to graduate from the very moment of medical mobilization in the the division of natural sciences in the Faculty of Moscow Province in 1892 A.P. Chekhov stood, Math and Physics (1891), and then the so to speak, under the gun. Around IMU Medical School (1895). As a Melikhovo he formed extensive local student he recorded and published medical sites comprising as many clinical lectures of Professor as twenty six villages…” [12, A.A. Ostroumov. A.I. Shingarev p. 67]. A.P. Chekhov used his declined the offer to stay at the own money to open a medical faculty in order to continue center at Melikhovo, where he his scientific work and instead led outpatient care in the early returned back home to the morning hours from 5 until 9 Voronezh Province, where he o’clock. Additionally, along started to work as a country with his friend and colleague physician. Later, he became Kurkin, he participated in the the head of the Sanitation sanitary inspection of factories, Bureau of the Voronezh Province which was refl ected in his work and carried out a systematical “Medical Report on the Temporary research on sanitary condition of Melikhovo Site in 1892,” where local villages. His work “The Dying “sanitary inspections always bring clear Fig. 7. A.P. Chekhov. Countryside: The Experience of and real benefi ts. Not one inspection Sanitary Economic Research in Two has gone without results” [13, p. 70]. Villages of the Voronezh District,”6 which In the years of epidemics many physicians, describes the appalling conditions of country including those who previously worked in life, caused a large public response [10]. zemstvos, were sent to fi ght very dangerous One of the most famous graduates of the IMU diseases. This was selfl ess, almost ascetic labor. Medical School, who worked as a country doctor Such physicians emerged a graduate of the IMU and wrote extensively about rural medicine was Medical School in 1871 V.F. Snegirev (Figure 8). A.P. Chekhov7 (Figure 7), a classic of literature. At the time there was an outbreak of cholera in Being a student, A.P. Chekhov worked in the the Podolsky District of the Moscow Province, Voskressenskaya District hospital, and later in the and the young doctor went around to each disease Zvenigorod District hospital. In 1890 he traveled hotbed, provided medical assistance to the local to Siberia, where on Sakhalin Island he conducted population, and also was engaged in sanitary and a census of the population, researched the preventative actions. In the preface to his famous sanitary conditions of prisons, living conditions, work “Uterine Hemorrhages, Their Etiology, and the state of health of convicts and the local Diagnosis, and Therapy” he wrote: “My work population. The results of this research were is dedicated to the country doctors, toiler, who published in the book “Sakhalin Island” [11]. is still underestimate because many people do A.P. Chekhov conducted a large part of not know all their diffi culties, all their heroism. his work from his estate, Melikhovo, which he But I know well from personal experience, what bought in 1892, in the Serpukhov District. In does it mean to be a country doctor. This can’t be measured in money only in honor” [14]. 6 The fi rst edition was released in 1901. As a well-known professor, V.F. Snegirev 7 A.P. Chekhov graduated from the IMU Medical School in 1884. bought a dacha near the town of Aleksin. There 201 Marina Y. Chernichenko

VV.F.F SSnegirev.i

Fig. 8. Professor V.F. Snegirev, Professor A.P. Gubarev and students of the Imperial Moscow University’s medical faculty. was located a small rural hospital, where he Many of the graduates of the IMU Medical immediately began to work. Very soon, the School, who become exceptional professors and hospital was unable to accommodate all those leaders in medical science had experience of needing treatment, and Snegirev, using his own working in zemstvo districts. Among them were money, expanded it. As a result, two additional P.F. Bogdanov, L.E. Golubinin, S.S. Golovin, housings with forty beds each were built. Snegirev V.A. Muratov, I.V. Davydovsky, N.I. Napalkov, worked in the Aleksin hospital during the R.M Fronshtein, and many others. Others, on summer holiday season, and slowly began to help the other hand, declined scientiﬁ c careers in favor colleagues from the Gynecological Clinic and of working in the country, and such examples are Gynecological Institute of IMU, which he was abundant. Thanks to the joint eﬀ orts of country governing, and also helped students and younger doctors on location and professors popularizing doctors. All medical assistance provided in the the idea of the zemstvo district and initiating hospital was free. Operations began at 6 in the public discussion on the problem of zemstvo morning, patients came at 12, and the professor district medicine, the existence of a new, unique usually ended his work no earlier than 3 AM. In form of organizing medical assistance became the summer months of 1885 and 1886, 102 general possible. This new form of medical treatment, surgeries were carried out in the Aleksin hospital which had no analogues in foreign medicine, was [15, p. 86]. conceived and grew in the Russian Empire.

REFERENCES

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About the Author Marina Yuryevna Chernichenko – Director of the Museum of the History of Medicine, I.M. Sechenov First Moscow State Medical University, Moscow (Russia).

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