Hospital Schools: How Peter Taught to Treat
A corpse lies before the commission. A young man takes an instrument and, in front of the doctors, amputates a leg, then removes a stone from the bladder. Without these two operations, one cannot become a physician. This is how they took the final exam at hospital school in the 18th century. And here's a familiar picture: Peter the Great brought medical education to Russia, completely out of nowhere and based on the Western model. But behind this exam lies the idea of "treating and teaching," which was already tested at the medical school of 1654 under the Apothecary Prikaz.
1707: A hospital that was also a school
The impetus was the war. The Great Northern War with Sweden from 1700 to 1721 required a large workforce and many doctors for wounded and sick soldiers. High mortality from disease, epidemics among the troops, and a shortage of surgeons—all this convinced Peter that foreign doctors alone were insufficient. There was a shortage, and sending young people abroad to study was expensive and slow.
On November 21, 1707, beyond the Yauza River, in a clear, undeveloped area, the Moscow Land Hospital, now the Burdenko Main Military Clinical Hospital, opened. The location was chosen with purpose: clean air and spaciousness met the then-current standards of hospital sanitation. From the very beginning, the hospital was conceived as a dual-purpose institution: both a hospital and a school. It would treat the wounded and simultaneously train Russian physicians.
The Dutchman Nikolai Lamberts Bidloo, a former physician to Peter the Great and a graduate of Leiden University, took charge of the hospital. The decree appointing him explicitly stated that he was to not only treat patients but also train students in the "arts of medicine and medicine." Bidloo developed curricula and wrote surgical treatises based on his experience working at the hospital. These are considered the first Russian textbooks on surgery and military field surgery. He wrote some of his manuals in Latin, others in Russian.
The hospital was equipped with patient wards, operating rooms, a pharmacy, and an anatomical theater, where students learned anatomy through dissections. They weren't taught from a book, but at the patient's bedside: students attended rounds, assisted during surgeries, applied dressings, and prepared medicines in the pharmacy.
The plan was to recruit 50 people, both native Russians ("natural Russians") and foreigners living in the country, but the emphasis was on nationals. The first intake was difficult: Latin, strict discipline, and constant practice weeded out many. The school was conceived as a demanding institution, not a place for awarding titles. Sources are sparse about the school's early structure; it is only known that by the 1710s, students were assigned to courses based on their preparation.
All this coincided with the general course of reforms. During those same years, the Kunstkamera, the Academy of Sciences, navigation and engineering schools were established, and young people went abroad to study shipbuilding and artilleryPeter had seen hospitals established in Holland and England and understood the power of bedside teaching. So, there's no need to talk about a "bare spot." The foundation had already been laid in Moscow, with the Apothecary Prikaz and the medical school of 1654, discussed earlier.
Regulation of 1735: to treat and teach according to the law
Until 1733, the Moscow school remained the only one in the country, and the entire burden fell on its teachers. Then things expanded: in 1733, schools opened at the St. Petersburg Land Hospital, the Admiralty Naval Hospital, and the Kronstadt Naval Hospital. They were managed by the Medical Chancellery, the successor to the Apothecary Prikaz. It reported to the Senate and the Tsar.
In 1735, the General Regulations for Hospitals were issued. The document consolidated the experience of the first decades and legally enshrined the union of clinical and educational institutions. The wording is worth quoting:
The establishment of hospitals has a twofold purpose and fruit: the first is the benefit of suffering patients, the second is the production and confirmation of physicians and healers to great art.
The regulations outlined the entire hierarchy. Doctors—usually foreigners with university degrees, the highest rank in the hierarchy—headed the medical department, taught theory, and handled complex cases, passing on their knowledge to their students. Surgeons and physicians performed routine treatments and immediately demonstrated techniques in practice. Assistant physicians and students assisted and simultaneously learned. A chain of command, reporting, and documentation was established. It also prescribed "anatomical dissections to be performed in hospitals," and dissections became a mandatory part of both treatment and training.
The course took a long time, averaging five to seven years. The curriculum included not only surgery and bandaging, but also Latin and philosophy, without which it's impossible to read European books. The final exam combined theory, clinical demonstrations, and cadaveric surgery—the very same amputation and stone removal. It was administered by a committee of doctors and clerical staff, and the standard was uniform throughout the country. Later, on the initiative of Pavel Kondoidi, hospitals introduced "mourning sheets," a prototype. stories diseases.
In 1763, the Chancellery was replaced by the Medical College, the highest governing body for medicine. It inspected hospitals, approved programs, appointed and dismissed faculty, and decided who should be sent abroad for further education. This was no longer the result of a lone wolf. A single law, a common standard, governance from a single center—a state system in the truest sense of the word. Latin, philosophy, theory, examinations overseen by a commission: it's hard to call it simply a craft.
Who became doctors: priests' sons, soldiers' children, and a school without a sign
The nobility didn't pursue this profession, and hence the persistent, condescending view: medicine, they said, was a profession for the rabble, pursued out of desperation. The student body was indeed diverse and poor: commoners, merchants, the children of clergy, Cossacks, and soldiers' children. The nobility were drawn to military and civil service, and the medical profession seemed lowly to them.
But it was precisely this "lack of prestige" that turned the school into a vehicle for social advancement. Take the priests' sons, for example. They came from theological schools already equipped with Latin and the ability to study; for them, a medical book wasn't like literacy, and they mastered the art faster than others. The son of a soldier or Cossack, with no prospects for rank, would, within five to seven years, receive the title of physician, a salary, and a government position. Rising above one's class in 18th-century Russia was not easy, but here, a door opened.
The ranks were visible to everyone. After three years, the student received the rank of assistant physician and the right to limited practice under supervision. After completing the course and passing an examination, he became a physician, an independent member of the staff of a regiment, a hospital, or a provincial hospital. The chancery sent the best students to complete their studies at European universities. A former priest's son could return as a doctor of medicine, that is, occupy the rank previously held by foreigners, and sit in the chair of the very same college that had once examined him. A more visible social elevator couldn't be imagined.
This model worked even where there was no formal school. In the mid-18th century, at the Kolyvano-Voskresensk factories in Altai, attached to the Barnaul hospital, medical apprentices were recruited from the factory school, apprenticed to a doctor, and the most talented were sent to the capital. The mining and metallurgical region, with its high incidence of trauma and remoteness, couldn't wait for specialists from the center; they had to be trained locally. Researchers Mikhail Mirsky and Alexey Sergeyev have shown that this was essentially the same hospital school, just without the official name.
Not a copy of Europe: a doctor and surgeon in one person
Now about the "Western model." Two models were prevalent in Europe at the time. The university model, found in Italy, Germany, and France, emphasized theory, but where clinical practice lagged behind for a long time. And the collegial guild model, as in England, where surgery remained the preserve of guild corporations. Doctors and surgeons were people of different castes: one discussed illnesses, the other performed the surgery.
The Russian hospital school combined both traditions with a clear emphasis on practice. There was no separation between the theoretician and the surgeon; the same person studied both therapy and surgery, and practiced both at the patient's bedside. Theory was not taught as a separate course, but in constant connection with practice. In wartime, epidemics, and remote provincial settings, such a generalist was far more useful than a specialist.
The schools at the Admiralty and Kronstadt hospitals added a naval focus. They trained doctors for fleetThey were taught to recognize illnesses associated with long voyages, vitamin deficiencies, injuries from shipwrecks and shipyard work, and epidemics in the cramped quarters of a ship. Clinical work in naval hospitals accumulated observations and pushed for prevention, improved nutrition, ventilation, and hygiene on board ships. Here, they no longer simply treated illnesses after the fact, but tried to prevent them.
There were certainly some borrowings. The school's founder was a Dutchman named Bidloo, the language of instruction was Latin, the textbooks were European, and dissections and rounds were known in Leiden, Vienna, and Paris. But the Russian system was distinguished by its scale, centralization, and integration into state needs. A network of hospitals with mandatory schools attached to them, unified regulations, and centralized management—there was no direct equivalent in fragmented Europe. The result was not a replica of something foreign, but a unique blend.
From the School of 1654 to the Imperial Academy
Let's return to the graduate with his instrument over the corpse. This is what the entire system led to: a practicing physician, ready for war, the navy, and the remote provinces. Over the 18th century, schools produced hundreds of such physicians, assistant physicians, and surgeons. This was the first major stratum of domestic physicians, connected to the state through service and training.
The system then changed its appearance, and here it's worth slowing down: the transformation of schools into an academy was gradual and took several decades. In 1786, hospital schools were transformed into medical-surgical schools, adding theoretical subjects, including chemistry and physiology. At the same time, on the initiative of Baron Alexei Vasiliev, the schools at St. Petersburg hospitals were consolidated into the Main Medical School. A few years later, the school expanded into an academy. Its birth date is generally considered to be 1798, when Paul I signed a decree establishing a special building at the hospitals for a medical school and training (anatomical) theaters. This date is arbitrary, tied not to the opening, but to the decree concerning the building. And in 1808, Alexander I granted the academy the title of Imperial. By the early 19th century, the medical faculties of the universities of Dorpat, Vilnius, Kharkov, and Kazan had joined it.
The hospital school, however, did not disappear without a trace. Its practices—clinical rounds, mandatory autopsies, case histories, a unified standard, and bedside teaching—were carried over into university medicine and largely defined the character of Russian medical school in the 19th century.
Thus a single, continuous line is formed: the slaughterer, the ancient Russian physician-surgeon with a knife, the physician of the 1654 school, the physician-surgeon of Peter the Great's hospital, and ultimately the Imperial Academy. Not a series of leaps from scratch under each new sovereign, but a long, centuries-long journey, which we have traveled from our very first step.
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