Institutionalisation and education in healthcare
A German princess became Empress of Russia
Already before the 17th-century on-and-off, the smallpox infection raged in Russia, which foreigners had probably brought into the country. The peasants of the Kazan province rubbed smallpox scabs in with a powder, inhaled it, and then soared in the banya (sauna). After the artificial infection, the smallpox disease was milder. The vaccination for smallpox in Russia came into practice in the middle of the 18th century. First in Dorpat (1756) and later in other cities of the Empire. It required great strength and support to move this issue forward. Empress Catherine the Great played a significant role in implementing vaccination. To set an example, she sought vaccination for her young son Paul and herself. She asked the London Medical Society to send one of the best doctors. Thomas Dimsdale acceded to this request and arrived in Russia in 1768. The smallpox vaccination was logged in the "Complete Collection of Russian laws" in 1770. The first Jenner vaccination against smallpox in Russia was given in 1801 by professor E.O. Mukhin of the Moscow university to the boy Anton Petrov, who got the family name with the help of Empress Maria Feodorovna, Vaccine.

Equestrian Portrait of Catherine II
oil on canvas, 1762, Danish artist (worked in Russia) Vigilius Eriksen (1722-1782)
Photographer - M.K. Lagotsky. ID GMZ Peterhof: KP 7697 PDMP 880-zh.
© The Peterhof State Museum-Reserve, 2021
Advances in medicine lead to changes in governance
During Empress Catherine the Great's reign (1763-1796), born as Princess Sophia Augusta Frederika of Anhalt-Zerbst-Dornburg, her predecessors' medical improvements in Russia flourished. She institutionalised healthcare even more, and Russia became increasingly self-sufficient in the field of trained medical professionals.
The Empress made significant changes in the management of medical affairs in Russia. In 1763 the Meditsinskaya Kantselyariya was transformed into the Meditsinskaya Kollegiya (Medical Collegium) with extended powers. She installed a board of directors (Collegium) with a Doctor Medicinae as one of the members. In 1764 the Meditsinskaya Kollegiya was given the right to confer the degree of Doctor Medicinae, although it rarely used this right.

Provincial medical charitable councils were created in all provinces of the Russian Empire in 1775. The boards, which were formed to supervise rural medical affairs, included representatives of all sections of society. Their functions included organising orphanages, alms-houses, hospitals and pharmacies. They fell under the supervision of the Meditsinskaya Kollegiya.

In 1786, the two acting medical schools were separated from the hospitals and converted into independent medico-surgical schools (the Bidloo school and the navy and land force hospital school in Saint Petersburg). They obtained the right to educate their own students and "lead them to the doctoral degree" together with Moscow University. Till that moment, this right belonged only to the Meditsinskaya Kollegiya. In 1798, 12 years later, the medico-surgical schools of Moscow and St. Petersburg had been renamed Imperial Medico-Surgical Academies. The Moscow Medico-Surgical Academy existed until 1804. Not only its 45 students but also all the medical instruments and the library were transferred to the Imperial Medico-Surgical Academy (now the Military Medical Academy named S.M. Kirov) in St.Petersburg.

Imperial Medico-Surgical Academy in Saint Petersburg,

pen-and-ink drawing, 2019, artist Margarita V. Apraksina, Saint Petersburg.

© Private collection, reproduced with permission

At the end of the eighteenth century, two centres of medical science existed, the Medical Surgical Academy in St. Petersburg and the Medical Faculty of the Moscow University. This university faculty concentrated on general pathology, therapy and physiology, while the Medico-Surgical Academy took a leading position in the development of anatomy, topographic anatomy and surgery.
In Russia, around 1800, there was a significant gap between the medically trained scientists using experimental methods of research and the practicing physicians. The latter still relied on traditional medicine.
After the death of Empress Catherine, her son Paul I (reign: 1796-1801) and then his both sons, Aleksander I and Nicholas I (reign: 1825-1855), continued the reforms of their ancestors. In 1801 Emperor Aleksander the First (reign: 1801-1825), who had succeeded his father Paul, instituted further far-reaching healthcare management reforms. He closed the Meditsinskaya Kollegiya and established the Ministry of Internal Affairs in 1802. The management of civil medicine, among others medical and sanitary control, became the responsibility of the Ministry of Internal Affairs. The management of medical education was transferred to the Ministry of National Education. Military medicine became the responsibility of the Ministry of Defence.

Portrait of Emperor Alexander I (1777-1825)
English School, oil on canvas, 1826, artist George Dawe (1781-1829), Photographer - V.S. Korolev. ID GMZ Peterhof: KP 6584 PDMP 755-zh.
© The Peterhof State Museum-Reserve, 2021
Under Emperor Aleksander I and Nicholas I, the Russian economy developed further, fostering a significant increase in higher education institutions with medical faculties.

The development of the Russian economy in the first half of the19th century resulted in a significant increase in the number of higher education institutions. By 1860, Russia had eight universities. Some of the universities opened medical faculties for example in Dorpat 1802 (now – Tartu), Vilnius (1803), Kazan (1804), Kharkov (1805) and Kiev (1841).

According to the university ruling of 1804, the universities have the right to autonomy (the election of the rector, deans, professors, etc.). Some universities were transmitters of progressive democratic ideals, and the government actively stifled the freedom-loving sentiments in the higher educational institutions. In 1820 the government announced audits of universities. Such an audit in Kazan University caused the closure of the anatomical theatre and museum, and autopsies were no longer allowed. All the anatomical specimens were made unrecognisable and buried in a church ceremony.

Portrait of Nicholas I with Alexandria in the Background
Russian School, oil on canvas, 1849, artist Georg von Bothmann (1821-1891)
Photographer - V.S. Korolev. ID GMZ Peterhof: KP 8311 PDMP 929-zh.
© The Peterhof State Museum-Reserve, 2021
Facts and figures
In the seventeenth and eighteenth centuries, close ties were established between Russia and the Netherlands in the field of medicine. Many Dutch physicians came to work in Russia, held very high positions in the Russian medical service and contributed to the development of medical services and medical education.

Numbers of barber-surgeons and their country of the highest medical education during the reigns of the rulers of Russia.

© Private collection, reproduced with permission

In particular, Leiden University has made an outstanding contribution to the development of medicine in Russia. Only six doctors of medicine were members of the Academy of Sciences, seven were professors of medical sciences, and more than thirty were simply doctors of medicine. All of them, at some point in their careers, graduated from Leiden University or received a doctorate.

Number of doctors medicinae (number of professors included) and their country where they obtained their highest education during the reigns of the rulers of Russia.

© Private collection, reproduced with permission

It took Russia approximately 130 years to build up self-sufficient medical training since Peter the Great started reforms in Russia. By the beginning of the 19th century, Russia had already 1519 doctors and barber-surgeons of Russian origin. Four hundred twenty-two were in the army, 128 in the navy and 879 in hospitals and medical boards.

The Tsars, Emperors and Empresses have laid the foundations and created the conditions for healthcare reform from Peter the Great on. However, the doctors had to shape the house and its contents. Above all, it also asked for indispensable chief supervisors with a well-trained medical knowledge.
Developing medical science further

Imperial University of Dorpat

In: Louis Höflinger, Tartu Album, 1860

© Tartu Art Museum

Both brothers, Alexander I and Nicholas I, wanted to become more and more independent from foreign medical doctors. As a great European power, they understood that Russia could not afford to fall far behind Europe after the Napoleonic War in 1812. Emperor Nicholas I (reigned 1825-1855) gave talented students from various departments of Russian universities the opportunity to study abroad. Young people, pre-selected by the professors of their universities, had to pass an entrance exam. Those who successfully passed it went to study at the Imperial German-Baltic University of Dorpat (now Tartu University in Estonia), the scholarship was awarded by the emperor. In Dorpat, students received a doctorate. Dorpat University was considered at that time one of the best higher education institutions in the German-speaking region in Europe and in Russia. The aim of their study in Dorpat and their traineeship of two more years at foreign universities in Europe was to prepare them as staff members in the Department of the Ministry of Public Education and as professors of the Universities. The first group of talented students arrived in 1828 in Dorpat, including Nikolay Ivanovich Pirogov (1810-1881). Another 30 year were needed to raise the medical skills in Russia to a level equal to that of the advanced countries of Europe, in which Pirogov played a crucial role.
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