Only immediately after graduating did Chekhov ever seek a full-time position as a doctor. Once he started becoming successful as a writer, medicine receded, into the background, but it remained a constant presence in his life, and never lost its importance for him. He was fnendly with numerous doctors throughout his life, depicted scores of them in his stories and plays, did his best to support the cause of public health, and helped a medical journal when it was threatened with closure.
His choice of medicine as a career had been rather arbitrary to begin with, as he confessed in his autobiographical note, but it was not one he regretted. The most important thing was for him to acquire a university education which could open up avenues, both professional and social, that would otherwise have been closed to him as a lower- class meshchanin. In other words, a university degree, to which his gymnasium education gave him access, was Chekhov's passport to freedom. He toyed for a while with the idea of studying med cine >n Zurich, and then cons iered the German university town of Dorpat (modern day Tartu in Estonia), which was part of the Russian Empire. As a boy in laganrog he had been treated by a German doctor from Dorpat;32 it was also where Dr Nikolai Pirogov, Russia's greatest nineteenth-century medical s( entist, had taught for many years. But Moscow University was the natural choice, and it turned out to be a good one. If Moscow was becoming a dynamic, and powerful city in the closing years of the nineteenth century, thanks to the forces of capitalism, medicine was also undergoing a profound transformation in Russia, and some of its most brilliant figures were linked to Moscow University. The 1880s when Chekhov was a student, were a time when its medical school particularly flourished.
When Chekhov graduated with h doctor's certificate in 1884, after five years of rigorous tB.ii mg, he was entering a highly respectable profession. This had not always been so. The practice of medicine, like so much else, was very backward in Russia and only began to enjoy a degree of prestige after the great reforms of the 1860s. Until the beginning of the eighteenth century, indeed, the doctors were all foreign. It was in Moscow that Peter the Great set up the first training institution for Russian doctors; eventually there were five others: the Medical-Surgical Academy in Petersburg, and the medical faculties of Dorpat, Vilna (present-day Vilnius - another city with a largely foreign population), Kharkov and Kazan. But the status of Russian doctors remained very low compared to that of their foreign colleagues, and their activities were strictly controlled by the state via the Table of Ranks. Status was made visible through the different uniforms for differing medical posts.
The medical profession offered commoners the possibility of social betterment: acquiring a degree brought with it some desirable privileges, such as exemption from the demeaning poll tax and the hated military service. But it was rare for doctors to rise above the lowest position in the Table of Ranks, and the profession therefore attracted few members of the gentry. State remuneration in add'tion was extremely modest. Since most medical personnel d'd not even make it on to the bottom rung of the Table of Ranks, and therefore lacked any kind of official recognition (the regime wished to protect the privileges of the noble class), even having completed the Lve-year degree, their position in society was significantly lower than lawyers, civil servants and army personnel. In the 1860s doctors were still being lumped together with piano tuners and typesetters when it came to classifying professions, and it was almost axiomatic that doctors came from poor backgrounds. All these factors together conspired to produce a recruitment crisis, and it was partly to solve it that a law was passed in 1876 which enabled the country's medical faculties to prov de student scholarships.
Chekhov was the beneficiary of a scholarship from laganrog, and he was one of the first generation of Russian doctors who did not have to become lowly government functionaries, their status and income determined by a controlling state. First of all the reforms of the 1860s led to the establishment oizemstvo medicine: a free national health care service administered by the new units of elective local government established all over Russia. Medical provision in rural areas was primitive, to say the least, With one doctor to tens of thousands of patients, so the influx of doctors and the building of clinics and hospitals funded by the zemstvo was a major step forward. From its position of backwardness, Russia suddenly vaulted itself into a position where it had taken the lead: no other European country had yet developed an equivalent of public zemstvo medicine. The Swiss-born F. F. Erisman, who founded hygiene science n Russia, was a leading figure in the movement for community medicine. He settled in Russia m 1875, four years before Chekhov matriculated, and that same year began the publication of long articles on public health in the leading lournal Notes of the Fatherland. In 1882 he became Professor of Hygiene at Moscow University, and so was one of Chekhov's teachers, Another major advance in Russian medicine came when doctors started to professionalize their activities and develop autonomy. The Pirogov Society, formed in 1881 when Chekhov was in his second year as a medical student, was named after the surgeon and educator who had |ust died. It was a national orgauzat on that committed tself to continuing Pirogov's quest to improve standards in public health and advance medical education. The first Congress, held in St Petersburg in 1885, attracted 573 delegates, only 44 of whom worked as zemstvo doctors, With twice as many working for hospitals and universities. The 1902 Congress, by contrast, the Society's eighth (which featured a special matinee performance of Uncle Vanya) attracted 1,994 delegates, 412 of whom worked for the zemstvo, with approximately 300 employed in either private practice, hospitals or universities.
When Chekhov later moved out of Moscow to his country estate at Melikhovo, he became an active supporter of the zemstvo medicine programme being developed in the Moscow province, which earned a reputation for being a model of its kind. And he played his part in helping to erase the huge chasm that existed between the educated population and the people by treating peasants himself. In her book on nineteenth-century Russian medicine, Nancy Mandelker-Frieden provides a graphic example of this divide:
A zemstvo physician who worked in Samara province for many years restrained the peasants from falling on their knees and addressing him as 'Your Honour' or 'Your Excellency' or 'Your Majesty' and later recalled how 'painful it was to see the debasement of the human personality. It was necessary to wean the population from these slave-like habits and explain that a physician was not a lord but a person who also served and worked.'33
Earlier in the century, physicians had to hover around doorways not daring to sit down, and were often treated little better than serfs; the zemstvo doctor at end of the nineteenth century was an often idealized figure, admired for his commitment to the noble cause of working for the people. Russian medicine had come a long way.