On the prerequisites for the state organization of epidemic control in Yakutia in the second half of the XVIII - early XIX century.

Borisov Andrian Afanas'evich Doctor of History Chief Researcher; Institute for Humanitarian Studies and Problems of Small Indigenous Peoples of the North SB RAS 677000, Russia, Republic of Sakha (Yakutia), Yakutsk, Petrovsky str., 1, office 409 a_a_borisov@mail.ru Other publications by this author

The pages of historical documents reflecting the events of Yakutia's past are full of information about epidemics. Smallpox, measles and other diseases, which took on a massive character, caused great damage to the population. The interests of the treasury suffered and the state was concerned to somehow counter these threats. Therefore, it is interesting how it acted in this direction. At that time, Yakutia was a remote, vast and sparsely populated suburb of the Russian Empire. The state power here was represented by regional management structures. It is obvious that the tasks of combating epidemics on the ground were assigned to them. Before considering how events took place during the XIX century stated in the title of the article, it is important to pay attention to the starting positions where the public services responsible for the fulfillment of these tasks were located.

In historiography, these structures are described in an overview. M.M. Gedenstrom, V. Chepalov^[1], N.V. Gushchin, V.N. Chemezov, F.G. Safronov at various times, referring to the Decree on the definition of medical ranks in the Yakut region in 1805, noted that according to the established staff here it was supposed to have "the chief physician of the region", five doctors, one for each of the districts. The rest of the information they provided related to later events. This, and the emergence of the first hospital in 1843 in Yakutsk, although the existence of a "smallpox house" in the city since 1764 was recognized, and information about that "chief physician" Reslane, and statistical data indicating an increase in the medical staff of the Yakutsk region over the subsequent time ^{[1; 2; 12; 15]}. Thus, the researchers were unanimous in the fact that the regional health care system was formed during the XIX century. Accordingly, the fight against epidemics organized at the state level was carried out at the specified time.

V.P. Nikolaev writes about attempts to prevent smallpox in pre-revolutionary Yakutia, but he also talks about the period starting from the second half of the XIX century ^[6]. Some modern works on the history of medicine in Yakutia, in particular, on leprosy in Kolyma, also provide fragmentary information about doctors who served in the early 19th century ^[9]. E.N. Romanova and L.B. Stepanova write about the centuries-old experience of the perception of epidemics by the indigenous peoples of the North and the strategy they have developed to prevent them ^[10]. In the table given by them about the years of epidemics in Yakutia from 1651 to 1924. the "pestilences" of the 1760s and the beginning of the XIX centuries remained overlooked, which also left a deep mark on the history of epidemics of the region. This omission occurred due to the fact that the documentary sources of the RGIA and the RS (Ya) were not involved, as well as the works of the above-mentioned authors based on these materials. Meanwhile, it was the severe demographic damage caused by these epidemics that became the starting point in organizing the fight against them at the state level in the Yakutsk region. Thus, it seems to us that the question of the early stage of the fight against epidemics in Yakutia and, especially, the prerequisites remains open.

At the same time, attention should be paid to the researchers' pejorative rhetoric, which has already become traditional. Unfortunately, it persists in modern historiography ^[16]. The statement of an unfavorable epidemiological situation is unjustified, if only because at the time in question, in principle, there were no such categories. After all, it is not possible to assess what to call "disadvantage" in a traditional society in which the very concept of medicine and healthcare has been replaced by relevant institutions, especially from the point of view of modern ideas. Thus, Sarychev, in his travel diary, while on Kolyma in 1787, noted that the local population believes that many diseases were caused by evil spirits that possessed the human body. Shamans were called for treatment, who tried to expel them from the body of a sick person with the help of stones ^{[11, p.200]}. And hence criticism of the authorities for their insolvency or neglect is also inappropriate, if only because at that time all the activities carried out in this area were the first steps. In order for the effect of them to be obtained, it took time, including for the population itself to get used to and the emergence of an understanding of the need for such events.

According to the "Institution for the administration of the provinces of the All-Russian Empire" in 1775, a new institution was created in the administration of the province - the order of public charity. In the province, staff units of one doctor, one physician, two assistants, two medical students were appointed^[2]. It was headed by the governor, and it included assessors from the provincial estate courts. In addition to educational institutions, they also managed hospitals and hospitals ^{[3, p.134]}. During the XVIII century, the functions of the health organization were transferred to the provincial level ^{[13, pp. 5-8]}.

On January 19, 1797, medical boards subordinate to the Medical College were established. The functions of the departments also included anti-epidemic measures^[3]. City and county doctors, as well as medical students, passed into their subordination. The Medical Board set the task of forming a county health care system for the councils ^{[13, p.7]}. At the beginning of the 19th century, the functions of the Medical College were transferred to the Ministry of Internal Affairs, at the same time the transition of the health organization to the provincial level was completed.

Thus, a new stage has begun in the history of healthcare organization in the region and, accordingly, the organization of anti-epidemic measures. This process has been traced with varying degrees of completeness in modern historiography. What were the starting positions of this important stage in Yakutia? According to sources, infectious diseases periodically penetrated here, which grew to epidemic proportions. It is important to note that the local authorities did not sit idly by and took concrete measures, which to a certain extent became prerequisites for the above-mentioned stage.

A report on the appearance of leprosy in the upper reaches of the Kolyma River dates back to 1765. In 1784, a doctor was sent there in connection with cases of this disease in the Rochev tract. The mention of the smallpox epidemic raging in Yakutia dates back to 1758. She came here from Transbaikalia and Irkutsk, where outbreaks of the disease were noted in the 1730s-1750s ^{[4, p.339]}. And the most devastating mass smallpox diseases in Yakutia occurred three times in the XVII century: 1651-1653, 1681, 1689-1692 ^{[5, pp. 186-349; 6, p.26]}. But if at that time it was not known about the measures that were taken to counteract it, then since the 1760s it is already possible to talk about the initial stage in the history of the fight against this dangerous disease.

So, the physician Grigoriev Klivetsky, who was "in the city of Yakutsk when using smallpox, in 1778 he vaccinated up to 800, 1782 up to 900, in 1790 500 people and polled out more than 1000 people infected with venereal disease, in 1796 about 500 people were infected with measles. In addition, he was seconded to crawl the native Gentiles to Kolyma and other difficult places"^[4]. According to Zadonina, in 1773-1776, numerous cases of smallpox were noted in Yakutia ^{[4, pp. 186-349]}.

The "Case of the Yakut hospital house, on the production of salaries to medical officials of the Irkutsk province according to the new staff, on the Yakut staff doctor Klevetsky and the determination of a student of the St. Petersburg Medical Surgical Academy Kremkov demoted to paramedics to help him" dated May 22, 1805 contains interesting information that allows us to judge the state of anti-epidemic measures in the Yakut district by the beginning of the XIX century. V.^[5].

From a letter from staff physician Grigory Klevetsky to court counselor Ivan Evers dated February 22, 1803, the author of the letter asks the addressee, who was going to go to St. Petersburg, to inform the main authorities, as well as from the report of the latter, written in May 1805, the following can be seen^[6].

According to the decree given by the Life Guards to the Prime Major of the Siberian governor Denis Ivanovich Checherin on July 26, 1764, "for the treatment of prematurely killed young Gentiles," to combat raging smallpox, measles, venereal and other diseases, a staff doctor, a healer and a podlekar were sent to the city of Yakutsk "and the districts." They apparently arrived there in 1765. Two houses were built there for their treatment at the state expense "without money". They were treated for smallpox and measles, and vaccinated repeatedly. The provincial chancellery released 200 rubles a year. for these purposes. After the opening of the viceroyalty in Irkutsk, the amount decreased to 100 rubles. In 1797, the infirmary burned down. Since then, there has been no hospital home here and the amount has not been released. Although Klivetsky repeatedly wrote to the Irkutsk medical board. Of the doctors who were sent thirty years ago, one staff doctor remained in place, and who repeatedly asked him to be dismissed for old age. Since it is difficult to find those willing, Evers asked to appoint Ivan Kremkov, a demoted exiled student, as a physician.

Gentiles with venereal and other diseases came to the staff physician who was left alone, but, as it is written in the documents, "there is no house to keep them"^[7]. As you can see, for at least two decades in Yakutsk there was a full-fledged hospital consisting of two buildings (one of them, the "infirmary", apparently intended for smallpox patients) with a whole medical staff and a significant amount of funding. The experience was not without success. This is evident from the fact that the local population has managed to get used to medical care and, as we will see below, asked to restore this beneficial undertaking.

It is obvious that this institution was heated in winter. Consequently, in addition to medical personnel, a certain staff of technical workers was attached to it: stokers, cooks, watchmen, etc. There is no information on how the activities of this staff were carried out, but its very duration over two to three decades speaks for itself.

This was followed by correspondence between higher authorities. In response to the request of the Minister of Internal Affairs, Count V. Kochubey, to the Governor-General of Siberia, Selifontov, dated June 10, 1805, No. 549, on the restoration of the hospital, the latter reported that the smallpox house organized on July 26, 1764, by special decree, was released from 1765 to December 1769 to 3363 rubles 39.5 kopecks, and from February 1, 1772 G. by decree, from provincial revenues up to 9825 rubles. 29 kopecks per year. Since 1784, Prosecutor General Prince Vyazemsky canceled allocations by order from the provincial chancellery on November 29, 1783, since the maintenance of the hospital, as well as for other institutions, for example, for nautical schools, had to be released from income for goods from Kyakhta. After that, only money for medicines was sent to the patient^[8].

It is curious how in 1789 the Yakuts asked to arrange a special smallpox house, but since the income from the Yacht ceased due to the cessation of trade with the Chinese, from 1790 to 1798 only 650 rubles were released for the maintenance of that house. In 1792, the Yakut commandant proposed a plan for a new hospital house, but it was not executed, and with In 1800, funding stopped altogether. In 1802-1803 there was an unsuccessful correspondence between the Yakut mayor and the Irkutsk civil governor Repyev. The latter said that he had not received the required provision from the mayor on the establishment of a hospital in Yakutsk. At the conclusion of his letter, Selifontov asked for consideration from the minister^[9]. Consequently, this first experience of organizing medical care for the population of the Yakut district in the 1760s - 1790s, including in order to counter the smallpox epidemic, although it had some success, it ended due to bureaucratic inconsistencies.

Also, the personnel problem played an important role. At first, when that group of doctors arrived in Yakutsk in the 1760s, at least in the surrounding districts and uluses, medical services were provided not only what is called "on the go", but also on a regular basis in a stationary "smallpox house" and in the form of receiving healers who came to the city of local residents. For the above reasons, the medical staff that was formed was reduced to one unit. Among the studied archival documents, we see a touching petition from Klevetsky, who remained alone from the former staff in office, addressed to Minister Kochubey on October 5, 1805, for his dismissal in old age and for the appointment of a boarding school for him. The case of the honored medic was considered at the highest level, i.e. at the level of the Medical Council of the Ministry of Internal Affairs and the desired boarding house was appointed^[10]. During his thirty years of service in Yakutia, he rose from the position of assistant physician to staff physician, receiving by 1802 the 7th class rank, i.e. the rank of court counselor. As we saw above, all these awards and ranks were fully deserved by him. To combat epidemic outbreaks, he was repeatedly sent to the most remote corners of the region. During his years of service, he was also sent to Zashiversk and Alensk by the horse route for the use of non-believers from fever, measles and venereal infection.

By 1800, Matvey Malinovsky served as a physician in Zashiversk, and Dr. Prokhor Malkeryev served in Olekminsk. In addition, an inspector of the Irkutsk Medical Board, Dr. Fedor Reslein, was sent to Okhotsk "to suppress yellow fever"^[11].

The first chief physician of the Yakut region, collegiate counselor Reslane, served in Siberia for a total of 40 years. It is noteworthy that he was not in one place and often traveled to the most isolated corners of Siberia and the Far East. As an Irkutsk official, court counselor M.M. Gedenstrom wrote, he "was one of the most charitable men of his time, but at the same time had the greatest oddities. He did not accept money or gifts from anyone for his treatment; he left most of his salary in the treasury and took only the amount he considered necessary for his meager maintenance. Hardly any cynic of modern times could surpass him in his lifestyle, but for that, his willingness to help his neighbor was immeasurable. In winter, in the bitterest cold, he wore a summer dress: a uniform, a hat, and rarely, a cloth cloak. I was the innocent cause of his death. In 1810, I informed the authorities about the unusual leprosy (elephantiasis) disease among the Yakuts, contagious and even hereditary in some families. By the highest command, Reslane was instructed to detach one of his subordinate doctors to those places for research and use. He took on this responsibility himself, and despite the elderly summer (he was over 70 years old), he went to Srednekolymsk. He left Yakutsk in October, and despite the cold, in a cloth dress. To keep warm, he was often forced to get off his horse, run, and somersault. Thus, in a strange way, he traveled more than 1,500 versts, but he chills his legs. He was already taken to Srednekolymsk in warm clothes and on a stretcher. Here he cut off his own toes and died six months later. Srednekolymsk should be proud of the ashes of a friend of mankind.

He served in Siberia for forty years, and was in Kamchatka for a long time. He left many manuscripts delivered to his heirs. The observations of this learned man should be very curious in all parts" ^{[1, pp.117-118]}.

Although, as the researchers write, the doctor's personality "was surrounded by various stories, among which it is difficult to distinguish truth from fiction" ^{[15, p. 159]}. His qualifications are noteworthy: he studied at Moscow University, St. Petersburg Hospital School and the University of Strasbourg. The "strangeness" of the doctor's behavior stemmed, apparently, from his Protestant faith. After all, one of his main tenets is the Protestant work ethic of virtue and diligence in work, the product of a long upbringing.

By the beginning of the XIX century, doctors who found themselves in the service in Yakutia, Grigory Klevetsky, Matvey Malinovsky, Prokhor Malkeryev, studied and served in the Moscow General Land State Capital, and the latter had previously been trained at the Moscow Main Pharmacy^[12]. The local population received medical care from qualified doctors, who obviously had the appropriate specialty at the level of that time.

In addition, the geographical and astronomical expedition of I.I. Billings-G.A. Sarychev (1785-1794) had four medical staff: Dr. G. Merck, staff physician M. Robek, physician P. Alegretti, podlekari A. Leyman, V. Voloshenov. There is an assumption that M. Robek could take part in the treatment of lepers in Kolyma ^{[14, p.159]}. He was sent to Upper and Middle Kolyma in 1784 specifically for these purposes. Here he tried to treat the families of the ancestors of the Mutyuzha Yakuts ^{[8, p.6]}.

It is interesting to note that by the beginning of the 19th century, the population of Yakutia was gradually "preparing" for government activities in this area. Christianization, which began in the 1760s, led to the beginning of the next century to almost universal baptism of the population of Yakutia. The authority of shamans has been shaken, including as healers. The customary legal norms of the Yakuts, recorded at the specified time, indicate that objective ideas about diseases began to penetrate into their environment, albeit clothed in an Orthodox shell. Thus, some of the oral laws specially recorded at the request of local officials read: Yakuts from among those "enlightened by faith and knowledge of the truth" began to understand that the disease "comes from natural causes, and the benefits through shamanism sometimes come from sympathetic actions" and "from great faith to this sometimes relief is obtained" ^{[7, pp. 120, 169-170]}. It is important that already at the beginning of the XIX century. among the Yakuts, an understanding of the usefulness of smallpox vaccination spread. They, through their ancestors, appealed to the authorities with a request to organize preventive vaccinations. It is known that in 1808-1809 another smallpox epidemic was noted in the Yakut region, which, as the documents of those years show, was not marked by such severe devastation as in earlier periods.

When regional state structures began to form in the first decades of the century under study, as we noted at the beginning of our article, the formation of organs of foreign self-government took place in parallel: district administrations and tribal national administrations. In addition to heads, prefects, clerks, corporals, smallpox students were certainly introduced into their staff ^{[7, pp.144, 158, 159]}. Their services were also paid for at the expense of the funds of the foreign self-government. Their training undoubtedly took place at the expense of the treasury by professional healers.

Thus, the countdown of the history of anti-epidemic measures in Yakutia begins in the second half of the XVIII century, when the prerequisites for such actions began to form.

Firstly, organizationally, the territory of the Yakutsk district (province) became subordinate to a special regional medical body, the Medical Board of the Irkutsk Provincial Administration.

Secondly, since the 1760s, doctors began to be sent to Yakutia to combat the emerging foci of epidemic diseases: leprosy and smallpox.

Thirdly, initially highly qualified medical personnel arrived in Yakutia, who were trained not only in Russia, but also abroad.

Fourthly, during the period under review, the local population began to form positive ideas about the benefits of these activities, which was important for the success of the fight against epidemics in the future.

^[1] Chepalov V. The history of the fight against leprosy in the Kolyma district of the Yakut region // Siberian doctor: [newspaper]. 1914. No. 10; Chepalov V. The history of the fight against leprosy in the Vilyuysky district of the Yakut region // Siberian doctor: [newspaper]. 1916. №23, №30.

^[2] Institutions for the administration of the provinces of the All-Russian Empire. M.: Printed at the Senate, 1775. 229 p.

^[3] The most highly approved report of the Medical Board // The Complete Collection of laws of the Russian Empire. Vol.24. St. Petersburg., 1830. pp.287-296; Instructions of medical departments dated January 19, 1797 // The Complete collection of laws of the Russian Empire. Vol.24. St. Petersburg., 1842. pp.287-296.

^[4] RGIA. F.1297. Op.296. D.113. L.173.

^[5] RGIA. F.1297. Op.1. D.66. L.1a.-36.

^[6] Ibid. l.1b.-3.

^[7] RGIA. F.1297. Op.1. D.66. L.1b.-3.

^[8] Ibid., pp.14-16.

^[9] RGIA. F.1297. Op.1. D.66. L.16ob.-18.

^[10] Ibid. l.19-20, 24-36.

^[11] RGIA. F.1297. Op.1. D.92. L. 353-356.

^[12] RGIA. F.1297. Op.1. D.92. L.353-356.