Zemstvo Medicine

Zemstvo Medicine


the district form of medical service for the rural population that arose in Russia in the second half of the 19th century.

Zemstvo medicine was organized as a “nonobligatory” responsibility of the zemstvo (district and provincial selfgovernment) at the time of its establishment. Zemstvo district doctors strove to combine treatment with public health improvement and with general cultural education in the countryside. However, preventive medicine and public health measures were not given proper attention (in 1913 there were only about 230 sanitary inspectors in all districts). Zemstvos appropriated trifling sums for the maintenance of zemstvo medicine, trying to cover expenditures for medical care at the expense of the peasantry itself through special medical taxes and fees for consultation. Payment by the peasants for hospital treatment was abolished only in the 1880’s. For the sake of economy the zemstvos in the 1860’s and 1870’s invited feldshers to practice instead of physicians (by 1910 the number of independent feldsher stations had reached 2,620); they were accorded the right of treatment without a physician’s supervision.

Table 1. Comparative data on the development of zemstvo medical institutions between 1870 and 1910
Number of medical districts5302,686
Hospitals in rural localities701,715
Hospitals in district cities325330
Average radius in versts3917
Population per medical district950,00028,000
Number of villages in the average medical district550105
Number of beds per 10,000 population1.54.8
Number of independent feldsher stations1,3502,620
Ratio of the number of feldsher stations to physicians’ stations2.5:11:1
Number of physicians serving district zemstvos6103,100
of these, in village localities2402,335

A large role in the history of the development of the ideas and organization ofzemstvo medicine was played by the N. I. Pirogov Society of Russian Physicians. An important measure of Russian zemstvo medicine was the organization of public health statistics. Some of the first theoretical centers of zemstvo medicine were the journal Arkhiv sudebnoi meditsiny i obshchestvennoi gigieny, founded in 1865 by S. P. Lovtsov, and the Kazan Society of Physicians, founded by A. V. Petrov. Statistical public health research on morbidity, physical development, and demography, conducted for the first time by workers in zemstvo medicine (P. I. Kurkin, E. M. Dement’ev, E. A. Osipov, F. F. Erisman, A. I. Pogozhev, N. I. Teziakov, D. N. Zhbankov, S. M. Bogoslovskii, and I. I. Molleson), had as its purpose the elaboration of a program of public health improvement in Russia and the organization of medical care for the peasantry. Many of the zemstvo physicians’ works had great social and cultural significance. The enormous accumulation of material served as the basis for some scientific generalizations. V. I. Lenin valued these researches very highly and used them widely in his works, for example, in his The Development of Capitalism in Russia.


Veselovskii, B. B. Istoriia zemstva za sorok let, vols. 1–4. St. Petersburg, 1909–11.