“This deficiency has reached extraordinary proportions” – Picture of the Day – Kommersant

215 years ago, on April 21, 1808, Emperor Alexander I approved the methods proposed by the Minister of the Interior, Prince A. B. Kurakin, to solve the main problem of military medicine, which suffered from an acute shortage of doctors, including an increased recruitment of specialists in the near and far abroad; at the end of the same 1808, very curious first results of the event were summed up, and ten years later, the final ones.

From a letter from the Commander-in-Chief of the Danube (Moldavian) Army, General of the Cavalry I. I. Mikhelson, to the Medical Expedition of the Ministry of Military Ground Forces, April 20, 1806.

… With a lot of sick people in the regiments, the last one will insist on a lack of medical ranks; although in some there is a full number of them by position, but they themselves are sick, sometimes they stayed in different places with the sick, sometimes they did not come from those places from where they were identified, meanwhile, the cash in the care and use of the patients does not have time …

From the work “Centenary of the War Ministry. 1802-1902″, 1902.

… Doctors were not supposed to and were not in all 14 irregular troops (with the exception of the Stavropol Kalmyk army, in which one doctor served), in 17 regiments, in 56 artillery garrisons and fortresses, 58 fortress engineering teams and a huge number of other separate teams, as well as in 34 hospitals and infirmaries (in the latter, seconded doctors probably served …).

So, with many regiments and even with entire troops, there was no medical assistance at all. The number of troops increased rapidly (in 1803 there were 448,776 people in the Russian army, in 1808 – 705,381.— “Story”), and there was a shortage of doctors. This constant deficiency became especially acute in 1807, during the war with France, and in 1808, when Russia was at war with several states at once and the plague raged in its southern regions, this deficiency reached extraordinary proportions. According to information compiled for the first issue of medical lists, only 768 doctors were in the military department. It happened that they fainted from fatigue …

From the report approved by Emperor Alexander I of the report of the Minister of the Interior, Actual Privy Councilor Prince A. B. Kurakin, April 21, 1808.

It is known that the Medico-Surgical Academy is the main place in the Empire, which trains doctors…

In 1807, an extreme shortage of medical officers in the land army forced students to take a premature examination at the Academy again. And 62 students of the 4th grade were released into the army as Candidates and distributed directly to the regiments in the position of Doctors.

Finally, this year the need for medical ranks for the army and navy has increased so much that 64 students only in August last year, 1807, were transferred from 3rd to 4th grade, released in February of this year on the examination of Candidates of Surgery and distributed to the places for the most part as healers.

When looking at such an inconvenience resulting from the premature release of pupils of the Medical-Surgical Academy into service, in addition to a perceptible disorder in the order of training courses, it seems especially another circumstance that deserves respect most of all, that these pupils enter the administration of a medical position without proper improvement, and therefore, they are not only of little use, but can often be harmful.

To the aversion of which I find no other means than to stop the graduation of pupils from the Medical-Surgical Academy, wherever it may be, until, after the last graduation of this year, those remaining in the upper classes have passed all the subjects of theoretical and practical teaching …

From this, the question arises in itself: where to borrow them from in this case.

In order to avoid such a difficulty, I have the good fortune to submit to the discretion of Your Imperial Majesty the following methods:

I. Invite now free practicing Doctors to serve in full-time positions, and those who agree to be determined in a military unit, and the condition will be made with them for three years, to put a lump sum upon entry into service, the annual salary does not count.

II. Through the Russian Ministers, acquired at foreign courts (Russian ambassadors.— “Story”), to call, according to the previous examples, Doctors from foreign lands on the basis of the rules attached to this one …

Decide as an immutable rule from now on:

1. So that every Medical Officer appointed from the students of the Academy to the military departments will certainly serve there for six years, not counting the time spent by him in the rank of Candidate in practice in the hospital …

2. That pupils who leave the Academy directly into the civil service, or who have not served in the aforementioned position for six years in military units, and who are converted from them, cannot retire the first before ten, and the last before eight years, including service by the military…

From the Rules on which the Russian Ministers are entrusted with calling foreign doctors to the service of His Imperial Majesty, attached to the report of Prince A. B. Kurakin.

1. Called Doctors, in addition to sufficient knowledge in their science, must be of good morals …

2. On this basis Physicians may be divided into three classes:

The first class will include those who, embracing the whole of medical science, would be capable of occupying the most important medical positions in the military and civilian units. They must be tested in Anatomy, Physiology, Pathology and Therapy, Materia Medica, Natural History, Physics, Chemistry; most importantly, practical and theoretical information is required from them in surgical operations and stitching; likewise they must be versed in Forensic Medicine and the Medical Police…

Moreover, they are required to have a sufficient knowledge of the Latin language, which is everywhere revered by the learned language.

The second class includes those Physicians who, having no proper knowledge of practical Surgery, are distinguished in other respects by a thorough knowledge of other parts of medical science …

Note. It is highly probable that the Doctors of these 2 classes already have diplomas for the Doctor’s dignity; if there were a case that a skillful Doctor, for some reason, had not yet received a diploma from a university that deserved trust, such as Vienna, Göttingen, Erlangen and Wirzburg, then this by no means blocks his way to be accepted into the second class; and then, if he wishes to solemnly defend in St. Petersburg (so in the text.— “Story”) a dissertation written by him in Latin, then in this case he can receive a diploma and the rights of a Doctor of the Russian Empire from the Medical Council.

The third class consists of Physicians who, although they lack some information and experience, nevertheless, under the guidance of senior Physicians and Surgeons, can be useful … Upon their arrival here, place them for a while in the Medical-Surgical Academy until they acquire additional knowledge, so that you can then define them in a real service. And since they still require education, they should not be more than 25 years old …

(Doctors who agreed to come were promised significant sums for moving and a huge salary for that time: a Russian senior doctor of the 2nd class received 600 rubles a year, a foreign doctor of the 2nd class – 800-1000. For comparison: first-class meat on average cost 25 kopecks per kg Salary to foreigners increased by 25% after three years of service, in addition, they were entitled to promotion and other benefits and privileges.— “Story”.)

From the report approved by Emperor Alexander I of the report of the Minister of the Interior, Actual Privy Councilor Prince A. B. Kurakin, December 15, 1808.

… Medical officials have already been invited to join the Russian service: in Vienna 121, in Königsberg 7, in Dresden 33 and in Paris 1, a total of 162; 133 of them arrived in St. Petersburg, of which, no matter how strict the examinations are, 56 were awarded and assigned to active service.

Of the rest, found by examinations not capable of being determined for service, 16 returned to their fatherland, and 31 were assigned to the Imperial Medical-Surgical Academy for improvement.

… I treated our Ministers, who are found at foreign Courts, so that they do not send 3 classes of doctors here, but choose the most such who have gained a reputation in their homeland and would come as close as possible to the 1st and 2nd classes of doctors accepted into our service.

As for the foreign doctors already assigned to the Academy for advanced training, they are housed in buildings on the Aptekarsky Island, provided with everything necessary for the initial equipment, and I suggested that the Imperial Medical-Surgical Academy elect from among the Professors and Adjuncts thereof, who know the German language, and begin for them teaching lectures …

Meanwhile, the President of the Imperial Medical-Surgical Academy, Acting Councilor of State Willie, came to me with the idea that it would be much more useful to turn these foreign doctors for improvement to the University of Dorpat, where lectures are taught in German.

Finding this proposal most useful on my part … I communicated on this subject with G. Minister of Public Education and the Trustee of Dorpat University, and received their feedback that this assumption could be conveniently fulfilled … And that the amount determined for their maintenance for each 402 rubles. 92.5 kopecks, although in other respects not quite sufficient in terms of the high cost there, they still hope to dodge …

From the report of the Chief Military Medical Inspector, Actual State Councilor Ya. V. Willie, to the Minister of War, Infantry General P. P. Konovnitsyn, July 13, 1818.

… Repeated experience has shown that the calls of doctors from foreign lands did not bring almost any benefit, because when the conditions (the terms of the agreement.— “Story”) were beneficial to the treasury, then either none of the foreigners entered the Russian service, or the most ignorant ones entered; when the conditions were beneficial for doctors, as in 1808 and the following years, although they received knowledgeable doctors, these, in proportion to the costs used for them, brought too little benefit to the military department …

In addition to the damage suffered by the treasury for discharge, salaries and pensions to these people, no less respectful for the government is the fact that Russian doctors, comparing the benefits provided to foreigners with those that they themselves enjoy, and the true benefit they bring to the Fatherland with the uselessness of an ignorant language, although in other respects a skilled foreigner, they feel humiliated, lose the vigor needed to endure the difficult military medical service, and therefore leave it at the first opportunity …

Inasmuch as it is necessary to increase the number of doctors in Russia, and especially to replenish the army with good doctors, then, in my opinion, it is necessary:

1) To try to keep in the military service those doctors who are now in it and will continue to be.

2) Strengthen the methods of multiplication against the current number of students in medical science …

Each of the Russian universities at the medical faculties should maintain from the treasury, in fact, for the study of medical sciences, a sufficient number of students …

Publication by Evgeny Zhirnov