1908 - Peasant attitudes towards zemstvo healthcare in Buguruslan uezd, Samara guberniya

The excerpts below are translated from the State Archive of Samara Oblast' (GASO), fond 5, opis' 4, delo 214. This file contains letters from local authority medical staff in response to a questionnaire from the Buguruslan uezd zemstvo about peasant attitudes towards health services and personnel. Buguruslan uezd was very rural, with an ethnic mix of Russians, Tatars, Bashkirs and others. It was centred around the then smallish town of Buguruslan, in an area near the mid-Volga region, not far from present day Tatarstan and Bashkortostan. Sheet number references are given at the end of the passages quoted. - Dr Francis King

a. Reply from zemstvo doctor of 5th sanitary uchastok of Buguruslan uezd, who describes the question as "complex"...
"First of all, the circular did not indicate which population of the uchastok it had in mind. If we take the entire population, it seems to me that it is better to divide it into two parts as far as trust is concerned: 1) the local intelligentsia and 2) the peasantry. Furthermore the peasantry in its turn can be broken down into two parts: 1) the Russians and 2) other nationalities - Mordva, Chuvash and Tatars.
"Of course, the greatest degree of trust towards medical personnel comes from the intelligentsia, then the Russian peasantry, then the other nationalities. But there have also been many cases of mistrust on the part of the intelligentsia..."
[Doctor goes on to refer to cases of educated people going to Samara city for treatment in preference to using the services of the local hospital]
"As for the peasantry of the 5th uchastok, this uchastok is more or less the most remote in all Buguruslan uezd, but I should say that, for all their [indecipherable] savagery and lack of enlightenment, in which state they have been kept for hundreds of years, they are beginning to trust in scientific medicine...
"...Trust on the part of the peasants begins to increase particularly after a successful operation - one only needs to remove a cataract in a certain place and almost all the sick there will turn up requesting the 'knife'...
"As for cases of mistrust, there are of course many of these given the lack of enlightenment here, especially among Old Believer Russians and non-Russians..." [sheet 5]

b. Letter from fel'dsher Yanokhov of XIII medical uchastok of Buguruslan uezd:-
"...despite the fact that the Russian population lives far from the medical point and the continual absence of the doctor, the point gets no fewer than 10000 visits per year... the Tatar population in the centre where the Kumshorynovsky medical point is located has started to come for medical treatment more and more every year...
"As for greater trust, moreover, in Troitskaya volost', the volost' skhody have resolved on two occasions to request that a fel'dsher point be set up in Troitskaya village...
"There is no sign of mistrust towards either the permanent or the epidemic medical staff, nor towards medical treatment..." [sheet 6]

c. Reply from zemstvo doctor of 17th medical uchastok, Buguruslan uezd:-
"...The population in general is very keen to get medical assistance in all cases. On some occasions, however, by way of an exception, in certain cases (anthrax, acute gastritis and gastroenteritis, commonly called 'inner ulcer') they turn at first to their znakhari for 'incantations', but, having quickly become convinced that these incantations are completely useless, nonetheless go to the doctor or the fel'dsher.
"...As for the epidemic fel'dsher staff in particular, the population relates to them (invariably, so far as I can see) in a much more demanding way..." [sheets 7, 10]

d. Letter in response to the circular, 2 October 1908, from the uchastok doctor of Utevka village, on how typhoid is not such a problem, in that the peasants are used to it, whereas cholera is much more alarming:-
"...During typhoid epidemics the population relates to the epidemic medical staff peaceably and trustingly goes for medical treatment.
"It is another matter with cholera. At the first news that cholera has broken out somewhere the population listens out intently but tries to talk about it as little as possible, fearing the very word 'cholera'.
"...During a cholera epidemic all sorts of stupid rumours from all sorts of sources start going round about the medical staff and the nature of the disease itself... the people, partially aware that the disease is infectious, do not go to pay their respects to the deceased. This offends the religious sentiments of the deceased's relatives, and they try either to hide the patient from the medical personnel entirely, or, once the deceased has been seen and a diagnosis made, they try to insist that it was not cholera at all, but an 'inner ulcer' or something like that. That was how it was last year when Dr N I Krylov's epidemic staff were sent to Utevka. Initially, for the first few cases he was still invited in, but soon, wherever they came from, the rumours started going round that 'the new doctors' had deliberately unleashed cholera in order to earn more money..." [sheets 8, 9]

f. Letter in response from doctor at Alekseevka surgery and medical uchastok of Buguruslan uezd, 16 October 1908, who sets out various cases (with fatal consequences) of mistrust towards himself and medical treatment.
Cites one case "...(and I want to believe that it is the only one in the entire guberniya) which occurred in the village of Patrovka in the volost' of that name. In confessing his sins to the priest, a peasant of that village listed, amongst his other sins, the fact that he had been visiting the doctor at the hospital..." [sheet 14]
"...Speaking in general about the attitude and especially about trust in the treatment offered, I shall say directly that there is never complete trust. The injection of diphtheria serum, which represents such a great step forward after the old, useless treatment does, it is true, enjoy a certain authority; it is very rare that the injection is refused.
"Only an insignificant percentage of the people who come to us for treatment fulfils doctor's orders exactly and turns up again on time, which is so difficult to get the rest to do. In this respect it has been observed that Tatars and non-Russians generally are much more enthusiastic and trusting towards the treatment prescribed..." [sheet 16]

Glossary of terms

fel'dsher paramedic (often semi- or untrained) uchastok catchment area
guberniya region, large local administrative unit uezd subdivision of a guberniya
skhod traditional peasant assembly zemstvo elected local authority 1864 - 1918
verst(a) approx. 1.067 kilometres znakhar' traditional healer, witch-doctor
volost' group of villages, smallest official administrative unit