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Author(s) of the publication: Lyubov MANKOVA

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No one war in the whole of world history has been so devastating as plague epidemics. Suffice it to recall the "black death" epidemic which struck Eastern China in 1332 and took a monstrous toll of 13 mln lives. Caravans of merchants carried the deadly infection as far as North Africa and in 1348 the "black death" wiped out the population of Cyprus. Ghost ships with dead crews were found drifting across the Mediterranean. Propelled by wind, they reached the European shores, and in a couple of years the epidemic gripped all countries of the Old World from Norway to Greenland and the death toll was greater than half of the local population. A few years later, in 1352, the "black death", spreading across Scandinavia, Poland, Germany and through Astrakhan, reached Russia, wiping out the population of whole cities. Moscow was hit by another outbreak of the disease in 1770 - 1772, and this time around local medics rose against the lethal challenge.

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By Lyubov MANKOVA, Cand. Sc. (Phil.)

During the Russian-Turkish War there was an outbreak of the epidemic in the Ottoman Empire which gradually spread to Moldavia and Walachia. Shortly after the epidemic returned to the Ukraine and the central regions of Russia, hitting Moscow in November 1770. The first to sound the alarm was the Chief Surgeon of the General Hospital, Afanasy Shafonsky-an outstanding Russian medic who had graduated from three European universities (at Halle, Leiden and Strasburg). He correctly identified the true nature of the outbreak and headed a campaign against it, paying special attention to preventive measures (isolation of patients, quarantine, clearing, or "sanitation" of the city, etc.). Later on he wrote a fundamental study "Description of the Plague Epidemic in the Capital City of Moscow from 1770 to 1772" which contained many interesting and progressive ideas on the nature of the disease, its origin and ways of propagation.

Having thus identified the plague, Dr. Shafonsky immediately presented a report to the Medical Collegium, and without waiting for its formal response, he got down to business all by himself, surrounding his hospital with a ring of guards and banning contacts with the city.

He personally attended to the patients around the clock, observing maximum precautions. Refuse was burned down, camp-fires were burning in the yard, plague patients were separated from the rest, the hospital wards were constantly ventilated and the floors and the yards were sprayed with quicklime. According to Dr. Shafon- sky's observations, the disease struck first infants, women and young people of a "raw" constitution, and less often elderly and "lean" males.

The cures included antipyretic and stimulating medicines like quinine, camphor, moschus, etc. Carbuncles and bubos were treated with poulices, plasters and incisions. Dr. Shafonsky used the mechanism of induced perspiration at the initial stages of the ailment and this helped even in some bubonic forms of the disease. Another effective remedy was vinegar: patients washed their faces with it, drunk it diluted with water and inhaled its vapours. They were recommended to smoke tobacco, wear camphor sacks on bare skin, chew spices (ginger), fumigate personal belongings and premises with jumper, frankincense and gun powder.

Especially valued was the "vinegar of four bandits" which became popular after the plague outbreak in Marseilles in 1720. The mixture contained vinegar, camphor and ground herbs: garden sage, mint, Ruta, garlic, cinnamon and other herbs. Recepies of 18th century recommended "taking this vinegar as remedy from plague and catching ailments; washing with it hands and face; smoking in rooms and homes, pouring it out upon hot stones or pieces of iron, and fumigating therewith one's underwear and garments."

Dr. Shafonsky managed to cure 5 patients out of 27 with no relapses. After a quarantine of 40 days all were released from hospital and the wooden ward and the former belongings of the patients were burned down.

But even despite these precautions plague outbreaks occurred in different spots of the city, although some medics persisted in their denials of such cases. Moscow Chief- Surgeon, Andrei Rinder insisted that plague could not occur in the local climate, or be carried all the way from the Ukraine, because of the great distance. He insisted that all anti-plague precautions be discontinued.

Despite protests by a number of medical experts of the time, the final choice was in favour of Dr. Kinder-a favorite of the ruling elite.

But the situation continued to change, and on January 15, 1771 the Governor-General of Moscow, General-Fieldmarshal Pyotr Saltykov, reported to Her Majesty: "On the Vvedenskye Hill (where the hospital was located- L.M.) everything is over. As for the epidemic, I can not say with confidence-whether or not there was one. And until now, with the exception of two orderlies, who remain locked up there, none has visited the place. Dr. Shafonsky has asked the Medical department to inspect his hospital, but no physician has gone there yet." Saltykov sent there Dr. Rinder who refused to enter the hospital or inspect the patients, but talked with Dr. Shafonsky across a bonfire.

In March 1771 the police was informed about the unusual death rate at the Sukonny Dvor in the Zamoskvorechye district of Moscow. The Governor-General sent to investigate the report Dr. Yagelsky a graduate of the St. Petersburg Hospital School, who defended his thesis on psychiatry at the Leiden University and then continued his medical education in several other educational centers of France and Germany. He immediately diagnosed the ailment as plague and established that among the service staff cases of plague began back in January and a total of 130 people had died since then. To confirm his diagnosis Dr. Saltykov sent 5 medics from Germany, but they again refused to confirm the diagnosis of plague, although declared that the ailment "is purulent and very contageous... being very similar to ulcers". And the Senate decided that all resident of the Sukonny Yard be moved to the Ugreshsky Monastery, located on the bank of the Moskva River, and the yard itself be cordoned off. But it was already too late and some 2000 factory workers had already escaped to various parts of the capital.

Dr. Yagelsky was the first to confirm the diagnosis of Dr. Shafonsky and they became the most active members of the "Commission for the Treatment of and Preservation From Plague". It was he who had invented a smoking powder for disinfection of premises and personal belongings of the sick. And he

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also wrote several instructions published by the Commission.

The Medical Council was set up only when the epidemic reached alarming proportions. Among its members were some of Moscow's best medical authorities and Moscow University professors-A. Shafonsky, O. Yagelsky and P Pogorelsky. Despite the fact that the epidemic took a daily toll of thousands of lives, the German medics with Dr. Kinder at the head, continued to deny its existence and were thus misleading the city authorities. Disagreement among the medics slowed down preventive measures against the epidemic and aroused public misgivings about the professional skill of the Russian doctors. Some of them even fell victim to violence, and Dr. Shafonsky was badly beaten by the crowd. The Muscovites ignored the necessary precautions and the epidemic continued to spread.

As for Russian medics, they divided the city among themselves into sector and paid from their own pocket local boys for reporting new cases of the disease. Poor patients were brought to the hospital of Dr. Shafonsky free of charge, and the more wealthy Muscovites, such as merchants and gentry, were treated at their homes.

And it was only after a tragic report from the town of Pushkin near Moscow (one of the workers of the local textile mill, who was already ill, came back home and all of his neighbors died as a result) the Medical Collegium admitted that the capital was in the grip of plague, and reported to the Governor General and the Senate. Preventive measures suggested by the Russian doctors were accepted, although too late. Road blocks were set up and a public plague hospital was opened in the Ugreshsky Monastery- outside of the city limits. Unfortunately, Moscow was not closed to visitors because Saltykov believed that it cannot be sealed off by quarantines.

Because of the lack of travel restriction in and from Moscow the epidemic spread out into the neighbouring goubernias: Smolensk, Nizhnegorodskaya, Kazanskaya and Voronezhskaya. Saltykov regarded Her Majesty's recommendations as superfluous and informed Her of his opinion. Irritated with the stubborn Field Marshal, the Empress charged Senator Pyotr Eropkin with leading the preventive measures against the epidemic. She herself sought the advice of the best medics on measures of combating the "black death", and ever started perusing medical books. Every day she wrote long letters which contained many bits of advice and recommendations, with emphasis on personal hygiene.

The formal registration of the dead started in Moscow in April 1771. The figure for that month was 778, and the estimate was far from reality. Being afraid of the quarantine, Muscovites buried the corpses in their own yards and cellars. Even according to incomplete data, the death toll for September and October of that year approached 40,000.

One of the Russian medics who self-lessly fought the epidemic was the aforesaid Dr. P. Pogoretsky. A graduate of the Kiev Theological Academy, he studied medicine since 1757 at the School of Medicine of the St. Petersburg Admiralty Hospital. Later, he was sent with the ten best graduates to Leiden, Germany, where he defended his thesis before returning to Russia. He taught at the Moscow Hospital School and translated medical books and articles from the Encyclopedia. But his fruitful scholarly and teaching pursuits, however, were suddenly interrupted. The reason was that, without a permission of the Medical Collegium, he dared to translate and publish at his own expense a book by the German physician, I. Schreiber. For this "arrogance" he was put under arrest, brought to trial add appointed doctor of the Siberian Corps. When the Empress was informed of the case she ordered that Dr. Pogoretsky be brought back to St. Petersburg without delay. He remained there for one year, then submitted his resignation and left for Moscow. Being in retirement, he voluntary joined the campaign against the plague epidemic and was assigned to a hospital located at the Lefortovo Palace.

In June 1771, the battle with the "black death" was joined by yet another outstanding Russian epidemiologist Dr. Danilo Samoilovich. He was a graduate of the medical school at the St. Petersburg Admiralty Hospital and took part in the Russian-Turkish \\ar since 1768. In the army he first saw plague patients and began to study the disease by observing the sick and conducting discussions with local medics on methods of healing. But after a short time he fell ill himself with "ruthless

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fever, accompanied by bloody diarrhoea. After 18 months of suffering he was transferred to Orenburg. On his way there Dr. Samoilov visited plague hospitals and patients, studying the course of the disease and discussing it with experienced doctors. Being informed of the epidemic in Moscow, he hurried back into the capital, and it was there that his medical talent came to the fore. He set an example of selfless dedication to his profession and medical science in general. In his book "Considerations Concerning Plague" Dr. Samoilovich summed up the available practical experience and outlined what was a progressive system for the time of scientific notions about the disease, its clinical progression, proliferation of epidemics and preventive measures.

At first Dr. Samoilovich was sent to the Ugreshsky Monastery. Having not fully recovered from his illness, he attended to local patients all of his time, caught infection and experienced three attacks of plague.

Dr. Samoilovich also used prisoners for tests of an anti-plague vaccine which he invented and tested on himself. He reported the results of this experiment at a session of the Commission for Epidemic Prevention on November 23, 1771.

Angered by the passive attitude on the part of most of the Moscow doctors and city authorities, Catherine II sent to the contaminated city her favourite, Count Grigory Orlov who was given broad powers. He arrived in Moscow on September 26 with four detachments of the guards, a team of aids and Dr. Gustaw Orreus of the St. Petersburg police.

As soon as he entered the city, the royal envoy ordered that Moscow be closed to anyone wishing to enter or leave it under the fear of death. These quarantine restrictions were abandoned only in 1774.

On the basis of recommendations of doctors a range of sanitary and also police measures were introduced, with emphasis on the prevention of robberies and plunders. The Count ordered that thieves and robbers be shot on the spot. This was accompanied by a campaign of clearing the city of all sorts of garbage and refuse and the annihilation of stray animals. Policemen and medics entered the abandoned and empty homes and burned everything found inside with the exception of metal utensils and icons which were handed over to local churches. Small and dilapidated dwellings were burned down, and teams of volunteer fumigators cleaned homes of the sick, public places and markets. The campaign continued until spring and a total number of houses set on fire was more than 3,000. Another 6,000 with patients inside were cleaned and fumigated. In March there were police raids searching for hidden and abandoned bodies, and more than one thousand were found across the city.

The available "plague" hospitals could not accommodate all patients and Count Orlov opened three more (in Lefortovo, Pokrovsky Monastery and in a stone building near the Donskoy Monastery - this one for "low-income officials"). And the Count even sacrificed his family mansion at the Nikitskaya Street for a hospital and established at government expense an orphanage on the Taganka. He also established what were called "quarantine homes" and saw to it that they were properly used. Muscovites who tried to hide their sick relatives were punished by making them to serve as attendants in hospitals.

Doctors often complained to the Count of the stubborn and uncooperative Muscovites many of whom would rather die in their own beds than go to hospital, and those who were in contact with the sick refused to go to "quarantines". The Count then announced a cunning scheme: sick Muscovites were permitted to stay at home, but those who went to quarantine hospitals were paid 10 rubles per married person and 5 rubles for single ones (a considerable sum of money for that time). People discharged from hospitals upon recovery were entitled to free meals and clothing These scheme proved to be so attractive that even healthy people applied for admission to hospitals.

Count Orlov made regular rounds of the hospitals, checked on the meals and medicines and insisted that the personal belongings of dead patients be burned down in his presence. This freed the medical staffs from the burden of formalities so that they could concentrate on their professional duties. As for the selfless medical staffs, the Count ordered that they be paid, in addition to their double monthly wages, monthly bonuses, and for those who died on the job he introduced monthly pensions for the families. Serf peasants working in hospitals were given letters of enfranchisement.

The aforesaid measures produced immediate results, as proved by the statistics: the death-toll in September was 21,401, in October-17,561, in November-5,235 and in December- 805 only.

Some so-called "well-wishers" tried to bring down to the minimum the role of doctors in combating plague. The end of the epidemic was attributed to bitter Russian frosts which wiped out the infection. But there is no denying the facts. First, daily weather records of the winter of 1771 -1772 speak of some unbelievable thaws which occurred in December, January and February. Second, on the eve of the Count's arrival in Moscow a "plague riot" broke out there with the rioters demolishing hospitals, killing a number of medics and chasing out the patients and thus making the situation even worse. But the doctors stood their ground and returned to their duties. They developed new methods of treatment and tested them on themselves. Their achievements became a universal legacy, making our epidemiology one of the most advanced in Europe. And it were not the proverbial Russian frosts which triumphed over the "black death", but our dedicated members of the medical profession who never betrayed the Oath of Hippocrates.


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