The history of homeopathy in the Russian Empire
until World War I, as compared with other European countries and the USA: similarities and
discrepancies
by Alexander Kotok, M.D.
On-line version of the Ph.D. thesis improved and enlarged
due to a special grant of the Pierre Schmidt foundation.
3.9 The Nizhnedevitsk zemstvo experience
The most interesting experience of one of the Russian provincial zemstvos to introduce homeopathy officially as a purely medical affair (not by laymen, as in some previous attempts!), demonstrated convincingly the strong hostility of regular practitioners toward homeopathy on the one hand and, even more important, the doubtless organizational weakness of Russian homeopathy on the other hand.
In the beginning of 1901, the Nizhnedevitsk zemstvo (Voronezh province) decided to invite a homeopathic physician to join the staff. Well-experienced General Nicholas Fedorovsky soon guessed what would be the following development:
In the coming days we shall experience how the opponents of homeopathy will be sacrificing the interests of the State to mercenary ends and ambitions. The last meeting of the Nizhnedevitsk zemstvo [...] decided to invite a homeopathic doctor to serve at the zemstvo [...]. [As a consequence, we shall see] the implementation of so-called 'scientific' pressure the 'ignorant society', i.e., protests and strikes of zemstvo physicians, the noise, rumpus and the badgering of the Voronezh zemstvo deputies who dare express their lack of belief in orthodox science, by the false-progressive Pharisees of the medical press, and also by their stooges from the general press. [...] They will cry out against trampling on the law, on science, and on freedom of conscience!106
The decision to invite a homeopathic physician was published in the issue No 10 of "Medico-sanitarnaia khronika Voronezhskoi gubernii" ['Medical-Sanitary Chronicles of the Voronezh province']. It was pointed out that
A significant decrease in the expenditures as well as a more complete allowance of 'free of charge' help to the population, may be expected only through a radical change in the method of treatment. Given the present situation of medicine, homeopathy may be such an alternative method.
The deputy [Kharkevich] argues that there are sufficient data both abroad and in Russia, to allow the zemstvo to test the homeopathic method in the frame of the zemstvo... [...]. The deputy proposes to invite, additionally to those physicians working in the district, a homeopathic physician without attaching him to a particular bailiwick, as such an assignment could be recognized as the introduction of a method which has not yet earned full popularity [...]. The proposal was accepted by the meeting unanimously. The meeting decided: to charge the board [uprava] with the invitation of a homeopathic doctor, while 1,425 rubles should be assigned as his salary and 300 rubles - for required homeopathic drugs107.
The following two pages of the "Khronika" were dedicated to the commentary on this decision, made by the Head of the Sanitary department of the Voronezh province, Dr. Nicholas Teziakov.
This decision regarding the invitation of a homeopathic physician represents an unique example in the Zemstvo and, doubtless, will remain so. In fact, one should treat this decision with indifference. Probably, the Nizhnedevitsk zemstvo, by making this decision, wished sincerely to help the sick population which had not been provided until now with rational medical support. The duty of those who know the real value of homeopathy from their special education, is to explain to the public institutions responsible for the people's health, how they endanger the population by spending their resources for such experiments. The perfect organization of zemstvo medicine became only possible due to the joint labour of the Zemstvo and its conscientious workers, i.e., zemstvo physicians. Accordingly, the latter have to inform the public institutions on this superstition named homeopathy...108
Further, Teziakov cited the brochure "Against homeopathy" of A. Lozinsky109 supporting the author's view that homeopathy becomes more and more popular because regular physicians appear to be indifferent toward homeopathy and its supporters, and consequently find it superfluous "to refute" it. In Teziakov's mind, this approach probably influenced the decision of the Nizhnedevitsk zemstvo. Teziakov proposed that all the medical organizations of the province express their opinions on homeopathy and on "the danger it represents for the people". He also promised that he would publish a special paper entitled "how to establish a right opinion on homeopathy and prevent zemstvo officials from making false steps" in "Khronika".
Till today zemstvo medicine, in its progressive gradual development, has been confronted with wizardry, later with feldsherism, and now, it seems, also with homeopathy... As the Nizhnedevitsk meeting itself recognises, the situation of medicine in the district is far from being satisfactory. [...] In the last year the meeting abolished a physician's tenure in Sinie Lipiagi and left there only the feldsher's tenure. The same meeting returned to the fee system, while ordering a charge of 5 kopecks for every medicine accepted according to physician's receipt [...]. Currently in the district one physician's tenure serves 822,1 square versta [about 932 km2 ] and 42,145 inhabitants. In relation to other districts within the province, the Nizhnedevitsk district takes the last place (in other districts one tenure serves from 25,000 to 34,000 of population). In such a situation, this means that the 1,725 rubles meant by the decision of the zemstvo meeting to be spent for homeopathy [...] might be spent with certain benefit for the improvement of existing zemstvo medicine110.
Obviously, the weekly "Vrach" could not ignore such an event as the invitation of a homeopathic physician to the zemstvo service. Strangely enough, "Vrach" became informed about this story, not just from the local zemstvo physicians as it had been usual in the past, but even from the general press, namely from the newspaper "Rossia" (Russia) of November 2nd , 1901. For the first time "Vrach" limited itself to a short recommendation:
Hopefully, the Pirogov Society of Russian Physicians will make clear to this zemstvo, which does not understand what it is doing, that their decision is inaccurate and show them the responsibility they must carry while depriving the people of scientific medical help111.
Three weeks later "Vrach" came back to this story with a detailed explanation of what had happened in the rebellious zemstvo, citing in detail the publications in "Khronika" and joining its own opinion:
The meeting assigned 1,725 rubles per year for the homeopath's salary and for purchasing homeopathic medicines; by the way, this is not so inexpensive for a 'cheap method of treatment' [...]. Doubtless, the experience of this zemstvo cannot be indifferent to the condition of the health of the population. Thus, the decision of the Sanitary Department of the Voronezh province [...] regarding the necessity of publishing in 'Khronika' an article devoted to describing and criticizng homeopathy in order to establish a right view on it and to prevent the zemstvo of taking false steps, ought to be welcomed112.
This was the last article on homeopathy published in "Vrach". After the death of its editor, Prof. V. Manassein, on February 26, 1901, the periodical was discontinued according to his will.
The position of the medical establishment presented in the periodicals was typical enough and clear: paternalism (the medical establishment should clarify to the stupid deputies who "do not understand what they are doing" what is the right way in medicine), mixed with open denigration by the zemstvo authorities. However, it hardly explained why the zemstvo made up its mind to try homeopathy, and why the zemstvo, being dissatisfied with allopathy, turned to homeopathy?
Fortunately, "Vrachebnaia gazeta" (Medical Newspaper) later published two letters signed by representatives of the medical staff employed at the district. Owing to those letters we can imagine more clearly the true picture of the story. It was not by chance that the letters were sent to "Vrachebnaia gazeta". After "Vrach" had been cancelled, it was "Vrachebnaia gazeta", together with "Russky vrach" (The Russian Physician), which were viewed by the Russian medical community as the main all-Russian professional periodicals.
In the first journal, feldsher A. Ekimov wrote in a letter to the editors:
It should be noted that the [Nizhnedevitsk] zemstvo, which spent 1/3 of its budget on medicine, could hardly be proud of an ideal or at least of an excellent organization of zemstvo medicine [...]; for till now this zemstvo has not abolished the 'fee system' of treatment which had been abolished everywhere else as inaccurate, and had been badly influencing zemstvo medicine. The invitation to a homeopath was motivated by a desire to significantly decrease its expenditures and to more completely attain [sic!] the goal of providing medical service 'free-of-charge' to the population. These changes may be expected, in the opinion of a deputy, 'by radically changing the methods of treatment [...], challenging the ruling allopathic one.' It would be probably preferable to destroy zemstvo medicine altogether...113
Although this letter mainly repeats information which has been already cited earlier, there is a new and important fact — the cost of medicine in the zemstvo budget, which seems to be rather high: one third. This partly explains the irritation and desire of the zemstvo deputies to make some positive changes in its ongoing medical affairs.
In the beginning of 1902 "Vrachebnaia gazeta" published another letter of the physicians employed at the zemstvo. They wrote:
We feel it is necessary to inform our colleagues of the circumstances under which this sad circumstance had happened. The zemstvo meeting was almost finished; all the medical reports had been read and the physicians had also left. At the end of the budget discussions, before the meeting was closed, one of the deputies, who was also the zemstvo manager, K. N. Kharkevich, raised the question of the benefit of homeopathy for zemstvo medicine. His proposal was supported by the chairman of the meeting and by 2 or 3 of the deputies. The remaining deputies greeted the proposal with silence - partly because they were unacquainted with homeopathy, partly because they were seduced by the proposal's seemingly cheap price. In this way, the proposal was accepted [...]. The resolution regarding inviting a homeopath to zemstvo service has some connection with the regression of medical status in the district in comparison with the previous years. So, in 1900, the meeting had abolished one physician's position [...]. The fact itself and the circumstances of inviting a homeopath as well as a very specific relation of the zemstvo meeting to medical affairs, no doubt bring harm to the right construction of the system of medical help in the district and also represented an undeserved injury for all the district physicians. Therefore, we physicians of the Nizhnedevitsk zemstvo, recognising this job as becoming morally more and more difficult, hereby decided [...] that a common service with a homeopath in a public institution is impossible because it contradicts the scientific principles and the physicians' dignity.
Nizhnedevitsk, 16.01.1902
Signed: the zemstvo physicians I. Gorshechnikov, V. Vassil'v, V. Kravets, Y. Nevelstein, V. Es'kov114.
The editorial board of the periodical added the following comments to the letter:
We are publishing this statement of our highly respected colleagues with special satisfaction. In our opinion, the light-minded decision of the Nizhnedevitsk zemstvo meeting, threatens the main foundations of zemstvo medicine, and should not be regarded in another way. Honor to our zemstvo colleagues, who are steadily keeping the dignity of medical science!115
Furthermore, the allopaths in the Voronezh province did not limit themselves to sending letters to "Vrachebnaia gazeta". On November 26, 1901, Dr. Andrey Shingarev (1869—1918)116, then a zemstvo physician in the Voronezh province, delivered a speech at the meeting of the Voronezh branch of the Russian Society for Protecting People's Health. His speech, entitled "What is homeopathy and why it should have no place within zemstvo medicine", was almost immediately published in the periodical "Meditsinskaia beseda" ('Medical Talking') issued in the Voronezh province, in January 1902.Dr. Shingarev stated:
The true reason for my appearance here with this lecture is the unanimous decision of the last session of the Nizhnedevitsk zemstvo [...]. If I am not wrong, this is the first example of inviting a homeopath to the zemstvo service117.
He was right indeed. Nevertheless, Dr. Shingarev presented in his lecture no serious discussion on homeopathy and its laws. Many facts which form the history of homeopathy were misinterpreted, many events were presented from a definitely subjective point of view. For example, he implied a negative attitude of homeopaths toward the editor of "Vrach" Prof. Manassein and toward Rudolf Virchow, a subject of particular importance for Russian physicians, as being a proof of "evil inclinations" of homeopathy, etc. However, he also had to recognize that homeopathy was spreading all over the world in general and in Russia in particular.
Shingarev ended his lecture with the following conclusions:
1. Homeopathy is not a science and its 'laws' have no significance.
2. Its successes within some circles are caused first by the need of the people for the nebulous and the mysterious, and by the accidental coincidences of self-recoveries from the diseases when treated with homeopathic medicines [...].
3. It is necessary to cope both verbally and in print with the spreading of homeopathy; to cope, not by applying prohibitive measures and punitive laws, but by promoting a wide popularisation of true scientific medicine.
4. It is necessary to energetically protest against the establishment of homeopathic healing among the ignorant rural population118.
Summing up, the situation of the medical services in the Nizhnedevitsk district seems so far more or less clear. The zemstvo deputies, being bitterly disappointed by the high expenditures on medicine (one third of the whole zemstvo budget), wanted to change this. This disappointment, together with the impact of homeopathic propaganda, brought the deputies (at least the zemstvo manager Kharkevich) to conclude that the root of all the evil is in the medical system, i.e., allopathy, adopted by the zemstvo. Hence, it would be beneficial to try a new medical system, i.e., homeopathy. Most probably, that the medical reports presented at the meeting (it is very demonstrative that the physicians left the meeting without even waiting for a discussion on the matters or statistics submitted by them — at least they did not mention in the letter to "Vrachebnaia gazeta" that their reports were in some way discussed) consolidated the deputies in the opinion that the medical affairs are being badly managed. Therefore, the proposal regarding the invitation of homeopathic physicians did not meet obstacles and was approved unanimously.
Answering this initiative, the zemstvo physicians, after they had listed their opposition to the zemstvo in an open letter, informed the zemstvo authorities that they would leave the zemstvo service if the invited homeopath would start working. Naturally, the pro-allopathic periodical "Vrachebnaia gazeta" supported them.
Regarding the letter of the Nizhnedevitsk physicians [...] 'Novoe vremia' [New Times] of February 2nd , says: 'By leaving their places, the Nizhnedevitsk physicians will give a large field for the activity of representatives of wizardry and probably homeopathy. [....] Thus, this is a reason toward their duty - to prevent the spreading of ignorance and superstitions among the people, etc.' 'Novoe vremia' as well as 'Khar'kovsky listok' [The Khar'kov Letters] of February 6th , did probably not understand the reasons of the zemstvo colleagues' action. As seen from the [above mentioned] letter, the Nizhnedevitsk zemstvo reverses the usual sense of medical affairs. [...] They [zemstvo physicians] say: if you want to introduce homeopathy for the sake of economy, then invite homeopaths to all the physicians' places in the district. Only in this way would the 'experience' of the Nizhnedevitsk zemstvo become a demonstration. Collaborative work between a homeopath and zemstvo physicians is impossible because the activity of the homeopaths denies the science to which physicians dedicate all their lives119.
It is remarkable that neither physicians nor the periodicals refer to the fact that the zemstvo, according to its decision cited in "Khronika", did not plan to replace any local zemstvo physician by a homeopath nor did they suggest enlisting some zemstvo doctor to work jointly with a homeopath. On the contrary, the invitation intended to establish an "extraterritorial" physician's position, thus to allow the local population to have access to a homeopath. All that, in fact, in order to make the everyday labour of zemstvo physicians easier. The periodicals continued delivering explanations on their behalf, not disdaining to collect rumours:
'Kur'er [The Courier] on February 15th , was informed from the Nizhnedevitsk district that the last decision of the zemstvo meeting is not being executed only because homeopaths are not satisfied with the reward of 1,300 rubles assigned by the zemstvo meeting but asking the by far non-homeopathic sum of 3,000 rubles120. [...] It is interesting to see how the zemstvo will solve this 'physicians' problem' which is significant for the whole district. It is impossible that it [the zemstvo] will remain with only one single homeopathic physician. Another question is whether other physicians, after they have read the letter of their colleagues published in 'Vrachebnaia gazeta', will come to serve at the Nizhnedevitsk zemstvo. One might suppose that if other zemstvo meetings would follow this instance, the homeopaths would increase their wages up to 5,000 rubles and more. Then it would be clear that this is not for the people's benefit (which is the goal and purpose of the work of zemstvo physicians), and homeopaths would destroy zemstvo medicine with their propaganda121.
In turn, the zemstvo manager K. Kharkevich sent a letter to "Vrach-gomeopat", in which he wrote:
According to a motivated proposal of Yacov Kharkevich and me, the Nizhnedevitsk zemstvo meeting decided unanimously to invite a homeopathic doctor […] and to assign him a sum of 1420 rubles, i.e., the salary of our doctors, and 300 rubles for medicines […]. Many criticize us, but we were ready for it when making this decision. Our allopaths are being insulted and do threat to leave the service – I think nobody would keep them on the condition that a replacement would be found, but this is the problem! We have to find a good homeopath, not a charlatan who turned to homeopathy after having failed in allopathy […]. In my opinion, it is a moral duty of the best [homeopathic] people to find out such a man from among them […]. Let's see, we have spent a third of the whole budget for medicine, some 5,000 rubles yearly, some years even more, and nevertheless, we had to give up free of charge medicine for the lack of finances […]. As to results [of these expenditures], you are well aware how poor they are. Our doctors have considered their duty discharged after they had examinated a patient and prescribed him/her some medicine, no matter how the patient would feel later on, as they had been convinced that the lack of culture within the common people and the anti-hygienic situation in general make them free of any responsibilty. Fortunately, homeopaths have a different view and treat even in bad conditions. So, be so kind to inform us whether there is a chance to get a good homeopath to our service and to whom should we turn for that122.
This is indeed a very interesting point to be discussed. After numerous failures, Russian homeopaths finally succeeded to convince one zemstvo to introduce homeopathy. Moreover, the zemstvo authorities did surrender neither to the physicians' threats to leave their service, nor to the pro-allopathic support in the medical and general periodicals, athough they, most probably had no slightest idea whether homeopathy was indeed "superior" over allopathy or not — they just tried to find the most appropriate way to lower their expenditures for medical services. One way or another, this might have been a wonderful opportunity for homeopaths to prove the promulgated "doubtless superiority of homeopathy over allopathy" — the conviction that homeopaths never tired of speaking about. But the end of the story was completely discouraging for homeopaths.
After a long silence on the subject, a homeopathic periodical "Vestnik gomeopaticheskoi meditsiny", in one of the closing issues of 1903, sadly noted that the affair finally ended when the zemstvo received ... a lot of "warmest greetings" both from individuals and from homeopathic societies. Like in the story that happened 15 years earlier in the Novgorod-Seversk zemstvo, not even one homeopathic physician agreed to come to the Voronezh province to prove not only by word but also by deed "the superiority of homeopathy"! From the editorial commentaries on the matter in "Vestnik", one could understand that this end was anticipated. Even large cities like Saratov and Yalta for several years could obtain no homeopathic physician, although they published their needs in homeopathic periodicals permanently. The opportunity had gone, never to return123.
All that was left was to criticise allopaths:
The rural population has been treated with only morphine, castor oil, salicylate, carbolic acid and other allopathic drugs. Now the Zemstvo is going to add to this allopathic arsenal also an arsenal of Aconitum, Bryonia and other homeopathic medicines through efforts of a physician who is also familiar with homeopathy. Why does not the zemstvo [...] have sensible ground for adding this kind of medical care? Is it only because the zemstvo physicians do not want this? But that is not a sufficient ground [...]. Homeopathy is not intended to replace the system of public health in the zemstvos, like smallpox vaccinations, free-of-charge treatment, surgical and obstetrical support, fighting epidemics, area and hospital activity of physicians, etc., but it wishes only to add the homeopathic method to all these124.
The zemstvo inquired also at the St. Petersburg Charitable Society of the Followers of Homeopathy whether some homeopathic doctor could be recommended to be employed by the zemstvo. Replying to this inquiry, the Board of the Society noted that
There is no possibility to recommend a homeopathic physician to the zemstvo for the scantiness of medical staff. At the same time, the Board proposes its services in teaching homeopathy to feldshers, who can be sent on an official journey trip for this goal to the Emperor Alexander II Hospital125.
Having heard this reply at its meeting, the zemstvo board decided "to keep the matter open unless more favourable time comes"126. Most probably, this time never came.
I think that this conclusion could have been anticipated not only because of the chronic shortage of homeopathic physicians in Russia but also because of the poor working conditions within the rural population. The overwhelming part of Russian homeopathic physicians had their profitable private practices in the large cities where they also enjoyed all the advantages of urban life. One could hardly imagine that anyone of them might desire to move into a god-forsaken locality to work side-by-side with hostile allopathic counterparts, without receiving a significant enough financial reward.
This zemstvo experience was the breaking point for homeopathic propaganda in Russia. Although pre-war and later pre-revolutionary situations within the Empire in 1903—1904 and later, also considerably influenced the development of homeopathy, in my opinion the Nizhnedevitsk experience ought to be viewed as a serious defeat of both homeopaths and their lay supporters headed unofficially by Nicholas Fedorovsky. Both groups revealed that they had misled themselves by supposing that homeopathy would easily be introduced into zemstvo medicine with the agreement of the zemstvo authorities. The open hostility and blackmail of the allopaths, together with the bitter truth of the inability of the Russian homeopathic community to provide even one zemstvo with a follower of Hahnemann who had graduated from the university, explain this failure. The massive and expensive zemstvo-directed homeopathic propaganda from the 1880s onwards, proved to be absolutely pointless. Although the leading homeopaths and the homeopathic societies took this experience in silence (to the best of my knowledge there were neither analytical articles in homeopathic periodicals nor any serious discussion of the matter within homeopathic societies), they learned a lesson. First of all, all kinds of publications entreating the zemstvos to introduce homeopathy were abandoned. The St. Petersburg Society of the Followers of Homeopathy virtually stopped its Russia-wide activity and limited itself mainly to managing its hospital and dispensaries. The local societies in Russia and Ukraine also continued mainly to manage their own internal affairs. All these events could probably not be connected exclusively or at least directly with the sad Nizhnedevitsk experience. Be this as it may, the topic of the zemstvos adopting homeopathy in the capacity of a competitor of allopathy remained a non-issue in the homeopathic press till the Bolsheviks solved the problem in a different way, when they put an end both to the zemstvos and to the homeopathic societies.
3.10 Summary
After it had become evident that homeopathy could not compete with allopathy as State supported kind of medical service because of the small number of physicians who converted to homeopathy and because of the lack of homeopathic institutions in Russia, the Zemstvo reform of 1864 gave an additional opportunity to homeopaths and their supporters. But they proved unable to seize this opportunity.
The main reasons for this, in my opinion, are the following:
1. Systematic propaganda and systematic efforts to develop popular conviction in the advantages of homeopathy were only possible by means of constant support by homeopathic societies. Russian homeopaths did not yet have those in 1864. The first homeopathic society was established in Russia in 1868 (The St. Petersburg Society of Homeopathic Physicians) and had a character similar to that of allopathic societies. As we have seen, among its main aims were research, meeting different universities' graduates, etc. Such a topic as propaganda was not mentioned in the "Regulations" of the society at all. The first lay society of the followers of homeopathy was created only in 1881, when allopathy had been firmly rooted within the zemstvo medical system. More Russian homeopathic societies were established in the 1890s and later, and played a relatively modest role in the propaganda of homeopathy, in comparison with that of the St. Petersburg Society of the Followers of Homeopathy. I may speculate that if a systematic propaganda had been started in the 1860s or in the 1870s at least, homeopathy would have had more chances to be introduced into the Zemstvo.
2. A more important factor, in my opinion, was the institutional weakness of Russian homeopathy. As far as we can learn from the related documentation available, the homeopathic propaganda went no further than the simplest appeals to introduce homeopathy in the Zemstvo by the distribution of homeopathic literature and publishing eloquent articles in the general press. There was no mention in either homeopathic periodicals, nor in contemporary allopathic publications, that after some zemstvo had decided to have an experience with homeopathy, this decision was supported in any way by homeopaths. The examples of the Ostersk, Trubchev and Belev (on the latter see the chapter "Homeopathy and clergy") zemstvos all testify that the decision to try homeopathy failed to secure a future development of homeopathic affairs within the zemstvos. Most probably, these decisions lacked any support by word and or by deed from homeopaths. While facing the hostility of their own local zemstvo physicians, the zemstvos soon became disappointed, lost interest in homeopathy and returned to allopathy.
3. Even recognizing that the homeopathic propaganda in Russia had an obvious enough zemstvo-directed character, I ought to stress that neither homeopaths nor their lay supporters had a clear idea how, or in which way homeopathy should have been adopted by the zemstvos. On the one hand, most articles published by the homeopathic societies till World War I, appealed to intelligent laymen living in the countryside, like priests, teachers, and landlords. On the other hand, it was evident that without first attracting a number of physicians and of feldshers to practice homeopathy in the zemstvos, laymen practice would forever remain a matter of passing fashion and would disappear as soon as it had emerged. Except for the more or less formulated, although naive, proposals of priest Karolinsky127, I was not able to find even one sensible idea regarding a real, day-to-day use of homeopathy in zemstvos till 1900. The establishment of the Christ-Loving Society of Self-Help in Diseases in 1900128, intended to distribute the homeopathic teaching and homeopathic drugs through the church-parish communities, was belated and relatively pointless, as allopathy meanwhile had been accepted everywhere throughout the Russian countryside. Moreover, homeopaths had not even succeeded to work out the problem of introducing homeopathy into the zemstvos. No meeting of Russian homeopathic societies dealt with this subject, not one serious discussion took place, not one worthy proposal was submitted. In fact, the book by Deriker and Grech was as actual and legitimate in 1914, as it had been almost 50 years earlier, in 1867! Their attempt to stress the value of homeopathy as a valuable method in preventive medicine and in the early stages of disease had however lost part of its utility, in view of the progress of allopathy in the bacteriological era.
Copyright © Alexander Kotok 2001
Mise en page, illustrations Copyright © Sylvain Cazalet 2001
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