Anton Chekhov's MD Thesis

If you had to choose the world's five greatest dramatists who would they be? Shakespeare and Moliere would figure highly on most people's list. Then perhaps the Ancient Greeks, Aeschylus and Sophocles (or Euripides); and then in more modern times there may be a toss-up between Ibsen and Chekhov for fifth place. I would personally go for Chekhov—he is less harrowing to watch than Ibsen. There is usually a Chekhov play showing somewhere in the United Kingdom every year. Ivanov is currently showing in London. If you had to choose the world's five greatest short story writers who would they be? The number to choose (Maupassant, Henry James, Graham Greene, etc.) seems to be much larger than for dramatists perhaps it is an easier craft to ply. But again Chekhov would figure highly on many people's list. It must be quite unique for a practicing physician to get on two such short lists. Anton P. Chekhov (1860–1904) qualified in medicine from Moscow University in 1884. While a student he had worked in the Vozkresenk Hospital and after taking his degree was employed on the staff of the Zvenigorod Hospital. He went into practice and from 1892–93 he was medical superintendent of the Melikhovo district near Moscow. In 1890, Chekhov wanted to join the lecturer staff of a medical school and to do this he had to write a thesis towards the degree of Doctor of Medical Sciences at Moscow University. He completed the thesis in 1895. The project was to undertake a medico-social study of Sakhalin Island. His aim as a physician was to study the social conditions of the Island to see how it affected the health and welfare of the inhabitants. He was secondarily drawn to criticise the practical effects of the Code on Convicts that prevailed on the Island which naturally brought him into conflict with the Russian Authorities. He was friendly with Maxim Gorky but none of his plays were as overtly revolutionary as Gorkys’. Perhaps the Cherry Orchard that hints at the overthrow of the old order is as near as he gets to this in his plays. Sakhalin is an Island about twice the size of Greece situated off the eastern coast of Siberia. From about 1860 it was used as a place of exile and convict settlement for Imperial Russia. In 1890, it had a population of about 10 000, of whom 6000 were convicts, 2000 soldiers and rest administrators and free colonists (such as families of the convicts who wished to follow them to the Island). Chekhov was given access to all the prisons and settlements on Sakhalin and could visit anyone he wished except political prisoners. In order to become acquainted with the exiles he conducted a census going into each hut to record the names of the owners, members of their families, their occupations and so on. This gave him semi-official status and in 3 months he interviewed about 6000 people, taking their histories, reporting on their social conditions and taking particular care to record details of all the children. His findings in brief were as follows. Epidemics of diphtheria, typhoid, pneumonia and an ill-defined feverish illness called Sakhalin fever regularly swept the island. Syphilis, tuberculosis and scurvy were endemic. Of the population 10% were incapacitated in other ways by marasmus, conjunctivitis and gastrointestinal disorders. The causes were not far to seek. The food was of very poor quality; for example flour was mixed with sifted clay to increase the weight of bread; and due to inadequate rations, convicts were known to supplement their diet by eating tallow candles. Hygienic conditions were abysmal. Latrines were cesspools and the drinking water was frequently contaminated from the latrines by seepage through the soil. In some of the older prisons there were no latrines and prisoners had to relieve themselves in the prison yards. Chekhov put much weight on the adverse social conditions producing ill health. The Island was a highly abnormal and disorganised society with more than half the population being convicted criminals and presented features unlike any normal form of village or town life in Russia. The administration of the island was incompetent, corrupt and inefficient. The commandant V. O. Konovich was a cultured and well-read man with benevolent intentions but his influence did not extend to the lower ranks. Social institutions such as schools and hospitals were all but names on paper. Family relations were disrupted for two major reasons. There were approximately four times as many men than women; and free and transient cohabitation was as frequent as marriage. The lack of women and the weak social ties in the households fostered widespread prostitution. All convict women were considered to serve as a ‘requisite source for satisfying the natural needs of men’. More than 30% of the children born on the Island were illegitimate. They fitted into no social category and were registered as ‘illegal son of convict woman’ or ‘daughter of male settler’, etc. They were thin, pale, dressed in rags and always hungry. Their food was mainly potatoes and bread for months on end with some salted fish or cured meat. This lead to stunted growth and development. Chekhov was haunted by the plight of these children and gave a detailed series of suggestions on how they should be helped by government agencies rather than relying on the sporadic efforts of private charities. On his return home to Moscow, he personally organised the despatch of thousands of books to the Sakhalin schools. The conditions described by Chekhov on the Island appear to be the extreme limits of a disintegrating society with many features reminiscent of the prison and work camps of World War II. Chekhov's originality was to show how this social deprivation affected the health of the inhabitants in a variety of interacting ways. For 1890, this must be one of the first scientific works on environmental medicine; before had only been individual case reports such as the liability of chimney sweepers to develop scrotal cancer. The actual ‘shape’ of the society on Sakhalin was determined by abstract theories of penal reform as laid down in the Russian Criminal Code of 1860. The major destructive influences were loss of individual freedoms, transience of the population, fragmentation of society into categories with degraded status for many, unrecognised family households in about 50% of cases, no employment for women and oppressive forced labour for men. The functioning of a society can sometimes be judged by statistics on crime. This could not apply to Sakhalin since the majority of the population were already criminals. Thievery was regarded as a legitimate occupation. The prisoners stole everything that was not concealed, giving preference to food and clothing. They stole from each other, they stole from the settlers and they stole at work particularly when unloading ships. Chekhov found it very nearly impossible to say anything good about the social organisation on the Island and he concluded that the main role of the physician was not to treat individual patients but to eliminate the adverse social conditions that reduced resistance to disease. Chekhov made a plea for the reform of the economic and social regulations of the Criminal Code. But Tsarist Russia in 1895 was not in the mood to listen to any mention of reform since the ground swell of what was to become the Russian Revolution was already felt in many places. Luckily for world literature the thesis was rejected by Moscow University—perhaps they thought the writing was too poor. This failure led Chekhov to give up academic medicine. He never tried again to re-enter a medical faculty but privately had the thesis published. It troubled the conscience of many liberal-minded Russians and drew attention to the plight of the convicts on Sakhalin. A government commission was sent to the Island in 1896 to investigate conditions and make recommendations. Chekhov had spent 3 months on Sakhalin. Did the appalling conditions there lead to the reactivation his own tuberculosis? It certainly became more active on returning to Moscow and he died of a pulmonary haemorrhage 8 years later. He has left us five magnificent plays and more than 140 short stories that are a never-ending source of delight and interest.

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