SUMMARY:

At the start of the nineteenth century, the government of Alexander I embarked on an ambitious task of reforming the imperial state on the most modern foundations. The reformers had a rather vague vision of the future state as a single mechanism assembled out of rationally identified individual functions. It was to replace the older imperial state composed of an assortment of self-governing blocs of territorial or “thematic” responsibilities. Medicine was identified as one of the main types of modern expert knowledge that should be used in the reconfiguration of the state, which explains the centrality of it to the reforms, and the surprisingly chaotic history of finding a proper arrangement for medical expertise within the new government structure.
As it turned out, the very field of medicine in the Russian Empire lacked any internal professional cohesion due to the lack of locally trained cadres, institutional underdevelopment, and, most important, the absence of any common culture of professional solidarity. Therefore, state building went hand in hand with professionalization, and they enhanced each other along the way. Any new step toward the formalization of governance had a direct impact on structuring the medical profession, and vice versa. In the process, they developed the very discourse of modern governance based on expert knowledge and discipline, which was not exclusively “statist” or “professional” in nature. Eventually, the medicalization of public discourse resulted in producing a new concept of authority as based not on the political sovereignty (of the emperor) and not on the seniority of status (of the elite circle of physicians) but on the expertise provided by a qualified professional.
The unsettled nature of the modern Russian state, still lacking a developed class of bureaucracy and formalized procedures (or even, until the 1830s, codified law), made the reform of government-regulated health highly protracted and haphazard. The professionalization of physicians had directly influenced the professionalization (institutionalization and bureaucratization) of the state through the transfer of practices and values. By looking at the history of “regulatory agreement” between the state and professionals and bringing previously unknown sources into the discussion, the author of the article reads the zigzagging path of institutional development as a story of the complex process of self-organization of the modern state and the medical profession behind the facade of administrative arbitrariness.