Disease as an important tool for economic, cultural and political analysis has long been recognised by historians. In particular, historians of social medicine have paid much attention to cholera epidemics in nineteenth-century England, France and Germany. Although a number of studies on public health in pre-revolutionary Russia have dealt with cholera epidemics and various facets of its socio-political impact, Charlotte Henze’s book is the first to concentrate entirely on the history of cholera in Saratov throughout the nineteenth to the early twentieth century. The choice of the locale is rightfully justified since Saratov, an important shipping port on the Volga, one of Russia’s major trade routes, with its socially, culturally and ethnically diverse population, including a large German community, experienced all major cholera pandemics of 1823–1914. With this central focus, Henze is able to construct a social, political and public health history of the city of Saratov. She uses the cholera outbreak of 1892 in Saratov as a means of exploring living conditions and medical and administrative infrastructures in the city on the Volga. She applies the same approach to address broader issues of Russia’s socio-economic developments at the age of modernisation associated with rapid urbanisation, increasing migration of impoverished rural population and growing social tension.

The book is divided into five chapters. The first chapter traces the history of cholera in Russia before 1892, focusing on the multiple outbreaks during 1823–59. It also analyses anti-epidemic policies after Russia’s defeat in the Crimean war, when Russia entered the reform era that drastically changed the existing economic and social structure of the country. Chapter 2 documents Saratov’s appalling sanitary conditions and inadequate public health provision and administration, which in large measure were responsible for disaster in coping with the cholera epidemics of 1892. Chapter 3 provides detailed coverage of this epidemic. It analyses anti-epidemic measures, set up by the central government to combat cholera arrival to Russia, discussing briefly the reception of Robert Koch’s discovery of vibrio-cholerae. It also examines the responses of local administrative and medical authorities, as well as the notoriously famous ‘cholera riots’ and underlying social constraints and conflicts. Chapter 4 is devoted to cholera’s impact on Saratov, the most important being the growing self-identity and self-confidence of local physicians. Improvements in the sphere of city renewal and public health care are attributed to economic factors rather than to direct consequences of the cholera outbreak. The subject of chapter 5 is cholera’s return to Saratov in the early 1900s. The city was better prepared for the epidemics in terms of medical and public health care as well as administrative logistics. The new outbreak revealed the new realities of anti-cholera combat at the age of bacteriology, and old social contradictions of the coming turbulent 1905.

The book convincingly covers Saratov’s cholera history. References to similar developments in combating cholera in Western Europe are valuable and highlight the peculiarities of the Russian situation. Although the severity of the sixth pandemic in Russia is undisputable, extensive areas of Greece, the Balkans and the Ottoman Empire were also severely affected during the first decade of the twentieth century. The Italian wave of 1910–11 was quite heavy in Venice, Aquila, Palermo and Naples, so we cannot say there was none recorded in Europe after 1892. A more elaborate comparative perspective is welcome.

The book touches upon some important political and social issues; however, it contains little that adds to our knowledge or alters our understanding of the processes that eventually led to the unprecedented social and political upheavals of 1905 and 1917, which ended in the collapse of imperial Russia. Does the cholera epidemic of 1892 therefore provide an appropriate criterion for assessing the viability of the autocratic regime, a thesis which Henze has particularly emphasised? Another reiterating thesis is Russia’s confrontation with modernity and the ultimate inability of the autocratic regime to cope with challenges such as cholera outbreaks. This is, I believe, an overstatement of the case, and overtones some of the complexity mapped out in the text, returning us to a rather standard treatment of Russia’s development during the late imperial period. Lastly, important advances in Russian military medicine in combating epidemic diseases including cholera translated to the civil population remain unexplored and need to be addressed if the government strategies to prevent epidemics are to be fully understood.

Overall, the study is useful insofar as it contributes to Russia’s history of cholera and is stimulating for provoking discussion on some important episodes in the history of late imperial Russia, and has undoubtedly confirmed the importance of examining the impact of individual disease and the issues surrounding public health as a means of exploring key debates in social and political history. Given the dearth of scholarly studies of epidemics and the health care system in Russia, this volume is particularly noteworthy.