HEALTH CARE SERVICES, IMPERIAL

Prior to the reign of Peter the Great there were virtually no modern physicians or medical programs in Russia. The handful of foreign physicians employed by the Aptekarskyi prikaz (Apothecary bureau) cared almost exclusively for the ruling family and the court. Peter himself took a serious interest in medicine, including techniques of surgery and dentistry. His expansion of medical services and medical practitioners focused on the armed forces, but his reformist vision embodied an explicit concern for the broader public health.

As of 1800 there were still only about five hundred physicians in the empire, almost all of them foreigners who had trained abroad. During the eighteenth century schools in Russian hospitals provided a growing number of Russians with limited training as surgeons or surgeons' assistants. The serious training of physicians in Russia itself began in the 1790s at the medical faculty of Moscow University and in medical-surgical academies in Moscow and St. Petersburg. Later these were joined by medical faculties at universities in St. Petersburg, Dorpat, Kazan, and elsewhere. The early medical corps in Russia also included auxiliary medical personnel such as feldshers (physicians' assistants), midwives, barbers, bonesetters, and vaccinators. Much of the population relied upon traditional healers and midwives well into the twentieth century.

Catherine the Great made highly visible efforts to improve public health. In 1763 she created a medical college to oversee medical affairs. She had herself and her children inoculated against smallpox in 1768 and sponsored broader vaccination programs. She established foundling homes, an obstetric institute in St. Petersburg, and several large hospitals in the capitals. Her provincial reform of 1775 created Boards of Public Welfare, which built provincial hospitals, insane asylums, and almshouses. In 1797, under Paul I, provincial medical boards assumed control of medicine at the provincial level, and municipal authorities took over Catherine's Boards of Public Welfare. With the establishment of ministries in 1803, the Medical College was folded into the Ministry of Internal Affairs and its Medical Department.

The paucity of medical personnel made it difficult to provide modern medical care for a widely dispersed peasantry that constituted over eighty percent of the population. During the 1840s the Ministry of State Domains and the Office of Crown Properties initiated rural medical programs for the state and crown peasants. The most impressive advances in rural medicine were accomplished by zemstvos, or self-government institutions, during the fifty years following their creation in 1864. District and provincial zemstvos, working with the physicians they employed, developed a model of rural health-care delivery that was financed through the zemstvo budget rather than through payments for service. By 1914 zemstvos had crafted an impressive network of rural clinics, hospitals, sanitary initiatives, and schools for training auxiliary medical personnel. The scope and quality of zemstvo medicine varied widely, however, depending upon the wealth and political will of individual districts. The conferences that physicians and zemstvo officials held at the district and provincial level were a vital dimension of Russia's emerging public sphere, as was a lively medical press and the activities of professional associations such as the Pirogov Society of Russian Physicians.

By 1912 there were 22,772 physicians in the empire, of whom 2,088 were women. They were joined by 28,500 feldshers, 14,000 midwives, 4,113 dentists, and 13,357 pharmacists. The fragmentation of medical administration among a host of institutions made it difficult to coordinate efforts to combat cholera and other epidemic diseases. Many tsarist officials and physicians saw the need to create a national ministry of public health, and a medical commission headed by Dr. Georgy Ermolayevich Rein drafted plans for such a ministry. Leading zemstvo physicians, who prized the zemstvo's autonomy and were hostile to any expansion of central government control, opposed the creation of such a ministry. The revolutions of 1917 occurred before the Rein Commission's plans could be implemented.

See also: feldsher; health care services, soviet

bibliography

Alexander, John T. (1980). Bubonic Plague in Early Modern Russia: Public Health and Urban Disaster. Baltimore and London: Johns Hopkins University Press.

Conroy, Mary Schaeffer. (1994). In Health and in Sickness: Pharmacy, Pharmacists, and the Pharmaceutical Industry in Late Imperial, Early Soviet Russia. Boulder, CO: East European Monographs.

Frieden, Nancy. (1981). Russian Physicians in an Era of Reform and Revolution, 1856–1905. Princeton, NJ: Princeton University Press.

Hutchinson John F. (1990). Politics and Public Health in Revolutionary Russia, 1890–1918. Baltimore: Johns Hopkins University Press.

McGrew, Roderick E. (1965). Russia and the Cholera, 1823–1832. Madison: University of Wisconsin Press.

Ramer, Samuel C. (1982). "The Zemstvo and Public Health." In The Zemstvo in Russia: An Experiment in Local Self-Government, ed. Terence Emmons and Wayne S. Vucinich. Cambridge, UK: Cambridge University Press.

Solomon, Susan, and Hutchinson, John F., eds. (1990). Health and Society in Revolutionary Russia. Bloomington: Indiana University Press.

Samuel C. Ramer