Guardianship for the "protection of public health" in the activities of local government authorities in Russia in the pre-reform period of the XIX century (using the example of the South Ural region)

Saihislamoh Rashit Badretdinovich ORCID: 0000-0001-6500-8343 Doctor of History Professor; Department of Russian History, Historiography and Source Studies; Ufa University of Science and Technology (UNiT) 32 Zaki Validi str., Ufa, 450076, Russia shrbb2007@mail.ru

Kildigusheva Zaliya Ramilevna Postgraduate student; Department of Russian History, Historiography and Source Studies; Ufa University of Science and Technology 32 Zaki Validi str., Ufa, 450076, Russia shrbb2007@mail.ru

The priority task of each State is to protect public health through various instruments of government. In essence, healthcare, the purpose of which is to protect and promote human health, is a social, organizational, and regulatory function of the state. Currently, the healthcare sector is one of the priorities of the social policy of our state. Significant changes in the life of modern Russia, measures to modernize the healthcare system (concepts, programs, projects are being adopted), and the need for their deep historical understanding actualize the rationale for the chosen research topic. In the context of the proclamation of the continuity of a number of institutions of the Russian Federation and the Russian Empire, it is important to analyze historical experience. In the Russian state, the effectiveness and efficiency of public health policy is possible based on the use of the rich experience accumulated by our country in the social sphere. Studying and understanding this experience is necessary to improve the organization of modern healthcare, which should combine elements of both national and local approaches in its management. As a result, in addition to scientific and cognitive significance, retrospective research has socio-political and practical aspects.

The relevance of the research topic is not limited to the mentioned aspects. Many issues related to the functioning of public administration in the field of healthcare in the Southern Urals in the first half of the 19th century have not been sufficiently developed and are reflected in the historical literature. In Russian historiography, there is a sufficient number of works devoted to highlighting the development of various aspects of healthcare in the South Ural region of Russia from its origins to the emergence of the state system in this area, including from the perspective of the spread of mass infectious diseases [1 – 3; 7; 15; 23; 26; 27; 28]. However, the formulation and solution of such an important social problem as public health care has not been the subject of direct study until now. In this regard, the analysis of the institute of guardianship in the field of healthcare in pre-reform Russia and its regions is becoming particularly relevant, which determines the choice of the research topic. The object of the research is the social policy of the state as a set of basic principles, norms and activities for the exercise of state power. The subject is the state policy of care in the field of healthcare.

The objective of the work is to identify the specifics of the implementation of state policy in the field of healthcare, which are the basis for effective and efficient operation of the healthcare system.

The methodological basis of the research is represented by general scientific methods, analysis and synthesis, comparative historical and historical-typological methods using systematic analysis to identify the factors that led to the heyday of guardianship in the social policy of Russia in the first half of the XIX century.

The purpose of the study is, based on a comprehensive scientific analysis of archival and published sources, to investigate the historical experience of the formation and development of the institute of guardianship in the field of healthcare in Russia using the example of its South Ural region, to identify common patterns and regional features of the guardianship process, to reveal the integrity and interdependence of its components.

In Russia, since the beginning of the 19th century, there has been a shift in the emphasis of guardianship work from issues of "care and supervision" (typical for the 18th century) to the tasks of state social protection, which simultaneously led to the creation, improvement, and institutionalization of the guardianship system. The legal framework of the institution of guardianship was emerging, which became the lever of state regulation in the field of guardianship; the directions of social policy were expanding: organizational, financial, economic, personnel, managerial, etc.

The Ministry of Internal Affairs and the Ministry of Police were responsible for the implementation of the health care policy at various times. Within the South Ural region, "care" in this area of social policy was carried out by local government bodies: the Orenburg Provincial Board, the Orenburg Order of Public Charity, the Chamber of State Property, the special office, the Orenburg Medical Board, the Orenburg Provincial Smallpox Committee, the Orenburg Provincial Committee for the Cessation of Cholera, the Ufa City Orphan Court, the Orenburg Provincial Board of Trustees The Committee on Prisons. The guardianship was also carried out by educational authorities, city self-government, rural and volost self-government bodies of state and appanage peasants, and noble guardianship.

Brief instructions and information on medical care in the Orenburg province are contained in the Medical Regulations, according to which the Orenburg Border Commission, which was in charge of managing the Orenburg Kyrgyz, was to have a doctor to monitor public health, a veterinary physician, a veterinary assistant, one paramedic, ten students of medical art and smallpox vaccination from the Kyrgyz ^[4].

In 1811, the provincial government received an order from the Ministry of Police to spread smallpox vaccination throughout the provinces of the empire. For proper control in provincial cities, special committees were established consisting of the civil governor, the vice-governor, the provincial leader of the nobility and the inspector of the medical board, and corresponding committees headed by the county authorities were established in the counties. And since 1812, the Orenburg Provincial Smallpox Committee began to function ^{[5, l.2]}.

Familiarization with legislative Act No. 49984 of December 1, 1848 "On the procedure for assigning daily and feed allowances to doctors and paramedics for the use of cholera patients", published in the Orenburg Provincial Gazette on January 1, 1849, gives an idea of the financial support of doctors working with the most seriously ill ^{[6, p.2]}. The same bulletin dated January 1-3, 1849 contains information about the course of the epidemic cholera disease in the Orenburg province (in the counties of Birsky, Ufa, Troitsk); how the state shares information with the population about the spread of dangerous diseases in order to protect and prevent a sad outcome.

In the first half of the 19th century, despite the support of the state, the state of medical institutions in the Orenburg province did not meet the basic requirements. An audit in 1822 of the institutions of public charity located in Ufa showed that the premises were unsuitable for the maintenance of patients, most hospitals lacked departments for infectious patients, and technical equipment was at an extremely low level. There was an acute shortage of medical personnel in medical institutions: Thus, as of 1821, the Orenburg medical board consisted of only 9 doctors and several district doctors (often there was only one doctor per two districts). Due to the shortage and extremely low level of professional training of paramedic personnel, it was often necessary to resort to the help of company paramedics, they began to train paramedics from the peasant environment. Hospital treatment was paid for, therefore, inaccessible to the vast majority of the population due to lack of funds. Therefore, it is not surprising that the official data of that time show a small number of people seeking medical help ^{[7, pp. 72-73]}.

But still new hospitals were opening. If the reports for 1826-1828 noted the absence of city hospitals in the county towns of the Orenburg province ^{[8, l. 2]}, then in 1843, as can be seen from the report of the medical board, in the cities of the province (Ufa, Belebey, Buzuluk, Buguruslan, Bugulma, Birsk, Menzelinsk, Sterlitamak, Chelyabinsk) there were functioning 9 county hospitals. In 1833, by order of the civil governor, the first women's hospital with 10 beds was opened in Ufa for the free treatment of poor women and orphans, which, however, ceased to function due to lack of finances in 1837. In 1821, the Committee of Trustees for the Poor in Ufa was opened, whose purpose was to provide care for the poor. This Committee was responsible for a free hospital for poor patients with a maternity ward and a shelter for the elderly ^{[9, p. 46]}. According to the document on the state of hospitals in the Orenburg province for 1836, the civil governor issued an order on the need to provide medical care in hospitals to poor urban residents without any payment. But such benefits were sometimes difficult to fulfill due to the lack of places in the medical institution. Poor patients, in order to receive medicines, were required to submit written certificates about themselves to police officials at their place of residence, about their rank and lack of power, and about the number of persons in their family. In the province, they are trying to open specialized medical institutions: in 1810-1812, a 36–bed nursing home was established in Ufa for the first time, under the supervision of a member of the provincial medical council. There were two almshouses and two prison hospitals in Orenburg and Ufa. According to the Gazette, 1845, in the conduct of the Orenburg order of public charity, and institutions of charity people in them were: 1. Hospitals in the city of Ufa – 1 (contained 1560 shower, M. p. and 44 W. p.); in the provincial cities Birsk – 1 (contained shower 46 M. p.); Buzuluk – 1 (93 was held shower, M. p.); Belebey – 1 (87 was held shower, M. p.); Menzelinsk – 1 (contained 77 M. p. souls and 1 soul well. p.); Buguruslan – 1 (contained 112 a shower of M. p.); Chelyabinsk – 1 (contained 150 shower, M. p.) Sterlitamak – 1 (contained 112 a shower of M. p. and 2 soul train. p.). 2. Borodulin: in Ufa – 1 (contained 78 shower 44 M. p. and shower W. p.); Orenburg contained on capital, donated collegiate asesora Shaposhnikov – 1 (3 contained the souls of M. p. and shower W 19. p.); 3. House in Ufa: insane – 1 (contained 35 p. M. and 11 W. p.); Strait – 1 (contained 20 shower p. M. and 4 soul train. p.); working – 1 (held 5 shower p. M. and 2 soul train. p.). Total: institutions of the Orenburg order of public charity in 1845 was 14, which contained a shower 2378 M. p. 127 and shower W. p.^[10]. According to the data of the early 1860s, 1,153 people received medical care in institutions of the Orenburg order of public charity. p. and 207 people received medical care, 29,857 rubles were spent on their maintenance.^{[11, l. 273]}.

The State also took care of the timely implementation of smallpox vaccinations. By a Synodal decree of October 10, 1804, all bishops and priests were instructed to promote the spread of smallpox vaccination ^[12], and by the most highly approved Regulation of the Committee of Ministers of May 3, 1811, smallpox committees were established in all provincial and county cities in order to use "all possible means at local discretion" to combat smallpox and take active measures against the spread of this disease. diseases; locally, all full-time medical officials, military doctors with paramedics under their supervision, as well as midwives were involved in smallpox vaccination; smallpox committees were responsible for organizing smallpox vaccination training for "people of all ranks"; parish priests, city and county doctors, and the police were charged with explaining the benefits of smallpox vaccination to the people ^[13]. Smallpox vaccination was mandatory in all public and religious schools. The governors ordered all departments of the region to take care of smallpox vaccination and report on the success of vaccination every quarter ^{[14, pp. 209-301]}. Thus, this measure becomes mandatory. The Imperial Free Economic Society was also involved in the fight against smallpox in Russia, which in 1824 opened the "V Board of Trustees for the preservation of human health and all kinds of domestic animals." The first cowpox vaccination in the Orenburg province was carried out in October 1803. At that time, in Troitsk County, the population of villages belonging to the factory owner A. A. Knauf was vaccinated ^{[15, p. 36]} After that, other categories of the population were vaccinated, but this event was not without failures. The extremely low number of medical personnel and distrust on the part of the population prevented the successful spread of smallpox vaccination. At first, preventive vaccination and the measures taken by the authorities on this subject were opposed by the population of the region, who considered cowpox vaccination a sin, harmful and dangerous business. It was obvious that it was impossible to overcome the prejudices and prejudices ingrained in the people by decrees and administrative measures alone.: that it is necessary to conduct, so to speak, sanitary and educational work among the population. Therefore, the authorities obliged city and county doctors and local clergy to explain to the population the necessity and benefits of vaccination. The following figures indicate the success of smallpox vaccination: in 1844, in the Orenburg province, preventive smallpox was vaccinated – in the 1st half of 30326 residents, in the 2nd half - 29173; in 1848 in the 1st half – 23110, in the second half – 27763; in the first half of 1849 – 27356, in the second half half – 25785 inhabitants ^{[16, l. 89 – 102, 142 – 155; 17, L. 61-70; 18, L. 18 – 27, 41 – 56; 19, L. 11-22]}.

The area of care was medical measures for the Bashkir population. With the creation of the smallpox committee, smallpox vaccinators from among the Bashkirs appeared. Every year, the cantonal chiefs from each Bashkir yurt sent one young man to teach smallpox vaccination, who were released from all duties during the training period and were supported by the society from which they were sent. After gaining knowledge and becoming smallpox vaccinators, these young men returned to their cantons and vaccinated the population free of charge. Initially, they did not receive any salary, only being released from all duties during the period of work. Some payment for their work was established only from the end of the 1840s. In the 1820s, there were only 3-4 vaccinators in 17 Bashkir cantons, in the 1830s – 7-10, in the 1840s - 187; in 1847 – 259 vaccinators. On average, there was one smallpox vaccine for every 1,800 people, i.e. too few to solve such an important task. Gradually, but slowly, progress has been observed in the field of Bashkir healthcare. The "List of Mohammedan boys sent to study at Kazan University in 1835" has been preserved, from which it follows that 11-year-old boys from Bashkir cantons were sent to study that year ^{[20, p. 23]}.

By the early 1940s. This includes information about Bashkirs with the titles of doctors who graduated from Kazan University. At the same time, the Bashkir and Misharian cantons had smallpox vaccinators, paramedics and a district doctor, and 5 hospitals (with 140 beds and operating in the summer). Midwives were sent to the largest cities – Ufa, Orenburg, Bugulma, Buzuluk, Menzelinsk ^{[21, pp. 157-159]}.

The cholera epidemic that broke out in the region in 1829-1830 was the strongest impetus for the activation of medical measures and protective measures in the field of healthcare. In the historical document "Collection of acts and observations..." ^[22] it was noted that this disease was brought to the region by a caravan from Bukhara (before that time, cholera had already raged in Bukhara, Khiva, and the Kyrgyz steppes). The actions of the central government to counteract the approaching disease were extremely inconsistent. Having appeared in Orenburg in August 1829, cholera spread through the counties of the province a month later and remained in the region until February 1830. During this period, 747 people fell ill with cholera in Orenburg and 130 died, and 3,500 cases were registered in the province as a whole, of which 865 died. Since that time, cholera has been raging here for 17 years, with short breaks for the winter ^{[23, pp. 1-15]}. During the first time of the cholera epidemic, the actions of doctors and provincial authorities were aimed at limiting the spread of the epidemic by quarantine measures, as evidenced by circulars of the Ministry of Internal Affairs and Finance preserved in the National Archives of the Republic of Bashkortostan and instructions from the Orenburg Military Governor's office on preventing the spread of the cholera epidemic in the Orenburg province ^{[24, pp. 10-720]}; instructions from the Orenburg Military Governor and copies of meetings of the Orenburg provincial government; reports of the zemstvo courts, city and county committees for the prevention of cholera, on the spread of cholera and measures to combat it in the Orenburg province ^{[25, l. 1-190]}. The clergy of the province were advised to worship outdoors in order to prevent the spread of cholera in cramped rooms. As we can see, the fight against cholera was limited to emergency anti-epidemic measures, and the care of the population during the epidemic was limited to medical and police measures. Among the doctors and military personnel called up to fight cholera, there were many diligent and honest people who explained the contagiousness of cholera and its spread. Nevertheless, the issues of sanitary protection of populated areas, the requirements and rules of sanitation were generally still insufficiently regulated, which, combined with the lack of medicines, lack of doctors and hospitals, caused high morbidity and mortality of the population ^{[26, pp. 160-165; 27, pp. 56-594; 28]}.

In the case of care, the guiding function belonged to the State. Administrative transformations in the management system are taking place both in the center and in the regions. The relevant ministries were responsible for the implementation of care, while provincial institutions headed by governors were based on a network of city and county government structures. The departmental bodies of the higher central institutions, which had their own management structures, were the instruments for solving trusteeship tasks (hence, the institutions of trusteeship). However, there were contradictions between the central authorities, whose orders did not always take into account local regional peculiarities, and local government bodies. From the first years of the 19th century, within the framework of the existing estate-state system, institutions of social assistance in the field of public health received an impetus to development. Moreover, from the very beginning, care in all areas of this sphere of life was reduced to regulation, guardianship, and control of wards.