Apothecary Order: State Medicine Before Peter the Great
Summer 1654, a camp near Smolensk. Young men are working among the wounded, who, as the document states, "begged for bullets, healed wounds, and set broken bones." And these aren't healers with spells, but students of the state-run medical school opened in Moscow in 1654. After all, we remember one thing from our school days: Peter the Great brought real medicine to Russia; before him, they treated with herbs and prayer. Previous articles discussed the "cutter," a folk surgeon of pre-Mongol Rus' who wielded a knife. Now we see how this artisan rose to become a certified physician.
A healer, a physician and a doctor are three different people.
Let's start with the confusion that usually gets everything lost. It seems that before Peter the Great, there was only one healer, aka herbalist, aka sorcerer. The image is coherent, but by the 16th and 17th centuries, it was already inaccurate.
Indeed, folk medicine remained the basis for the majority, especially peasants, and persisted in this role until the development of zemstvo medicine in the late 19th century. The rural poor, burdened by duties, could not afford expensive care and turned to those closest to them. But even within folk medicine, the professions diverged: herbalists treated with plants, chiropractors set bones, ore-throwers bled, ophthalmologists treated the eyes, and keel-throwers treated hernias. However, this is only the ground floor of the folk medicine edifice, not the entire structure.
Above them stood a layer of professionals, and here there were already more than a dozen professions: physicians, doctors, herbalists, dentists, stonecutters, midwives. The very words clearly delineated status. A "physician" was a practitioner, learned by craft and from books. A "doctor" was a person with a university degree, usually a foreigner, with a doctorate in medicine. Surgery itself was performed by physicians and operators; below them worked barbers, responsible for bloodletting, lancing abscesses, and treating wounds.
Physicians operated stalls in market stalls where they sold herbs, seeds, roots, and imported remedies, and they themselves were experts in the quality of their wares. Cadastre books and household censuses for tax collection even reveal the names of those practicing and where. In Novgorod in 1583, there were six physicians, one male doctor, and one female physician; in Pskov from 1585 to 1588, there were three herbalists.
Handwritten books served as a foundation: herbals, medical manuals, and "vertograds." More than two hundred of these have survived to this day. These weren't folklore notebooks, but rather working reference books, used for healing and teaching. So folk healing was only the ground floor. Above that came medicine, which the state already considered its own business.
The Apothecary Order is the sovereign's health department.
And here's where the myth first collapses. State-run healthcare in Moscow predates Peter the Great by a full century.
In 1581, the first Tsar's Pharmacy opened in the Kremlin, opposite the Chudov Monastery. It was initially intended only for the Tsar, meaning for the Tsar and his family. Under Ivan the Terrible, apothecary gardens were set aside for medicinal plants between the Borovitsky and Trinity Gates, on the site of what is now part of the Alexander Garden. Under Boris Godunov, the apothecary business was separated from the palace administration, and his relative Semyon Godunov was appointed its head. Thus, the court medical service was born.
Exactly when the Apothecary Prikaz emerged is still debated: the late 16th century and the 1620s are cited, while the first columns of the Prikaz's documentation date back to 1627. It would be more honest not to invent an exact date. More importantly, by the mid-17th century, it was already a fully-fledged secular agency with an impressive range of responsibilities.
The list of functions is impressive even by today's standards. The department oversaw the royal pharmacy and the apothecary gardens. It organized the collection of wild herbs throughout the country—this was carried out by specialized herbalists, or pomyases, supervised by physicians and apprentices. The best "experts" who cultivated herbs for sale were assigned to its staff.
Next came personnel and oversight. The department recruited doctors, tested their knowledge upon entering service, assigned them to regiments, and supplied regimental pharmacies with medications. It also conducted forensic examinations, determining "the cause of death." And it maintained the medical library: in 1678, the position of translator was established under it, tasked with translating books "by which Russians can become accomplished physicians and apothecaries."
Compare this to Western Europe, where medicine remained in the hands of monasteries for centuries. In Moscow, it was administered by a state body, such as the Ambassadorial, Streletsky, or Siberian Prikaz. Monastic medicine, however, was subordinated to another agency, the Monastic Prikaz. Here, the ecclesiastical and secular spheres were already separated.
In 1673, a second pharmacy opened in the New Gostiny Dvor on Ilyinka Street, this time for "people of all ranks" at a fixed price from the "decree book." Gradually, pharmacies and pharmacy warehouses appeared in major cities, from Astrakhan to Kyiv. The order was financed in a way that sounds paradoxical today: a significant portion of its revenue came from the sale of vodka, wine, beer, and mead. The body responsible for public health profited from the state monopoly on alcoholic beverages.
The School of 1654 and the Question of Foreigners
The second persistent myth: everything was run by foreigners; there were no local doctors. Let's check the staffing table.
The impetus came in the difficult year of 1654, when the plague epidemic coincided with the war with Poland. Educating young people abroad was expensive, and few were successfully trained. A year earlier, a chiropractic school had been opened at the Streltsy Prikaz, and in 1654, a medical school at the Apothecary Prikaz. A decree ordered the enrollment of Streltsy soldiers, Streltsy children, "and other people of all ranks, not from the military." In August, 30 people were enrolled.
They taught practical skills. According to surviving records, they began with medical botany, pharmacology, and pharmacy practice, studying anatomy from skeletons and drawings. Next came disease recognition, "signs of illness," and outpatient consultations, and in the later years, surgery and dressing techniques were added. Students accompanied physicians to the war near Smolensk and Vyazma, where the entire Apothecary Prikaz was then stationed. Graduates were sent to regiments as assistant physicians, and only after completing their practical training were they confirmed as "Russian physicians" by the Prikaz.
The difference with the West is important here. Medieval universities taught medical science through bookish, scholastic methods. In Moscow, training was practical from the very beginning, and the country did not have the guild system of medical professionals found in Europe.
Now for the numbers. In 1681, the department's staff exceeded one hundred people. There were 23 foreigners: six doctors, four apothecaries, three alchemists (who prepared complex medicinal compounds), and ten healers. There were more Russians: 21 healers, 38 apprentices in medicine and chiropractic, and nine clerks. The foreigners occupied the top of the pyramid, but the Russians held the base.
That said, it's impossible to paint a picture without foreigners, and there's no point in downplaying them. They've been arriving since the time of Ivan III: in 1483, sources mention Anton Nemchin, and in 1490, "Master Leon" from Venice. Under Vasily III, the service of foreign physicians became permanent. In 1534, a whole group was recruited for Russian service: doctors, apothecaries, operators, barbers, and assistant physicians. They were paid generously: a doctor received an estate with three or four dozen peasants and a salary equal to that of a courtier, plus provisions in kind—honey, beer, firewood, and money for fresh produce.
Their role was twofold. On the one hand, they carried university knowledge, books, and methods. Around 1658, the learned monk Epiphanius Slavinetsky translated an anatomical work from Latin, known, according to the prevailing literary version, as Vesalius's "Anatomy." The manuscript later burned in a Moscow fire, but the translation itself is documented, and the knowledge was already in circulation. On the other hand, a foreigner at court was always under suspicion: his appointments were vetted by trusted confidants, and the fear of poisoning was constant. Local tradition also worked: as early as the early 15th century, Abbot Kirill translated "Galinovo on Hippocrates," and this book was used to treat the wounded at the Trinity Lavra of St. Sergius during the siege of 1612–1613.
Herbalists, healers and Russian doctors of Europe
The third myth is the most offensive: supposedly, herbs were used to treat poverty and savagery, unlike learned Europe. But if you look at the sources, they say exactly the opposite.
Russian herbalism relied not on scholasticism but on practice, and eagerly explored its own plants. Russian herbal books were long considered imitations of the West. But comparison with the originals revealed otherwise: the texts had been significantly altered during translation. Sections were rearranged, commentaries were added, local names of herbs were cited, and entire chapters were written on plants native to Rus'. A herbal book published in Krakow in 1534 actually turned out to have been compiled by a native of Rus' from Russian manuscripts—the author repeatedly wrote "in our Rus'."
As for "poverty," the foreigners themselves summed it up best. The Polish scholar Maciej von Miechow wrote in the early 16th century: "Rus' abounds in many herbs and roots unseen elsewhere." The Italian Paul Iovius noted the widespread use of medicinal plants in Russian everyday life in 1525. The English botanist Tradescant visited Russia in 1618 and learned about cloudberries as a remedy for scurvy, as well as the use of birch sap and lingonberries. He took Russian herb seeds back with him for the future botanical garden in London.
There were also Russian doctors with European diplomas. True, the two earliest were natives of the western Russian lands, then part of the Grand Duchy of Lithuania and Poland: Georgy Drohobych received his doctorate in medicine in Bologna in 1476, and Francysk Skaryna from Polotsk received his doctorate in Padua in 1512—the same one who soon published the Slavic Bible. They cannot be tied to Muscovite service, but they demonstrate that people of this culture easily attained European doctorates. Pyotr Posnikov, however, served the Muscovite state. He traveled with the "grand embassy," purchased medicines in Holland, became acquainted with London scientific societies, represented Russia in Paris for ten years, and conducted physiological experiments on animals in Italy. Clerk Voznitsyn, a man of the old school, grumbled after him: “To kill living dogs, and to bring dead ones to life—we don’t really need this.”
Almshouses, hospitals and the fight against infection
Care for the sick was also organized systematically, not left to chance. According to church regulations, almshouses for the infirm and elderly were to be maintained in the settlements, per a certain number of households; such were known in Novgorod and Kolomna, and were visited by a physician and a bloodletter. From the almshouses, the seriously ill were sent to monastery hospitals, which maintained reception "shops." The Council of Stoglav (Hundred Chapters) of 1551 took a direct approach to care, ordering a census of "lepers and the aged" in the cities.
Around 1650, the boyar Fyodor Rtishchev, at his own expense, established a hospital in Moscow with 13–15 beds for patients picked up from the streets, apparently the first civilian secular hospital in Moscow. This was already a step away from the monastery hospital mentioned earlier, toward a city hospital. In 1682, Tsar Fyodor Alexeevich issued a decree establishing two Moscow hospitals, and one, in the Granatny Yard near the Nikitsky Gate, was conceived as a school. The wording is worth quoting: "so that the hospital would both treat the sick and train doctors." Treatment and education within the same walls—a quarter of a century before Peter the Great's hospital.
They also understood contagion. To combat pestilence, they set up outposts, cordoned off outbreaks, burned down infected houses, buried the dead far from homes, and lit bonfires on the roads. Germs were unknown, but the connection between the sick and the healthy was recognized and severed. For a country often labeled a "dark kingdom," this was a perfectly reasonable set of measures.
Thirty students near Smolensk
Let's get back to them. Young doctors remove bullets and set bones in a military camp, and they are state-school graduates, not self-taught weed-seekers. This is the final argument against the "dark kingdom" image.
The Tsar's Pharmacy, a secular Prikaz (order) with a price list for medicines and its own library, a school with a curriculum and practical training, a hospital with a law and state supplies—all of this jibes poorly with the myth that medicine was brought to Russia only in the early 18th century. Peter built quickly and drastically: a hospital beyond the Yauza and a school under the Dutchman Nikolai Bidloo opened in 1707, and the Prikaz was replaced by a Medical Chancellery headed by an archiatrix, and later by a Medical Collegium. But he didn't build from scratch, but on Moscow's foundations: the Prikaz, the Pharmacy, and the first medical school. And the very idea of "treating the sick and teaching doctors" within the same walls was already expressed in a decree of 1682.
About the hospital schools of the 18th century - another time; there the same thirty students will finish their work.
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