Healthcare reform under Nicholas II

PHOTO: Nicholas II with wounded soldiers at a military hospital near the front in World War I. Artist: Pavel Viktorovich Ryzhenko (1970-2014)

During the 1920s, the Bolsheviks boasted of how they had improved healthcare in Russia after the overthrow of Nicholas II, however, this is just one more lie which the new order utilized in their campaign to discredit the reforms of Russia’s last Tsar. And to this day, Nicholas II’s detractors continue to claim that the Russian people “suffered” and that the Tsar did “nothing” to help them.

During the reign of Nicholas II, the population of the Russian Empire increased from 122 million in 1894 to 182 million in 1914 – an increase of 62 million! Given such a staggering increase in the country’s population, Nicholas II’s health care reforms were nothing short of impressive.

After Nicholas II ascended the throne in 1894, healthcare reform in the Russian Empire became the subject of special concern for the new Emperor. It was during his reign that the development of medicine and healthcare accelerated throughout the Russian Empire.

On 11th January 1897, Nicholas II approved a Special Commission on measures to prevent and combat plague, chaired by Duke Alexander Frederick Constantin of Oldenburg [1] whom the Tsar allowed to use the premises of the Emperor Alexander I Fort at Kronstadt for experimental anti-plague purposes. In October 1897, Oldenburg traveled to Turkestan to take emergency measures to prevent the plague from entering the Empire, for which he received “His Imperial Majesty’s deepest gratitude for the labours incurred” for his efforts to spare European Russia and the rest of Europe from plague penetrating their borders.

PHOTO: preparation of anti-bacterial plague drugs in the Plague Control Laboratory of the Emperor Alexander I Fort at Kronstadt

One of the main reasons for the spread of disease, was of course poor sanitation. As a result, in August 1908, Nicholas II advised the Minister of Internal Affairs to pay “serious attention to the dismal state of sanitation in Russia. It is necessary at all costs to achieve its improvement”. The Emperor emphasized the need to be able to “prevent epidemics, not just fight them”. He demanded that the case of streamlining the sanitary-medical organization in Russia be urgently developed and submitted for legislative consideration.

Various commissions were established during Nicholas II’s reign to prevent the occurrence of highly infectious diseases. In March 1912, the Emperor approved the Interdepartmental Commission for the revision of medical and sanitary legislation, writing in the margins of the Journal of the Council of Ministers: “This is to be done at an accelerated pace.” The head of the commission was appointed the chairman of the Medical Council of the Ministry of Internal Affairs, honorary life surgeon academician Georgy Ermolaevich Rein (1854-1942). In the spring of 1912, the commission presented its project for the transformation of the central and local authorities of medical and sanitary affairs. After reviewing it, Nicholas II noted: “Submit to the Council of Ministers. Continue to conduct business at an accelerated rate. “

Nicholas II supported the introduction of a territorial system of medical districts within the Russian Empire, a system not found anywhere else in the world at the time. This system was later adopted by the Bolsheviks, who appropriated its authorship. In the course of the health care reform in the Russian Empire, a three-tier structure of medical assistance to the population was formed: a medical department, a county hospital, and a provincial hospital. Treatment in these health facilities was free of charge.

The opening of new hospitals and medical institutions developed at a rapid pace. The number of hospitals increased from 2,100 in 1890 to 8,110 in 1912 and 8,461 in 1916 +170 psychiatric hospitals. The number of hospital beds increased from 70,614 in 1890 to 227,868 in 1916. The number of doctors also increased from 13,000 in 1890 to 22,772 doctors in 1914 and 29,000 in 1916.

In addition, there were 5,306 medical districts and paramedic points. By 1914 there were 28,500 medical assistants, 14,194 midwives, 4,113 dentists, 13,357 pharmacies. In 1913, 8,600 students studied at 17 medical universities.

In 1901, 49 million people received medical care in Russia, three years later, in 1904 – 57 million, in 1907 – 69 million, in 1910 – 86 million and in 1913 – 98 million. These efforts led to a significant decrease in overall mortality. In the period 1906-1911 there were 29.4 deaths per thousand inhabitants, 26 deaths per thousand in 1911, and 25 per thousand in 1912.

Mortality from smallpox decreased 2.5 times, from typhus decreased 2 times, from acute childhood diseases decreased 1.4 times. In the period from 1891 to 1895 – 587 thousand people died on average from acute infectious diseases, and steadily decreased during the period from 1911 to 1914 to 372 thousand people.

On 19th March 1899, Russia’s first ambulance station was opened in St. Petersburg.

PHOTO: the first ambulance station was opened in St. Petersburg on March 19, 1899

Under Nicholas II, Russian scientific medicine received world recognition, which could not have developed without state support. For the first time, Russian medical scientists were awarded the Nobel Prize: physiologist Ivan Petrovich Pavlov (1904) and microbiologist Ilya Ilyich Mechnikov (1908). Russian medical science carried out pioneering studies of the structure of the brain, and the origins of such fields of medicine as forensic psychiatry, gynecology and hygiene. At the beginning of the 20th century. more than 150 general and specialized scientific medical journals were published in Russia.

Despite the advancements in health care in the Russian Empire, serious health problems remained. For instance, at the beginning of the 20th century Russia experienced a high mortality rate from common widespread infections: plague, smallpox, cholera, typhoid. It was not until the 1940s and the invention of antibiotics did things improve.

Infant mortality under Nicholas II steadily declined. The downward trend in mortality (both children and adults) began before the revolution. According to statistics, the death rate during the reign of Nicholas II per 1000 people had been steadily decreasing.

PHOTO: Medical examination of children in a children’s clinic, St. Petersburg. 1903

Emperor Nicholas II also made efforts to fight against drunkenness. Both the Tsar and Russian society, considered the situation with drunkenness in Russia depressing. Russian historian and journalist Sergei Sergeiivich Oldenburg (1888-1940) wrote that in 1913, “The Tsar, during his trip to the Russian provinces, saw bright manifestations of gifted creativity and labour; but next to this, with deep sorrow, one saw sad pictures of national weakness, family poverty and abandoned households – the inevitable consequences of a drunken life.”

In 1913, the year marking the 300th anniversary of the House of Romanov, Emperor Nicholas II stated that he “came to the firm conviction that the welfare of the treasury should not be made dependent on the ruin of my loyal subjects.”

From 1914, schools of the Ministry of Public Education have been instructed to teach high school students a course in hygiene with the obligatory reporting of information about the dangers of alcohol. In March 1914, the Holy Synod of the Russian Orthodox Church decided to establish a national day of sobriety on 29th August[2], the day of the Beheading of John the Baptist. This holiday was held annually and collected donations for the fight against drunkenness.

By 1913, there were about 1,800 temperance societies in Russia with a total number of members of more than half a million.

As a result of this important decision of Nicholas II, serious changes took place in the country, affecting both the private life of people and their health, and the economy of Russia. The Emperor noted: “Sobriety is the basis of the well-being of the people.”

On 11th August 1908, Emperor Nicholas II initiated the creation of a unified state health care system. In July 1914, a few days before the outbreak of World War I, a bill to create the Ministry of Health was introduced to the Council of Ministers. On 1st September 1916, the Chairman of the Medical Council of the Russian Empire, Honorary Life Surgeon, Academician Georgy Ermolaevich Rein (1854-1942), who held these duties until 27th February 1917. Thus, Georgy Ermolaevich became the first and last Minister of Health of the Russian Empire.

PHOTO: in 1897, the Women’s Medical Institute (the first medical institute of this kind in Russia) opened in St. Petersburg


[1] Father-in-law of Nicholas II’s younger sister Grand Duchess Olga Alexandrovna (1882-1960), who was married to his only son Duke Peter Alexandrovich (1868-1924), from August 1901 to October 1916.

[2] A national Day of Sobriety was revived in 21st century Russia, today an unofficial Russian holiday instituted by the Russian Orthodox Church. The date of 11th September (O.S. 29th August) was chosen because on this day Orthodox Christians celebrate the Beheading of the Holy and Glorious Prophet, Forerunner and Baptist John. On this day, the faithful are expected to observe a strict fast, which includes abstinence from alcohol.

© Paul Gilbert. 7 August 2021