Medicine of the Russian Empire of the late XVIII – early XX century in the new scientific literature Babenko, O. V. Medicine of the Russian Empire of the end of the XVIII – early XX century in the new scientific literature / O.

Medicine of the Russian Empire of the late XVIII – early XX century in the new scientific literature

Babenko, O. V. Medicine of the Russian Empire of the late XVIII – early XX century in the new scientific literature / O. V. Babenko. – Text: Immediate // History and Archeology: Materials V International. Scientific conf. (Krasnodar, February 2018). – Krasnodar: NOVATION, 2018. – P. 7-13. – URL: https://moluch.ru/conf/hist/Archive/290/13641/ (Date of handling: 11.04.2022).

Medical issues in the history of the Russian Empire are constantly in the center of the attention of researchers – historians, doctors, lawyers, philosophers. This is due to the fact that health care is one of the paramounts of the state of the state, which allows to preserve human health and extend his life. Over the past ten years, hundreds of scientific works on this issue have been released [1; 7; 10 et al.] The review presents the publications of modern scientists 2017 publications on the development of medicine in the Russian Empire of the late XVIII – early XX centuries. Materials relate to various issues of health care: management of medical institutions, legal framework of medicine, features of therapeutic case in individual provinces, military medicine, Zemstvo medicine, etc.

Medicine B.Russian Empire of the Epoch of Capitalism: General Development Trends

The development of medicine in the Russian Empire and its legal framework is devoted to the article by the Head of the Department of the Medical Academy. S. I. Georgievsky, Dr. Honey. Sciences O. S. Tretyakova [9]. As the author rightly notes, at the beginning of the XIX century. The Russian Empire is carried out by the reform of the state apparatus, as a result of which ministries are created, but "the creation of the Ministry of Health has not been provided for this reform …" [9, p. 177].

At the beginning of the XIX century. Hospitals and shelters for disabled and orphans were founded and held by the Medical Council of the Ministry of Internal Affairs of the Russian Empire and orders of public charity, the number of which grew due to an increase in the number of provisions. The Medical Council was established in 1803 at the Police Department of the Ministry of Internal Affairs, and in 1810 he was transferred to the Ministry of Folk Enlightenment. In 1811-1822. There were two national medical councils: one under the Ministry of Police (since 1819 under the Ministry of the Interior), and the other – under the Ministry of Folk Enlightenment. From 1822, only one medviset worked – with the Ministry of Internal Affairs. From the end of the XVIII century. The provincial medical advice also acted. Regulation of medical care was carried out "on the basis of a regulatory framework consisting of both the decrees of the emperor and departmental acts of the Ministry of Internal Affairs" [9, p. 178].

Under Alexandra I, the development of public medicine is obtained. In 1802, "Imperial Personnel Society" is being created in St. Petersburg under the auspices of members of the Imperial Familia, and in 1816 – a similar society in Moscow. Under the leadership of the Empress of Mary Fedorovna, members of society "organized massive vaccinations against smallpox, treatment at home, established medical care in shelters and maternity hospitals, in prisons and correctional homes, were engaged in hospitals" [9, p. 178].

Improved legal health care. In 1833, "Code of Laws of the Russian Empire" is published, one of the volumes of which is devoted to the medical charter. According to the Charter, the general focus of the organization and development of medicine was regulated at that time a medical police. Due to the activities of the medical police, the general prophylactic focus of the organization and development of medical practices in the country, which contributes to a decrease in the number of massive diseases "[9, p. 178].

It should be noted that medicine has evolved not only in the central provinces of the Russian Empire, but also on distant outskirts. So, as far from the development of Far Eastern land at the end of the XVIII – middle of the XIX century. On this territory, elements of military medical service are being created, the first hospitals are opened, which are devoted to the draft associate professor of the branch of the Far Eastern Federal University, Cand. East Sciences T A. Knyazkina (3). The author notes the great role of military doctors in the process of formulating medical care to the civilian population. The remoteness of Far Eastern ports from the supply points and limited material resources complicated the protection of the health of soldiers and sailors. However, this did not prevent organize the professional work of the doctors, which allowed, in particular, to increase the combat capability of the military, to restore their health, reduce losses and defeat the defense of Petropavlovsk in 1854

One of the oldest military medical institutions of Russia was the Kronstadt hospital. A brief essay of his history was published by the staff of the 442th military clinical hospital of the Ministry of Defense of the Russian Federation by Professor V. V. Lyutov and Lieutenant Colonel of the Medical Service M. V. Roskostov [4]. The Kronstadt Hospital was founded "during the formation of the Russian Navy, its 300-year-old history is related to many bright pages of domestic, especially naval medicine" [4, p. 79]. In this hospital, for the first time in the history of medicine, pericardial puncture was carried out, an anticipated vaccine was obtained and chlorination of drinking water was applied. With it, there was a hospital school for the preparation of medical personnel for the army and fleet, which gave impetus to the development of medical science. In 1859, the Society of Marine Doctors was founded in Kronstadt.

In the second half of the XVIII century. Such a direction of medical work was born as military epidemiology.The history of the military epidemiology is devoted to the article of the Military Medical Academy to them. S. M. Kirov Professor P. I. OGARKOV, Associate Professor A. A. Kuzin and Association M. I. Ishkolddina [5]. The birth of epidemiology occurred in the army of A. V. Suvorov, where "the medical control over the nutrition and water supply of troops, the state of uniforms, labor regime and the fatigue of soldiers" [5, p. 55]. The basics of military epidemiology are laid in the works of D. S. Samoilovich (1744-1805) and A. F. Sharon (1740-1811). By the end of the XIX century. Military epidemiology has become an independent science: she was taught at the Military Medical Academy, where in 1894 the Department of Infectious Diseases and Medical Bacteriology was created.

In the defective time, Zemskaya medicine developed in the Russian Empire, the purpose of which was "ensuring equal availability of medical care to the entire population of the country …" [9, p. 178]. Zemskaya medicine was to cooperate with factory-factory medicine. In accordance with the resolution of 1866, the owners of industrial enterprises were called upon not only to organize, but also contain hospitals and hospitals at their own expense. Management of medical institutions in cities was transferred to the minds.

The legal support of the Zemstvo Medicine served as officials for doctors. To this end, "job descriptions for doctors, paramedics and obedala grandmas" were developed and accepted [9, p. 178]. The work of the provincial hospitals, psychiatric hospitals and Feldsher schools was fully controlled by the provincial Zemskie Supports. About the development of rural medicine and hospital institutions in county cities took care of county forest councils.

In the 1870s. The idea of the priority of sanitary and preventive work, which is devoted to the publication of Saratov scholars d. N., Professor A. V. Petrov and Cand. East Sciences O. S. Kitzenko [6]. This idea required the study of the main factors of morbidity and mortality. For example, in the Saratov province, a special role in the organization of research was played by the creation of a commonlyubnoy center coordinating the sanitary activities: the Saratov Sanitary Office and the Department of People's Gubernskiy toast. Zemstvo sanitary statistics made it possible to detect the role of professional, religious, cultural and anthropological factors in the distribution of certain diseases. The obtained data was also demonstrated by the need for social transformations in the Russian village: improving the welfare of the population, raising the level of education.

In the 80s. XIX century The stationary system of Zemskaya rural medicine appears, the essence of which, as O. S. Tretyakova writes, "was as follows: the departments were divided into several medical sites, a hospital was built in the central of them for 15-20 beds with the release of special beds for the fencers, a small Ambulatory.The doctor acted daily and treated patients from all areas, his assistants had a paramedic, hangup and nanny "[9, p. 178]. The doctor traveled to the patient to call, that is, in Russia, then "the district principle of service of the rural population originated" [9, p. 178]. The peculiarities of Zemstvo medicine was a combination of medical and preventive care, as well as its free character. O. S. Tretyakova notes that free medicine was expensive by the departments: they were annually expelled from their budget significant amounts for health care, for example, in 1890, 21% of all budget funds were expelled [9, p. 179].

Problems of the status and development of medicine in Russia of the end of the XIX – internally of the XX centuries. Also in the article by the Associate Professor of the Moscow Regional Branch of the Moscow University of Russia in Russia in Ruze, K.Yu.N. I. A. Tarasova [8]. The author notes that as a result of a number of transformations in the medical sphere, in the Russian Empire of the late XIX – early XX centuries. "The system of government agencies of medical activities was finally formed" [8, p. 148]. A kind of mouth of the medical community was the congresses of doctors. In 1892, the charter was adopted by the Charter, and in 1893 the charter of the medical institutions of the civilian department, which limited the independence of the Zemstvo institutions and contained a number of contradictions, as a result of which caused medical displeasure. In 1905, XIII was issued by the crust of the laws of the Russian Empire, which included the charter of medical in the new edition.

In the Charter, there was a section "On the Management of Mineral Waters", which determined the basis for the management of mineral waters under the jurisdiction of the Ministry of Commerce and Industry (Caucasian, Agricultural, Lipetsk, Staroral, Sergievsky) and in the jurisdiction of the Military Ministry (abastunum). The charter also introduced a new section "On Hospital institutions", in which "the procedure for managing public, earth and private hospitals was determined [8, p. 148].

The charter also reflects the emergence and development of the Institute of Zemstvo doctors. Given that the Zemstvo doctors "in their actions were to be guided by the instructions of the Zemsky Assembly, it should be noted that they were subordinated to the medical department and the medical inspector only in the order of supervision," says I. A. Tarasova [8, p. 149].

Medical government in the provinces was carried out by the provincial government, and the medical departments for the counties and cities are county and city doctors. By 1911, almost all the deaths of the Russian Russia "were divided into a greater or smaller number of medical sites, with hospitals in the center, or there were an ambulatory, headed by doctors" [8, p. 150]. The number of doctors has increased. Institute of Sanitary Doctors, who worked on previously developed programs. There was a gradual reduction in paramedic points and the opening of medical sites. In addition, by the beginning of the XX century.Numerous charitable organizations were founded in the Russian Empire: the Pirogovsky Congress of Doctors, the Folk Health Society, the Russian Society of the Red Cross, etc.

I. A. Tarasova believes that "the system of medical medical institutions established in Russia remained very far from the desired perfection, especially in individual provinces and counties and even more so – in remote regions and in the" national outskirts "of the giant empire. Nevertheless, the experience of creating and functioning of Zemstvo medicine was unique, did not have analogues in the world … "[8, p. 150]. O. S. Tretyakova notes that "by the beginning of the XX century, there was no unified health care system in Russia. Public health security was designed to provide numerous departments and institutions, both public, government and private, charitable. The Department of Health of the Ministry of Internal Affairs, Red Cross, Military Office, Institutions of Factory and Zemstvo Medicine, and others belonged to them. [9, p. 179].

Special attention deserves the issue of medical support for soldiers during the First World War. Professor of the Moscow branch of the Military Medical Academy. S. M. Kirov, Honored Worker of Healthcare of the Russian Federation O. V. Voronkov published an article on this issue [2]. In it, he claims that the military department of the Russian Empire to the beginning of the First World War approached "mainly with the ideology of organizing the provision of troops with medical property and the structure of the medical supply authorities, which remained since the Russian-Japanese war 1904-1905." [2, p. 83]. This led to the weak functioning of the medical service, a shortage of medicines, surgical instruments and other medical supplements. In the military area lacked the bases of medical supply. However, during the war years, emergency measures were taken, in particular, to create pharmacy stores and field pharmacies, which made it possible to improve the supply of the army.

Thus, the preferential attention of specialists is given the history of military and Zemstvo medicine. In their works, it is said that the development of medicine in the Russian Empire of the late XVIII – early XX centuries. It took place in different directions and was actively actively conducted. However, the results of this process were far from the desired, since numerous bodies and structures involved in the organization of medical care in Russia failed to create a unified health care system. Military medicine faced with the difficulties of military time and the remnants of the weak medical service of past years. Zemskaya medicine was imperfect, especially in remote areas of the empire and on its national outskirts.

Health of the Kiev Province of the end XVIII– The first half XIX.in.

Problems of development of medicine in the Kiev province are considered in the article by a researcher from Pereyaslav-Khmelnitsky State Pedagogical University. G. Frying T. V. Sela [11].She analyzes unpublished archival materials on the activities of various authorities in the field of healthcare in the Kiev province after the medical reform of 1797. The author examines the issues of providing hospitals with the necessary medicines and materials, as well as the epidemiological situation and measures to control the level of morbidity in the region.

The analyzed materials were obtained by T. V. Morey from the Central State Historical Archive of Ukraine in Kyiv. Particular attention is paid to the funds of the Kiev, Podolsk and Volyn governors-general. The source base of the study also includes the "Compendium for Physicians on the Knowledge of Russian Laws, Institutions and Public Service" (1843).

The article notes that after the reform of 1797 in the Russian provinces, including Kiev, Medical Councils were created, which were responsible for civil and military medicine. Until that time, representatives of the local administration dealt with health problems, and doctors did not have the right to administrative activities. The Provincial Medical Council consisted of four people: a doctor-inspector, a doctor-operator, an obstetrician and one employee. The Council coordinated the actions of medical workers of military hospitals. Such a subordinate position of military doctors often led to their conflicts with the command. There were not enough military doctors in the hospitals, so civilians often took their places. On the other hand, in each city, military doctors “served in the Medical Councils and other civilian medical institutions of the Ministry of the Interior” [11, p. thirty].

The first public hospital in Ukraine, designed for 50 beds, was founded in Kyiv in 1787. In 1792, the first military hospital was opened in Kyiv. It had one doctor and two paramedics treating 100–150 patients. In 1803, the first somatic hospital for the population of Kyiv was opened with 20 beds. In 1811, a two-bed maternity hospital appeared, in which a midwife and a vaccinator were on duty around the clock. In provincial cities there were hospitals with 20-25 beds, but in reality they were used as shelters for the homeless and disabled soldiers. Working conditions in medical institutions were far from required. “Especially in right-bank Ukraine, hospitals were kept in poor conditions,” writes T.V. Morey [11, p. thirty].

The supply of hospitals with provisions, clothing, linen, building materials was under the jurisdiction of the War Ministry. And funds for the acquisition of property were allocated by the Ministry of the Interior, which was also responsible for providing hospitals with medicines. However, it was only in the 1830s that district hospitals in the Kiev province began to receive everything they needed on a regular basis. At the same time, the order to supply local hospitals with linen, as can be seen from archival materials, was issued as early as 1812.

At the turn of the XVIII-XIX centuries. the total number of doctors in the Russian Empire increased from 1,500 to 8,072. In 1846, a third of these doctors worked in the army and navy. At the same time, a significant part of these specialists served in the management of medical institutions, and did not provide direct assistance to patients. Some doctors were in private practice. From this, T.V. Morey concludes that "the majority of the country's population did not receive proper medical care" [11, p. 31].

Archival materials show that some hospitals in the Kiev province did not provide significant assistance to patients. And Count Adlerberg, who was sent for the purpose of inspection to the military hospitals of Kyiv, Radomyshl, Zhitomir, Berdichev, Letichev and Novgorod Volynsky, as well as to hospitals under the jurisdiction of the 4th and 5th infantry corps, noted in his report "shortcomings in management them” [11, p. 31].

Orders of public charity tried to improve patient care. Their functions included expressing the opinion of the population of the provinces regarding the work of hospitals to the relevant state bodies and informing the latter about the required number of doctors that were required in specific places. If in the 1840s the military hospital in Kyiv was designed for 82 beds, then the hospital in Berdichev – only 35 beds, and the hospital building was built "at the personal expense of Prince Radziwill …" [11, p. 31]. Up to 159 people were treated at the Kiev hospital at the same time, who were served by two doctors, one senior assistant and two junior assistants. A difficult situation developed in the Vasilkovsky hospital “with 15 beds and 92 patients”, where “one doctor and one paramedic” worked [11, p. 31].

The Kyiv Medical Council obliged the corresponding order of public charity to inform him about such hospitals, where the number of patients is twice the number of beds. And the management of hospitals was obliged to inform the order of the number of their patients. Archival materials record that in 1848 the number of patients in hospitals in the Kiev province ranged from 98 to 198 per hospital [11, p. 31].

Based on the data received, the Kyiv Medical Council decided to increase the number of beds in hospitals in Kyiv, Vasilkov, Berdichev and Radomyshl. Control over the level of morbidity in the region was carried out by county doctors. They also vaccinated the population and tried to open new hospitals, monitored the condition of livestock. Among the most dangerous infectious diseases in the early XIX century. smallpox was. It was considered one of the leading causes of death among adolescents. Since 1787, regular vaccination of the population against smallpox began in the city hospitals of the Kiev province, and from 1802 they began to inoculate against calf pox. According to archival data for 1833, quarantine was never declared in the Kiev province [11, p. 32].

In archival materials for 1841–1842. describes the diet of patients in hospitals in the Kiev province.It included, in particular, bread, milk, vegetable oil, vinegar, honey, wine. In addition, patients were provided with a bed, linen, dishes and shoes. The documents also provide the cost of “paper, books, other stationery, heating, lighting in hospitals” [11, p. 33].

T.V. Morey comes to the following conclusions:

1) In connection with the inclusion of the Kiev Medical Council in the provincial administrative apparatus, employees with medical education appeared in it.

2) At the beginning of the XIX century. supply of hospitals in the region was at a low level.

3) The administration of the Kiev province tried to correct the situation: “there were buildings suitable for hospitals, hospitals were provided with linen, a uniform for patients was introduced, the number of medical workers increased, especially in those hospitals where the number of patients was twice the norm” [11, p. 33].

Zemstvo medicine of Vyatka andPerm provinces end XIX– start XXcenturies

The development of health care in the context of the activities of zemstvos in the Perm and Vyatka provinces in the late 19th – early 20th centuries. is considered in the article by Associate Professor of the Perm branch of the RANEPA, Dr. ist. Sciences T. Shestova [12]. The article was written on the basis of a large array of unpublished materials from the State Archive of the Sverdlovsk Region, the Russian State Historical Archive, the State Archive of the Perm Territory. The State Archive of the Orenburg Region, the Central State Historical Archive of St. Petersburg and the State Archive of the Kirov Region.

At the turn of the XIX-XX centuries. the direction of the activities of the zemstvos changed – from anti-epidemic work to constant contacts with the population. The zemstvos established on the territory of the Perm and Vyatka provinces were among the largest zemstvos of the Russian Empire, “pursuing a long-term policy of creating a system of medical care for the population” [12, p. 24].

In the first half of the XIX century. The Perm province was the leading region of Russia in which factory medicine developed. After the abolition of serfdom, many of the factory hospitals were transferred by their owners to the zemstvos. The personnel composition of the Ural doctors also changed: a large number of medical students disappeared, and former serf doctors took exams for the position of a doctor outside the Urals. “Medical students were replaced by a paramedic, and in the 1880s an institute of sisters of mercy appeared here,” states T. Shestova [12, p. 26].

The city and zemstvo reforms testified to the development of local self-government and its orientation towards broader sections of the population, previously almost not covered by doctors: peasants, women, and children. Moreover, many natives of the Urals “began to receive education at the expense of targeted scholarships at local paramedic schools” [12, p. 26].

In the health management system, the main body was the Medical Board, renamed the department in the second half of the 19th century. The zemstvo doctor also had many duties.He "was engaged in the hiring and dismissal of personnel, was in charge of the site, exercised control over the work of paramedics and midwives, attended council meetings, prepared all types of reports and compiled medical and topographic descriptions" [12, p. 27].

In pharmacies there was a fairly extensive personnel structure, which included pharmacists, pharmacy assistants, pharmacy students, materialists and laboratory assistants for the preparation of medicines. Pharmaceutics developed. By the end of the XIX century. pharmacists had to work in the Medical Department, and pharmacists served in the pharmacies themselves. T. Shestova notes that in the reports of the governors these terms were sometimes interchanged, “but pharmacists were always opposed to pharmacists” [12, p. 27].

At the beginning of the XX century. Libraries were organized at hospitals at the suggestion of zemstvos. Medical periodicals became more accessible. The specialized Medical Library in Kazan was of great importance for Perm doctors. Scientific trips of doctors to university cities, "initiated by the Zemstvo, allowed them to get acquainted with the latest literature" [12, p. 27].

At the beginning of the XX century. in the Perm and Vyatka provinces in Zemstvo politics, much attention was paid to the training of female doctors. In 1897, the Women's Medical Institute was opened in St. Petersburg, which trained female doctors as a reserve for working with peasants and women in national regions due to the fact that women were often embarrassed to seek help from male doctors. Local authorities also believed that female doctors would perform the duties of midwives and nurses, participate in the creation of a nursery. T. Shestova emphasizes that “in the provinces of central Russia, nurseries were created to improve the life of female workers, while in other provinces of the country, when creating nurseries, they were guided by peasant women” [12, p. 28].

Until the end of the XIX century. Zemstvos were faced with the task of combating "paramedicism" in the countryside, where doctors were purposefully replaced by paramedics. Only anti-epidemic work was assigned to doctors. As a result, patients with serious illnesses were sent to cities for treatment. Professional doctors came to consult paramedics several times a month. T. Shestova believes that the reason for "paramedicism" was the "financial policy of the Zemstvo" [12, p. 29]. Only at the beginning of the XX century. feldsher points were replaced with medical ones whenever possible, and relations between doctors and paramedics improved.

Zemstvos actively intervened in medical affairs during hostilities and revolutions. So, during the years of the Russo-Japanese war, the Perm Zemstvo offered to keep jobs for mobilized doctors. During the First World War, it demanded that the government return civilian doctors to the province. In 1917, the Perm Zemstvo sent an appeal to the Provisional Government on the return "from captivity of all medical personnel, as persons belonging to the Red Cross according to the decision of the Geneva Conference" [12, p. thirty].

By 1915the medical contingent of the Perm province was twice the number of a similar service in the Vyatka province. The reason for this difference, T. Shestova believes, was in the system of personnel training, in particular, in the fact that “from the very beginning of the existence of the Perm provincial zemstvo, there was a scholarship training for doctors” [12, p. thirty]. In addition, the introduction of external education was an innovation in the Perm province. Uyezd doctors “were given the opportunity to get a narrow specialization through the provincial hospital, and the provincial hospital received a medical resident with a minimum salary” [12, p. 31].

Congresses became a common platform for meetings of doctors and discussion of medical problems. However, in the Perm and Vyatka provinces, the first experience of congresses of doctors was negative. Doctors I. I. Molleson and V. O. Portugalov, who were responsible for preparing the congresses, were arrested and lost their jobs because of populist views. In addition, zemstvos often made decisions that were questionable from the government's point of view. During the revolution of 1905, 13 members of the county committees were expelled from the Perm province, and the chairman of the province Zemstvo, L. V. Yumashev, was arrested.

In general, the congresses of doctors were advisory in nature. As T. Shestova writes, their main task “was to discuss the expansion of medical care” [12, p. 33]. The presence of zemstvo officials without medical education, but with the skills of financial calculations, “contributed to a more realistic view of the problems” [12, p. 33].

The salary of doctors in the Vyatka provincial zemstvo at the beginning of the 20th century. was 300 r. lower than in Perm. Increased amounts were paid only to psychiatrists and doctors who combined work in the hospital with teaching at the provincial paramedic school. Uyezd doctors “could not have such a part-time job, which caused complaints from them” [12, p. 35].

At the beginning of the 20th century, a district service system was established in both provinces. Such a system did not provide for private practice. Physicians received full days off only after 1905. A shortened working day of six hours was established by 1917 [12, p. 36].

T. Shestova comes to the conclusion that the "great reforms" gave rise to zemstvo and city medicine. Zemstvo medicine concentrated on the peasant population, and urban medicine focused on the sanitary conditions of life in the city. In the Vyatka province, ties were well established between the provincial and district zemstvos. In the Perm province, these ties were less significant and amounted to financing of anti-epidemic work. Both provinces have gone through the stages of "paramedic" and switched to a stationary system of public services. In the course of this experiment, a “district system of public services was born, when a doctor worked with residents of any material wealth outside of private practice, receiving wages from the zemstvo” [12, p. 38].

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Medicine of the Russian Empire of the late XVIII – early XX century in the new scientific literature | Article in the collection of an international scientific conference

Medicine of the Russian Empire of the late XVIII – early XX century in the new scientific literature

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