The Pugs and the Elephant: Dr Botkin and the Professional and National Identity of Physicians in the Russian Court

The Pugs and the Elephant: Dr Botkin and the Professional and National Identity of Physicians in... Summary This essay explores lesser-known members of the Russian court’s medical community and the printed press to trace information on the working environment, events and attitudes surrounding the ‘Great Russian Asclepios’, Sergei Botkin. It first shows how the changing intellectual atmosphere (from slavophilism to nihilism) affected the course of events inside the sphere of court medicine when Nicholas I’s era turned into a reform era. Then it demonstrates how Botkin and his fellow physicians balanced their professional autonomy with their service to the central state, reveals some of the medical community’s archetypes and finally identifies the opposing medical forces around Botkin. Resisting professional and political attempts at isolation and court intrigues, Botkin really came to personify the main events of the era. The medical community of the court is viewed here as a micro-cosmos of the professional peculiarities observed elsewhere in the medical community of Tsarist Russia. identity, politics, professionalisation, doctors, medical authority With the appearance of the physician Botkin, the vogue for his foreign colleagues ended. With his arrogance, he managed to displace the latter also inside the court, and with his energy and prestige, advance roads for his Russian colleagues—to men who mostly had the same temper as him, but lacked Botkin’s geniality.1 The above statement, made by a fellow court physician of Sergei Petrovich Botkin (1832–1889), sums up, in a highly simplified form, a long-term development in the history of the nineteenth-century Russian medical landscape: increasing levels of medical professionalisation and the growing autonomy of Russian physicians between the pre- and post-reform periods.2 Drawing on the idealised nineteenth-century notion of ‘great doctors’, it also attributes the symbolic position between the old and new to Botkin during this time of change, and in ending the antagonism between doctors of Russian and foreign origin.3 This positioning of Botkin was noted by his principal biographer, colleague and friend Nikolai A. Belogolovyi.4 Changes in the nationality of physicians in Russia are seen to have taken place during the reform period, approximately 1856 through the 1870s, predominantly for practical reasons.5 There had been a severe shortage of trained personnel in Russia in many scientific fields, including medicine, since the eighteenth century. Nicholas I’s administration had responded to this problem from the early 1830s by introducing Russian medical education reforms that stimulated the training of native-born medical personnel. The Tsar’s family, government officials and the upper nobility had traditionally employed doctors from abroad, often from Germany, due to their generally high confidence in their scientific, medical and ethical competencies.6 But the gradual replacement of foreign court physicians with domestic experts can also be seen in relation to the growth of national consciousness; Andreas Renner has noted a religiously motivated refusal to admit foreign innovations and oligarchic opposition to the German ‘domination’ of the court in St Petersburg dating from the late eighteenth century.7 And, although the great reforms signalled the liberalisation of academic and cultural life, they also created what Galina Kichigina has referred to as a highly peculiar compromise between the liberal reformers and conservatives in the government of Alexander II, which drastically changed the existing social structure of the country.8 One manifestation of this change that is central to the methodology of this study was the expansion of public opinion through a loosening of controls over the press from the 1860s.9 The periodical press became the main forum for opinion-making, creating what Renner has termed a ‘community of discourse’ in which the abstract concept of the Russian nation became visible.10 By the time of Botkin’s arrival at the Medico-Surgical Academy of St Petersburg (henceforth MSA), there were two competing factions in Russian medicine: an influential German faction and a Russian faction. Botkin, who had earned the title of Doctor of Medicine from the Moscow State University in 1855, was named Professor of the MSA in 1861. The reformist administration of the Medico-Surgical Academy saw Botkin, a German-educated internist, as an ideal candidate for a professorial post, yet he encountered opposition to his appointment from the influential (German) faction of the Conference. His novel ideas were received with scepticism and considered potentially harmful.11 Belogolvyi noted that the long-standing injustice in the medical sphere was too flagrant and that it ‘forced Botkin to intervene’.12 Among the many biographical works on Botkin, his activity as a court physician has remained rather uninvestigated, although court work contributed significantly to Botkin’s professionalisation and to his public reception.13 By examining lesser-known members of the Russian court’s medical community and the printed press, I will focus on the professional dimension between Botkin and his fellow medical practitioners, via unpublished archival materials, contemporary press materials, and end-of-career family memoirs.14 By examining at what levels, and in which contexts, the primary archival materials and periodical publications overlap and coincide, I will show how the changing intellectual atmosphere affected the course of events inside the sphere of Russian court medicine at this transitional time. I will demonstrate how Botkin and his Russian colleagues balanced their professional autonomy and service to the central state; identify the opposing forces circling around Botkin; and reveal some of the medical community’s archetypes. I will emphasize the importance of one essential element of political culture in the autocratic system, originated by Boris I. Kolonitskii: the rumour culture.15 From the 1860s onwards, with the expansion of public opinion, Russia was a society where rumour not only flourished but played an inordinately important political role. The newly liberated media machinery produced valuable information, albeit with multiple meanings and with sources that were mostly unclear. Rumours were created by both elites and ‘masses’.16 I will thus highlight Botkin’s public image, and how words were used to define him.17 By considering how the national identity of court physicians was a potential concern of the press, I show how Botkin’s public image reflected not only his authority as a physician and status as a scientific expert, but above all the hitherto lacking national feature in the medicine of the Romanov court. Resisting the political and professional attempts at isolation and court intrigue, I also demonstrate how Botkin came to personify the main events of the era. On a more theoretical level, I view the court medical community as a microcosm of the professional peculiarities observed elsewhere in the medical community of Tsarist Russia, recalling the contradictions, atypicalities and ambivalences in Russian physicians’ professional development, as noted by Nancy Frieden, but also the ‘politically charged’ role of physicians at this time, as documented by Elisa Becker.18 Botkin’s Fellow Leibmedicuses The four physicians considered in this study can be understood as a professionally homogenous group. All worked under the same patron (Emperor Alexander II; Zdekauer and Haartman also served under Nicholas I), in the same professional environment and over approximately the same time period. At some point in his career, each achieved the rank of leibmedicus or leibkhirurgus, titles they would hold for the rest of their lives.19 Sergei Botkin became leibmedicus in 1870, Nicolaus Theodor (von) Zdekauer was named leibmedicus in 1860, Carl (von) Haartman, was named leibmedicus in 1860 and Alexander (von) Collan was made leibkhirurgus in 1877.20 The court physicians also pursued their studies and careers using an approach typical of Russian medical students; each was first trained in government-supported institutions and, after graduation, undertook training and practice abroad, but within Europe.21 Each of the doctors became a state official, thus professional identities were strongly associated with the state, which was typical for the Russian context, and all maintained private practices.22 Each of these four physicians replaced one of the others at the court during some point in the 1860s or 1870s. The general pattern of entrance to the court for each of the leibmedicuses was quite similar: after an initial successful treatment of one member of the imperial family, each of their careers developed rapidly. Botkin first successfully treated the Tsarevich Alexander Alexandrovich (the future Alexander III).23 Zdekauer treated the Grand Duchess Elena Pavlovna of Russia; Haartman attended the daughter of Nicholas I, Grand Duchess Maria Nikolaevna. After having treated the Tsarevich Nicholas Alexandrovich, Collan’s career also took off quickly. He noted, ‘That this matter has benefited me greatly, I have already noticed. I have begun to do more business in my practice’.24 Each of the physicians represents different, yet still typical, social backgrounds of the predominantly non-noble Russian physicians of the period.25 Zdekauer and Haartman belonged to the hereditary nobility and were the sons of physicians, while Collan was the son of a clergyman and Botkin the son of a wealthy merchant. In terms of intellectual production, the major difference between the four was that, aside from serving as court physicians, Botkin and Zdekauer were reputable members of the Russian medical world and had successful careers at MSA. Of the four, Botkin was most entirely devoted to science; being a court physician often interrupted and disturbed his scientific career.26 All four physicians were nationals of the Russian Empire, with Botkin becoming, as we shall see, perhaps the most emblematic Russian physician of the court. Collan and Haartman were born in the Russian Empire, as was Zdekauer, but Zdekauer could be described more as a ‘Russified’ German, as his father was German and his mother Swedish. Zdekauer followed in the footsteps of his foreign-born parents by entering the field of medicine. Brückner noted that many proper ‘dynasties’ of foreign physicians were shaped in Russia, reflecting Zdekauer’s experiences.27 However, the conception of nationality in the court medical sphere at this particular time should perhaps not be taken as rigidly fixed. For example, Zdekauer is described in the source material at times as a ‘foreigner’, whereas Haartman seems to have associated himself as part of the ‘German gang’, participating in meetings of the German Medical Association at St Petersburg. The overall complexity of the question of origin or nationality in relation to the leibmedicus is stressed in the work of medical historian Boris Nahapetov, who differentiates between the court physician of the eighteenth-century Aptekarskii prikaz, or Apothecary Chancery, before the announcement of the Table of Ranks in 1722, and the later figures of leibmedicus. According to Nahapetov, leibmedicuses (‘leib-medik’) differed in many ways from the court doctors of the time of Apothecary Chancery.28 The Apothecary physicians were mostly foreign specialists who were typically called on for shorter periods, whereas the overwhelming majority of leibmedicuses working after 1722 were natives of Russia, despite the fact that many of them bore foreign names.29 Furthermore, leibmedicuses did not work on a contract, but rather on an on-going basis, often serving in this role until the end of their lives. To summarise, Botkin, Zdekauer, Collan and Haartman can be seen as representative professional equivalents of each other, with similar career patterns, Russian origins (in the broad sense of the term) and lifetime service as leibmedicuses, the distinction of national identity appearing quite artificial at this time. To highlight the contrast in the court-based medical work between the pre- and post-reform periods before Botkin’s entrance, and to reflect the presence of German ‘domination’ and its alliance with autocracy during the pre-reform period, we may first look at the image of the Russian medical class under Nicholas I, in the form in which it was described in an unpublished source. Although referring to the usual schemes and stereotypes, Nahapetov associated a typical physician of Nicholas I’s era with a foreign origin, having trained abroad and working for Russian high officials with one controversial and mysterious leibmedicus, Dr Martin Mandt.30 This was also commented on by Collan: Being able to see through [the] Emperor’s authoritarian character, Mandt stood right from the beginning in a completely independent status, unusual in the court at the time. Mandt never stood like a valet at the door of Emperor’s cabinet, but rather walked straight forward, put his hat on the desk and asked the Emperor to throw off his uniform coat and to lay down in his tent bed for the auscultation. In order to avoid addressing the Majesty with the usual мы [we, paternalistic expression between the doctor and the patient], Mandt always spoke German and impressed His Majesty with these features.31 Nahapetov has noted that Mandt’s influential position in the court contributed to the increasing influence of German medicine on Russian medicine during this period.32 Contemporary testimonials also draw a somewhat clichéd image of a firmly established German physician of the court, who kept even the Emperor in his thrall, referring to his vanity, careerism and magnetiser's qualities (‘Mandt was a man with a tremendous power, a strange, mysterious man was he’).33 This often gave foreign physicians an ‘advantage over the pre-reform Russian medical class’.34 Other court physicians of German and Baltic origin named in the document are Dr Nikolai Fedorovich Arendt and Dr Philipp Jakob Karell, the pupil and famulus of Dr Mandt.35 The account also contains some traits of Emperor Nicholas I’s personality and physique, including a strong, ‘herculean body’ with ardent ‘Romanov blood’, but also, to use Nahapetov’s expression, the end of ‘a story of a brilliant charlatan’ [Mandt] and his suspected involvement in events that led to the death of Nicholas I.36 Mandt’s tenure apparently undermined the prestige of foreign physicians, paving the way for the Russian court physicians later in the century. The Tsar’s Patriotic Sympathies The major contradiction in the nationalist scenario of the Russian court as noted by Richard Wortman, and which actually characterises the whole course of its history, was that the Romanov dynasty was almost entirely of German extraction by bloodline, yet with a long tradition to preserve a genuinely ‘Russian spirit’.37 According to the source material for this study, this precondition seems to be applicable to the court’s medical sphere during this particular period as well; although the strictly state ideological era of Nicholas I turns into a reform-era glasnost, the primary and secondary sources contain a national factor. To put it differently, the fates of all the court physicians here, in terms of ideas and practice, were dominated by the ‘German’ Empress, Maria Alexandrovna, who possessed not only the characteristics but also all the contradictions seen in the Russian medical community of the time: a Russian Empress with German origin, devoted to the Orthodoxy and slavophile predilections. Physicians of Russian origin could certainly be found at the court before Botkin, and the Tsar’s earliest ‘patriotic sympathies’ for Botkin can be traced to as early as 1860, when he bestowed 1000 roubles for equipment for Botkin’s study room.38 However, the actual dearth of ‘Russianness’ among the court’s medical staff was addressed only when Botkin appeared: ‘a Russian of the Russians’, with strong associations to the old Moscow.39 As if he were an ideal projection of the court’s slavophile aspirations and desires, Botkin became known as ‘the only Russian who ever held the post of confidential physician to either the Emperor or the Empress’:40 Some years ago, the Emperor [Alexander II], finding that his wife was constantly suffering from pulmonary attacks, asked a German physician, high in favour at the court of St. Petersburg [Zdekauer?] to draw up a list of well-known medical men. He did so, and the Emperor, finding that they were all Germans, asked if there was not in all his dominions a Russian doctor of reputation. To humour the Czar’s patriotic sympathies, Botkin’s name was added to the list. He was accordingly sent for. He is a Russian of the Russians, born in Moscow, the son of a Moscow merchant, and educated at Moscow University.41 In November 1870, Botkin was conferred the title of honorary leibmedicus, and from 1872, leibmedicus to the imperial family.42 Indeed, when the Empress’ condition worsened in early 1872 due to chronic pains in her chest and lungs stemming from tuberculosis, Botkin was assigned to care for her health and left St Petersburg and escorted her to Crimea.43 The Empress and Botkin forged a keen patient–doctor relationship, and Botkin became known as a physician who understood the Empress’s case better than anyone else at the court.44 The Empress’s conditions were significantly ameliorated due to Botkin’s ministrations also according to Haartman, whose responsibility the empress’s health had been prior to Botkin.45 Haartman reported in 1873 that the Empress’s catarrh had passed, although her pneumonia returned in 1874, and she reported not feeling very well.46 The actual course of events regarding the change of the Empress’s health guardian remains unclear. According to Zhuravskii, Haartman—who had a great reputation as an obstetrician, and was acclaimed as an innovator in obstetrics through his introduction of chloroform anaesthesia to the Russian court—was considered insufficiently versed in internal diseases.47 Haartman has also been accused of having antagonised ‘the mightiest medical potentates of St Petersburg, including Botkin’.48 But the fault has also been placed on Botkin: ‘Haartman left St. Petersburg in the middle of the 1870s as a victim of intrigues developed by influential people, and was displaced from his position at the court by the renowned clinician Botkin’.49 Either way, Botkin inherited Haartman’s office, apartment and salary in 1875.50 During the spring of 1872 when Botkin came to the court, Haartman was uncertain of his future as a leibmedicus. He met with the Emperor, who gave him ‘the best intelligence over the Empress’s condition and disposition. What Her Majesty shall do for the winter is not yet definite, and therefore I am also still vague for myself and my family. I manifested my feeling even before the Emperor, who seemed to take it quite naturally’.51 Haartman seems to have referred to the changing intellectual atmosphere in the court with the term ‘patriotism’, often used as an equivalent for slavophilism, in a nearly illegible letter. The only legible words by Haartman, who suffered from arthritis and whose handwriting became difficult to read toward the end of his career, are patriotism and callousness, and his aim to insinuate all missing details regarding the change from the Empress.52 Haartman, who knew the Empress well, pointed to the intellectual movement among the educated Russian elite, slavophilism, which had repercussions for the Empress and the court’s medical community from approximately 1865 onwards. This is despite the fact that, only a few years earlier, Haartman had mentioned the opposite, the Empress’s exclusive confidence in foreign doctors: ‘Her Majesty does not trust the doctors of our city’.53 On this occasion, an unidentified foreign physician had been chosen as a consultant, because he had similar views as Haartman: ‘And then there are also political reasons, thus, so far everything has remained as before’, Haartman wrote. This period of intellectual turn can be roughly dated to the death of Tsarevich Nikolai Alexandrovich, in the spring of 1865, which affected the Empress deeply. She never fully recovered from the death and instead retreated into the company of romantic intellectuals from the Moscow slavophile circle and her own coterie of friends, finding solace in mysticism and religion (i.e. Russian Orthodoxy).54 But the avocation of Russian culture in the court’s medical staff, and the actual connection between slavophilism and the promotion of native practitioners’ professional status at the court, was something Collan also noted: During this epoch, the movement of Slavophilia had not yet taken over in Russia. The general opinion was still in favor of strangers, among them also several physicians, many of them luminaries in their field (Kansler, Eichwald, oculist Junge, Zdekauer, among others). But in the appearance of the physician Botkin, the vogue for his foreign colleagues ended.55 When Botkin entered, Collan’s memoirs reads: ‘The time was no more for the timid and the delicate, with too great a self-esteem to operate in the manner as the Great Russian Asclépios, and his rough and unscrupulous followers’.56 Although the significant change among court physicians and their origins is associated here with Botkin’s position at the court, the overall return of the mystical-irrationalist tradition in the Empress’s orientation towards religious thinking on the eve of the scientific and rationalist era belongs with the major contradictions of the Russian medical community at this specific moment. Applying Andrzej Walicki’s and Alexander Vucinich’s interpretation of social thought in Russia at this time, the change also encapsulates the broader philosophical difference between the medical practitioners of the preceding generation and that of Botkin’s generation, which is central to the context of this study. The timid and the delicate represent the pre-reform era (Collan and Haartman), the ‘weak’ men of the 1840s, with all the dominant ideas that the ‘men of the 1860s’ (e.g. Botkin) wanted to eliminate. The preceding generation was associated with idle daydreamers and idealists who had ample knowledge but not enough will and who were often accused of adopting the parasitic way of life of the privileged class. In contrast, the ‘new man’ of the 1860s, appeared on the scene after the Crimean War, here in the guise of the Greek god of medicine, Asclepios, the deified Botkin. Botkin, with his new manners, was an embodiment of scientific rationalism, individualism and the pronunciation of his own ideas, and he had a readiness for social action and a thirst for positive knowledge that the preceding generation did not.57 This was also the physician archetype of the Russian genius, to which Collan refers in the epigraph of this essay. Collan and Botkin, indeed, had a collegial and friendly professional relationship during the 1870s. Just prior to Botkin’s tenure, Collan had attended the Grand Dukes and Empress at their summer residence of Livadia, in Crimea, in 1866, followed by Haartman in 1867.58 Collan substituted for Haartman in Peterhof in the summer of 1868 and made a trip to Kissingen with the Empress that same year.59 During the summers of 1870 and 1871, Collan was posted in Tsarskoye Selo, Peterhof and Crimea, due to Haartman’s ailing health.60 In 1874, Collan mentioned the forthcoming winter, when Botkin and the Empress would be in the South of France, noting it being ‘the case of Botkin’.61 Inside their working area, the so-called ‘palace city’, Collan and Botkin often visited the same patients and wore similar military uniforms with the epaulettes of a leibmedicus and Alexander II’s monogram.62 Botkin offered his opinions, for example, regarding one of Collan’s patients, a junker from the Nikolaevsky Cavalry School with an unidentified brain disease, and made several patient visits to another shared patient, Prince Georgii Romanovsky, the son-in-law of Nicholas I.63 In a letter, Botkin apologises for not remembering the exact number of his visits to the Prince.64 He was always very precise in his communications, perhaps reflecting his scientific scrupulousness and strong professionalism, also remarked upon by Zhuravskii.65 In the case of another shared patient, an unidentified baroness, Botkin regretted the inexactness of his information regarding the patient, for whom he wished to find a half an hour for a consultation: ‘Most respected confrere, I beg you to apologize for not being exact enough’.66 ‘Millionaires’ and ‘Proletarians’ Each of the physicians who are the subject of this article was motivated by career and patronage pressures, and each exhibited the type of relationship to money that is abundant in European medical narratives: generosity, financial naivety or a completely indifferent attitude to the value of money.67 But the same sources also reveal the unresolved contradictions between professional goals and the reality of medical work in Tsarist Russia, as Frieden has noted. Two recurring issues were physicians’ simultaneous underemployment and unemployment despite the great demand for their medical services. While remunerations from the court increased at times, well-paying clients were simultaneously lost in private practice. A recurrent element in Haartman’s narratives is that his court career threatened his regular income.68 Although private practice was expanded due to increased public prestige, court physician was a position for life and could thus act as a barrier to a lucrative private practice. Moreover, court physicians were predisposed to general economic fluctuations in the society. For example, during the financial depression of the early 1860s, physicians faced stringent financial conditions.69 Collan noted in 1862 that there was less work for all court physicians because 12,000 of the wealthiest families were gone: ‘The practice has during this year for all practitioners here been very poor; people are poorer, have gone abroad, to the countryside or pay their doctors extremely poorly’.70 A recurring trope in the correspondence is that of a court physician who had the potential to make ‘great money’, but instead chose a virtuous career and whose professional vocation always remained greater than matters of economy. ‘If I had been watchmaker, I would have made better fortune’, Collan remarked.71 Botkin’s attitude toward finances, as Belogolovyi notes, appeared to be rather similar.72 He worked for money only when necessary, in order to maintain a large family and provide an education for his children. Botkin was not attached to money and did not die a rich man, which he could easily have done so, according to Belogolovyi, as Botkin’s private practice began to reach enormous proportions around 1862–1863.73 Indeed, a noteworthy contradiction regarding the professional identity of two physicians from the same professional milieu can be noted here, that is, the simultaneous association of a physician as a ‘millionaire’ and a ‘proletarian’. Although these identities cannot necessarily be considered mutually exclusive, Botkin’s public image and the archival image of his colleague Collan, are in great contrast to one another. Collan’s perception of his class identity in one of the most prestigious positions in the profession was once reflected as follows: ‘Work, work. For you see, work is the ransom of life when you are a proletarian. For the rich man the ransom of life is enjoying, enjoying of the poor man’s work’.74 Collan made another similarly class-related remark, when maintenance costs and a fiscal crisis threatened the reputed military institute Nikolaevsky Cavalry School, where he initially worked as a military physician: ‘It seems that Russian nobility may no more afford their sons to strut at the Guards Cavalry’.75 Collan thus corroborated almost exclusively what Frieden refers to as the physician’s social position in the professional hierarchy of Russian society at the time, considering himself to be a part of the proletarian class, whereas Botkin was associated in the press with the image of a millionaire at the height of his fame as a scientist and leibmedicus:76 It’s expensive to live here in St. Petersburg, but even more expensive it is to die here. But the most expensive of all it is to remain on the stage between life and death. A Russian doctor does not content himself with these microscopic fees which Scandinavian and German physicians are satisfied with. If one calls for a fairly well-known doctor, one dares not to offer him a pay envelope with less than 5 or 6 rubles. Ten rubles is common for a first visit, five rubles for each following visit, and I have the honor to know one doctor here, who does not move under fifteen rubles. The notorious Botkin charges up to fifty rubles for a visit inside the city limits. Botkin has set his price so high, because he does not wish to be disturbed too often. Botkin has already long been a millionaire. He gives consultations at his home twice a week, and the stream of patients is constantly huge. If you wish to have a consultation from Botkin and do not want to pay the fifty rubles, you should write and request an audience from the great man, who afterwards by mail will inform the day and time for the audience.77 Indeed, as a typical indicator of a physician’s value in this time of growing capitalism, and perhaps shaping the ethos of the profession, Botkin’s professional prestige became strongly weighted in relation to the magnates’ rewards: Large rewards are not so rare among our practitioners, and as a rule, the reward is provided by diagnoses, which is of course entirely explicable. When the diagnosis becomes certain, the successful expiry of the disease is almost assured, unless the disease has already gone too far. The foremost of our Russian medical diagnosticians, the late Professor Botkin, frequently obtained 10.000 rubles for establishing a diagnosis. For example, when the famous millionaire Benardsky fell ill, for successful care over three weeks, Botkin was rewarded with 30.000 rubles. The Odessa patrons Rafalovich and Brodsky called Botkin to Odessa for a period of three days and every time paid him 15.000 rubles. Botkin was also often called to Berlin and Vienna, where the fee was set at 15 to 25,000 Thaler, but he could not travel because he was occupied with his clinical presentations.78 The press drew a very puzzling picture of Botkin’s income. According to Belogolovyi, Botkin indeed earned a significant amount, and he also received three solid inheritances from his brothers. When his practice experienced an influx of patients, Botkin’s residence was packed with up to 50 patients per day, a number which Botkin could not examine. He also made five or six city consultations daily, the so-called ‘palace city’ consultations as previously noted.79 Furthermore, Botkin was not only a first-class clinician, but also an excellent pharmacologist.80 His prescriptions (drops, pills, ointments) became widely available and added to his reputation in the remotest provinces in Russia.81 To put it another way, comparison between the archival material and the press sources indicates that the unpredictability of income was common among court physicians who were not celebrities, as was the case for Haartman: A child of the century I am, like so many others, in this my depravity of having become hard burned, always too much preoccupied by today’s and this life’s vile and sordid tasks, striving too often after material gain. … Just like a passing of a storm which makes the most ignorant and purest lilies tremble, I also must confess to someone that during these times, when I have had so little gains in my practice, and the costs have day by day arisen, I have not infrequently been à sec. This has indeed happened to me. I am very downcast because of so huge monetary losses, which I have made with my own hands, additionally aggravated by the Russian currency depression.82 To summarize, notwithstanding the reported divergence in the incomes of an average reputable physician and a celebrity physician, we can assume that if the annual salary in the late-1870s of a full professor at the Medico-Surgical Academy was about 3,150 rubles, and for a physician-in-ordinary 4,290 rubles, the annual income of a physician-in-ordinary without a private practice could not compete with the fees obtained from the private practice.83 Another recurring theme indirectly related to income is that of betrayal and intrigues between the factions. A physician’s particular skills and positive (as well as negative) feedback played an important role in professional identity, reputation and finances. This was particularly true when an important patient was treated successfully; then, the physician’s material benefits and professional opportunities multiplied.84 A singular and confidential relationship with the Empress are recurring elements of Haartman’s narratives, as is the continuous presence of court intrigues and plotting: ‘She has full confidence in me, which I have reason to suppose, as every known intriguer more or less against me has only fortified my position. … Her Majesty knows that what I say, I think’.85 One documented episode of factionalism introduced a new physician archetype, one with German scientific excellence, an impressive pedigree and medical administrative career: Zdekauer.86 His image was, however, slightly tinged by a rival image. An example of the factionalism between Haartman and Zdekauer also belies the nationality factor and another recurring theme of the narratives, that of professional integrity regarding patients’ medical documentation, which reappeared in a nearly identical fashion during the spring of 1879 between Zdekauer and Botkin, as we shall see in the next section. Haartman worked as a bedside physician during the period when the Tsarevich’s condition was worsening, in 1865, and he treated him until his eventual death from tubercular meningitis.87 Haartman complained of having ‘unspeakable worries and irritation inside and outside the House with Zdekauer’.88 The Tsarevich had seizures, for which Haartman used a therapy of cold, calomel (mercurous chloride) and vesicatorium. The conditions of the Tsarevich were slightly mitigated, and Zdekauer, who had been called to France, congratulated the Empress on the fortunate turnaround.89 After the Tsarevich’s death and autopsy in St Petersburg, following a reassuring discussion with the Emperor, who did not accuse any of the doctors of hastening the death of the heir, ‘in a moment when everything was as good as it could be’, Haartman found ‘our German documents made by him [Zdekauer], and a certified Russian and French translation that had been in a very infantile manner changed’. Haartman accused Zdekauer of having forged the autopsy documents and went to the Emperor to report on Zdekauer’s demeanor towards him and to request a change in both the Russian and French reports. Zdekauer’s autopsy claimed meningitis cerebro-spinalis as the cause of death, but the choice of words did not please Haartman who suggested Hirnhautentzündung [germ. brain fever, meningitis]. The Emperor suggested he drop the case.90 A court administrator also informed Haartman that too many weeks had passed since the death, and thus it was impossible to make changes to the documents. Afterwards, Haartman was consoled in a letter from the Viennese Professor Johann von Oppolzer, ‘Your opinion on the disease was, after all, quite right’. As for the basis of the document, it is difficult to establish what Haartman intended with the ‘German gang’, the disagreements between Zdekauer and Haartman seemed to have been on professional (diagnostic) and factional grounds. There may already have been rivalry between them by 1863, when Haartman lost his 3000-rouble annual salary for the ‘loss of the Grand Duchess Marie Nikolaevna’ (the end of the patient relationship). When discussing his future plans with the Empress, she had to inform him that she already had found ‘another’, possibly Zdekauer, who was well established at the court by that time.91 Overall, the death of the Tsarevich threatened Haartman’s reputation as a physician: ‘What impact all this shall have to my private practice is difficult to predict, but most likely it will suffer, and lead to an exceptionally long absence’.92 The Strange Mixture of Nihilism and Medicine or the Mysterious Play The factionality of the court’s medical staff, with a mixture of nationalism, conspiracy theories and ideological suspicion, seems to have projected into the professional milieu of the leibmedicuses and culminated during the spring of 1879. Botkin, who was known among his friends to be indifferent to politics, became closely associated (in the press) with the destructive influence of nihilism on Russian society.93 The evidence suggests that there was the question of an attempt to tarnish and desacralize Botkin’s professional image and scientific authority. The episode can also be read as an example of a public conceptualization of Botkin’s authority and status as a scientific expert, combined with the political stakes attached to his physician’s role, and a demonstration of how Botkin balanced his professional autonomy with his service to the central state. Botkin’s position during the scandal also suggests that he represented the new, democratic version of Russian masculinity, which rejected the former, Nicholaevan ideas of obedience and servility in front of the autocracy. Botkin echoed the new ideal of masculinity which valued rationality, education, integrity, social responsibility, diligence and independence of thought.94 Botkin’s name had appeared for the first time in 1866 in relation to ‘suspicious’ circumstances in a notebook owned by the notorious prisoner and nihilist Dmitri Karakozov, who had been treated in Botkin’s therapeutic clinic at the Medico-Surgical Academy in March 1866, but who had concealed his real name and ‘true’ condition.95 There is some confusion about whom Karakozov really consulted with on this occasion, Dr Botkin or his assistant, Dr Golovin, but the press noted that Botkin recognised him as a patient he had treated under another name, Dmitri Vladimirov.96 This time, in 1879, the rumour mill began after Botkin had demonstrated the preliminary diagnosis of a mild form of plague in a young man in a lecture in St Petersburg (the case of a porter for the Imperial Artillery School Naum Prokofiev).97 During the spring, two seemingly unconnected elements, a medical diagnosis of plague and the philosophical-political concept of nihilism, became tightly associated.98 In the late 1870s, when a second generation of nihilists emerged, the revolutionary activity took place, in particular, in the capital and against the autocracy.99 In the spring of 1879 in particular, there was heightened nihilist activity in St Petersburg.100 The Third Division (the Tsar’s secret police) found hidden presses operated by the revolutionary movement.101 The nihilist movement thus had a direct impact on the internal security of the Russian state. The authorities’ main fear was that even the moderates in society might sympathise with the revolutionaries.102 Frieden has noted that, aside from university students in general, medical students also had a reputation for radicalism, although the average medical student usually moderated his stance before completing his training, and only a small segment of the profession actually allied itself with more radical ideas.103 Two different medical commissions investigated the patient Prokofiev separately, with Zdekauer taking part in one of the commissions. The commissions argued against ‘Professor Botkin’s energetically claimed and maintained allegation’ of a light, benign, non-contagious form of the disease.104 Botkin’s authority and status as a scientific expert came under question, and he was accused of announcing the threat of plague in the European context, which was interpreted as an attempt to destroy Russia’s economy and prestige.105 According to some rumours, during his visit to inform the Emperor on the discovery, Botkin had been obsessed with the plague diagnosis, wanting to have a ‘plague in St Petersburg at all cost’.106 Botkin’s students were also rumoured to have reported with exultation that Botkin had a case of plague in hospital.107 The overall interest that Botkin showed in the Prokofiev affair was interpreted to mean either that he had made a mistake, or that some ‘mysterious play was going on behind the scenes’.108 As an illustrative example of the new reform era of scientists and physicians, Botkin stood alone, with only his energy and prestige, before the medical administration and the entire scientific world.109 ‘I am obliged’, he stated ‘to maintain the meaning of my statement as my sincerest scientific belief, notwithstanding all the attacks directed against me, which I, with perseverance, shall have to understand to bear’.110 Botkin’s heroic image came to be strongly supported by the positive rumour mill, which praised him for his straightforward manner: ‘The people die while the doctors dispute’, Botkin had noted.111 But very soon his medical authority was combined with the political stakes attached to his physician’s role and moved beyond purely medically based accusations: ‘We cannot exclude, that the assaults against Botkin are [the] result of ignorance, envy and party passion’.112Morgonbladet, citing Sankt-Peterburgskie Vedomosti, insinuated a rather important adversary with the metaphor of a pug and an elephant: ‘The pug must surely be rather big and strong as it dares to bark to an elephant’.113 The pug’s German, Swedish and Finnish variation, mops, referred to Botkin’s unknown adversary, a loyal lackey, whereas the elephant, used to represent Botkin, symbolized wisdom, strength and power. This implied two competing factions, the German and the Russian, in the sphere of court medicine, but the mops also bore connotations of Freemasonry. The mops was the symbol of an eighteenth-century Masonic society, Mops Orden, the Order of the Pug, which is known to have been active in Germany. Reference to Freemasonry was in fact a typical multiple signifier used in the contemporary Russian press for foreign, often German domination, elitism, and veil of secrecy.114 The ‘unbridled cancan’ around Botkin’s authority continued, with revelations of more specific interests and agendas behind the disproportionate reaction: Notwithstanding to commissions with different diagnosticians, Professor Botkin has not abandoned his view. Professor Botkin is the most feared, but also the most hated person in the St Petersburg administrative circles. His bravery and his energy are well known. No one dares to oppose this man, who not so long ago dared to refuse to give services as a doctor to a very highly-placed wife, because she had not enough strictly followed his advice and regulations; at that time, in court and aristocratic circles, this incident brought unheard attention, and Botkin fell out of favor. However, very soon Botkin was asked to take over her treatment. Botkin, who is indispensable to the imperial couple as a physician and is in possession of their highest favors, has very high earnings, and has aroused the administration’s attention, which no longer leaves him in peace. Botkin gives daily consultations to the Emperor, gives lectures in the Medical Society, publishes articles in which he blames persons for their laziness, and makes radical proposals in the sanitary commission, watching carefully over their eventual implementation. In short—Botkin masters the situation.115 Besides exposing Botkin’s actual power at court, this passage also speaks to a sort of therapeutic nihilism wherein Botkin, as Kichigina notes, was criticised for expressing his opinions. Therapeutic nihilism was considered a highly stigmatic therapeutic faith, originating in the Viennese school of medicine, promoting scepticism of drugs, attaching less importance to symptomatic therapy and attributing greater importance to adequate diet and proper patient care.116 As Botkin’s treatment of the unknown highly-placed wife indicates, he did, indeed, dare at times to express opinions and statements that did not sit well with patients or courtiers, although Zhuravskii’s study refutes the presence of therapeutic scepticism in Botkin’s medical arsenal.117 Zdekauer appeared at a Union of Practicing Physicians session and, when asked to express his opinion on the Prokofiev case, stated that he ‘did not wish to start a polemic with Professor Botkin’, and concluded cryptically, ‘I’m an enemy of any battle; time will tell which of us is right or, wrong’.118 When an allusion was made that Botkin had not differentiated the case of bubonic plague from syphilis during his initial examination of Prokofiev (Botkin was well informed of the patient’s previous syphilis diagnosis), Zdekauer became exposed. A telegram had arrived at a journal’s desk with information that Botkin’s diagnosed case of bubonic plague was actually syphilitic sores.119 Zdekauer personally confessed that as a member of the administrative commission who examined the patient, ‘at the completion of the Commission’s minutes, a mistake occurred, and the word syphilis inadvertently went there’.120 Professor Botkin was right after all in his diagnosis of the suspicious case in St. Petersburg. His opinion was of course misrepresented by his enemies, of which he has a great many. … His worst enemy is old Professor Zdekau[e]r, whom he replaced as physician extraordinary to the Czar, and who is naturally jealous. The storm of abuse went so far as to assert that Professor Botkin was a secret Nihilist, and declared the case to be one of plague in order to stir up panic and discontent in the kingdom.121 Aside from professional jealousies, a lack of patriotism, therapeutic nihilism, gambling with the stock exchange, conspiring with the British and the falling value of the Russian rouble, the most serious charge against Botkin was naturally a political one.122 Accusations of political nihilism also came from higher directions than from his colleague Zdekauer, although the highly similar pattern of irregularities in patient documentation in the Zdekauer–Haartman case of 1865 is worth recalling here.123 In April 1879, one of Botkin’s assistants was arrested on suspicion of being a nihilist sympathiser aware of revolutionary propaganda being spread via secret presses.124 Two of Botkin’s assistants were rumoured to be leading Nihilists. Botkin’s second wife, Ekaterina Alekseievna Mordvinova, neé Duchess Obolenskaia, as the spouse of a high military procurator, was suspected of sympathising with nihilist ideas and charged with engaging in revolutionary intrigues and conspiracy: ‘Here [in St Petersburg] they quite openly speak that even the wife of the learned professor, Princess O., might be sympathetic to nihilistic ideas’.125 The two ladies had contained promises of assistance to two young male university students, written benevolent letters to them and given them money and advice.126 Still, in the autumn of 1879, Botkin’s family was under police surveillance, and a police officer was ‘always close to the place where the family resided’. Madame Botkin, since her release from prison, was noted to be leading a mostly retired life in the countryside.127 A satirical reference to ‘look for the woman’ behind Botkin as a root cause, had appeared in the press as early as 1875, suggesting Madame Botkin’s strong influence on Botkin. Botkin was portrayed, although showing character and firmness in his dealings with the court, as also being powerless before his own wife.128 The authorities’ suspicions of nihilist contacts, especially among physicians, may indeed have been warranted. Among Collan’s letters, there is one from a key member of the early Russian nihilist movement who has left very few documents and about whom very little is generally known—the young revolutionary Nikolai Serno-Solovyovich, who at the time had emigrated to Bern in Switzerland. This letter seems to imply that Collan had the two brothers as patients, the Serno-Solovyoviches.129 Nikolai belonged to the first generation of Russian nihilists, was a member of the clandestine organisation Land and Liberty and a correspondent for the revolutionary newspaper Kolokol.130 Collan’s memoirs describe Nikolai as follows: There was the young Serno-Solovyovich, a noble and ardent soul with eminent intellectual abilities. His capacity as correspondent of the revolutionary journal Kolokol, published in England in the 1860s, his disinterested patriotism and his liberal ideas caused his captivity, and he was sentenced to deportation to Siberia. His delicate health could not endure the hardships of the journey, and he died before arriving.131 Collan supposedly treated Nikolai’s more renowned brother, Alexander Serno-Solovyovich, too. Alexander played an important role in the early history of the Geneva Organisation of the First International, cooperated directly with Karl Marx and was named among the first who was planned to translate Marx’s works into Russian, an idea that he never realised; Alexander Serno-Solovyovich committed suicide in 1869.132 In a letter of 1860, Nikolai appealed to Collan to watch carefully over his brother Alexander’s fragile health. He had learned of his brother’s illness only recently, and it affected him profoundly, ‘like a sharp pain’. In his anguish, Nikolai addressed Collan, for whom he had ‘sincere feelings of friendship’, and asked him not to refuse his appeal.133 In this patient relationship, we can observe the conflicts a physician of the Russian court faced between his status as a state official and adherence to a code of medical ethics, balancing between professional and political demands.134 Botkin was already expressing the high pressures of being a court physician in 1877 in a letter to his wife, where he notes that his ‘nerves’ were too stretched to continue to bear the plight of the role; the doctor’s duties at times made his position intolerable.135 In the letter, Botkin refers to the court intriguers and to subsequent working conditions in which every fact had to be treated with extreme caution. At 45 years of age, he was losing his independence, freedom of action and a certain freedom of thought ‘listening to everything, seeing everything and saying nothing,’ which made him feel it was time to ‘get out of the hell of vanity, envy and avarice’.136 Similarly, a few years prior to this, Collan used nearly identical wording in a letter from the Romanovs’ Livadia Palace in which he mentions the physician’s social position in the court, the loss of independence after 31 years of autonomous living, the difficulty of being the court’s ‘habitual servant’ and being surrounded by the ‘purest parasites’ (i.e. court insiders). As a physician, he felt forced to maintain a joyful face or otherwise be considered a gloomy type. Collan noted, for example, that ‘Livadia is a gorge for me; only the body prospers, but my soul sleeps’.137 Yet one telling aspect of Botkin’s manner deserves a mention; in the midst of his personal torment, he directed public attention to the living conditions of Prokofiev and his fellow workers. At the outset of the scandal, Botkin had ordered his assistant to visit Prokofiev’s home, the dark, damp, underground den and pestilential cellar in which ‘even in broad daylight it is necessary to keep a lamp burning’. The press published a report on the uninhabitable cellar and reminded that if the published sketch of the dwellings regarded the Imperial Artillery School where Prokofiev was employed, ‘what must the cellars be like in the poor quarters?’138 Overall, the political turmoil surrounding Botkin elucidates the difficult task of the reform era authorities’ efforts to balance between encouraging medical professionalisation and the heightened fear of underground radical movements.139 The authorities suspected that the nihilists would not hesitate to use the opportunity of the plague to further their revolutionary schemes.140 Kichigina has noted that Botkin appeared as a convenient target for the conservative press to attract public attention to an old-new evil (nihilism) in Russian society.141 On the other hand, a revolutionary underground was active at this particular moment, and inevitably there were connections between some physicians and patient-revolutionaries, as evidenced in the materials of this essay. Botkin certainly stood at the centre of intersecting political and professional agendas, by which the political one, represented by the state security apparatus, seems to have been reasonably justified, albeit extremely heavy-handed. Also, within the setting of Botkin’s prior image as an ideal projection of the court’s Slavophile aspirations, added to his alleged nihilist connections, the press implicitly referred to the question of whether Botkin was, after all, a ‘true’ Russian. Even if the medical society soon forgot the scandal and, over the long-term, it did not affect Botkin’s professional status and reputation, the accusation was a heavy blow that affected his faith in those around him and led him to become more distant from the court in the following years.142 While he is noted to have been close to the Emperor Alexander II and his family, he stayed away from the court of Alexander III, showing up only for occasions of medical consultation.143 Although Alexander III had great respect for Botkin as a physician and scientist, it is unlikely that Botkin was very close with the court, as he was considered too far to the political left in relation to his wife.144 Such a distance was noted, for example, during one of Botkin’s consultations with the Princess Catherine Dolgorukova (Alexander II’s morganatic wife), whose fever Botkin cured in 1883: ‘Professor Botkin, who was Tsar Alexander II’s leibmedicus and is an intimate friend of the princess, has already for a long time completely withdrawn himself from the court circles. It is known that he remained an adherent of Alexander II’s liberal ideas and does not feel gratified with the current regime’.145 During the 1880s, Botkin bought a manor in Finland at a distance of three hours from St Petersburg, where he spent several summers devoting himself to more leisure time.146 In Finland’s ‘salubrious climate’ (i.e. the environment of his summer residence, which was characterised by coniferous forests, dry air and a proximity to the sea), he planned to establish a spa and bathing establishment, but the notion never materialised.147 During his final summer, Botkin rested at his villa in Finland: Professor Botkin, the Empress’s personal physician, every year during the summer months stays on his property [in Finland]. Here rests the European-wide celebrity from the efforts of his enormous practice in the Russian capital. During the beautiful season here stays also Botkin’s son-in-law, the reputable and sympathetic Petersburghian Doctor Borodulin, who completed his education under Professor’s [Botkin] own supervision and who has nowadays even taken over part of Botkin’s practice, as well as the three sons of Botkin, likewise physicians. Moving is that helpfulness by which the named doctor treats the peasants in the neighborhood, providing peasants both medical care and pharmacy goods from the [Botkin] family’s medicine chest [home pharmacy], handing them over without any compensation.148 Conclusion In this essay, we have observed how some of the major peculiarities of the practice of medicine under an autocratic system (such as physicians’ keen professional associations with the state), visible already by the era of Nicholas I, met the waves of mid-nineteenth-century rationalist thought and how these were manifested in the court’s medical community during the reform period. Slavophilism, ideology quite subservient to autocracy, was a force of the 1840s, which, in the studied material, encountered an intellectual reaction in the shape of nihilism, the most anti-autocratic ideology of the 1860s. The influence of this changing intellectual atmosphere to the course of events in the sphere of court medicine during this period requires a deeper understanding and evaluation. Based on the materials available for review, it seems that slavophilism was linked to the change in the nationality of the court’s physicians. Generally speaking, the return of the mystical-irrationalist line of thinking, in the shape of slavophilism, on the eve of scientific rationalist era and its role in the shaping of the events can be included among the major contradictions or atypicalities of the development of the Russian court’s medical community.149 That is to say, slavophilism introduces the religious and spiritual strand relevant to the setting of the court medicine at this time. The discourses present in the correspondence and press materials cited in this study make it possible to expose some of the typical archetypes present in the court’s medical community. These include the alleged ‘Germanness’ of the Russian medical staff, still insisting in the mid-nineteenth century on the clichéd images of a cunning magnetiser (Mandt) and a slightly deceitful representative of German scientific excellence and member of a medical dynasty (Zdekauer). Physician archetypes also include the court’s habitual servants, idle day dreamers of the pre-reform era (Collan and Haartman), whose time was doomed. This archetype of the faithful valet behind the (Emperor’s) door, who never took offence, with attributes of patience, comfort and kindness, was less independent than their illustrious colleague, but as he ‘belonged to the picture’, he was no less irreplaceable in the court of Romanov.150 A different image is created of the most emblematic representative of Russian science in the second half of the nineteenth century, Sergei Botkin; he represents the physician archetype of the Russian genius, and the ‘new man’ of 1860s. Not only did he earn the sympathy of the Tsar, but he also won over both of the two persecuting parties during the nihilism scandal (collegial jealousy and the ideological suspicion by the state), maintaining his image and power at the court, while resisting political and professional attempts to isolate him in court intrigues. Botkin’s public image produced a climate of opinion that reflected both his physician’s authority and status as scientific expert, but above all, the lacking national feature in the Romanov court medicine. ‘A Russian of the Russians’, Botkin most likely also possessed a core personal prerequisite without which no high authority in the patriarchal Russian society and, in the political culture of the time, he would have been able to obtain and maintain longer lasting power: a sense of manliness. His personality traits of ‘confidence and dignity’, combined with the firmness that ‘no one dared to oppose’, and even his size (Botkin is noted to have been quite physically robust) and tastes strengthened the image suitable for the patriarchal ideal of this period.151 As is remarked upon in both the archival and secondary materials, Botkin represents all stages of the hero myth, from trial with his adversaries to self-realization and final liberation, and to eventual deification; all of which occurred in his lifetime. Although the nihilism hunt in the medical community concerned the actual threat of revolutionary underground movements active during the spring of 1879, the events and people involved may in fact reveal a deeper crisis and struggle for power in the court’s medical staffing in the shape of factionalism. It is presumable that an ultimate change of court physicians from the age-old German ‘yoke’ to their Russian replacements was going on, and that Botkin either took or was given the part of personifying this scenario. The duel between the unknown adversary and Botkin can be interpreted as a metaphor for the generational change in the court physicians’ nationalities, and more generally, between German and Russian authority in the sphere of court medicine. Frieden noted that the Russian physicians experienced an ambivalent relationship with the state, as in Western Europe, but in Russia this ambivalence was more extreme and required a constant interplay of professional and political demands. Frieden also noted that the state at times blocked attempts at autonomous professional organization.152 The evidence in this study confirms, to a certain extent, the atypical development of court physicians when achieving professional autonomy and the coexistence of several controversies (class identity, employment patterns, the question of nationality, finances, controversial ideological elements affecting the course of events). As is noted about zemstvo physicians of this particular period, the court physicians’ relations with the state seem ambivalent in this material as well, although this is a question that requires further evaluation. Acknowledgements I would like to thank the anonymous reviewers of the Social History of Medicine for their comments and recommendations, which significantly improved this paper. Footnotes 1 Description of Botkin in the memoirs of Alexander Collan by Adèle Collan, La Vie de Mon Père (Helsingfors: Imprimerie Centrale de Helsingfors, 1911), 66–7. 2 Nancy Mandelker Frieden, Russian Physicians in an Era of Reform and Revolution, 1856–1905 (Princeton: Princeton University Press, 1981); Galina Kichigina, The Imperial Laboratory: Experimental Physiology and Clinical Medicine in Post-Crimean Russia (Amsterdam: Brill Academic Publishers, 2009). I shall also refer to a lesser-known study on the medical secrecy of the house of Romanov by Boris A. Nahapetov, Vrachebnie tainy doma Romanovykh (Moscow: Veche, 2008) and to Sergei G. Zhuravskii, ‘Diaries of S.P. Botkin, Physician-in-Ordinary to the Tzar Family, as Encyclopedia of Medicine of the Russian Imperial Court’, History of Medicine, 2016, 3, 121–32. 3 For the term ‘great doctors’, see Susan M. Reverby and David Rosner, ‘Beyond the “Great Doctors”’, in S. Reverby and D. Rosner, eds, Health Care in America: Essays in Social History (Philadelphia, PA: Temple University Press, 1979), 3–16; Frank Huisman and John Harley Warner, Locating Medical History: The Stories and Their Meanings (Baltimore, MD: Johns Hopkins University Press, 2004), 167–93. 4 Nikolai A. Belogolovyi, S. P. Botkin: ego zhizn’ i vrachebnaia deiatel’nost’ (St Petersburg: Tipografiia J.N. Erlikha, 1892), 34–5, 44; Boris A. Nahapetov, ‘O deiatel’nosti S. P. i E. S. Botkinikh na postu leib-medika’, Klinicheskaia Meditsina, 1996, 74, 79–81; Evgraf A. Golovin, Pamiati Sergeia Petrovicha Botkina (St Petersburg: Tipografiia M.M. Stasiulevicha, 1890). On the history of Russian medicine, see also B. Mark Mirskii, Meditsina v Rossii XVI–XIX vekov (Moscow: Rosspen, 1996). 5 The era of fundamental changes in Russian society began at the end of the 1850s, reached its climax in the early 1860s and had run its course by 1868 (e.g. the emancipation of the serfs, the reorganisation of the universities and the liberalisation of local government and justice). 6 The Tsar’s preference for doctors from Germany is documented in Alexander Brückner, Aerzte in Russland bis zum Jahre 1800. Ein Beitrag zur Geschichte der Europäisirung Russlands (St Petersburg: Kaiserliche Hofbuchhandlung H. Schmitzdorff, 1887), 13, 39; Andreas Renner, ‘The Concept of the Scientific Revolution and the History of Science in Russia’, in R. Bartlett and G. Lehmann-Carli, eds, Eighteenth-Century Russia: Society, Culture, Economy. Papers from the VII International Conference of the Study Group of Eighteenth-Century Russia (Wittenberg, Berlin: Lit Verlag, 2004), 365–6; Sabine Dumschat, Ausländische Mediziner im Moskauer Rußland (Stuttgart: Franz Steiner Verlag, 2006), 548; Loren R. Graham, Science in Russia and the Soviet Union: A Short History (New York: Cambridge University Press, 1993), 245. German physicians constituted a majority of physicians in Russia until 1800, after which the proportion started gradually to turn in favour of the Russians. On the medical and ethical competence of the foreign medics in particular, see Frieden, Russian Physicians, 21, 31; John T. Alexander, Bubonic Plague in Early Modern Russia: Public Health and Urban Disaster (Baltimore, MD: Johns Hopkins University Press, 1980), 37–9, 45; Kristin Zieger, Die Bedeutung der deutschen Ärztevereine für das wissenschaftliche Leben, die medizinische Versorgung und soziale Belange der Stadt St. Petersburg von 1819–1914 (Leipzig: Universität Leipzig, 2003), 11–13, 22–4. 7 Andreas Renner, Russischer Nationalismus und Öffentlichkeit im Zarenreich 1855–1875 (Köln, Weimar, Wien: Böhlau Verlag, 2000), 46, 295; Andreas Renner, ‘Defining a Russian Nation: Mikhail Katkov and the “Invention” of National Politics’, The Slavonic and East European Review, 2003, 81, 659–82; Nahapetov, Vrachebnie tainy, 16, 159–60. 8 Kichigina, The Imperial Laboratory, 151. 9 Andreas Renner, Russischer Nationalismus, 63; Richard S. Wortman, Scenarios of Power: Myth and Ceremony in Russian Monarchy from Peter the Great to the Abdication of Nicholas II (Princeton, NJ: Princeton University Press, 2006), 190. 10 Renner, ‘Defining a Russian Nation’, 680. 11 Kichigina, Imperial Laboratory, 201–4; Belogolovyi, S. P. Botkin, 44. 12 Belogolovyi, S. P. Botkin, 34–5. 13 Zhuravskii, ‘Diaries of S.P. Botkin’, 131. Three of Botkin’s diaries have shed light on the practical organisation of the court’s medical care, but there is considerably less reference in them to personal and professional matters. 14 For medical professionalisation, see also William F. Bynum, Science and the Practice of Medicine in the Nineteenth Century (Cambridge: Cambridge University Press, 1994); Vivian Nutton, Medicine at the Courts of Europe, 1500–1837 (London: Routledge, 1990) in which in particular J. T. Alexander, ‘Medicine at the Court of Catherine the Great of Russia’, 182–208, and William F. Bynum, ‘Medicine at the English Court’, 262–89. The documents accessed for this paper are housed as follows: the manuscript collection held by the National Library of Finland in Helsinki (henceforth NLF/MC) analysed here contains the correspondence of leibkhirurg Alexander von Collan (1819–1910) (Catalogue 42); the manuscript collection of the Åbo Akademi University Library, in Turku (henceforth ÅAUL/MC), contains correspondences by both leibmedicus Carl von Haartman (von Wendt 3 collection) and Alexander von Collan (A. v. Collan’s letter collections II and III). 15 Rumour is central to the analyses by Boris Ivanovich Kolonitskii, a specialist in the linguistic peculiarities of the Russian monarchy and political culture. See Orlando Figes and Boris Kolonitskii, Interpreting the Russian Revolution. The Language and Symbols of 1917 (New Haven, CT: Yale University Press, 1999), 5–10; Boris Ivanovich Kolonitskii, ‘Tragicheskaia erotika’: Obrazy imperatorskoi sem’i v gody pervoi mirovoi voiny (Moscow: Novoe literaturnoe obozrenie, 2010). 16 Ibid. 17 Digitised versions of nineteenth-century periodicals used in this study come from the Digital Collections of the National Library of Finland and from the British Library Newspapers. 18 Elisa M. Becker, Medicine, Law, and the State in Imperial Russia (Budapest, New York: Central European University Press, 2011), 2–6, 273–4; Frieden, Russian Physicians, 14–16. 19 Nahapetov, Vrachebnie tainy, 158, 162–3. Leibmedic[us] (germ. leib, body, belly + lat. medĭcus) corresponds to leibartz in German. Leibmedik (internist) and leibkhirurg (surgeon) were the two major medical ranks in eighteenth-century Russia. Collan used the Swedish variant of leibmedicus, lifmedicus [livmedicus] to address or refer to all of his medical peers in the Russian court. 20 For Botkin becoming leibmedicus, see Nahapetov, ‘O deiatel’nosti’, 79–81; Belogolovyi, S. P. Botkin, 51; Kichigina, Imperial Laboratory, 97, 201–4. For Zdekauer, see Julius Pagel, Biographisches Lexikon hervorragender Ärzte de neunzehnten Jahrhunderts. Mit einer historischen Einleitung (Berlin: Urban & Schwarzenberg, 1901), 1891; R. von Liliencron and A. Bettelheim, Allgemeine Deutsche Biographie 55, (Leipzig: Verlag von Duncker & Humblot, 1910), 401. Zdekauer earned his Doctor of Medicine degree from MSA in 1842. From 1860 to 1861, he served as the honorary consultant leibmedicus to the Emperor, and from 1865 as the consultant leibmedicus of the Emperor and Grand Dukes Vladimir, Alexei and Pavel Alexandrovich. For Haartman, see Gustaf Heinricius, Obstetrikens och Gynäkologiens Historia i Finland under 18de och 19de århundradet (Helsingfors: Frenckellska Tryckeri-Aktiebolaget, 1903), 194–200; Tor Carpelan, Ättartavlor för de på Finlands Riddarhus inskrivna efter 1809 adlade, naturaliserade eller adopterade ätterna (Helsingfors: Frenckellska Tryckeri Aktiebolagets Förlag, 1937), 123–6; Kai Kartio, The Beer King of Helsinki, The Czarina’s Personal Physician and Dutch Old Masters (Helsinki: Frenckellin Kirjapaino, 1994), 128. For Collan, see Collan Family, signum 37.1, NLF/MC; Carpelan, Ättartavlor, 69–70; J. E. Railo, ‘Kunniahenkikirurgi Alexander von Collan ja hänen instrumenttikaappinsa’, Hippokrates, 1991, 8, 93–122. 21 Kichigina, Imperial Laboratory, 105–9; Collan, La Vie, 44–8; Heinricius, Obstetrikens, 194–200; A. Collan to C. Collan (henceforth Collan to Collan), St Petersburg, 21 May 1869, signum 37.9, NLF/MC. 22 Kichigina, Imperial Laboratory, 10; Frieden, Russian Physicians, 21. Andreas Renner, ‘Wissenschaftstransfer ins Zarenreich des 18. Jahrhunderts. Bemerkungen zum Forschungsstand am Beispiel der Medizingeschichte’, Jahrbücher für Geschichte Osteuropas, 2005, 53, 65–85; Renner, ‘The Concept of the Scientific Revolution’, 366. 23 Nahapetov, Vrachebnie tainy, 265. 24 A. Collan to C. Collan, undated, signum 37.9, NLF/MC. 25 Frieden, Russian Physicians, 44–51. 26 Belogolovyi, S. P. Botkin, 51; Nahapetov, Vrachebnie tainy, 265. 27 Brückner, Aerzte in Russland, 38–9, 49; Zieger, Die Bedeutung, 14. 28 Nahapetov, Vrachebnie tainy, 158, 162–3. 29 Nahapetov, Vrachebnie tainy, 158–9; Alexander, Bubonic Plague, 41. 30 Nahapetov, Vrachebnie tainy, 210. 31 A. Collan, ‘Historier, anekdoter och squaller från hofvet i St Petersburg’, undated, unpaginated account book, signum 37.7, NLF/MC (henceforth ‘Historier, anekdoter’, NLF/MC). 32 Nahapetov, Vrachebnie tainy, 203. 33 Nahapetov, Vrachebnie tainy, 206–7. 34 Ibid. 35 ‘Historier, anekdoter’, NLF/MC. 36 For the quote, see Nahapetov, Vrachebnie tainy, 206. For the suspicions about the death of the Tsar, see ‘Historier, anekdoter’, NLF/MC. The document speculates between the two renowned theories on the cause of death, but does not bring significant new information to it. Only a minor misunderstanding regarding the method of embalming the Emperor’s corpse is noted. 37 Wortman, Scenarios of Power, 334. 38 Kichigina, Imperial Laboratory, 202. 39 His Moscow University alma mater and excellence in practice had already been noted in 1873, in Finland’s Allmänna Tidning, 14 February 1873, 3. 40 Freeman’s Journal, 2 July 1875, 2. 41 North Wales Chronicle, 23 January 1875, 5. 42 Belogolovyi, S. P. Botkin, 51; Kichigina, Imperial Laboratory, 97, 201–4. 43 Belogolovyi, S. P. Botkin, 50. 44 North Wales Chronicle, 23 January 1875, 5. 45 On Botkin's ministrations and the Empress’s response, see Zhuravskii, ‘Diaries of S.P. Botkin’, 130; C. F. G. von Haartman to C. D. von Haartman (henceforth Haartman to Haartman), 30 November 1863; undated 1864 or 1865; 29 July 1864; 29 April 1868; 7 July 1868; 13 February 1869; 17 February 1869, ÅAUL/MC. Comparing Botkin’s treatment strategy, available in Botkin’s diaries, to those of Haartman and Collan, it is apparent that several therapeutic approaches used by Botkin were already in use during Haartman’s and Collan’s tenures. These include balneotherapy or spa water treatments, the so-called climate therapy, passive gymnastics or massage therapy, as well as the intake of mineral water made from evaporated Carlsbad salt. Instead, Botkin’s pioneering scientific approach, such as his use of microscope and exact laboratory methods to examine the Empress’s health, were certainly innovative and specific solely to Botkin. 46 C. F. G. Haartman to A. Collan, 15 May 1873, signum 37.5, NLF/MC contains mention of the Empress’s catarrh improving, while her subsequent feeling unwell is documented in C. F. G. Haartman to A. Collan, undated, 1874, signum 37.5, NLF/MC. 47 For the introduction of chloroform, see C. F. G. von Haartman, ‘Några iakttagelser om Chloroformens bruk i Barnförlossningskonsten’, Finska Läkare-Sällskapets Handlingar, 1849, IV, 11–32. Haartman had studied and used chloroform during his London and Edinburgh visits, in particular under Professor James Simpson in 1848. He tested chloroform at the General Lying Hospital in London on 25 randomly selected cases (observing 105 childbirths and personally completing 81 deliveries). His lack of knowledge of internal medicine is mentioned in Zhuravskii, ‘Diaries of S.P. Botkin’, 122. 48 Railo, ‘Kunniahenkikirurgi’, 112; Kartio, Beer King of Helsinki, 128. 49 Heinricius, Obstetrikens, 200. 50 Nahapetov, ‘O deiatel’nosti’, 79–80; Nahapetov quotes a primary source in the Russian State Historical Archive (RGIA), fund 479, op. 1 in Nahapetov, Vrachebnie tainy, 267. In May 1875, the Emperor assigned Botkin ‘1430 rubles salary for staff, dining rooms and apartment and the amount of money currently received by leibmedicus Hartmann, 2860 rubles, making altogether 4290 rubles’. 51 Haartman to Haartman, undated, 1872, ÅAUL/MC. 52 Haartman to Haartman, May 1872, ÅAUL/MC. 53 Haartman to Haartman, 23 [July?] 1863, ÅAUL/MC. 54 On the slavophile group in Moscow, see Nicholas Riasanovsky, Russian Identities: A Historical Survey (Oxford: Oxford University Press, 2005); Nicholas Riasanovsky, Russia and the West in the Teachings of the Slavophiles: A Study of Romantic Ideology (Cambridge, MA: Harvard University Press, 1952), 152–4; Nicholas Riasanovsky, Nicholas I and Official Nationality in Russia, 1825–1855 (Berkeley, CA: University of California Press, 1959); Andrzej Walicki, The Slavophile Controversy (Oxford: Clarendon Press, 1975); Olga Maiorova, From the Shadow of Empire: Defining the Russian Nation through Cultural Mythology, 1855–1870 (Madison, WI: University of Wisconsin Press, 2010). According to Riasanovsky, Slavophile ideology fits into the framework of European Romanticism (German romantic thinkers), but the Slavophiles adapted Romantic doctrines to their own situation and needs, including the influence of Orthodox religious thought and tradition. Haartman to Haartman, Ilinskoe, 2/14 June 1866 and 9 June 1866, ÅAUL/MC discusses the Empress’s own circle. Haartman stayed occasionally with the Empress at her Ilinskoe-estate near Moscow on the Moscow River. Richard Wortman, in his Russian Monarchy: Representation and Rule (Boston: Academic Studies Press, 2013), 102, looks at the Empress’s turn to Russian Orthodoxy. 55 Collan, La Vie, 67. 56 Ibid. 57 Andrzej Walicki, ‘Russian Social Thought: An Introduction to the Intellectual History of Nineteenth-Century Russia’, The Russian Review, 1977, 36, 18–19; Alexander Vucinich, Science in Russian Culture, 1861–1917 (Stanford, CA: Stanford University Press, 1970), 3–11. 58 Collan documents this in A. Collan Sr. to A. Collan Jr., 22 September 1866, ÅAUL/MC, and Haartman in C. F. G. Haartman to A. Collan, 4 October 1867, signum 37.5, NLF/MC. 59 Collan to Collan, 10 July 1868, signum 37.9, NLF/MC. 60 Collan to Collan, 1/13 May 1870; 19 August 1870; 23 September 1870; 12/24 September 1871, signum 37.9, NLF/MC. 61 Belogolovyi, S. P. Botkin, 51; Collan to Collan, 8/20 November 1874, signum 37.9, NLF/MC. 62 Sergei Botkin, Pis’ma S.P. Botkina iz Bolgarii 1877 g (St Petersburg: Tipografiia M.M. Stasiulevicha, 1893), 12; Nahapetov, Vrachebnie tainy, 261. 63 Junker (germ. Junker) in the Russian context refers to a graduate from the military cadet school. In the specific case of Nikolaevsky Cavalry School, it referred to a young cadet of noble family. The unidentified brain disease is mentioned in Sergei Botkin to Collan, 27 or 26 March 1874, signum 37.3, NLF/MC which contains details of their shared patient. 64 Sergei Botkin to Collan, undated, signum 37.3, NLF/MC. 65 Zhuravskii, ‘Diaries of S.P. Botkin’, 125. 66 Sergei Botkin to Collan, 9 January 1873, signum 37.3, NLF/MC. 67 Beth Linker, ‘Resuscitating the “Great Doctor”. The Career of Biography in Medical History’, in T. Söderqvist, ed., The History and Poetics of Scientific Biography (Aldershot: Ashgate, 2007), 221–39; Stana Nenadic, ‘Writing Medical Lives, Creating Posthumous Reputations: Dr Matthew Baillie and his Family in the Nineteenth Century’, Social History of Medicine, 2010, 23, 509–27; Frieden, Russian Physicians, 221. 68 Haartman to Haartman, 10/23 October 1863; 30 November 1863, ÅAUL/MC. 69 Frieden, Russian Physicians, 43. 70 Collan to Collan, 8/20 July 1862, signum 37.9, NLF/MC. 71 Collan, La Vie, 66. 72 Belogolovyi, S. P. Botkin, 78–9. 73 Belogolovyi, S. P. Botkin, 38–40. 74 Collan to Collan, 15/24 March 1874, signum 37.9, NLF/MC. 75 Collan to Collan, 18 May 1862, signum 37.9, NLF/MC. 76 Frieden’s comment can be found in Russian Physicians, 209. 77 Morgonbladet, 1 August 1884, 2. 78 Åbo Tidning, 25 October 1894, 3. 79 Belogolovyi, S. P. Botkin, 39–40. 80 E. V. Korsun and M. A. Avkhukova ‘Vklad S. P. Botkina v razvitie otechestvennoi fitoterapii’, Klinicheskaia Meditsina, 2012, 90, 22–3. 81 Belogolovyi, S. P. Botkin, 40. 82 Haartman to Haartman, undated by month, date 13, 1865, ÅAUL/MC. 83 The income figure for an Academy professor is taken from Zhuravskii, ‘Diaries of S.P. Botkin’, 127. 84 Collan to Collan, 2 August 1860, signum 37.9, NLF/MC. In the Peterhof military training camp, an unidentified Grand Duke and Admiral Yevfimy Putyatin acclaimed Collan for not having a single cadet fallen ill among 1200 cadets during the summer of 1860. 85 Haartman to Haartman, 29 July 1864, ÅAUL/MC. 86 Zdekauer to Collan, signum 37.6, NLF/MC. 87 The Tsarevich died in Nice. ‘Because of my daily and long presence this winter with him, I learned to know and learned to love the successor to the throne and he learned to like me too’, Haartman wrote; Haartman to Haartman, 3 May 1865, ÅAUL/MC. 88 Haartman to Haartman, undated, 1865, ÅAUL/MC. 89 Haartman to Haartman, 3 May 1865, ÅAUL/MC. 90 Haartman to Haartman, undated, 1865, ÅAUL/MC. 91 The loss of this patient to another physician is documented in Haartman to Haartman, 10/23 October 1863, ÅAUL/MC. 92 Haartman to Haartman, undated, 1865, ÅAUL/MC. 93 Belgolovyi, S. P. Botkin, 54; Kichigina, Imperial Laboratory, 217. 94 Rebecca Friedman, Masculinity, Autocracy, and the Russian University, 1804–1863 (New York: Palgrave Macmillan, 2005); Barbara Evans Clements, A History of Women in Russia: From Earliest Times to the Present (Bloomington and Indianapolis: Indiana University Press, 2012), 90. 95 Claudia Verhoeven, The Odd Man Karakozov. Imperial Russia, Modernity, and the Birth of Terrorism (Ithaca and London: Cornell University Press, 2009), 140–1. 96 The prisoner acknowledged that he knew Dr Botkin; Wiborgs Tidning, 28 April 1866, 3; Helsingfors Dagblad, 18 August 1866, 1; Daily News, 3 May 1866, 6; Verhoeven, The Odd Man Karakozov, 140–1. 97 Belgolovyi, S. P. Botkin, 54; Hans Heilbronner, ‘The Russian Plague of 1878–79’, Slavic Review, 1962, 21, 89–112; Maria Pirogovskaya, ‘The Plague at Vetlyanka, 1878–1879: The Discourses and Practices of Hygiene and the History of Emotions’, Forum for Anthropology and Culture, 2014, 10, 133–64. 98 Riasanovsky, Russian Identities, 173–4; Alexander Polunov, Russia in the Nineteenth Century. Autocracy, Reform, and Social Change, 1814–1914 (Armonk, NY: M.E. Sharpe, 2005), 141–2, 150. Nihilism (Latin meaning nothing), enjoyed broad support among the intelligentsia from the early 1860s (this was the so-called first generation of nihilists). The term originated in an 1862 novel by Ivan Turgenev, Fathers and Sons. The protagonist of the novel is physician Yevgeni Bazarov. Nihilism is often used to refer to the men of 1860s, who hoisted the banners of critical realism against accepted values and standards. 99 Richard Wortman, The Crisis of Russian Populism (Cambridge: Cambridge University Press, 1967), 24. 100 Helsingfors Dagblad, 22 April 1879, 2. 101 Morgonbladet, 19 May 1879, 3–4; Helsingfors, 20 June 1879, 2–3. 102 Polunov, Russia in the Nineteenth Century, 141–2, 150. 103 Frieden, Russian Physicians, 12–13. 104 Helsingfors Dagblad, 2 March 1879, 3. 105 Morgonbladet, 8 March 1879, 2–3. 106 Heilbronner, ‘The Russian Plague’, 89–112. 107 Daily News, 4 March 1879, 5. 108 Ibid. 109 ‘Everyone realizes that Professor Botkin with these two diagnoses, issued ex cathedra, not only took a great responsibility in front of his native land, but also put his entire scientific reputation at stake’. Morgonbladet, 1 March 1879, 3. 110 Helsingfors Dagblad, 5 March 1879, 2. 111 The Pall Mall Gazette, 31 January 1879, 9. 112 Helsingfors Dagblad, 5 March 1879, 1–2. 113 Morgonbladet, 5 March 1879, 2–3; The newspaper used as basis for this metaphor Ivan Andreevich Krylov's fable named the Elephant and the Pug-dog, central in the Russian nineteenth-century culture. 114 Douglas Smith, Working the Rough Stone: Freemasonry and Society in Eighteenth-Century Russia (DeKalb: Northern Illinois University Press, 1999). 115 Morgonbladet, 5 March 1879, 2–3; Morgonbladet, 8 March 1879, 2–3. 116 Kichigina, Imperial Laboratory, 214. 117 Zhuravskii, ‘Diaries of S.P. Botkin’, 128. 118 Morgonbladet, 8 March 1879, 3. 119 Helsingfors Dagblad, 1 March 1879, 3. 120 Wiborgs Tidning, 8 March 1879, 2; Helsingfors Dagblad, 8 March 1879, 3. 121 The Evening News, 17 March 1879, 3. 122 During the scandal, Botkin communicated to the British Medical Journal seven more cases similar to that of Prokofiev; The British Medical Journal, 8 March 1879, 206; The British Medical Journal, 15 March 1879, 404. 123 On criticism from voices other than Zdekauer’s, see Kichigina, Imperial Laboratory, 216–17; Belgolovyi, S. P. Botkin, 54–6. 124 Wiborgs Tidning, 12 April 1879, 1. 125 Åbo Posten, 21 May 1879, 2; Morgonbladet, 7 June 1879, 2. 126 The Standard, 2 May 1879, 5; Aberdeen Weekly Journal, 15 May 1879, 3. 127 The Examiner, 13 September 1879, 1171. 128 Freeman’s Journal, 2 July 1875, 2. 129 Nikolai Serno-Solovyovich to Collan, 17 August 1860, signum 37.6, NLF/MC. 130 Kolokol was published in London and Geneva in the 1850s and 1860s. 131 Collan, La Vie, 68. 132 Woodford McClellan, Revolutionary Exiles: The Russians in the First International and the Paris Commune (London: Routledge, 2005), xv, 27. 133 Serno-Solovyovich to Collan, 17 August 1860, signum 37.6, NLF/MC. 134 Frieden, Russian Physicians, 106–7. 135 Nahapetov, ‘O deiatel’nosti’, 80. 136 Nahapetov, Vrachebnie tainy, 269. 137 Collan to Collan, 1/13 August 1871; Livadia, 1/13 and 12/24 September 1871, signum 37.9, NLF/MC. 138 Helsingfors Dagblad, 2 March 1879, 3; The Standard, 7 March 1879, 3. 139 Elisa M. Becker, ‘Judicial Reform and the Role of Medical Expertise in Late Imperial Russian Courts’, Law and History Review, 1999, 17, 1–26; Joseph Bradley, Voluntary Associations in Tsarist Russia: Science, Patriotism, and Civil Society (Cambridge, MA: Harvard University Press, 2009), 214–18. 140 Daily News, 4 March 1879, 5. 141 Kichigina, Imperial Laboratory, 217. 142 Belogolovyi, S. P. Botkin, 55, 69. 143 Åbo Tidning, 14 April 1883, 2. 144 Nahapetov, Vrachebnie tainy, 262. 145 Åbo Tidning, 9 May 1883, 3. 146 Helsingfors, 11 April 1882, 3; Belogolovyi, S. P. Botkin, 70. 147 Nya Pressen, 16 March 1883, 3; Åbo Tidning, 17 March 1883, 2; Östra Finland, 29 March 1889, 2. 148 Wiborgsbladet, 16 August 1889, 2. 149 For the return of the mystical-irrationalist line of thinking, see Vucinich, Science in Russian Culture, 3–11. 150 Nahapetov, Vrachebnie tainy, 261–2. 151 Figes and Kolonitskii, Interpreting the Russian Revolution, 14; Wortman, Scenarios of Power, 334. 152 Frieden, Russian Physicians, 14. © The Author 2017. Published by Oxford University Press on behalf of the Society for the Social History of Medicine. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Social History of Medicine Oxford University Press

The Pugs and the Elephant: Dr Botkin and the Professional and National Identity of Physicians in the Russian Court

Social History of Medicine , Volume Advance Article – Sep 11, 2017

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© The Author 2017. Published by Oxford University Press on behalf of the Society for the Social History of Medicine.
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Abstract

Summary This essay explores lesser-known members of the Russian court’s medical community and the printed press to trace information on the working environment, events and attitudes surrounding the ‘Great Russian Asclepios’, Sergei Botkin. It first shows how the changing intellectual atmosphere (from slavophilism to nihilism) affected the course of events inside the sphere of court medicine when Nicholas I’s era turned into a reform era. Then it demonstrates how Botkin and his fellow physicians balanced their professional autonomy with their service to the central state, reveals some of the medical community’s archetypes and finally identifies the opposing medical forces around Botkin. Resisting professional and political attempts at isolation and court intrigues, Botkin really came to personify the main events of the era. The medical community of the court is viewed here as a micro-cosmos of the professional peculiarities observed elsewhere in the medical community of Tsarist Russia. identity, politics, professionalisation, doctors, medical authority With the appearance of the physician Botkin, the vogue for his foreign colleagues ended. With his arrogance, he managed to displace the latter also inside the court, and with his energy and prestige, advance roads for his Russian colleagues—to men who mostly had the same temper as him, but lacked Botkin’s geniality.1 The above statement, made by a fellow court physician of Sergei Petrovich Botkin (1832–1889), sums up, in a highly simplified form, a long-term development in the history of the nineteenth-century Russian medical landscape: increasing levels of medical professionalisation and the growing autonomy of Russian physicians between the pre- and post-reform periods.2 Drawing on the idealised nineteenth-century notion of ‘great doctors’, it also attributes the symbolic position between the old and new to Botkin during this time of change, and in ending the antagonism between doctors of Russian and foreign origin.3 This positioning of Botkin was noted by his principal biographer, colleague and friend Nikolai A. Belogolovyi.4 Changes in the nationality of physicians in Russia are seen to have taken place during the reform period, approximately 1856 through the 1870s, predominantly for practical reasons.5 There had been a severe shortage of trained personnel in Russia in many scientific fields, including medicine, since the eighteenth century. Nicholas I’s administration had responded to this problem from the early 1830s by introducing Russian medical education reforms that stimulated the training of native-born medical personnel. The Tsar’s family, government officials and the upper nobility had traditionally employed doctors from abroad, often from Germany, due to their generally high confidence in their scientific, medical and ethical competencies.6 But the gradual replacement of foreign court physicians with domestic experts can also be seen in relation to the growth of national consciousness; Andreas Renner has noted a religiously motivated refusal to admit foreign innovations and oligarchic opposition to the German ‘domination’ of the court in St Petersburg dating from the late eighteenth century.7 And, although the great reforms signalled the liberalisation of academic and cultural life, they also created what Galina Kichigina has referred to as a highly peculiar compromise between the liberal reformers and conservatives in the government of Alexander II, which drastically changed the existing social structure of the country.8 One manifestation of this change that is central to the methodology of this study was the expansion of public opinion through a loosening of controls over the press from the 1860s.9 The periodical press became the main forum for opinion-making, creating what Renner has termed a ‘community of discourse’ in which the abstract concept of the Russian nation became visible.10 By the time of Botkin’s arrival at the Medico-Surgical Academy of St Petersburg (henceforth MSA), there were two competing factions in Russian medicine: an influential German faction and a Russian faction. Botkin, who had earned the title of Doctor of Medicine from the Moscow State University in 1855, was named Professor of the MSA in 1861. The reformist administration of the Medico-Surgical Academy saw Botkin, a German-educated internist, as an ideal candidate for a professorial post, yet he encountered opposition to his appointment from the influential (German) faction of the Conference. His novel ideas were received with scepticism and considered potentially harmful.11 Belogolvyi noted that the long-standing injustice in the medical sphere was too flagrant and that it ‘forced Botkin to intervene’.12 Among the many biographical works on Botkin, his activity as a court physician has remained rather uninvestigated, although court work contributed significantly to Botkin’s professionalisation and to his public reception.13 By examining lesser-known members of the Russian court’s medical community and the printed press, I will focus on the professional dimension between Botkin and his fellow medical practitioners, via unpublished archival materials, contemporary press materials, and end-of-career family memoirs.14 By examining at what levels, and in which contexts, the primary archival materials and periodical publications overlap and coincide, I will show how the changing intellectual atmosphere affected the course of events inside the sphere of Russian court medicine at this transitional time. I will demonstrate how Botkin and his Russian colleagues balanced their professional autonomy and service to the central state; identify the opposing forces circling around Botkin; and reveal some of the medical community’s archetypes. I will emphasize the importance of one essential element of political culture in the autocratic system, originated by Boris I. Kolonitskii: the rumour culture.15 From the 1860s onwards, with the expansion of public opinion, Russia was a society where rumour not only flourished but played an inordinately important political role. The newly liberated media machinery produced valuable information, albeit with multiple meanings and with sources that were mostly unclear. Rumours were created by both elites and ‘masses’.16 I will thus highlight Botkin’s public image, and how words were used to define him.17 By considering how the national identity of court physicians was a potential concern of the press, I show how Botkin’s public image reflected not only his authority as a physician and status as a scientific expert, but above all the hitherto lacking national feature in the medicine of the Romanov court. Resisting the political and professional attempts at isolation and court intrigue, I also demonstrate how Botkin came to personify the main events of the era. On a more theoretical level, I view the court medical community as a microcosm of the professional peculiarities observed elsewhere in the medical community of Tsarist Russia, recalling the contradictions, atypicalities and ambivalences in Russian physicians’ professional development, as noted by Nancy Frieden, but also the ‘politically charged’ role of physicians at this time, as documented by Elisa Becker.18 Botkin’s Fellow Leibmedicuses The four physicians considered in this study can be understood as a professionally homogenous group. All worked under the same patron (Emperor Alexander II; Zdekauer and Haartman also served under Nicholas I), in the same professional environment and over approximately the same time period. At some point in his career, each achieved the rank of leibmedicus or leibkhirurgus, titles they would hold for the rest of their lives.19 Sergei Botkin became leibmedicus in 1870, Nicolaus Theodor (von) Zdekauer was named leibmedicus in 1860, Carl (von) Haartman, was named leibmedicus in 1860 and Alexander (von) Collan was made leibkhirurgus in 1877.20 The court physicians also pursued their studies and careers using an approach typical of Russian medical students; each was first trained in government-supported institutions and, after graduation, undertook training and practice abroad, but within Europe.21 Each of the doctors became a state official, thus professional identities were strongly associated with the state, which was typical for the Russian context, and all maintained private practices.22 Each of these four physicians replaced one of the others at the court during some point in the 1860s or 1870s. The general pattern of entrance to the court for each of the leibmedicuses was quite similar: after an initial successful treatment of one member of the imperial family, each of their careers developed rapidly. Botkin first successfully treated the Tsarevich Alexander Alexandrovich (the future Alexander III).23 Zdekauer treated the Grand Duchess Elena Pavlovna of Russia; Haartman attended the daughter of Nicholas I, Grand Duchess Maria Nikolaevna. After having treated the Tsarevich Nicholas Alexandrovich, Collan’s career also took off quickly. He noted, ‘That this matter has benefited me greatly, I have already noticed. I have begun to do more business in my practice’.24 Each of the physicians represents different, yet still typical, social backgrounds of the predominantly non-noble Russian physicians of the period.25 Zdekauer and Haartman belonged to the hereditary nobility and were the sons of physicians, while Collan was the son of a clergyman and Botkin the son of a wealthy merchant. In terms of intellectual production, the major difference between the four was that, aside from serving as court physicians, Botkin and Zdekauer were reputable members of the Russian medical world and had successful careers at MSA. Of the four, Botkin was most entirely devoted to science; being a court physician often interrupted and disturbed his scientific career.26 All four physicians were nationals of the Russian Empire, with Botkin becoming, as we shall see, perhaps the most emblematic Russian physician of the court. Collan and Haartman were born in the Russian Empire, as was Zdekauer, but Zdekauer could be described more as a ‘Russified’ German, as his father was German and his mother Swedish. Zdekauer followed in the footsteps of his foreign-born parents by entering the field of medicine. Brückner noted that many proper ‘dynasties’ of foreign physicians were shaped in Russia, reflecting Zdekauer’s experiences.27 However, the conception of nationality in the court medical sphere at this particular time should perhaps not be taken as rigidly fixed. For example, Zdekauer is described in the source material at times as a ‘foreigner’, whereas Haartman seems to have associated himself as part of the ‘German gang’, participating in meetings of the German Medical Association at St Petersburg. The overall complexity of the question of origin or nationality in relation to the leibmedicus is stressed in the work of medical historian Boris Nahapetov, who differentiates between the court physician of the eighteenth-century Aptekarskii prikaz, or Apothecary Chancery, before the announcement of the Table of Ranks in 1722, and the later figures of leibmedicus. According to Nahapetov, leibmedicuses (‘leib-medik’) differed in many ways from the court doctors of the time of Apothecary Chancery.28 The Apothecary physicians were mostly foreign specialists who were typically called on for shorter periods, whereas the overwhelming majority of leibmedicuses working after 1722 were natives of Russia, despite the fact that many of them bore foreign names.29 Furthermore, leibmedicuses did not work on a contract, but rather on an on-going basis, often serving in this role until the end of their lives. To summarise, Botkin, Zdekauer, Collan and Haartman can be seen as representative professional equivalents of each other, with similar career patterns, Russian origins (in the broad sense of the term) and lifetime service as leibmedicuses, the distinction of national identity appearing quite artificial at this time. To highlight the contrast in the court-based medical work between the pre- and post-reform periods before Botkin’s entrance, and to reflect the presence of German ‘domination’ and its alliance with autocracy during the pre-reform period, we may first look at the image of the Russian medical class under Nicholas I, in the form in which it was described in an unpublished source. Although referring to the usual schemes and stereotypes, Nahapetov associated a typical physician of Nicholas I’s era with a foreign origin, having trained abroad and working for Russian high officials with one controversial and mysterious leibmedicus, Dr Martin Mandt.30 This was also commented on by Collan: Being able to see through [the] Emperor’s authoritarian character, Mandt stood right from the beginning in a completely independent status, unusual in the court at the time. Mandt never stood like a valet at the door of Emperor’s cabinet, but rather walked straight forward, put his hat on the desk and asked the Emperor to throw off his uniform coat and to lay down in his tent bed for the auscultation. In order to avoid addressing the Majesty with the usual мы [we, paternalistic expression between the doctor and the patient], Mandt always spoke German and impressed His Majesty with these features.31 Nahapetov has noted that Mandt’s influential position in the court contributed to the increasing influence of German medicine on Russian medicine during this period.32 Contemporary testimonials also draw a somewhat clichéd image of a firmly established German physician of the court, who kept even the Emperor in his thrall, referring to his vanity, careerism and magnetiser's qualities (‘Mandt was a man with a tremendous power, a strange, mysterious man was he’).33 This often gave foreign physicians an ‘advantage over the pre-reform Russian medical class’.34 Other court physicians of German and Baltic origin named in the document are Dr Nikolai Fedorovich Arendt and Dr Philipp Jakob Karell, the pupil and famulus of Dr Mandt.35 The account also contains some traits of Emperor Nicholas I’s personality and physique, including a strong, ‘herculean body’ with ardent ‘Romanov blood’, but also, to use Nahapetov’s expression, the end of ‘a story of a brilliant charlatan’ [Mandt] and his suspected involvement in events that led to the death of Nicholas I.36 Mandt’s tenure apparently undermined the prestige of foreign physicians, paving the way for the Russian court physicians later in the century. The Tsar’s Patriotic Sympathies The major contradiction in the nationalist scenario of the Russian court as noted by Richard Wortman, and which actually characterises the whole course of its history, was that the Romanov dynasty was almost entirely of German extraction by bloodline, yet with a long tradition to preserve a genuinely ‘Russian spirit’.37 According to the source material for this study, this precondition seems to be applicable to the court’s medical sphere during this particular period as well; although the strictly state ideological era of Nicholas I turns into a reform-era glasnost, the primary and secondary sources contain a national factor. To put it differently, the fates of all the court physicians here, in terms of ideas and practice, were dominated by the ‘German’ Empress, Maria Alexandrovna, who possessed not only the characteristics but also all the contradictions seen in the Russian medical community of the time: a Russian Empress with German origin, devoted to the Orthodoxy and slavophile predilections. Physicians of Russian origin could certainly be found at the court before Botkin, and the Tsar’s earliest ‘patriotic sympathies’ for Botkin can be traced to as early as 1860, when he bestowed 1000 roubles for equipment for Botkin’s study room.38 However, the actual dearth of ‘Russianness’ among the court’s medical staff was addressed only when Botkin appeared: ‘a Russian of the Russians’, with strong associations to the old Moscow.39 As if he were an ideal projection of the court’s slavophile aspirations and desires, Botkin became known as ‘the only Russian who ever held the post of confidential physician to either the Emperor or the Empress’:40 Some years ago, the Emperor [Alexander II], finding that his wife was constantly suffering from pulmonary attacks, asked a German physician, high in favour at the court of St. Petersburg [Zdekauer?] to draw up a list of well-known medical men. He did so, and the Emperor, finding that they were all Germans, asked if there was not in all his dominions a Russian doctor of reputation. To humour the Czar’s patriotic sympathies, Botkin’s name was added to the list. He was accordingly sent for. He is a Russian of the Russians, born in Moscow, the son of a Moscow merchant, and educated at Moscow University.41 In November 1870, Botkin was conferred the title of honorary leibmedicus, and from 1872, leibmedicus to the imperial family.42 Indeed, when the Empress’ condition worsened in early 1872 due to chronic pains in her chest and lungs stemming from tuberculosis, Botkin was assigned to care for her health and left St Petersburg and escorted her to Crimea.43 The Empress and Botkin forged a keen patient–doctor relationship, and Botkin became known as a physician who understood the Empress’s case better than anyone else at the court.44 The Empress’s conditions were significantly ameliorated due to Botkin’s ministrations also according to Haartman, whose responsibility the empress’s health had been prior to Botkin.45 Haartman reported in 1873 that the Empress’s catarrh had passed, although her pneumonia returned in 1874, and she reported not feeling very well.46 The actual course of events regarding the change of the Empress’s health guardian remains unclear. According to Zhuravskii, Haartman—who had a great reputation as an obstetrician, and was acclaimed as an innovator in obstetrics through his introduction of chloroform anaesthesia to the Russian court—was considered insufficiently versed in internal diseases.47 Haartman has also been accused of having antagonised ‘the mightiest medical potentates of St Petersburg, including Botkin’.48 But the fault has also been placed on Botkin: ‘Haartman left St. Petersburg in the middle of the 1870s as a victim of intrigues developed by influential people, and was displaced from his position at the court by the renowned clinician Botkin’.49 Either way, Botkin inherited Haartman’s office, apartment and salary in 1875.50 During the spring of 1872 when Botkin came to the court, Haartman was uncertain of his future as a leibmedicus. He met with the Emperor, who gave him ‘the best intelligence over the Empress’s condition and disposition. What Her Majesty shall do for the winter is not yet definite, and therefore I am also still vague for myself and my family. I manifested my feeling even before the Emperor, who seemed to take it quite naturally’.51 Haartman seems to have referred to the changing intellectual atmosphere in the court with the term ‘patriotism’, often used as an equivalent for slavophilism, in a nearly illegible letter. The only legible words by Haartman, who suffered from arthritis and whose handwriting became difficult to read toward the end of his career, are patriotism and callousness, and his aim to insinuate all missing details regarding the change from the Empress.52 Haartman, who knew the Empress well, pointed to the intellectual movement among the educated Russian elite, slavophilism, which had repercussions for the Empress and the court’s medical community from approximately 1865 onwards. This is despite the fact that, only a few years earlier, Haartman had mentioned the opposite, the Empress’s exclusive confidence in foreign doctors: ‘Her Majesty does not trust the doctors of our city’.53 On this occasion, an unidentified foreign physician had been chosen as a consultant, because he had similar views as Haartman: ‘And then there are also political reasons, thus, so far everything has remained as before’, Haartman wrote. This period of intellectual turn can be roughly dated to the death of Tsarevich Nikolai Alexandrovich, in the spring of 1865, which affected the Empress deeply. She never fully recovered from the death and instead retreated into the company of romantic intellectuals from the Moscow slavophile circle and her own coterie of friends, finding solace in mysticism and religion (i.e. Russian Orthodoxy).54 But the avocation of Russian culture in the court’s medical staff, and the actual connection between slavophilism and the promotion of native practitioners’ professional status at the court, was something Collan also noted: During this epoch, the movement of Slavophilia had not yet taken over in Russia. The general opinion was still in favor of strangers, among them also several physicians, many of them luminaries in their field (Kansler, Eichwald, oculist Junge, Zdekauer, among others). But in the appearance of the physician Botkin, the vogue for his foreign colleagues ended.55 When Botkin entered, Collan’s memoirs reads: ‘The time was no more for the timid and the delicate, with too great a self-esteem to operate in the manner as the Great Russian Asclépios, and his rough and unscrupulous followers’.56 Although the significant change among court physicians and their origins is associated here with Botkin’s position at the court, the overall return of the mystical-irrationalist tradition in the Empress’s orientation towards religious thinking on the eve of the scientific and rationalist era belongs with the major contradictions of the Russian medical community at this specific moment. Applying Andrzej Walicki’s and Alexander Vucinich’s interpretation of social thought in Russia at this time, the change also encapsulates the broader philosophical difference between the medical practitioners of the preceding generation and that of Botkin’s generation, which is central to the context of this study. The timid and the delicate represent the pre-reform era (Collan and Haartman), the ‘weak’ men of the 1840s, with all the dominant ideas that the ‘men of the 1860s’ (e.g. Botkin) wanted to eliminate. The preceding generation was associated with idle daydreamers and idealists who had ample knowledge but not enough will and who were often accused of adopting the parasitic way of life of the privileged class. In contrast, the ‘new man’ of the 1860s, appeared on the scene after the Crimean War, here in the guise of the Greek god of medicine, Asclepios, the deified Botkin. Botkin, with his new manners, was an embodiment of scientific rationalism, individualism and the pronunciation of his own ideas, and he had a readiness for social action and a thirst for positive knowledge that the preceding generation did not.57 This was also the physician archetype of the Russian genius, to which Collan refers in the epigraph of this essay. Collan and Botkin, indeed, had a collegial and friendly professional relationship during the 1870s. Just prior to Botkin’s tenure, Collan had attended the Grand Dukes and Empress at their summer residence of Livadia, in Crimea, in 1866, followed by Haartman in 1867.58 Collan substituted for Haartman in Peterhof in the summer of 1868 and made a trip to Kissingen with the Empress that same year.59 During the summers of 1870 and 1871, Collan was posted in Tsarskoye Selo, Peterhof and Crimea, due to Haartman’s ailing health.60 In 1874, Collan mentioned the forthcoming winter, when Botkin and the Empress would be in the South of France, noting it being ‘the case of Botkin’.61 Inside their working area, the so-called ‘palace city’, Collan and Botkin often visited the same patients and wore similar military uniforms with the epaulettes of a leibmedicus and Alexander II’s monogram.62 Botkin offered his opinions, for example, regarding one of Collan’s patients, a junker from the Nikolaevsky Cavalry School with an unidentified brain disease, and made several patient visits to another shared patient, Prince Georgii Romanovsky, the son-in-law of Nicholas I.63 In a letter, Botkin apologises for not remembering the exact number of his visits to the Prince.64 He was always very precise in his communications, perhaps reflecting his scientific scrupulousness and strong professionalism, also remarked upon by Zhuravskii.65 In the case of another shared patient, an unidentified baroness, Botkin regretted the inexactness of his information regarding the patient, for whom he wished to find a half an hour for a consultation: ‘Most respected confrere, I beg you to apologize for not being exact enough’.66 ‘Millionaires’ and ‘Proletarians’ Each of the physicians who are the subject of this article was motivated by career and patronage pressures, and each exhibited the type of relationship to money that is abundant in European medical narratives: generosity, financial naivety or a completely indifferent attitude to the value of money.67 But the same sources also reveal the unresolved contradictions between professional goals and the reality of medical work in Tsarist Russia, as Frieden has noted. Two recurring issues were physicians’ simultaneous underemployment and unemployment despite the great demand for their medical services. While remunerations from the court increased at times, well-paying clients were simultaneously lost in private practice. A recurrent element in Haartman’s narratives is that his court career threatened his regular income.68 Although private practice was expanded due to increased public prestige, court physician was a position for life and could thus act as a barrier to a lucrative private practice. Moreover, court physicians were predisposed to general economic fluctuations in the society. For example, during the financial depression of the early 1860s, physicians faced stringent financial conditions.69 Collan noted in 1862 that there was less work for all court physicians because 12,000 of the wealthiest families were gone: ‘The practice has during this year for all practitioners here been very poor; people are poorer, have gone abroad, to the countryside or pay their doctors extremely poorly’.70 A recurring trope in the correspondence is that of a court physician who had the potential to make ‘great money’, but instead chose a virtuous career and whose professional vocation always remained greater than matters of economy. ‘If I had been watchmaker, I would have made better fortune’, Collan remarked.71 Botkin’s attitude toward finances, as Belogolovyi notes, appeared to be rather similar.72 He worked for money only when necessary, in order to maintain a large family and provide an education for his children. Botkin was not attached to money and did not die a rich man, which he could easily have done so, according to Belogolovyi, as Botkin’s private practice began to reach enormous proportions around 1862–1863.73 Indeed, a noteworthy contradiction regarding the professional identity of two physicians from the same professional milieu can be noted here, that is, the simultaneous association of a physician as a ‘millionaire’ and a ‘proletarian’. Although these identities cannot necessarily be considered mutually exclusive, Botkin’s public image and the archival image of his colleague Collan, are in great contrast to one another. Collan’s perception of his class identity in one of the most prestigious positions in the profession was once reflected as follows: ‘Work, work. For you see, work is the ransom of life when you are a proletarian. For the rich man the ransom of life is enjoying, enjoying of the poor man’s work’.74 Collan made another similarly class-related remark, when maintenance costs and a fiscal crisis threatened the reputed military institute Nikolaevsky Cavalry School, where he initially worked as a military physician: ‘It seems that Russian nobility may no more afford their sons to strut at the Guards Cavalry’.75 Collan thus corroborated almost exclusively what Frieden refers to as the physician’s social position in the professional hierarchy of Russian society at the time, considering himself to be a part of the proletarian class, whereas Botkin was associated in the press with the image of a millionaire at the height of his fame as a scientist and leibmedicus:76 It’s expensive to live here in St. Petersburg, but even more expensive it is to die here. But the most expensive of all it is to remain on the stage between life and death. A Russian doctor does not content himself with these microscopic fees which Scandinavian and German physicians are satisfied with. If one calls for a fairly well-known doctor, one dares not to offer him a pay envelope with less than 5 or 6 rubles. Ten rubles is common for a first visit, five rubles for each following visit, and I have the honor to know one doctor here, who does not move under fifteen rubles. The notorious Botkin charges up to fifty rubles for a visit inside the city limits. Botkin has set his price so high, because he does not wish to be disturbed too often. Botkin has already long been a millionaire. He gives consultations at his home twice a week, and the stream of patients is constantly huge. If you wish to have a consultation from Botkin and do not want to pay the fifty rubles, you should write and request an audience from the great man, who afterwards by mail will inform the day and time for the audience.77 Indeed, as a typical indicator of a physician’s value in this time of growing capitalism, and perhaps shaping the ethos of the profession, Botkin’s professional prestige became strongly weighted in relation to the magnates’ rewards: Large rewards are not so rare among our practitioners, and as a rule, the reward is provided by diagnoses, which is of course entirely explicable. When the diagnosis becomes certain, the successful expiry of the disease is almost assured, unless the disease has already gone too far. The foremost of our Russian medical diagnosticians, the late Professor Botkin, frequently obtained 10.000 rubles for establishing a diagnosis. For example, when the famous millionaire Benardsky fell ill, for successful care over three weeks, Botkin was rewarded with 30.000 rubles. The Odessa patrons Rafalovich and Brodsky called Botkin to Odessa for a period of three days and every time paid him 15.000 rubles. Botkin was also often called to Berlin and Vienna, where the fee was set at 15 to 25,000 Thaler, but he could not travel because he was occupied with his clinical presentations.78 The press drew a very puzzling picture of Botkin’s income. According to Belogolovyi, Botkin indeed earned a significant amount, and he also received three solid inheritances from his brothers. When his practice experienced an influx of patients, Botkin’s residence was packed with up to 50 patients per day, a number which Botkin could not examine. He also made five or six city consultations daily, the so-called ‘palace city’ consultations as previously noted.79 Furthermore, Botkin was not only a first-class clinician, but also an excellent pharmacologist.80 His prescriptions (drops, pills, ointments) became widely available and added to his reputation in the remotest provinces in Russia.81 To put it another way, comparison between the archival material and the press sources indicates that the unpredictability of income was common among court physicians who were not celebrities, as was the case for Haartman: A child of the century I am, like so many others, in this my depravity of having become hard burned, always too much preoccupied by today’s and this life’s vile and sordid tasks, striving too often after material gain. … Just like a passing of a storm which makes the most ignorant and purest lilies tremble, I also must confess to someone that during these times, when I have had so little gains in my practice, and the costs have day by day arisen, I have not infrequently been à sec. This has indeed happened to me. I am very downcast because of so huge monetary losses, which I have made with my own hands, additionally aggravated by the Russian currency depression.82 To summarize, notwithstanding the reported divergence in the incomes of an average reputable physician and a celebrity physician, we can assume that if the annual salary in the late-1870s of a full professor at the Medico-Surgical Academy was about 3,150 rubles, and for a physician-in-ordinary 4,290 rubles, the annual income of a physician-in-ordinary without a private practice could not compete with the fees obtained from the private practice.83 Another recurring theme indirectly related to income is that of betrayal and intrigues between the factions. A physician’s particular skills and positive (as well as negative) feedback played an important role in professional identity, reputation and finances. This was particularly true when an important patient was treated successfully; then, the physician’s material benefits and professional opportunities multiplied.84 A singular and confidential relationship with the Empress are recurring elements of Haartman’s narratives, as is the continuous presence of court intrigues and plotting: ‘She has full confidence in me, which I have reason to suppose, as every known intriguer more or less against me has only fortified my position. … Her Majesty knows that what I say, I think’.85 One documented episode of factionalism introduced a new physician archetype, one with German scientific excellence, an impressive pedigree and medical administrative career: Zdekauer.86 His image was, however, slightly tinged by a rival image. An example of the factionalism between Haartman and Zdekauer also belies the nationality factor and another recurring theme of the narratives, that of professional integrity regarding patients’ medical documentation, which reappeared in a nearly identical fashion during the spring of 1879 between Zdekauer and Botkin, as we shall see in the next section. Haartman worked as a bedside physician during the period when the Tsarevich’s condition was worsening, in 1865, and he treated him until his eventual death from tubercular meningitis.87 Haartman complained of having ‘unspeakable worries and irritation inside and outside the House with Zdekauer’.88 The Tsarevich had seizures, for which Haartman used a therapy of cold, calomel (mercurous chloride) and vesicatorium. The conditions of the Tsarevich were slightly mitigated, and Zdekauer, who had been called to France, congratulated the Empress on the fortunate turnaround.89 After the Tsarevich’s death and autopsy in St Petersburg, following a reassuring discussion with the Emperor, who did not accuse any of the doctors of hastening the death of the heir, ‘in a moment when everything was as good as it could be’, Haartman found ‘our German documents made by him [Zdekauer], and a certified Russian and French translation that had been in a very infantile manner changed’. Haartman accused Zdekauer of having forged the autopsy documents and went to the Emperor to report on Zdekauer’s demeanor towards him and to request a change in both the Russian and French reports. Zdekauer’s autopsy claimed meningitis cerebro-spinalis as the cause of death, but the choice of words did not please Haartman who suggested Hirnhautentzündung [germ. brain fever, meningitis]. The Emperor suggested he drop the case.90 A court administrator also informed Haartman that too many weeks had passed since the death, and thus it was impossible to make changes to the documents. Afterwards, Haartman was consoled in a letter from the Viennese Professor Johann von Oppolzer, ‘Your opinion on the disease was, after all, quite right’. As for the basis of the document, it is difficult to establish what Haartman intended with the ‘German gang’, the disagreements between Zdekauer and Haartman seemed to have been on professional (diagnostic) and factional grounds. There may already have been rivalry between them by 1863, when Haartman lost his 3000-rouble annual salary for the ‘loss of the Grand Duchess Marie Nikolaevna’ (the end of the patient relationship). When discussing his future plans with the Empress, she had to inform him that she already had found ‘another’, possibly Zdekauer, who was well established at the court by that time.91 Overall, the death of the Tsarevich threatened Haartman’s reputation as a physician: ‘What impact all this shall have to my private practice is difficult to predict, but most likely it will suffer, and lead to an exceptionally long absence’.92 The Strange Mixture of Nihilism and Medicine or the Mysterious Play The factionality of the court’s medical staff, with a mixture of nationalism, conspiracy theories and ideological suspicion, seems to have projected into the professional milieu of the leibmedicuses and culminated during the spring of 1879. Botkin, who was known among his friends to be indifferent to politics, became closely associated (in the press) with the destructive influence of nihilism on Russian society.93 The evidence suggests that there was the question of an attempt to tarnish and desacralize Botkin’s professional image and scientific authority. The episode can also be read as an example of a public conceptualization of Botkin’s authority and status as a scientific expert, combined with the political stakes attached to his physician’s role, and a demonstration of how Botkin balanced his professional autonomy with his service to the central state. Botkin’s position during the scandal also suggests that he represented the new, democratic version of Russian masculinity, which rejected the former, Nicholaevan ideas of obedience and servility in front of the autocracy. Botkin echoed the new ideal of masculinity which valued rationality, education, integrity, social responsibility, diligence and independence of thought.94 Botkin’s name had appeared for the first time in 1866 in relation to ‘suspicious’ circumstances in a notebook owned by the notorious prisoner and nihilist Dmitri Karakozov, who had been treated in Botkin’s therapeutic clinic at the Medico-Surgical Academy in March 1866, but who had concealed his real name and ‘true’ condition.95 There is some confusion about whom Karakozov really consulted with on this occasion, Dr Botkin or his assistant, Dr Golovin, but the press noted that Botkin recognised him as a patient he had treated under another name, Dmitri Vladimirov.96 This time, in 1879, the rumour mill began after Botkin had demonstrated the preliminary diagnosis of a mild form of plague in a young man in a lecture in St Petersburg (the case of a porter for the Imperial Artillery School Naum Prokofiev).97 During the spring, two seemingly unconnected elements, a medical diagnosis of plague and the philosophical-political concept of nihilism, became tightly associated.98 In the late 1870s, when a second generation of nihilists emerged, the revolutionary activity took place, in particular, in the capital and against the autocracy.99 In the spring of 1879 in particular, there was heightened nihilist activity in St Petersburg.100 The Third Division (the Tsar’s secret police) found hidden presses operated by the revolutionary movement.101 The nihilist movement thus had a direct impact on the internal security of the Russian state. The authorities’ main fear was that even the moderates in society might sympathise with the revolutionaries.102 Frieden has noted that, aside from university students in general, medical students also had a reputation for radicalism, although the average medical student usually moderated his stance before completing his training, and only a small segment of the profession actually allied itself with more radical ideas.103 Two different medical commissions investigated the patient Prokofiev separately, with Zdekauer taking part in one of the commissions. The commissions argued against ‘Professor Botkin’s energetically claimed and maintained allegation’ of a light, benign, non-contagious form of the disease.104 Botkin’s authority and status as a scientific expert came under question, and he was accused of announcing the threat of plague in the European context, which was interpreted as an attempt to destroy Russia’s economy and prestige.105 According to some rumours, during his visit to inform the Emperor on the discovery, Botkin had been obsessed with the plague diagnosis, wanting to have a ‘plague in St Petersburg at all cost’.106 Botkin’s students were also rumoured to have reported with exultation that Botkin had a case of plague in hospital.107 The overall interest that Botkin showed in the Prokofiev affair was interpreted to mean either that he had made a mistake, or that some ‘mysterious play was going on behind the scenes’.108 As an illustrative example of the new reform era of scientists and physicians, Botkin stood alone, with only his energy and prestige, before the medical administration and the entire scientific world.109 ‘I am obliged’, he stated ‘to maintain the meaning of my statement as my sincerest scientific belief, notwithstanding all the attacks directed against me, which I, with perseverance, shall have to understand to bear’.110 Botkin’s heroic image came to be strongly supported by the positive rumour mill, which praised him for his straightforward manner: ‘The people die while the doctors dispute’, Botkin had noted.111 But very soon his medical authority was combined with the political stakes attached to his physician’s role and moved beyond purely medically based accusations: ‘We cannot exclude, that the assaults against Botkin are [the] result of ignorance, envy and party passion’.112Morgonbladet, citing Sankt-Peterburgskie Vedomosti, insinuated a rather important adversary with the metaphor of a pug and an elephant: ‘The pug must surely be rather big and strong as it dares to bark to an elephant’.113 The pug’s German, Swedish and Finnish variation, mops, referred to Botkin’s unknown adversary, a loyal lackey, whereas the elephant, used to represent Botkin, symbolized wisdom, strength and power. This implied two competing factions, the German and the Russian, in the sphere of court medicine, but the mops also bore connotations of Freemasonry. The mops was the symbol of an eighteenth-century Masonic society, Mops Orden, the Order of the Pug, which is known to have been active in Germany. Reference to Freemasonry was in fact a typical multiple signifier used in the contemporary Russian press for foreign, often German domination, elitism, and veil of secrecy.114 The ‘unbridled cancan’ around Botkin’s authority continued, with revelations of more specific interests and agendas behind the disproportionate reaction: Notwithstanding to commissions with different diagnosticians, Professor Botkin has not abandoned his view. Professor Botkin is the most feared, but also the most hated person in the St Petersburg administrative circles. His bravery and his energy are well known. No one dares to oppose this man, who not so long ago dared to refuse to give services as a doctor to a very highly-placed wife, because she had not enough strictly followed his advice and regulations; at that time, in court and aristocratic circles, this incident brought unheard attention, and Botkin fell out of favor. However, very soon Botkin was asked to take over her treatment. Botkin, who is indispensable to the imperial couple as a physician and is in possession of their highest favors, has very high earnings, and has aroused the administration’s attention, which no longer leaves him in peace. Botkin gives daily consultations to the Emperor, gives lectures in the Medical Society, publishes articles in which he blames persons for their laziness, and makes radical proposals in the sanitary commission, watching carefully over their eventual implementation. In short—Botkin masters the situation.115 Besides exposing Botkin’s actual power at court, this passage also speaks to a sort of therapeutic nihilism wherein Botkin, as Kichigina notes, was criticised for expressing his opinions. Therapeutic nihilism was considered a highly stigmatic therapeutic faith, originating in the Viennese school of medicine, promoting scepticism of drugs, attaching less importance to symptomatic therapy and attributing greater importance to adequate diet and proper patient care.116 As Botkin’s treatment of the unknown highly-placed wife indicates, he did, indeed, dare at times to express opinions and statements that did not sit well with patients or courtiers, although Zhuravskii’s study refutes the presence of therapeutic scepticism in Botkin’s medical arsenal.117 Zdekauer appeared at a Union of Practicing Physicians session and, when asked to express his opinion on the Prokofiev case, stated that he ‘did not wish to start a polemic with Professor Botkin’, and concluded cryptically, ‘I’m an enemy of any battle; time will tell which of us is right or, wrong’.118 When an allusion was made that Botkin had not differentiated the case of bubonic plague from syphilis during his initial examination of Prokofiev (Botkin was well informed of the patient’s previous syphilis diagnosis), Zdekauer became exposed. A telegram had arrived at a journal’s desk with information that Botkin’s diagnosed case of bubonic plague was actually syphilitic sores.119 Zdekauer personally confessed that as a member of the administrative commission who examined the patient, ‘at the completion of the Commission’s minutes, a mistake occurred, and the word syphilis inadvertently went there’.120 Professor Botkin was right after all in his diagnosis of the suspicious case in St. Petersburg. His opinion was of course misrepresented by his enemies, of which he has a great many. … His worst enemy is old Professor Zdekau[e]r, whom he replaced as physician extraordinary to the Czar, and who is naturally jealous. The storm of abuse went so far as to assert that Professor Botkin was a secret Nihilist, and declared the case to be one of plague in order to stir up panic and discontent in the kingdom.121 Aside from professional jealousies, a lack of patriotism, therapeutic nihilism, gambling with the stock exchange, conspiring with the British and the falling value of the Russian rouble, the most serious charge against Botkin was naturally a political one.122 Accusations of political nihilism also came from higher directions than from his colleague Zdekauer, although the highly similar pattern of irregularities in patient documentation in the Zdekauer–Haartman case of 1865 is worth recalling here.123 In April 1879, one of Botkin’s assistants was arrested on suspicion of being a nihilist sympathiser aware of revolutionary propaganda being spread via secret presses.124 Two of Botkin’s assistants were rumoured to be leading Nihilists. Botkin’s second wife, Ekaterina Alekseievna Mordvinova, neé Duchess Obolenskaia, as the spouse of a high military procurator, was suspected of sympathising with nihilist ideas and charged with engaging in revolutionary intrigues and conspiracy: ‘Here [in St Petersburg] they quite openly speak that even the wife of the learned professor, Princess O., might be sympathetic to nihilistic ideas’.125 The two ladies had contained promises of assistance to two young male university students, written benevolent letters to them and given them money and advice.126 Still, in the autumn of 1879, Botkin’s family was under police surveillance, and a police officer was ‘always close to the place where the family resided’. Madame Botkin, since her release from prison, was noted to be leading a mostly retired life in the countryside.127 A satirical reference to ‘look for the woman’ behind Botkin as a root cause, had appeared in the press as early as 1875, suggesting Madame Botkin’s strong influence on Botkin. Botkin was portrayed, although showing character and firmness in his dealings with the court, as also being powerless before his own wife.128 The authorities’ suspicions of nihilist contacts, especially among physicians, may indeed have been warranted. Among Collan’s letters, there is one from a key member of the early Russian nihilist movement who has left very few documents and about whom very little is generally known—the young revolutionary Nikolai Serno-Solovyovich, who at the time had emigrated to Bern in Switzerland. This letter seems to imply that Collan had the two brothers as patients, the Serno-Solovyoviches.129 Nikolai belonged to the first generation of Russian nihilists, was a member of the clandestine organisation Land and Liberty and a correspondent for the revolutionary newspaper Kolokol.130 Collan’s memoirs describe Nikolai as follows: There was the young Serno-Solovyovich, a noble and ardent soul with eminent intellectual abilities. His capacity as correspondent of the revolutionary journal Kolokol, published in England in the 1860s, his disinterested patriotism and his liberal ideas caused his captivity, and he was sentenced to deportation to Siberia. His delicate health could not endure the hardships of the journey, and he died before arriving.131 Collan supposedly treated Nikolai’s more renowned brother, Alexander Serno-Solovyovich, too. Alexander played an important role in the early history of the Geneva Organisation of the First International, cooperated directly with Karl Marx and was named among the first who was planned to translate Marx’s works into Russian, an idea that he never realised; Alexander Serno-Solovyovich committed suicide in 1869.132 In a letter of 1860, Nikolai appealed to Collan to watch carefully over his brother Alexander’s fragile health. He had learned of his brother’s illness only recently, and it affected him profoundly, ‘like a sharp pain’. In his anguish, Nikolai addressed Collan, for whom he had ‘sincere feelings of friendship’, and asked him not to refuse his appeal.133 In this patient relationship, we can observe the conflicts a physician of the Russian court faced between his status as a state official and adherence to a code of medical ethics, balancing between professional and political demands.134 Botkin was already expressing the high pressures of being a court physician in 1877 in a letter to his wife, where he notes that his ‘nerves’ were too stretched to continue to bear the plight of the role; the doctor’s duties at times made his position intolerable.135 In the letter, Botkin refers to the court intriguers and to subsequent working conditions in which every fact had to be treated with extreme caution. At 45 years of age, he was losing his independence, freedom of action and a certain freedom of thought ‘listening to everything, seeing everything and saying nothing,’ which made him feel it was time to ‘get out of the hell of vanity, envy and avarice’.136 Similarly, a few years prior to this, Collan used nearly identical wording in a letter from the Romanovs’ Livadia Palace in which he mentions the physician’s social position in the court, the loss of independence after 31 years of autonomous living, the difficulty of being the court’s ‘habitual servant’ and being surrounded by the ‘purest parasites’ (i.e. court insiders). As a physician, he felt forced to maintain a joyful face or otherwise be considered a gloomy type. Collan noted, for example, that ‘Livadia is a gorge for me; only the body prospers, but my soul sleeps’.137 Yet one telling aspect of Botkin’s manner deserves a mention; in the midst of his personal torment, he directed public attention to the living conditions of Prokofiev and his fellow workers. At the outset of the scandal, Botkin had ordered his assistant to visit Prokofiev’s home, the dark, damp, underground den and pestilential cellar in which ‘even in broad daylight it is necessary to keep a lamp burning’. The press published a report on the uninhabitable cellar and reminded that if the published sketch of the dwellings regarded the Imperial Artillery School where Prokofiev was employed, ‘what must the cellars be like in the poor quarters?’138 Overall, the political turmoil surrounding Botkin elucidates the difficult task of the reform era authorities’ efforts to balance between encouraging medical professionalisation and the heightened fear of underground radical movements.139 The authorities suspected that the nihilists would not hesitate to use the opportunity of the plague to further their revolutionary schemes.140 Kichigina has noted that Botkin appeared as a convenient target for the conservative press to attract public attention to an old-new evil (nihilism) in Russian society.141 On the other hand, a revolutionary underground was active at this particular moment, and inevitably there were connections between some physicians and patient-revolutionaries, as evidenced in the materials of this essay. Botkin certainly stood at the centre of intersecting political and professional agendas, by which the political one, represented by the state security apparatus, seems to have been reasonably justified, albeit extremely heavy-handed. Also, within the setting of Botkin’s prior image as an ideal projection of the court’s Slavophile aspirations, added to his alleged nihilist connections, the press implicitly referred to the question of whether Botkin was, after all, a ‘true’ Russian. Even if the medical society soon forgot the scandal and, over the long-term, it did not affect Botkin’s professional status and reputation, the accusation was a heavy blow that affected his faith in those around him and led him to become more distant from the court in the following years.142 While he is noted to have been close to the Emperor Alexander II and his family, he stayed away from the court of Alexander III, showing up only for occasions of medical consultation.143 Although Alexander III had great respect for Botkin as a physician and scientist, it is unlikely that Botkin was very close with the court, as he was considered too far to the political left in relation to his wife.144 Such a distance was noted, for example, during one of Botkin’s consultations with the Princess Catherine Dolgorukova (Alexander II’s morganatic wife), whose fever Botkin cured in 1883: ‘Professor Botkin, who was Tsar Alexander II’s leibmedicus and is an intimate friend of the princess, has already for a long time completely withdrawn himself from the court circles. It is known that he remained an adherent of Alexander II’s liberal ideas and does not feel gratified with the current regime’.145 During the 1880s, Botkin bought a manor in Finland at a distance of three hours from St Petersburg, where he spent several summers devoting himself to more leisure time.146 In Finland’s ‘salubrious climate’ (i.e. the environment of his summer residence, which was characterised by coniferous forests, dry air and a proximity to the sea), he planned to establish a spa and bathing establishment, but the notion never materialised.147 During his final summer, Botkin rested at his villa in Finland: Professor Botkin, the Empress’s personal physician, every year during the summer months stays on his property [in Finland]. Here rests the European-wide celebrity from the efforts of his enormous practice in the Russian capital. During the beautiful season here stays also Botkin’s son-in-law, the reputable and sympathetic Petersburghian Doctor Borodulin, who completed his education under Professor’s [Botkin] own supervision and who has nowadays even taken over part of Botkin’s practice, as well as the three sons of Botkin, likewise physicians. Moving is that helpfulness by which the named doctor treats the peasants in the neighborhood, providing peasants both medical care and pharmacy goods from the [Botkin] family’s medicine chest [home pharmacy], handing them over without any compensation.148 Conclusion In this essay, we have observed how some of the major peculiarities of the practice of medicine under an autocratic system (such as physicians’ keen professional associations with the state), visible already by the era of Nicholas I, met the waves of mid-nineteenth-century rationalist thought and how these were manifested in the court’s medical community during the reform period. Slavophilism, ideology quite subservient to autocracy, was a force of the 1840s, which, in the studied material, encountered an intellectual reaction in the shape of nihilism, the most anti-autocratic ideology of the 1860s. The influence of this changing intellectual atmosphere to the course of events in the sphere of court medicine during this period requires a deeper understanding and evaluation. Based on the materials available for review, it seems that slavophilism was linked to the change in the nationality of the court’s physicians. Generally speaking, the return of the mystical-irrationalist line of thinking, in the shape of slavophilism, on the eve of scientific rationalist era and its role in the shaping of the events can be included among the major contradictions or atypicalities of the development of the Russian court’s medical community.149 That is to say, slavophilism introduces the religious and spiritual strand relevant to the setting of the court medicine at this time. The discourses present in the correspondence and press materials cited in this study make it possible to expose some of the typical archetypes present in the court’s medical community. These include the alleged ‘Germanness’ of the Russian medical staff, still insisting in the mid-nineteenth century on the clichéd images of a cunning magnetiser (Mandt) and a slightly deceitful representative of German scientific excellence and member of a medical dynasty (Zdekauer). Physician archetypes also include the court’s habitual servants, idle day dreamers of the pre-reform era (Collan and Haartman), whose time was doomed. This archetype of the faithful valet behind the (Emperor’s) door, who never took offence, with attributes of patience, comfort and kindness, was less independent than their illustrious colleague, but as he ‘belonged to the picture’, he was no less irreplaceable in the court of Romanov.150 A different image is created of the most emblematic representative of Russian science in the second half of the nineteenth century, Sergei Botkin; he represents the physician archetype of the Russian genius, and the ‘new man’ of 1860s. Not only did he earn the sympathy of the Tsar, but he also won over both of the two persecuting parties during the nihilism scandal (collegial jealousy and the ideological suspicion by the state), maintaining his image and power at the court, while resisting political and professional attempts to isolate him in court intrigues. Botkin’s public image produced a climate of opinion that reflected both his physician’s authority and status as scientific expert, but above all, the lacking national feature in the Romanov court medicine. ‘A Russian of the Russians’, Botkin most likely also possessed a core personal prerequisite without which no high authority in the patriarchal Russian society and, in the political culture of the time, he would have been able to obtain and maintain longer lasting power: a sense of manliness. His personality traits of ‘confidence and dignity’, combined with the firmness that ‘no one dared to oppose’, and even his size (Botkin is noted to have been quite physically robust) and tastes strengthened the image suitable for the patriarchal ideal of this period.151 As is remarked upon in both the archival and secondary materials, Botkin represents all stages of the hero myth, from trial with his adversaries to self-realization and final liberation, and to eventual deification; all of which occurred in his lifetime. Although the nihilism hunt in the medical community concerned the actual threat of revolutionary underground movements active during the spring of 1879, the events and people involved may in fact reveal a deeper crisis and struggle for power in the court’s medical staffing in the shape of factionalism. It is presumable that an ultimate change of court physicians from the age-old German ‘yoke’ to their Russian replacements was going on, and that Botkin either took or was given the part of personifying this scenario. The duel between the unknown adversary and Botkin can be interpreted as a metaphor for the generational change in the court physicians’ nationalities, and more generally, between German and Russian authority in the sphere of court medicine. Frieden noted that the Russian physicians experienced an ambivalent relationship with the state, as in Western Europe, but in Russia this ambivalence was more extreme and required a constant interplay of professional and political demands. Frieden also noted that the state at times blocked attempts at autonomous professional organization.152 The evidence in this study confirms, to a certain extent, the atypical development of court physicians when achieving professional autonomy and the coexistence of several controversies (class identity, employment patterns, the question of nationality, finances, controversial ideological elements affecting the course of events). As is noted about zemstvo physicians of this particular period, the court physicians’ relations with the state seem ambivalent in this material as well, although this is a question that requires further evaluation. Acknowledgements I would like to thank the anonymous reviewers of the Social History of Medicine for their comments and recommendations, which significantly improved this paper. Footnotes 1 Description of Botkin in the memoirs of Alexander Collan by Adèle Collan, La Vie de Mon Père (Helsingfors: Imprimerie Centrale de Helsingfors, 1911), 66–7. 2 Nancy Mandelker Frieden, Russian Physicians in an Era of Reform and Revolution, 1856–1905 (Princeton: Princeton University Press, 1981); Galina Kichigina, The Imperial Laboratory: Experimental Physiology and Clinical Medicine in Post-Crimean Russia (Amsterdam: Brill Academic Publishers, 2009). I shall also refer to a lesser-known study on the medical secrecy of the house of Romanov by Boris A. Nahapetov, Vrachebnie tainy doma Romanovykh (Moscow: Veche, 2008) and to Sergei G. Zhuravskii, ‘Diaries of S.P. Botkin, Physician-in-Ordinary to the Tzar Family, as Encyclopedia of Medicine of the Russian Imperial Court’, History of Medicine, 2016, 3, 121–32. 3 For the term ‘great doctors’, see Susan M. Reverby and David Rosner, ‘Beyond the “Great Doctors”’, in S. Reverby and D. Rosner, eds, Health Care in America: Essays in Social History (Philadelphia, PA: Temple University Press, 1979), 3–16; Frank Huisman and John Harley Warner, Locating Medical History: The Stories and Their Meanings (Baltimore, MD: Johns Hopkins University Press, 2004), 167–93. 4 Nikolai A. Belogolovyi, S. P. Botkin: ego zhizn’ i vrachebnaia deiatel’nost’ (St Petersburg: Tipografiia J.N. Erlikha, 1892), 34–5, 44; Boris A. Nahapetov, ‘O deiatel’nosti S. P. i E. S. Botkinikh na postu leib-medika’, Klinicheskaia Meditsina, 1996, 74, 79–81; Evgraf A. Golovin, Pamiati Sergeia Petrovicha Botkina (St Petersburg: Tipografiia M.M. Stasiulevicha, 1890). On the history of Russian medicine, see also B. Mark Mirskii, Meditsina v Rossii XVI–XIX vekov (Moscow: Rosspen, 1996). 5 The era of fundamental changes in Russian society began at the end of the 1850s, reached its climax in the early 1860s and had run its course by 1868 (e.g. the emancipation of the serfs, the reorganisation of the universities and the liberalisation of local government and justice). 6 The Tsar’s preference for doctors from Germany is documented in Alexander Brückner, Aerzte in Russland bis zum Jahre 1800. Ein Beitrag zur Geschichte der Europäisirung Russlands (St Petersburg: Kaiserliche Hofbuchhandlung H. Schmitzdorff, 1887), 13, 39; Andreas Renner, ‘The Concept of the Scientific Revolution and the History of Science in Russia’, in R. Bartlett and G. Lehmann-Carli, eds, Eighteenth-Century Russia: Society, Culture, Economy. Papers from the VII International Conference of the Study Group of Eighteenth-Century Russia (Wittenberg, Berlin: Lit Verlag, 2004), 365–6; Sabine Dumschat, Ausländische Mediziner im Moskauer Rußland (Stuttgart: Franz Steiner Verlag, 2006), 548; Loren R. Graham, Science in Russia and the Soviet Union: A Short History (New York: Cambridge University Press, 1993), 245. German physicians constituted a majority of physicians in Russia until 1800, after which the proportion started gradually to turn in favour of the Russians. On the medical and ethical competence of the foreign medics in particular, see Frieden, Russian Physicians, 21, 31; John T. Alexander, Bubonic Plague in Early Modern Russia: Public Health and Urban Disaster (Baltimore, MD: Johns Hopkins University Press, 1980), 37–9, 45; Kristin Zieger, Die Bedeutung der deutschen Ärztevereine für das wissenschaftliche Leben, die medizinische Versorgung und soziale Belange der Stadt St. Petersburg von 1819–1914 (Leipzig: Universität Leipzig, 2003), 11–13, 22–4. 7 Andreas Renner, Russischer Nationalismus und Öffentlichkeit im Zarenreich 1855–1875 (Köln, Weimar, Wien: Böhlau Verlag, 2000), 46, 295; Andreas Renner, ‘Defining a Russian Nation: Mikhail Katkov and the “Invention” of National Politics’, The Slavonic and East European Review, 2003, 81, 659–82; Nahapetov, Vrachebnie tainy, 16, 159–60. 8 Kichigina, The Imperial Laboratory, 151. 9 Andreas Renner, Russischer Nationalismus, 63; Richard S. Wortman, Scenarios of Power: Myth and Ceremony in Russian Monarchy from Peter the Great to the Abdication of Nicholas II (Princeton, NJ: Princeton University Press, 2006), 190. 10 Renner, ‘Defining a Russian Nation’, 680. 11 Kichigina, Imperial Laboratory, 201–4; Belogolovyi, S. P. Botkin, 44. 12 Belogolovyi, S. P. Botkin, 34–5. 13 Zhuravskii, ‘Diaries of S.P. Botkin’, 131. Three of Botkin’s diaries have shed light on the practical organisation of the court’s medical care, but there is considerably less reference in them to personal and professional matters. 14 For medical professionalisation, see also William F. Bynum, Science and the Practice of Medicine in the Nineteenth Century (Cambridge: Cambridge University Press, 1994); Vivian Nutton, Medicine at the Courts of Europe, 1500–1837 (London: Routledge, 1990) in which in particular J. T. Alexander, ‘Medicine at the Court of Catherine the Great of Russia’, 182–208, and William F. Bynum, ‘Medicine at the English Court’, 262–89. The documents accessed for this paper are housed as follows: the manuscript collection held by the National Library of Finland in Helsinki (henceforth NLF/MC) analysed here contains the correspondence of leibkhirurg Alexander von Collan (1819–1910) (Catalogue 42); the manuscript collection of the Åbo Akademi University Library, in Turku (henceforth ÅAUL/MC), contains correspondences by both leibmedicus Carl von Haartman (von Wendt 3 collection) and Alexander von Collan (A. v. Collan’s letter collections II and III). 15 Rumour is central to the analyses by Boris Ivanovich Kolonitskii, a specialist in the linguistic peculiarities of the Russian monarchy and political culture. See Orlando Figes and Boris Kolonitskii, Interpreting the Russian Revolution. The Language and Symbols of 1917 (New Haven, CT: Yale University Press, 1999), 5–10; Boris Ivanovich Kolonitskii, ‘Tragicheskaia erotika’: Obrazy imperatorskoi sem’i v gody pervoi mirovoi voiny (Moscow: Novoe literaturnoe obozrenie, 2010). 16 Ibid. 17 Digitised versions of nineteenth-century periodicals used in this study come from the Digital Collections of the National Library of Finland and from the British Library Newspapers. 18 Elisa M. Becker, Medicine, Law, and the State in Imperial Russia (Budapest, New York: Central European University Press, 2011), 2–6, 273–4; Frieden, Russian Physicians, 14–16. 19 Nahapetov, Vrachebnie tainy, 158, 162–3. Leibmedic[us] (germ. leib, body, belly + lat. medĭcus) corresponds to leibartz in German. Leibmedik (internist) and leibkhirurg (surgeon) were the two major medical ranks in eighteenth-century Russia. Collan used the Swedish variant of leibmedicus, lifmedicus [livmedicus] to address or refer to all of his medical peers in the Russian court. 20 For Botkin becoming leibmedicus, see Nahapetov, ‘O deiatel’nosti’, 79–81; Belogolovyi, S. P. Botkin, 51; Kichigina, Imperial Laboratory, 97, 201–4. For Zdekauer, see Julius Pagel, Biographisches Lexikon hervorragender Ärzte de neunzehnten Jahrhunderts. Mit einer historischen Einleitung (Berlin: Urban & Schwarzenberg, 1901), 1891; R. von Liliencron and A. Bettelheim, Allgemeine Deutsche Biographie 55, (Leipzig: Verlag von Duncker & Humblot, 1910), 401. Zdekauer earned his Doctor of Medicine degree from MSA in 1842. From 1860 to 1861, he served as the honorary consultant leibmedicus to the Emperor, and from 1865 as the consultant leibmedicus of the Emperor and Grand Dukes Vladimir, Alexei and Pavel Alexandrovich. For Haartman, see Gustaf Heinricius, Obstetrikens och Gynäkologiens Historia i Finland under 18de och 19de århundradet (Helsingfors: Frenckellska Tryckeri-Aktiebolaget, 1903), 194–200; Tor Carpelan, Ättartavlor för de på Finlands Riddarhus inskrivna efter 1809 adlade, naturaliserade eller adopterade ätterna (Helsingfors: Frenckellska Tryckeri Aktiebolagets Förlag, 1937), 123–6; Kai Kartio, The Beer King of Helsinki, The Czarina’s Personal Physician and Dutch Old Masters (Helsinki: Frenckellin Kirjapaino, 1994), 128. For Collan, see Collan Family, signum 37.1, NLF/MC; Carpelan, Ättartavlor, 69–70; J. E. Railo, ‘Kunniahenkikirurgi Alexander von Collan ja hänen instrumenttikaappinsa’, Hippokrates, 1991, 8, 93–122. 21 Kichigina, Imperial Laboratory, 105–9; Collan, La Vie, 44–8; Heinricius, Obstetrikens, 194–200; A. Collan to C. Collan (henceforth Collan to Collan), St Petersburg, 21 May 1869, signum 37.9, NLF/MC. 22 Kichigina, Imperial Laboratory, 10; Frieden, Russian Physicians, 21. Andreas Renner, ‘Wissenschaftstransfer ins Zarenreich des 18. Jahrhunderts. Bemerkungen zum Forschungsstand am Beispiel der Medizingeschichte’, Jahrbücher für Geschichte Osteuropas, 2005, 53, 65–85; Renner, ‘The Concept of the Scientific Revolution’, 366. 23 Nahapetov, Vrachebnie tainy, 265. 24 A. Collan to C. Collan, undated, signum 37.9, NLF/MC. 25 Frieden, Russian Physicians, 44–51. 26 Belogolovyi, S. P. Botkin, 51; Nahapetov, Vrachebnie tainy, 265. 27 Brückner, Aerzte in Russland, 38–9, 49; Zieger, Die Bedeutung, 14. 28 Nahapetov, Vrachebnie tainy, 158, 162–3. 29 Nahapetov, Vrachebnie tainy, 158–9; Alexander, Bubonic Plague, 41. 30 Nahapetov, Vrachebnie tainy, 210. 31 A. Collan, ‘Historier, anekdoter och squaller från hofvet i St Petersburg’, undated, unpaginated account book, signum 37.7, NLF/MC (henceforth ‘Historier, anekdoter’, NLF/MC). 32 Nahapetov, Vrachebnie tainy, 203. 33 Nahapetov, Vrachebnie tainy, 206–7. 34 Ibid. 35 ‘Historier, anekdoter’, NLF/MC. 36 For the quote, see Nahapetov, Vrachebnie tainy, 206. For the suspicions about the death of the Tsar, see ‘Historier, anekdoter’, NLF/MC. The document speculates between the two renowned theories on the cause of death, but does not bring significant new information to it. Only a minor misunderstanding regarding the method of embalming the Emperor’s corpse is noted. 37 Wortman, Scenarios of Power, 334. 38 Kichigina, Imperial Laboratory, 202. 39 His Moscow University alma mater and excellence in practice had already been noted in 1873, in Finland’s Allmänna Tidning, 14 February 1873, 3. 40 Freeman’s Journal, 2 July 1875, 2. 41 North Wales Chronicle, 23 January 1875, 5. 42 Belogolovyi, S. P. Botkin, 51; Kichigina, Imperial Laboratory, 97, 201–4. 43 Belogolovyi, S. P. Botkin, 50. 44 North Wales Chronicle, 23 January 1875, 5. 45 On Botkin's ministrations and the Empress’s response, see Zhuravskii, ‘Diaries of S.P. Botkin’, 130; C. F. G. von Haartman to C. D. von Haartman (henceforth Haartman to Haartman), 30 November 1863; undated 1864 or 1865; 29 July 1864; 29 April 1868; 7 July 1868; 13 February 1869; 17 February 1869, ÅAUL/MC. Comparing Botkin’s treatment strategy, available in Botkin’s diaries, to those of Haartman and Collan, it is apparent that several therapeutic approaches used by Botkin were already in use during Haartman’s and Collan’s tenures. These include balneotherapy or spa water treatments, the so-called climate therapy, passive gymnastics or massage therapy, as well as the intake of mineral water made from evaporated Carlsbad salt. Instead, Botkin’s pioneering scientific approach, such as his use of microscope and exact laboratory methods to examine the Empress’s health, were certainly innovative and specific solely to Botkin. 46 C. F. G. Haartman to A. Collan, 15 May 1873, signum 37.5, NLF/MC contains mention of the Empress’s catarrh improving, while her subsequent feeling unwell is documented in C. F. G. Haartman to A. Collan, undated, 1874, signum 37.5, NLF/MC. 47 For the introduction of chloroform, see C. F. G. von Haartman, ‘Några iakttagelser om Chloroformens bruk i Barnförlossningskonsten’, Finska Läkare-Sällskapets Handlingar, 1849, IV, 11–32. Haartman had studied and used chloroform during his London and Edinburgh visits, in particular under Professor James Simpson in 1848. He tested chloroform at the General Lying Hospital in London on 25 randomly selected cases (observing 105 childbirths and personally completing 81 deliveries). His lack of knowledge of internal medicine is mentioned in Zhuravskii, ‘Diaries of S.P. Botkin’, 122. 48 Railo, ‘Kunniahenkikirurgi’, 112; Kartio, Beer King of Helsinki, 128. 49 Heinricius, Obstetrikens, 200. 50 Nahapetov, ‘O deiatel’nosti’, 79–80; Nahapetov quotes a primary source in the Russian State Historical Archive (RGIA), fund 479, op. 1 in Nahapetov, Vrachebnie tainy, 267. In May 1875, the Emperor assigned Botkin ‘1430 rubles salary for staff, dining rooms and apartment and the amount of money currently received by leibmedicus Hartmann, 2860 rubles, making altogether 4290 rubles’. 51 Haartman to Haartman, undated, 1872, ÅAUL/MC. 52 Haartman to Haartman, May 1872, ÅAUL/MC. 53 Haartman to Haartman, 23 [July?] 1863, ÅAUL/MC. 54 On the slavophile group in Moscow, see Nicholas Riasanovsky, Russian Identities: A Historical Survey (Oxford: Oxford University Press, 2005); Nicholas Riasanovsky, Russia and the West in the Teachings of the Slavophiles: A Study of Romantic Ideology (Cambridge, MA: Harvard University Press, 1952), 152–4; Nicholas Riasanovsky, Nicholas I and Official Nationality in Russia, 1825–1855 (Berkeley, CA: University of California Press, 1959); Andrzej Walicki, The Slavophile Controversy (Oxford: Clarendon Press, 1975); Olga Maiorova, From the Shadow of Empire: Defining the Russian Nation through Cultural Mythology, 1855–1870 (Madison, WI: University of Wisconsin Press, 2010). According to Riasanovsky, Slavophile ideology fits into the framework of European Romanticism (German romantic thinkers), but the Slavophiles adapted Romantic doctrines to their own situation and needs, including the influence of Orthodox religious thought and tradition. Haartman to Haartman, Ilinskoe, 2/14 June 1866 and 9 June 1866, ÅAUL/MC discusses the Empress’s own circle. Haartman stayed occasionally with the Empress at her Ilinskoe-estate near Moscow on the Moscow River. Richard Wortman, in his Russian Monarchy: Representation and Rule (Boston: Academic Studies Press, 2013), 102, looks at the Empress’s turn to Russian Orthodoxy. 55 Collan, La Vie, 67. 56 Ibid. 57 Andrzej Walicki, ‘Russian Social Thought: An Introduction to the Intellectual History of Nineteenth-Century Russia’, The Russian Review, 1977, 36, 18–19; Alexander Vucinich, Science in Russian Culture, 1861–1917 (Stanford, CA: Stanford University Press, 1970), 3–11. 58 Collan documents this in A. Collan Sr. to A. Collan Jr., 22 September 1866, ÅAUL/MC, and Haartman in C. F. G. Haartman to A. Collan, 4 October 1867, signum 37.5, NLF/MC. 59 Collan to Collan, 10 July 1868, signum 37.9, NLF/MC. 60 Collan to Collan, 1/13 May 1870; 19 August 1870; 23 September 1870; 12/24 September 1871, signum 37.9, NLF/MC. 61 Belogolovyi, S. P. Botkin, 51; Collan to Collan, 8/20 November 1874, signum 37.9, NLF/MC. 62 Sergei Botkin, Pis’ma S.P. Botkina iz Bolgarii 1877 g (St Petersburg: Tipografiia M.M. Stasiulevicha, 1893), 12; Nahapetov, Vrachebnie tainy, 261. 63 Junker (germ. Junker) in the Russian context refers to a graduate from the military cadet school. In the specific case of Nikolaevsky Cavalry School, it referred to a young cadet of noble family. The unidentified brain disease is mentioned in Sergei Botkin to Collan, 27 or 26 March 1874, signum 37.3, NLF/MC which contains details of their shared patient. 64 Sergei Botkin to Collan, undated, signum 37.3, NLF/MC. 65 Zhuravskii, ‘Diaries of S.P. Botkin’, 125. 66 Sergei Botkin to Collan, 9 January 1873, signum 37.3, NLF/MC. 67 Beth Linker, ‘Resuscitating the “Great Doctor”. The Career of Biography in Medical History’, in T. Söderqvist, ed., The History and Poetics of Scientific Biography (Aldershot: Ashgate, 2007), 221–39; Stana Nenadic, ‘Writing Medical Lives, Creating Posthumous Reputations: Dr Matthew Baillie and his Family in the Nineteenth Century’, Social History of Medicine, 2010, 23, 509–27; Frieden, Russian Physicians, 221. 68 Haartman to Haartman, 10/23 October 1863; 30 November 1863, ÅAUL/MC. 69 Frieden, Russian Physicians, 43. 70 Collan to Collan, 8/20 July 1862, signum 37.9, NLF/MC. 71 Collan, La Vie, 66. 72 Belogolovyi, S. P. Botkin, 78–9. 73 Belogolovyi, S. P. Botkin, 38–40. 74 Collan to Collan, 15/24 March 1874, signum 37.9, NLF/MC. 75 Collan to Collan, 18 May 1862, signum 37.9, NLF/MC. 76 Frieden’s comment can be found in Russian Physicians, 209. 77 Morgonbladet, 1 August 1884, 2. 78 Åbo Tidning, 25 October 1894, 3. 79 Belogolovyi, S. P. Botkin, 39–40. 80 E. V. Korsun and M. A. Avkhukova ‘Vklad S. P. Botkina v razvitie otechestvennoi fitoterapii’, Klinicheskaia Meditsina, 2012, 90, 22–3. 81 Belogolovyi, S. P. Botkin, 40. 82 Haartman to Haartman, undated by month, date 13, 1865, ÅAUL/MC. 83 The income figure for an Academy professor is taken from Zhuravskii, ‘Diaries of S.P. Botkin’, 127. 84 Collan to Collan, 2 August 1860, signum 37.9, NLF/MC. In the Peterhof military training camp, an unidentified Grand Duke and Admiral Yevfimy Putyatin acclaimed Collan for not having a single cadet fallen ill among 1200 cadets during the summer of 1860. 85 Haartman to Haartman, 29 July 1864, ÅAUL/MC. 86 Zdekauer to Collan, signum 37.6, NLF/MC. 87 The Tsarevich died in Nice. ‘Because of my daily and long presence this winter with him, I learned to know and learned to love the successor to the throne and he learned to like me too’, Haartman wrote; Haartman to Haartman, 3 May 1865, ÅAUL/MC. 88 Haartman to Haartman, undated, 1865, ÅAUL/MC. 89 Haartman to Haartman, 3 May 1865, ÅAUL/MC. 90 Haartman to Haartman, undated, 1865, ÅAUL/MC. 91 The loss of this patient to another physician is documented in Haartman to Haartman, 10/23 October 1863, ÅAUL/MC. 92 Haartman to Haartman, undated, 1865, ÅAUL/MC. 93 Belgolovyi, S. P. Botkin, 54; Kichigina, Imperial Laboratory, 217. 94 Rebecca Friedman, Masculinity, Autocracy, and the Russian University, 1804–1863 (New York: Palgrave Macmillan, 2005); Barbara Evans Clements, A History of Women in Russia: From Earliest Times to the Present (Bloomington and Indianapolis: Indiana University Press, 2012), 90. 95 Claudia Verhoeven, The Odd Man Karakozov. Imperial Russia, Modernity, and the Birth of Terrorism (Ithaca and London: Cornell University Press, 2009), 140–1. 96 The prisoner acknowledged that he knew Dr Botkin; Wiborgs Tidning, 28 April 1866, 3; Helsingfors Dagblad, 18 August 1866, 1; Daily News, 3 May 1866, 6; Verhoeven, The Odd Man Karakozov, 140–1. 97 Belgolovyi, S. P. Botkin, 54; Hans Heilbronner, ‘The Russian Plague of 1878–79’, Slavic Review, 1962, 21, 89–112; Maria Pirogovskaya, ‘The Plague at Vetlyanka, 1878–1879: The Discourses and Practices of Hygiene and the History of Emotions’, Forum for Anthropology and Culture, 2014, 10, 133–64. 98 Riasanovsky, Russian Identities, 173–4; Alexander Polunov, Russia in the Nineteenth Century. Autocracy, Reform, and Social Change, 1814–1914 (Armonk, NY: M.E. Sharpe, 2005), 141–2, 150. Nihilism (Latin meaning nothing), enjoyed broad support among the intelligentsia from the early 1860s (this was the so-called first generation of nihilists). The term originated in an 1862 novel by Ivan Turgenev, Fathers and Sons. The protagonist of the novel is physician Yevgeni Bazarov. Nihilism is often used to refer to the men of 1860s, who hoisted the banners of critical realism against accepted values and standards. 99 Richard Wortman, The Crisis of Russian Populism (Cambridge: Cambridge University Press, 1967), 24. 100 Helsingfors Dagblad, 22 April 1879, 2. 101 Morgonbladet, 19 May 1879, 3–4; Helsingfors, 20 June 1879, 2–3. 102 Polunov, Russia in the Nineteenth Century, 141–2, 150. 103 Frieden, Russian Physicians, 12–13. 104 Helsingfors Dagblad, 2 March 1879, 3. 105 Morgonbladet, 8 March 1879, 2–3. 106 Heilbronner, ‘The Russian Plague’, 89–112. 107 Daily News, 4 March 1879, 5. 108 Ibid. 109 ‘Everyone realizes that Professor Botkin with these two diagnoses, issued ex cathedra, not only took a great responsibility in front of his native land, but also put his entire scientific reputation at stake’. Morgonbladet, 1 March 1879, 3. 110 Helsingfors Dagblad, 5 March 1879, 2. 111 The Pall Mall Gazette, 31 January 1879, 9. 112 Helsingfors Dagblad, 5 March 1879, 1–2. 113 Morgonbladet, 5 March 1879, 2–3; The newspaper used as basis for this metaphor Ivan Andreevich Krylov's fable named the Elephant and the Pug-dog, central in the Russian nineteenth-century culture. 114 Douglas Smith, Working the Rough Stone: Freemasonry and Society in Eighteenth-Century Russia (DeKalb: Northern Illinois University Press, 1999). 115 Morgonbladet, 5 March 1879, 2–3; Morgonbladet, 8 March 1879, 2–3. 116 Kichigina, Imperial Laboratory, 214. 117 Zhuravskii, ‘Diaries of S.P. Botkin’, 128. 118 Morgonbladet, 8 March 1879, 3. 119 Helsingfors Dagblad, 1 March 1879, 3. 120 Wiborgs Tidning, 8 March 1879, 2; Helsingfors Dagblad, 8 March 1879, 3. 121 The Evening News, 17 March 1879, 3. 122 During the scandal, Botkin communicated to the British Medical Journal seven more cases similar to that of Prokofiev; The British Medical Journal, 8 March 1879, 206; The British Medical Journal, 15 March 1879, 404. 123 On criticism from voices other than Zdekauer’s, see Kichigina, Imperial Laboratory, 216–17; Belgolovyi, S. P. Botkin, 54–6. 124 Wiborgs Tidning, 12 April 1879, 1. 125 Åbo Posten, 21 May 1879, 2; Morgonbladet, 7 June 1879, 2. 126 The Standard, 2 May 1879, 5; Aberdeen Weekly Journal, 15 May 1879, 3. 127 The Examiner, 13 September 1879, 1171. 128 Freeman’s Journal, 2 July 1875, 2. 129 Nikolai Serno-Solovyovich to Collan, 17 August 1860, signum 37.6, NLF/MC. 130 Kolokol was published in London and Geneva in the 1850s and 1860s. 131 Collan, La Vie, 68. 132 Woodford McClellan, Revolutionary Exiles: The Russians in the First International and the Paris Commune (London: Routledge, 2005), xv, 27. 133 Serno-Solovyovich to Collan, 17 August 1860, signum 37.6, NLF/MC. 134 Frieden, Russian Physicians, 106–7. 135 Nahapetov, ‘O deiatel’nosti’, 80. 136 Nahapetov, Vrachebnie tainy, 269. 137 Collan to Collan, 1/13 August 1871; Livadia, 1/13 and 12/24 September 1871, signum 37.9, NLF/MC. 138 Helsingfors Dagblad, 2 March 1879, 3; The Standard, 7 March 1879, 3. 139 Elisa M. Becker, ‘Judicial Reform and the Role of Medical Expertise in Late Imperial Russian Courts’, Law and History Review, 1999, 17, 1–26; Joseph Bradley, Voluntary Associations in Tsarist Russia: Science, Patriotism, and Civil Society (Cambridge, MA: Harvard University Press, 2009), 214–18. 140 Daily News, 4 March 1879, 5. 141 Kichigina, Imperial Laboratory, 217. 142 Belogolovyi, S. P. Botkin, 55, 69. 143 Åbo Tidning, 14 April 1883, 2. 144 Nahapetov, Vrachebnie tainy, 262. 145 Åbo Tidning, 9 May 1883, 3. 146 Helsingfors, 11 April 1882, 3; Belogolovyi, S. P. Botkin, 70. 147 Nya Pressen, 16 March 1883, 3; Åbo Tidning, 17 March 1883, 2; Östra Finland, 29 March 1889, 2. 148 Wiborgsbladet, 16 August 1889, 2. 149 For the return of the mystical-irrationalist line of thinking, see Vucinich, Science in Russian Culture, 3–11. 150 Nahapetov, Vrachebnie tainy, 261–2. 151 Figes and Kolonitskii, Interpreting the Russian Revolution, 14; Wortman, Scenarios of Power, 334. 152 Frieden, Russian Physicians, 14. © The Author 2017. Published by Oxford University Press on behalf of the Society for the Social History of Medicine.

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