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].