In 1864, the tsarist government began a reform of local self-government, which provided for the creation of zemstvo institutions in provinces and districts. They were entrusted with the task of taking care of the health of the population. The relevance of this study is due, first of all, to the need for scientific understanding of the role of zemstvos in the development of medicine; the importance of studying the mechanism of coexistence of zemstvos with government agencies in the process of meeting local needs.
The purpose of this article is to study the issue of the formation and development of zemstvo medicine in the Kremenchug district of the Poltava province, from the second half of the 60s to the mid-80s of the XIX century.
This problem is still under-researched. It was touched upon in their writings by local historians L. Evselevsky and V. Fedko [1]; [2]. The key base for this publication is the resolutions of the Kremenchug district zemstvo, materials from periodicals, doctors’ memoirs, and zemstvo statistics.
By the mid-60s of the XIX century, medical services were virtually absent in the Ukrainian village. Natural selection dominated, only the strongest people survived. B. Veselovsky, characterizing the situation of pre-reform medicine, rightly noted: “In the whole county there was only one doctor-head of the city hospital, who performed medical and police functions and only accidentally, when passing through villages, provided medical assistance to the population. Medical care was virtually non-existent; population was satisfied with the treatment of semi-literate paramedics. »[3, p. 268].
In 1865, the Kremenchug district zemstvo began its activity. Already at its second meeting, a draft of the organization of medical work in our region was heard. It provided for the creation of two sections, each of which was supposed to have one doctor and 10 paramedics and their students. It was planned to open two pharmacies in the county, medicines were provided to poor people free of charge.
For the next 1867, the Zemstvo budget under the item “Medicine” provided for the following expenses: for the maintenance of two doctors – 1200 rubles; apartment to them – 200 rubles; for the maintenance of ten senior paramedics – 1000 rubles; 10 youngest – 750 rubles; apartment for 10 paramedics – 200 rubles. The one-time costs were planned as follows: for the arrangement of pharmacies – 216 rubles; for the purchase of medicines – 250 rubles; for the purchase of things for a new establishment – 100 rubles. Total 3916 rubles. [4, c. 511]. In subsequent years, funds for medicine from the zemstvo budget were distributed as follows: 1870 – 58255 rubles; 1875 – 61259 rubles; 1880 – 74747 rubles; 1885 – 117456 rubles. [4, c. 512].
An analysis of the above figures shows that the zemstvo’s spending on health care has been constantly growing. Approximately half of them went to the maintenance of medical personnel, primarily doctors, paramedics, midwives. In the 60s, due to the virtual absence of medical institutions, the financing of medicine was scarce, moreover, they often tried to shift it onto the shoulders of rural communities. Since the mid-1970s, however, there has been an upward trend in spending on health care.
An important direction in the activities of zemstvo institutions was the fight against epidemic diseases. Smallpox, cholera, diphtheria, typhus, etc. belonged to the most common in our region. With the introduction of zemstvos, the organization of vaccination against smallpox was assigned to local governments. In 1864, an order was issued that the rural societies, among their members or outsiders, should choose young people, preferably with their consent, to train them free of charge from local doctors in smallpox vaccination. These persons were exempted from all taxes and duties, as well as from military service. They were kept at the expense of local rural societies.
In 1869, at a meeting of the Kremenchug district zemstvo, a decision was made on the conditions for the introduction of vaccination against smallpox in our region. However, despite the measures taken, in 1873 epidemic outbreaks of smallpox were observed in the county. On this occasion, extraordinary zemstvo meetings were convened. It decided to charge the costs of stopping the epidemic epizootic disease at the expense of the provincial zemstvo [4, p. 600].
In 1884, zemstvo meetings discussed the problem of smallpox vaccination. Vowels, based on the recommendations of the second congress of zemstvo doctors of the Poltava province, decided to reorganize anti-epidemic measures. It was decided to abandon the system of public smallpox vaccinators, which was practiced earlier, and transfer these duties to the paramedic. The local administration was obliged to inform doctors about newborns, as well as to advertise the date, time and place of vaccination. A special estimate has been developed for this problem. It provided: a payment to five paramedics who were vaccinated against smallpox for 240 rubles. annually. Total – 1500 rubles; for the purchase of lymph and instruments – 300 rubles. and the same for unforeseen expenses. Total – 1800 rubles. From the provincial zemstvo, the meeting was asked to send and pay for the practice of medical students
for 75 rubles. monthly for each, the maintenance of 10 assistants at 20 rubles. monthly and for unforeseen expenses -350 rubles. Usyogo1500 rub. [4, c. 602].
Diphtheria, scarlet fever, and typhus were other dangerous epidemic diseases that local governments had to deal with. Dr. Eigorn, who from 1871 to 1877 served as a doctor in Kremenchug and Kremenchug district, at the medical congress provided interesting information about the state of morbidity in our region. Here are the most interesting excerpts from his report. “In October 1871, I began to notice cases of scarlet fever frequently. At the end of the same year, the incidence became more frequent, so that I had to see 1-2 fresh cases a week, and by 1872 the incidence became formidable. Although the cholera epidemic raged in the Kremenchug district in the summer of 1872 (June, July, August, September), eating up all the care of the population, forcing the latter to forget about scarlet fever, nevertheless, the scarlet fever epidemic continued to spread, so that in 1873 it assumed monstrous proportions, reaching the first maxim in October 1873. In 1874 the scarlet fever epidemic abated somewhat, but in March of that year it progressed again, reaching a second maxima in September. In the autumn of 1875, crying and crying stood out for the victims of diphtheria, it became universal in Kremenchug” [5, p. 244-247]”.
In 1879, an epidemic of diphtheria spread in our region. Provincial and county zemstvos, government organizations, together with the Red Cross Society, took measures to combat it. On this occasion, an extraordinary meeting of the Kremenchug district zemstvo was convened. It read a letter of the Minister of Internal Affairs to the Governor of Poltava regarding the adoption of measures to stop mass diseases. The Kremenchug Committee of Public Health petitioned the county councilors to temporarily invite two doctors and 10 paramedics, as well as to divide the county into four sections and, accordingly, increase spending on the medical industry. The Poltava governor proposed to the Kremenchug district zemstvo to create a mobile sanitary detachment, which consisted of a doctor, paramedics and sisters of mercy, to fight the epidemic. It was supposed to allocate funds for the total amount of 5,000 rubles for its organization. This proposal was discussed at the extraordinary zemstvo meetings of 1880. The response to the governor’s initiative characterizes the attitude of the peasants towards the medical staff and its prejudices. I quote it in full in the original language: “Regarding the proposal of the Poltava governor to form a mobile sanitary detachment, the council reported that, in view of the poor state of zemstvo medicine, the formation would be desirable, only with the replacement of sisters of mercy, whom the people look at as a sorcerer, therefore they expose even frequent insults, male staff [4, p. 610]”.
It was noted above that one of the main reasons for the spread of epidemics was the unsanitary conditions in which a significant number of peasants lived, as well as their disregard for elementary safety rules. The Sanitary Council worked out measures to combat the diphtheria epidemic, which were approved at zemstvo meetings. Their implementation fell on the shoulders of zemstvo doctors and paramedics. So, the regional body of local self-government made a significant contribution to the fight against epidemic diseases. However, this problem cannot be overcome by his efforts alone, but nevertheless they undoubtedly contributed to the improvement of the demographic situation in our region.
Analyzing the activities of the Kremenchug district zemstvo in the development of healthcare institutions over the first decades, we come to the conclusion that during this period it acted without a clear system. Zemstvo tried to save money on a doctor, to replace them with paramedics. The traveling system, together with feldsherism, almost everywhere constituted the first stage in the development of zemstvo medicine. It was inherited from the pre-reform medical profession, when illiterate paramedics provided “medical” assistance to the peasants.
The only positive of this period was that two doctors and about two dozen paramedics worked in the county, who provided, albeit small, but assistance to the population, some funds were allocated by the zemstvo for medical supplies. Medical services were free.
LITERATURE
- Evselevsky L.I. O. Bogaevsky – doctor. Hromadsky diyach / L. I. Evselevsky, V. T. Fedko. – Kremenchuk: Kremenchuk’s mіska drukarnya, 1995. – 40 p.
- Yevselevsky L. I. Kremenchuccini at XIX on the soil. XX Art. Historical drawing / L. I. Evselevsky. – Kremenchuk, 1996. – 144 p.
- Veselovsky B. History of the Zemstvo: [in 4 volumes]. T.1. / B. Veselovsky. – St. Petersburg, 1909. – 729 p.
- Systematic collection of resolutions of the Kremenchug (Poltava province) district zemstvo assembly 1865-1899. / [comp. O. M. Bondarenko]. – Kremenchug: Type. I. A. Dikovsky, 1900. – 871 p.
- Eigorn S. Ya. Causal relationship between diphtheria and scarlet fever / S. Ya. Eigorn // Speeches and protocols of the VI Congress of Russian Naturalists researchers and doctors in St. Petersburg from December 20 to 30, 1879. – St. Petersburg: Printing house of the Imperial Academy of Sciences, 1880. – 456 p.
Author: Krot Vladimir Alexandrovich
Source: “Kremenchuk region in the context of the history of Ukraine” 2013