Abstract: The article is devoted to the analysis of the most ambitious and promising project of the reform of medical and sanitary legislation developed by the central government of the Russian Empire in 1906-1917. The measures proposed by the reformers to optimize health care management, modernize medical and sanitary legislation and provide the population with public medical care are considered; special emphasis is placed on ensuring a balance of interests of state authorities and local self-government bodies. The object of the study is the healthcare system of the Russian Empire at the beginning of the twentieth century, the subject is the corpus of bills in the field of medical law developed by the Interdepartmental Commission for the Revision of Medical and Sanitary Legislation, as well as the Ministry of Internal Affairs under the Office of the Chief Medical Inspector. The author used traditional methods for historical and legal research: analysis, synthesis, systematic approach, formal legal and statistical. The conclusions are drawn that the reform project under study corresponded to the trends of the development of Russian statehood and pan-European trends in medicine policy, was adequate to the needs of domestic healthcare of the period under review, and also sought to take into account, if possible, the long-standing traditions of Russian public medicine. The reasons for the failure of the reform are primarily associated with subjective political factors, rather than with its internal shortcomings. The results of the study allow us to correct the traditional historiographical approaches to public health policy in the early twentieth century and to the relationship between state authorities and local self-government in the inter-revolutionary period.