Publish or Perish: The Scientific Publications of Women Physicians in Late Imperial Russia

Publish or Perish: , The Scien tific Publications of Women Physicians in Late Imperial Russia (*) MICHELLE DENBESTE-BARNETT (**) SUMMARY Types of Publications by Women Physicians. Hygiene and Women's Health: Elizabeth Drentel'n and Mariia Volkova. Aleksandra Ekkert and School Hygiene. Evgeniia Serebrennikova: Pioneering Ophthalmologist. Mariia Pokrovskaia: Physician, Feminist and Public Health Crusader. Anna Shabanova: Pediatrician and Women's Rights Activist. Impact of Women's Publications on the Profession. Conclusions. ABSTRACT Women physicians in late 19th century Russia emerge just as the Russian professions begin attempting to achieve some degree of autonomy from bureaucratic interference. Women took advantage of this discourse to portray themselves as competent professionals dedicated to bettering the lives of Russian people. Quite often these attempts to justify their work in the profession also motivated them to publish their scientific findings so ~ that they could be viewed as legitimate scholars and physicians. This article concentrates on six women physicians, Elizabeth Drentel'n, Aieksandra Ekkert, Maria Pokrovskaia, Evgeniia Serebrennikova, Anna Shabanova, and Maria Volkova (*) Much of the research for this paper was conducted during two research trips to the National Library of Medicine in Washington D.C. Funding for the most recent trip was provided by the Kennan Institute for Advanced Russian Studies of the Woodrow Wilson Center. An earlier trip was financed by a Phi Alpha Theta Graduate student scholarship award. Early drafts of the paper were presented at the Southern Conference on Slavic Studies, Chape1 Hill, North Carolina in March 1998 and the British Association for Slavonic and East European Studies, Fitzwilliam College, Cambridge, April 1998. ("*) Assistant Professor, Russian History. Arkansas Tech University. Social Sciences and Philosophy Dept., WPN 255, Russellville, AR 72801, USA. DYNAMIS. Acta Hisp. Med. Sci. Hist. Illus. 1999, 19, 215-240. 216 MICHELLE DENBESTE-BARNETT who provide illustrative case studies for what many other women physicians were doing. Women physicians published on a wide variety of topics, from women's and children's health to various types of cancers and infectious diseases. A few also used their medical training to advocate for wornen's political and social rights. BIBLID [O21 1-9536(1999) 19; 215-2401 Fecha de aceptación: 30 de noviembre de 1998 By the beginning of the twentieth century, medical schools in Russia had graduated large nuxnbers of women physicians. The 1904 medical register lists 738 women physicians. By 1914, 3,352 women are registered as practicing physicians. As their numbers grew, their influence also spread in the medical world. Women participated in medical congresses, giving reports and speeches, and their medical research and experience treating patients found it.s way into important medical journals. Russian women published prolifically, especially when compared to women in other countries who often ran up against severe obstacles. While elsewhere women struggled to practice, to gain entrance to research facilities and to join medical societies, in Russia women accomplished these goals early and moved to involvement in shaping the future of Russia's medical profession (1). Interestingly, Russian women not only attended medical school earlier than women from other European countries but they also practiced, published, and participated in ,their profession on a much more equal basis than women from other countries. The national medical journal Vrach regularly carried articles by and about women physicians as did other regional and specialized medical journals. The English medical journal The Lancet by way of contrast discussed women physicians only when debating whether or not they should be allowed into medical school and what types of restrictions should be put on their practicing (2). (1) For information on womeil physicians in other countries see BONNER, T.N. To the Ends of the Earth: Women's Search for Education in Medicine, Cambridge, Harvard University Press, 1992. (2) This is particularly true early on (1872-1876). The University of London opened to women in 1877 and while publications by women do not appear until later, the DYNAMIS. Acta Hisp. Med. Sci. Hist. Rlus. 1999, 19, 215-240. The Scientific Publications of Women Physicians in Late Imperial Russia 217 The published works of Russian women physicians should be seen not only as part of their attempt to join the profession on its own terms but also as a contribution to the medical and social discourse surrounding reforms in medicine and medical issues. Their writings added a feminine (and sometimes feminist) voice to the debate in the press, in the medical literature, and at professional congresses not only over women's capacity to practice medicine but also over women's capabilities and role in society. By placing themselves in the public arena and publishing their scientific and literary achievements, these women physicians, publicly challenged common conceptions about women's roles and capacities. As Sidonie Smith writes, if a woman seeks a place in the public arena, «she transgresses patriarchal definitions of female nature by enacting the scenario of male selfhood. As she does so she challenges cultural conceptions of the nature of women and thereby invites public censure for her effortsn (3). Russian women at the end of the century transgressed these boundaries with less opposition than women in other countries. Women physicians not only published but were actively encouraged to do so by male mentors. Russian women received their medical degrees both at home and abroad but in order to practice in Russia, al1 physicians had to pass the state exam and be registered on the list of physicians. A combination of factors led to large numbers of Russian women studying medicine. By studying and practicing medicine, Russian women could satisfy their quest for scientific study (emphasized by new intellectual movements such as nihilism) while at the same time helping the peasants, urban workers, and the poor (a goal of other movements such as populism). The incredible intellectual and social ferment in late nineteenth century Russia meant that class and gender roles were not firmly established and Russian women took advantage of this to try out new possibilities for education and employment. early hostility toward women in medicine gradually dissipates. On the English situation see BLAKE, Catriona. The Charge of the Parasols: Women's Entv to the Medical Profession, London, The Women's Press, 1990, pp. 178-199 and BONNER, T.N. Becoming a Physician, New York, Oxford University Press, 1995. (3) SMITH, Sidonie. A Poetics of Women's Autobiography, Bloomington, Indiana University Press, 1987, p. 8. DYNAMIS. Acta Hisp. Med. Sci. Hist. Illus. 1999, 19, 215-240. 218 MICHELLE DENBESTE-BARNETT The writings of women physicians leave us a valuable historical record of their achievements. Their publications provide information on the medical debates of the time, women's struggles to enter the profession, daily practice, and occasionally a peek into their private lives (4). Those women who published came from a wide variety of medical specialties and included both regular physicians and women with Ph.D.'s. Their publications can be divided into severa1 genres: memoirs, medical research, self-help or instructional material designed for a general audience, and literary works. Women physicians in late nineteenth century Russia emerge just as professionals begin attempting to achieve some degree of autonomy from bureaucratic interference. Women took advantage of this discourse to portray themselves as competent professionals dedicated to bettering the lives of Russian people. This same impulse to justify their work in the profession also motivated them to publish their scientific findings so that they could be viewed as legitimate, professional, scholars and physicians. In fact, since women studied with top male physicians due to the association of the women's medical courses with the St. Petersburg Medical-Surgical Institute (the premier medical school in Russia), women's scholarship often examined new and cccutting edgen issues. At the same time, women's requests for better pay, independence in the work environment, and improvements in public health frightened a government already concerned about radicalism among the newly emerging professional classes. TYPES OF PUBLICATIONS BY WOMEN PHYSICIANS About thirty-seven percent of women's publications are directly concerned with women's and children's health, the vast majority (4) My database consists of 270 publications by 140 women physicians published between 1870 and 1905. The database was compiled by searching medical periodicals such as Vrach, Akusherka, Meditsinskii Vestnik, and Vestnik Oftalmologii and by searching GOLITSYN, N.N. Bibliograficheskii slouar' russkikh pisatel'nits, St. Petersburg, 1889; PETROV, N.P. Bibliopaficheskii ukazatel' russkikh dissertatsii po meditsin,e i veterinam'i, Vyp. 1, 1860-1892 and Vyp. 2, 1893-1898, St. Petersburg, 1893; ZMEEV, L.F. Russkie vrachi pisateli s 1863 g., St. Petersburg, '1888; and ZMIGORODSKII, K.I. Bibliograficheskii ukazatel' rossiiskoi meditsinskoi literatury, St. Petersburg, 1890. DYNAMZS. Acta Hisp. Med. Sci. Hist. Illus. 1999, 19, 215-240. The Scientific Publications of Women Physicians in Late Imperial Russia 219 concentrating on pregnancy and childbirth (5). Part of the reason for the large numbers of works on gynecology lies in the degrees granted to women physicians (6). Originally, women could only officially study issues related to women and children (although their professors often flouted the rule). Secondly, women could more easily profess legitimacy in the medical profession if they claimed to be specially suited to caring for women and children. However, when working in the zemstvo and in remote areas they had to treat whoever came in since other doctors were usually miles away. Eleven of the publications in my database are popular manuals intended for women to use as reference manuals for themselves and their daughters. These manuals often contained illustrations and discussed the phases of a woman's life and her reproductive cycle. Women physicians of this genre concerned themselves with educating women about the dangers of corsets, breast feeding their babies, and basic information on reproduction and hygiene. These were important topics for many women who, fearful of discussing such intimate topics with male physicians, lived in ignorance. Women did not confine research only women and children. A.G. Arkhangelskaia wrote the first of a series of brochures put out by the Pirogov society. Her brochure explained the importance of prompt medical attention, indications for surgery, what doctors might do prior to and during surgery, and the necessity of following the doctor's instructions ('7). Another large group of publications by women physicians (eight percent) concerns the practice of medicine itself. These include reports on medical congresses, articles about foreign meetings attended, minutes of both domestic and foreign medical societies, and reports on various types of clinics and hospitals. Publications such as cThe condition of (5) A few women physicians also published fictional stories or wrote on topics unrelated to medicine. 1 have left such publications out of this database. (6) When the women's medical courses opened in St. Petersburg in 1872, they were designed to be a four year course after which students earned the degree uchenaia akusherka (learned midwife). In 1876 the courses expanded to five years and students received certificates stating that they were qualified to treat women and children. Not until 1880 did they receive the title zhenskii vrach (woman physician). (7) ARKHANGELSKAIA, A.G. Dlia chego doktora delaiut operatsii i kakaia ot togo byvaet polta bolhomu, Moscow, Pirogov Commission, 1897. DYNAMIS. Acta Hisp. Med. Sci. Hist. lllus. 1999, 19, 215-240. 220 MICHELLE DENBESTE-BARNETT medicine in the West. or «Sanitary conditions in Moscow in 1889~ indicate the integration of women into the profession (8). Women were not merely passive bystanders as others defined the medical profession. Their activities and their writings helped to form both the questions and the possible answers to the direction Russian medicine should take. Women physicians also took part in non-medical congresses on prostitution and women's education. Many of the women who published on other topics also published memoirs of their experience. These memoirs have enticing titles such as «War with Bacillin, ~House Calls: A Day in the Life of a Duma Woman Doctor in St. Petersburg~, and .A Mission Against Choleran (9). Many of the articles supporting medical education for women contained first hand accounts by women students at the courses which served severa1 purposes (10). First, they publicized the activities and successes of women physicians. Autobiographical writing for women served as a way for a woman to shape her own fate by publicly defining their own realities (11). Secondly, they allowed individual women to write about personal experiences in the context of a professional account. Because (8) ARKHANGELSKAIA, A.C. S sostoianii meditsiny na zapade (iz putebykh vpechatienii). Trudy 7-go gubernskogo s"ezda vrachei Moskovskogo zemstvo. March 1883, Moscow, 1884, pp. 148-64 and POKROVSKAIA, M. Sanitarnoe polozhenie Moskvy v 1889 g. na osnovanii dannylch poluchennykh iz otchetov Moskovskikh gorodskikh sanitarnykh vrachei. Russkaia Meditsina, 1890, Nos. 41, 42, 43 and 45. (9) DRAGNEVICH, Natalia. Iz vospominanii zhenschiny-vracha. Russkoe Bogatstvo, June 1903, No. 1, pp. 61-74; GRIN, S. Voina s batsillami: Iz zametok zhenshchiny vracha. Vestnik Evropy, 1890, 5, 601-654; PAEVSKAIA, A. Komandirovka na kholera: Iz zametok zhenshchiny .vracha. Russkoe Bogatstvo, Nos. 7 and 8, July and August 1903, pp. 121-69 and pp. 49-93; and SLANSKAIA, Ekaterina. Den' dumskogo zhenshchiny-vrach v S. Peterburge. Vestnik Evropy, 1894, 3, 204-242. (10) For instance, ARKHANGELSKAIA, Aleksandra. Otchet Tsiurikhogo universitete za 1883 g. Drug Zhenshchin, 1883, No. 9, pp. 82-88; OKUNKOVA-GOLDENGER, Zinaida. Zhenshchina-vrach za granitsei. Meditsinskoe Obozrenie, 1876, 5, 189; and SHABANOVA, Anna. Zhenskoe vrachebnoe obrazovanoe v Rossii. Istoricheskii Vestnik, March 1913, 131, 952-961. (11) For more on women's autobiographical writing see HELDT, Barbara. Terrible Perfection, Bloomington, Indiana University Press, 1987, p. 102 and CLYMAN, Toby. Women Physicians Autobiography in the Nineteenth Century. In: Women Writers in Russian Literature, Westport, CN, Greenwood Press, 1994, pp. 111-126. DYNAMIS. Acta Hisp. Med. Sci. Hist. illus. 1999, 19, 215-240. The Scientific Publications of Women Physicians in Late Imperial Russia 22 1 many women began studying medicine out of a desire to do something useful or to help others, their memoirs served an educational purpose. As Anna Shabanova, a student in the first graduating class of the Women's Medical Courses, explained, «But why did the study of medicine attract women more than other professions? ... It seems to me that medical work attracted them because of its service to science and ties to altruistic tasks-relieving suffering while allowing greater independence than other professions» (12). Women memoirists describe the appalling conditions of ignorance, dirt and ill health in which a large percentage of Russia's population lived. They do so in order to inform a more privileged section of society and to press for health and hygiene reforms or larger social reforms. Other women physicians published self-help and instructional manuals for women, often in conjunction with public lectures, typical of women physicians in other countries as well, for this type of publication provided an acceptable place for them in the profession even among hostile elements (13). Elizabeth Blackwell, a pioneering English physician recalled that she was able to ward off starvation and attract possible clients by offering public lectures. Many women who published ~serious research~ also wrote works intended for the general public. Varvara KashevarovaRudneva, the first woman doctor educated in Russia wrote a textbook, Hygiene for the Female Organism in al1 Phases of Life, used by both medical specialists and non-medical personnel for its descriptions of female anatomy and hygiene (14). HYGlEIVE ANO WOMEN'S HEALTH: ELIZABETH DRENTELSVAhTD MARILA VOLKOVA Elizabeth Drentel'n, another of the early women physicians, specialized in self-help literature and established herself by writing and lecturing (12) SHABANOVA, note 10, p. 953. (13) For one example see HERROLD, Maude. Woman and Disease: A Collection of Facts for Women, Kansas City, MO, Published by the Author, 1896. (14) KASHEVAROVA-RUDNEVA, Varvara. Gigiena zhenskogo organizm uo usekh fazisakh zhizn, Kharkov, 1884 and St. Petersburg, 1892. DYNAMIS. Acta Hisp. Med. Sci. Hist. illus. 1999, 19, 215-240. 222 MICHELLE DENBESTE-BARNETT Photo on the opening page of Varvara Kashevarova-Rudneva's Autobiography in the anniversary yearbook of the Medical-Surgical Academy. «Avtobiografiia», Dvadtsatpiatletie vrachei bjlvshikh studentov imperatorskoi medikokhirurgicheskoi akademii (St. Petersburg, 1893), pp. 68-95. on women's health and liygiene. She wanted women to become more knowledgeable about their own bodies in order to decrease their fear of natural occurrences such as childbirth and menstruation. Other articles on menopause, venereal disease and the processes of childbirth are published in Vrach and Akusherka. Elizabeth Drentel'n apparently attended the St. Petersburg Medical Courses and is listed on the medical register for 1883. She wrote and lectured on women's health and maintained a private practice in St. Petersburg on the Fontanka. Her publications included The Health of Women: Four Public Lectures, The Necessity of Medical Supemision of Women in Women's Institutions, and On Prostitution (15). (15) DRENTEL'N, Elizabeth. O neobkhodimosti zhenskogo meditsinskogo nadzora u zhenskikh uchebnikh zavedeniiakh, Moscow, 1897; O prostitutsii s tochki zreniia dinamiki zhizni, DYNAMIS. Acta Hisp. Med. Sci. Hist. Illus. 1999, 19, 215-240. The Scientific Publications of Women Physicians in Late Imperial Russia 223 Drentel'n held fairly conservative views about the impact of education on women's health, noting that physicians still disagreed on whether studying and education intensified women's suffering during menstruation and childbirth. She favored educating young women about their health and reproduction but also felt that they should be closely watched for any harmful affects of too much activity. Drentel'n strongly opposed keeping young women in the dark about their own health and she discussed the terror of menstruation for young women, frightened by the sudden appearance of blood, unaware of what is happening to their body, and too embarrassed to ask. She cites the example of one young girl who, alarmed by the sudden appearance of blood, ran outside into the snow and remained sitting there hoping that the cold would stop the bleeding. Drentel'n hoped that having female medical personnel in the schools might give girls the opportunity to ask more questions and to seek medical attention when necessary. In fact, she expressed disappointment that more women doctors had not gone into this line of work. She emphasized that only four percent of women doctors had found work at teaching institutions whereas large numbers had been attracted to zemstvo work (16). She believed that the responsibilities of an institutional doctor (uchilishchnyi) should be broad, to include both teaching and more personal discussions with the pupils in order to facilitate greater openness. .A school doctor should not have a narrow specialty ... but should have a broad medical educationn (17). According to Drentel'n, the school doctor should discuss clothing and its effects upon physiology, especially corsets, hygiene, and menstruation. In Drentel'n's public lectures she discussed such issues as women's anatomy, differences between men and women, growth (from girl to woman), menstruation, pregnancy and childbirth, women's diseases, and diseases resulting from pregnancy and childbirth. Her published version of these lectures included drawings of women's organs, the uterus, eggs, and reproductive stages. Drentel'n strove to educate mothers about their own reproductive life and organs and hoped to give them Moscow, 1908; Zdorov'e zhenshchiny: Chetyre publichnye lektsii. Chitaniia iskliuchitel'no dlia zhenshchin v Kharkove i Moskve v 1898, Moscow, 1899. (16) DRENTEL'N (1897), O neobkhodimosti, note 15, p. 9. (17) DRENTEL'N (1897), O neobkhodimosti, note 15, p. 4. DYNAMZS. Acta Hisp. Med. Sci. Hist. Illus. 1999, 19, 215-240. 230 MICHELLE DENBESTE-BARNETT St. Petersburg schools to Finnish schools which she felt to be of superior design (26). SchooP hygiene was of great concern in the late nineteenth century and books and pamplilets discussed proper lighting, ventilation, floor plans, and school desks designed to create the most hygienic environment possible (2'7). Ekkert's four articles on the subject clearly contributed to work in the area. In one article she lays out specific floor plans for school construction. Eltkert's articles differ from Volkova and Drentel'n (also concerned with hygiene) by her use of statistics, charts, and diagrams to back up her arguments. While Volkova and Drentel'n make, use of anatomical drawings and knowledge of physiology, Ekkert used empirical data, drawn from studies of children over time. EVGENIIA SEREBRENNJKOVA: PIONEERING OPHTHALMOLOGIST Not al1 women physicians worked on specifically female related issues. Evgeniia Serebremnikova became one of the foremost experts on eye disease in Russia. She graduated from the St. Petersburg medical courses and then traveled to Perm with her husband, also a physician. There she worked for free as the town was unwilling to pay two doctors (especially when they could get one for free by paying the husband). But, recognizing the need for an eye clinic she began treating and researching eye diseases. Eventually she received funding to set up her own clinic at the hospital. This clinic, the first of its kind in Russia became the prototype for small cities elsewhere. Serebrennikova published over twenty articles on her techniques and findings and on the day to day operations of her clinic (28). (26) EKKERT. Obzor noveishikh dannykh po postroike shkol preimushchestvenno russkikh i skandinavskikh. Zhurnal Russkogo Obshchestva Okhraneniia Narodnogo Zdraviia, 1898, 8, 541-542; EKKERT. Opyt fizicheskogo izsledovaniia uchashchikhsia v nachal'nykh gorodskikh shkolakh Peterburga. Vrach, 1894, 15, 708-709. (27) On school hygiene see CONROY, Mary. School Hygiene in Late Tsarist Russia. Slavic and East European Education Review, 1981, 2, 17-26. (28) BABUSHKIN, V. A. Vrach E.P. Serebrennikova, Perm, 1957 and SHABYNIN, A. V. Khirurgicheskaia deiatel'nost zhenshchin-vrachei v Rossii v XIX veke. Vestnik khirurgii im. I.I. Grekova, 1897, 138, 128-130. DYNAMIS. Acta Hisp. Med. Sb. Hist. nlus. 1999, 19, 215-240. Serebrennikova concentrated on treating trachoma, a serious and widespread problem in the late nineteenth century. She taught her techniques at international conferences. In 1891, seeking more knowledge she traveled abroad and studied in Germany and France. Because she had the first independent eye clinic she treated large numbers of patients and built up a significant database on successful and unsuccessful treatment options which doctors elsewhere took seriously. Her statistics set the tone for discussions at medical congresses on the proper treatment of eye disease. For instance, in her report for 1889 she reported seeing 3,035 patients (1,984 peasants, 633 petty bourgeois, 261 government bureaucrats, 86 from the clerical estate, and 71 merchants). Most of her patients came from Perm or the Perm guberniia but-a few (99) traveled from other guberniia to see her. For many people she would have been the last chance for help and the only specialist for hundreds of miles (29). Al1 physicians had some training in eye disorders but Serebrennikova was one of only nine eguberniia oculists». Five other women physicians wrote articles on blindness and eye disease and by the 1880s an entire journal (to which Serebrennikova frequently contributed), Vestnik Oftalmologii was devoted to questions of eye disease and functioning of the eyes (30). In her reports she kept careful and detailed records of symptoms, diagnoses, treatment, occupation of the patient, and success or failures. In one year Serebrennikova performed 789 operations with ~antiseptic precautions. for such disorders as cataracts, prolapsed iris, keratotomia and removing cancers. Besides her reports Serebrennikova wrote articles on treating trachoma, blindness, cataracts and the optic nerve, and even on vaccinations (31). Aside from her surgical practice, research, - SEREBRENNIKOVA, E. V. Oftalmologicheskii nabliudenii za 1889 god iz Permskii gubernskii bolnitsy. Vestnik Oftalmologai, 1890, 7, 469-496. For example, ARKHANGELSKAIA. Otchet o sotne ekstraktsii katarakt v zemskoi praktike. Meditsinskoe obozrenie, 1891, No. 15; BOKOVA, Mariia. Sposob iskustvenno proizvodit tsvetnuiu slepotu, Meditsinskii Vestnik, 1862, Nos. 23 and 24; and GEORGIEVSKAIA. O tswetnoi skpote i sposobe eia opredeleniia, Ph.D. diss., St. Petersburg. SEREBRENNIKOVA, E.V. K lecheniiu trakhomy. Vrach, 1887; Neskolko slov o nashei slepote. Sbornik Permskogo Zemstvo, Perm, 1886; and Ob ospoprivivanii v DYNAMIS. Acta Hisp. Med. Sci. Hist. Illus. 1999, 19, 215-240. 232 MICHELLE DENBESTE-BARNETT and daily practice, Serebrennikova also found time to raise money for the women's medical courses, to raise money, build and supervise a gymnasium for blind students and to teach both at the blind gymnasium and the local feldsher school. MARIIA POKROVSKAIA: PHYSZCZAN, FEM11VZST AND PUBLZC HEALTH CRUSADER Mariia Pokrovskaia, one of the best known of the early women physicians also wrote her first article on cataracts. But she later became known more for her feminism and as an advocate of changing the prostitution regulations than for her medical practice. Her professional activities included editing a women's journal Zhenskii Vestnik, participating in congresses on prostitution and on women's issues, writing and editing severa1 books, and maintaining a private practice. She graduated in 1881 from the St. Petersburg medical courses and served in the zemstvo for severa1 years before returning to St. Petersburg to practice medicine and write. Pokrovskaia worked tirelessly for a number of important causes. She wrote frequent editorials in Zhenskii Vestnik about the necessity of better education for women, universal suffrage, and the importance of improved health care for the poor. Pokrovskaia, like many of her contemporaries, saw her medical training as both a means and an obligation to help the poor and downtrodden of society. Her medical articles centered on issues such as the unhealthy living conditions of Petersburg workers, treatment of tuberculosis, and health and sanitation. One of her first articles, published in Vrach, studied peasant huts in relation to their ventilation and its effects on health (32). She undertook her study because physicians believed that huts without chimneys were unhealthy and that cataracts were more common among people living in this type of peasant hut. In her region, however, more than half of the population lived in huts without chimneys, so she undertook to examine what Permskoi gubernii. Doklad na ZZZs"ezde Vrachei Permskoi Gubernii v 1886, St. Petersburg, 1886. (32) POKROVSKAIA. Vliianie lcurnykh izb na zabolevaniia organov dykhaniia i zreniia. Vrach, 1888, Nos. 4 arid 5, pp. 65-66 and pp. 89-91. DYNAMZS. Acta Hisp. Med. S&. Hist. Illus. 1999, 19, 215-240. The Scientific ~ublicatlons of Wornen Physicians in Late Imperial Russia 233 might be causing the problems. She studied temperatures, the content of carbonic acid in the huts, and patient records of the villagers. She found fewer incidents of eye disease in the huts without chimneys than in those with chimneys and thus concluded after comparing results with other zemstvo physicians that it was necessary to look for other causes of blindness and trachoma (33). In another article she studied the living conditions of St. Petersburg workers (34). The article summarized a survey carried out by city sanitary doctors which found horrible overcrowding, a lack of basic sanitation and toilet facilities, insufficient light and poor ventilation. Pokrovskaia recommended that more inexpensive housing be constructed and that the current building codes be enforced. She also felt that the people needed to be educated about hygiene by way of schools, lectures, and brochures written for a popular audience. Pokrovskaia also wrote extensively on prostitution and abortion. The regulation of prostitutes through the medical police surveillance committees was an issue of concern both to feminists and to many physicians who saw it as government infringement on medical territory. Physicians differed on whether regulation should be completely abolished but nearly al1 agreed that physicians and not the state should handle regulation. As Laurie Bernstein noted in her dissertation on prostitution in Russia: «The association between prostitution and venereal disease gave physicians an opportunity to claim professional expertise. ... Physicians hoped to see a form of regulation that conformed with more enlightened principles and adhered to the words of scientists about the transmission and prevention of diseases. ... To the Russian medical community, the government's role in regulation represented more interference from a bloated state that had never given doctors the professional autonomy they deserved. (35). (33) TUVE, Jeanette. Russian Women Physicians, Newtonville, MA, Oriental Research Partners, 1984, pp. 93-94. (34) POKROVSKAIA. O zhilishchakh peterburgskikh rabochikh. Russkoe Bogatstvo, 1897, 6, 19-38. (35) BERNSTEIN, note 21, pp. 306-307. DYNAMIS. Acta Hisp. Med. Sci. Hist. Illus. 1999, 19, 215-240. 234 MICHELLE DENBESTE-BARNETT Pokrovskaia herself was ardently opposed to prostitution (36). In her publications she argued that the key to eradicating prostitution was not regulation of prostitutes by the government but rather education and economic alternatives for women. In 1902 she wrote that sex education aimed at young men was the key to stopping the spread of venereal diseases, but by 1908 she claimed women would have to control their own fate by having the deciding voice in ~regulating sexual relations~ (37). She also strongly believed that regulation of prostitutes endangered al1 women. The ritual of rounding up any «suspicious» women found without proper identification as prostitutes (often defined simply as a woman walking alone Bn the evening or in a suspicious part of town) had nearly resulted in her own arrest one night in 1905 (38). On topics such as prostitution and abortion Pokrovskaia is much more outspoken than many of her female counterparts. Both male and female physicians engaged in an always-heated debate over prostitution because, as Bernstein points out, the prostitution debate concerned not only gender issues but professional ones as well. ANNA SHABANOVA: PEüIATñICIAN ANLI WOMEN'S RIGHTS ACTWIST Anna Nikolaevna Shabanova first studied at Helsingfors (Helsinki) University, aided by a small scholarship from the writer Saltykov-Schedrin. There she supported herself through translation work, returning home in the summers to earn money. When the women's medical courses opened in Russia, she transferred into the second year class and graduated (36) See for instance, POKROVSKAIA. Bor'ba s prostitutsiei. Doklad ZZ otdeleniiu Russkaia obshchestvo okhraneniia narodnogo zdraviia, St. Petersburg, 1900; Kak zhenshchina dolzhna borot'sia s prostitutsiei. Zhenskii Vestnik, February 1909, pp. 33-39; and K bor'be s prostitutsieiu. Zhenskii Vestnik, May-June 1904, pp. 113-114. (37) POKROVSKAIA. O zhertvakh obshchestvennogo tempermenta, St. Petersburg, 1902; POKROVSKAIA, Edinaia polovaia nravstvennost'. Zhenskii Vestnik, 1910, No. 4, p. 92; and ENGELSTEIN, Laura. The Keys to Happiness: Sex and the Search For Modernity in Fin-de-siecle Russia, Ithaca, NY, Cornell University Press, pp. 224-225. (38) BERNSTEIN, Laurie. Sonia's Daughters: Prostitutes and Society in Russia, Ph.D. dissertation, University of California, Berkeley, 1987, p. 337. DYNAMZS. Acta Hisp. Med. Sci. Hist. Illus. 1999, 19, 215-240. The Scientific Publications of Women Physicians in Late Imperial Russia 235 in 1878. The lectures of pediatrician KA. Raukhfus had strongly influenced her and she turned to pediatrics for a career (39). Though she had been involved in political circles (and was jailed briefly in 1866), as a pediatrician, Shabanova left her early political agitation behind and turned her reformist impulses to improving the lives of children. After graduation Shabanova worked in the children's clinic of Nikolaevsky military hospital, assisting the women medical students. At the same time she was invited by Raukhfus to work as a staff physician (ordinator) at his clinic at the Oldenburg Children's Hospital. She worked there for the rest of her life, working her way up to senior staff physician and continuing on as a consultant when she was in her eighties. Shabanova established the Society for the Treatment of Chronically 111 Children. Chemist and composer, A.P. Borodin contributed the proceeds from one of his concerts to the cause, and by 1882 she had enough money to open the first clinic at Gatchina and a second at Vindava later. At various international congresses she explained the success of such clinics in treating chronically ill children but bemoaned the fact that so few existed in Russia compared to countries such as Germany and Finland (40). Her clinic at Gatchina had twenty-two beds and served about 1,000 children a year. The average length of stay per child was approximately 130-150 days. Shabanova was intimately involved in women's issues and founded the Russian Women's Mutual Aid Society in 1895, the first women's rights organization in Russia which strove to work through legal and peaceful means to achieve equality for women. In 1908 she organized the First Al1 Russian Women's Congress. Shabanova also participated in the League of Struggle for the Rights of Women. In 1899 the International Women's League of Peace elected her chair (although with the advent of World War 1 this organization fe11 apart). Due to her affiliation with these organizations she traveled abroad and spoke at international (39) SHABANOVA, Anna. Dva goda v Gel'singforskom universitete. Vestnik Evropy, 1888, 2, 538-575. (40) SHABANOVA, Anna. Popechenii o khronichesko bol'nykh detiakh v Rossii. Zhurnal Russkogo Obshchestva Okhraneniia Narodnogo Zdraviia, 1899, 9, 849-857 and SHABANOVA, Anna. Obzor deiatel'nosti detskoi lechebnitsy u Gatchine, St. Petersburg, 1887. DYNAMIS. Acta Hisp. Med. Sci. Hist. Illus. 1999, 19, 215-240. 236 MICHELLE DENBESTE-BARNETT organizations. She published extensively and attended professional congresses both at home and abroad. Prior to her death the new Socialist Union of Doctors honored her and in 1928 she received a medal as a Hero of Labor. She also became one of the first women members of the St. Petersburg Scientific-Medical Society of Pediatricians. Shabanova's career spanned severa1 decades and she continued working even late in her 80's. IMPACT OF WOME2V'S PUBLICATIONS ON THE PROFESSION The fact that so many woman and men wrote on social and public hygiene should not be surprising. The ideas of germ theory had only begun to be introduced in the 1870s. Many of the hygienists' ideas continued to be useful even when used hand in hand with more modern knowledge of bacteria. Some physicians of the time even disputed whether bacteriology could be useful in Russia, claiming that improved hygiene could produce better results (41). In fact, hygiene and studies concerning hygiene remained irnportant in Russia partly because such dramatic improvements could be made to public health through (Ccommon sense» health improvements. lMany of these improvements could be made without a large monetary investment. Women physicians often researched such topics as ventilation in schools and homes, the effects of smoke from peasant huts on eye disease, and problems with the water supply. As these examples show, Russian women, like women in other countries published manuals for women on their own health and hygiene. However, unlike women in other countries, Russian women physicians also published large nu~bers of works on infectious diseases, «female complaints~, surgery and a variety of other medical topics. Severa1 women publish reports on the mentally ill and conditions in mental (41) On this debate see HACHTEN, Elizabeth A. Science in the Seruice of Society: Bactm'ology, Medicine and Hygiene in Russia 1855-1907, Ph.D. dissertation, University of WisconsinMadison, 1991, pp. 80-100; HUTCHINSON, John F. Tsarist Russia and the Bacteriological Revolution. Journal of the History of Medicine, 1985, 40, 420-439; and FRIEDAN, Nancy. Russian Physicians in an Era of Refonn and Revolution 18561905, Princeton, Princeton University Press, 1981, pp. 135-160. DYNAMIS. Acta Hisp. Med. Sci. Ziist. Illus. 1999, 19, 215-240. The Scientific Publications of Women Physicians in Late Imperial Russia 237 institutions (42). A significant number of women (about seven percent) publish articles on infectious diseases. Other women publish on a wide variety of topics such as worm infestations, blood pressure, carbonic acid in the air, skin transplants, hypnotism, cancers, and tumors. These works are published in major medical journals such as Vrach and Meditsinskii Vestnik. Elsewhere women struggled just to get into medical school, gain access to laboratories and be allowed to practice. Foreign medical journals do not begin publishing medical research by women until much later. While Russian women certainly met on occasion with prejudice and obstacles, they also received professional support and encouragement in very tangible ways (such as access to research facilities and the opportunity to interact with colleagues at professional conferences and in hospitals). One woman, speaking in the United States in 1900, explained: «We must note the fact that women doctors have really begun to play a part in the life of their country. Wherever there are wide-spread epidemics, famines or other diseases, they are in the front rank of the helpers. Besides this they write and lecture; and thanks to their efforts, interest has been aroused in various sanitary problems, such as, for example, the recently opened sanitarium for lung diseases, which was primarily due to the efforts of Dr. Pavlovskaia. ... In conclusion we may say that the Russian women doctors, by their work, have given the possibility to future generations to advance still further on the road to independence first opened up by them» (43). CONCL USIONS Clearly women physicians became active in Russian medicine. But, while we might expect and even hope that women physicians would (42) KOVALEVSKAIA, Lidiia. Zemskii dom umalishennykh v Shteiermarke. Arkhiv Psikhiatnia, Neirologii, i sudebno-meditsinskoi Tsikhopatologii, 1885, 5, .83; VALITSKAIA, M.K. Idiosinkraziia ili otravlenie? Russkaia Meditsina, 1886, No. 14; and VALITSKAIA. Frantsuzskie zakony o dushevno bol'nykh. Arkhiv Psikhiatni, Neirologii i sudebnomeditsinskoi Psikhopatologii, 1885, Nos. 4 and 5, pp. 101 and 66. (43) KAZAKOVICH-STEFANOVSKY, Helene. Women Physicians in Russia. Transactions of the Annual Meeting of the Alumnae Association of the Women's Medical College of Pennsylvania, 1900, 25, 66. DYNAMZS. Acta Hisp. Med. Sci. Hist. Zllus. 1999, 19, 215-240. 238 MICHELLE DENBESTE-BARNETT develop alternative treatments which might be more sympathetic and attentive to women's iieeds, this does not appear to be the case. In fact, it could hardly be otherwise. Women were trained by male physicians in previously al1 male medical schools. Their scientific view of medicine is therefore based on the male model. One supposed reason for training women physicians was to protect female modesty. This does not seem to occur, perhaps because too few women are trained to meet this need. Wealthy women have access to private practitioners in the cities. Poor women often prefer to visit traditional healers first and then when they need a physician are willing to see whoever is available. Varvara KashevarovaRudneva, allowed to attend the Medical-Surgical Academy on a scholarship in exchange for her promise to serve Bashkir women, never could fulfill her promise after graduation due to bureaucratic roadblocks. While not necessarily proposing radically different treatments than men, women physicians did tend to be more sympathetic towards women's health concerns and toward providing meaningful educational materials for women. In Zhuk's manual on hygiene he covers much of the same material as Volkova or Drentel'n but he presents disorders in a much more frightening way. While Volkova covers what might be expected during normal childbirth along with common complications, Zhuk includes extreme examples such as pictures of malformed heads, a woman with five breasts, and babies in incorrect positions (44). Another important aspect of women's participation in medicine was that they did increase interest in and knowledge about ~women's issuesn such as childrearing, and politicized issues such as prostitution, abortion and education for women. Certainly male physicians published and researched women's health but only seven percent of women physicians who published did not write anything on women's or children's health. Part of the reason for this may be that women were less likely than men to specialize. Working as a zemstvo, duma, or private physician required broad knowledge. Secondly, the early women earned certificates stating they were qualified to treat women, children, and syphilis only, so while many eventually branched off into broader areas, many began by working (44) ZHUK, V.N. Mat' i ditia: Gigiena v obshchedostupnom izlozhenii, St. Petersburg, 1894. DYNAMIS. Acta Hisp. Med. Sci. Hist. Illus. 1999, 19, 215-240. The Scientific ~ublications of Women Physicians in Late Imperial Russia 239 in women's clinics or for the zemstvo where they saw both men and women by necessity. Because Russian male and female physicians shared similar professional goals, the animosity which sometimes greeted women publishing «serious» literary, journalistic, or medical works in other countries, did not affect Russian women physicians. They were able to publish their research, memoirs and reports about hospitals, schools or regions of work. Scholars studying revolutionary women have noted that while women often participated in distributing propaganda and operating printing presses, they rarely had a part in formulating and writing theory or position papers (45). Women physicians encountered no such prejudices. The most prestigious medical journals published their works as did the published reports of smaller local physicians congresses. Respected male physicians not only tolerated them, but actively promoted their work, offering suggestions for research topics and advice and collaboration. This lack of animosity between male and female physicians may be partially due to the enormous need for more Russian physicians. In 1896 Russia had only 16,400 physicians for a population of 92 million (46). Until 1897, when the medical courses in St. Petersburg opened after a decade long hiatus, and the numbers of *women studying medicine rose sharply, Russia had only 959 female physicians. Thus, they did not present much of a threat to the economic well-being of male physicians. As women could not by law serve in military or government positions, most women served in the lower paying ranks of zemstvo work or private practice. In 1888 for instance, of 698 practicing female physicians, 540 listed their specialties as private practice, 92 worked in zemstvos and 66 served in hospitals and as duma physicians (47). A more difficult concept to assess is the effect their publications had on the target audience. Certainly women physicians contributed to (45) See for instance ENGEL, Barbara. Mothers and Daughters: Women of the Intelligentsia in Nineteenth Century Russia, Cambridge, Cambridge University Press, 1983, pp. 199-205 and MCNEAL, Robert. Women in the Russian Radical Movement. Journal of Social History, 1971-72, 5, 143-163. (46) FRIEDAN, note 41, p. 266. (47) AREPEV, Nikolai. Zhenskoe meditsinskoe obrazovanie v Rossii i zhenskii meditsinskii institut, Moscow, 1898, p. 27. DYNAMIS. Acta Hisp. Med. Sci. Hist. illus. 1999, 19, 215-240.