Russian zemstvo medicine is a purely social matter. Treatment by a doctor in the zemstvo is not a personal service to the patient at his expense, nor is it an act of charity. It is a social service.
This paper investigates the organization of medical services under extreme conditions, in some northerly parts of European Russia during the era of zemstvo reform: the period of rural self-government that existed between 1864 and 1917. It concentrates on the north-western guberniya (province) of Olonets, now largely part of the Republic of Karelia. An area characterized by its remoteness, relatively harsh geographic and climatic conditions and meagre economic resources from which to finance medical services, Olonets was also perceived as ‘culturally backward’. Its inhabitants were often suspicious of or antagonistic towards outside influences, whether in the form of governmental authorities or would-be improvers in health, hygiene and medicine. Arguably, the reluctance of health-care professionals to work in such an environment aggravated matters, although there were also distinct attractions in practising zemstvo medicine. Given such contexts, the study has relevance to suggested ‘core and periphery’ and ‘distance decay’ issues (see the introduction to this volume) affecting health care provision in remote areas.
The wretchedness of Russian peasant life in the late nineteenth century, readily apparent to contemporary observers, has also been a reoccurring theme for modern historians.
Thinking about Medical Care in the Workhouse
The literature on poverty and medicine has developed considerably since Anne Crowther, Ruth Hodgkinson, Michael Flinn, Joan Lane, and Geoffrey Oxley were building the field. New work—on doctoring contracts, subscriptions by parishes to extraparochial medical institutions, infirmary building programs, the extent of sickness and ill health among the poor, the nature of medical relief under the Old Poor Law, medical negligence, and the medical marketplace—has begun to test ingrained historiographical notions that the nature of medical relief was better under the Old Poor Law than the New and to establish the centrality of sickness to the pauperization process. It has also begun to highlight the essential complexity of medical care for the poor, with considerable regional and intraregional variation overlain by a remarkable expansion in the range of “medical things” that the poor law, Old and New, came to pay for. The sick poor as actors and agents have been given a voice in the flowering of literature on pauper narratives to match that long available for scholars considering the experiences of the insane. And London has moved from a veritable black hole in welfare history to the focus of a renewed appreciation of care and relief for the out-parish, lunatic, venereal, widowed, unemployed, and institutional poor under the Old and New Poor Laws.
Email your librarian or administrator to recommend adding this to your organisation's collection.