The army, and especially the navy, is characterized by the concentration of the population in small areas, which has always been fraught with the development of epidemic diseases. The border location of the navy and its expeditions led to the danger of new diseases in the country. In the 70s. XVIII century the domestic situation in the country was seriously affected by the plague epidemic; in 1829, cholera was introduced through Orenburg.
At the beginning of the nineteenth century. the post of Orenburg and Astrakhan governor was performed by I. Neplyuev, who first encountered cholera in 1807 in Astrakhan, Sevastopol and Kherson. In the documents, the disease was called "bilious fever", the disease ended in death in less than two days. Quarantine was introduced in urban areas, the fleet was ordered "to have no communication with the city." At first, the disease was regarded as a plague, "but without the bubonic form." It was not possible to establish the exact disease due to the decomposition of the body of the first victim. The woman who died first "for unknown reasons has already been dead for three days."
The governor has established a strict quarantine in Astrakhan. Soon a delegation of 12 merchants came to him with a claim that "from a contagious disease all the shops were sealed by their civilian authorities and that their trade had stopped." The opening of the shops could increase the spread of the disease. Probably, the merchants were refused, since only in May 1808 the governor announced the end of the 16-month epidemic. "Its last victim was a criminal, who was used with other others to cleanse Cossack shops." The quarantine period has not yet been defined by law and for this epidemic was 12 days from the last illness. I. Neplyuev extended the quarantine from the last death in order to prevent the possibility of the disease entering the center of Russia.
The second epidemic in Astrakhan began in 2823. The term "cholera morbus" was first used. Two doctors stopped the disease at an early stage. It was supposed to publish a report on the course of cholera in one of the medical journals, but this was not done. As a result, during the epidemic of 1829 - 1832. Russian doctors on the ground discovered ways to fight on their own. The Medical Council issued a summary of the course of the disease only in 1830.
In 1828, cholera appeared in the fortress of Baku, and for the first time some methods of treatment (rubbing with vinegar) are given in the documents. The following year, only 2 cases of cholera were noted in Baku, but "as the headquarters doctor Gladkov had and is observing this from the first beginning, it was stopped by the simplest means."
A feature of the epidemic of 1829 - 1833. became an extremely large coverage of territories. Cholera was not limited to Russia, it went to Europe, and its movement ended only in front of the ocean in 1833.
Since the summer of 1829 the governor of Orenburg P. K. Essen received information that “there is an infection in Bukharia, from which many people have allegedly died. It is known that a harmful poison acts not only on people, but is hidden in things and the wool of cattle, upon touching which death is inevitable. " In November, he asked the Ministry of Internal Affairs to verify the information "about the approach of the devastating disease of cholera from the eastern regions with Persia to Tehran." The Medical Council "considered it necessary to draw the attention of those living in that region, so that they would strictly observe the health of those arriving from Persia along the borders with Persia, as well as in Astrakhan and along the shores of the Caspian Sea, in case of doubt they would act according to the rules of quarantine regulations." Part of the coast of the Caspian Sea was occupied by the Ural Cossack army, already informed that "cholera appeared in Orenburg and its immediate environs."
On December 22, 1829, Orenburg, in turn, warned the Chinese flotilla and the Astrakhan fleet "about the morbus cholera that exists within Persia, not far from our borders."
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In 1829, the Orenburg province was the first in Russia to be declared unfavorable for cholera. The governor asked to speed up the development of quarantine rules and issued his own regulations. By 1830, the Special Committee on Public Safety began its work, and already during the epidemic, it developed the Quarantine Charter of the rules, which were previously "used only by guesswork and conclusions."
In April 1830 the Navy received a circular about the presence of cholera in Persia and its approach to the borders of Russia. In July, the disease was noted in the Caucasus and Astrakhan.
The main questions facing doctors and authorities were the sources and causes of the disease, the incubation period, and most importantly, whether cholera is an epidemic "widespread" disease. Economics was mingled with purely medical problems. In the Orenburg province, quarantine was either introduced or canceled. The main factor was an order from the center to prohibit "diverting trade with Khiva and Bukhara without extreme need."
Regarding cholera in Astrakhan, the head manager Ulenin expressed the opinion: "Among other properties of epidemic cholera, morbus also has its extraordinary characterizing volatility, so that, hitting one or several victims somewhere, it instantly disappears." When defining cholera as an epidemic disease, he referred to the experience of 1823. In July, he was echoed by other physicians, believing that cholera "decisively prescribe epidemic properties." But the Astrakhan governor, like the Orenburg governor, came under pressure from higher authorities. In August, he convened the Medical Council, which declared the disease non-infectious.
But the further development of cholera forced to change this point of view. In September, the first cases were detected on a ship sailing from Sukhumi. The measures were taken in two ways. "Local doctors do not recognize cholera, most of them, however, are separated into special houses, but the city is not cordoned off." Nevertheless, as in the epidemic, movement was controlled by written permits, the sick were not left at home, immediately evacuating to hospitals, a 14-day quarantine was maintained.
The headquarters of the doctors of Sokolsky and Orlov were sent to Astrakhan, on a business trip they were given sums equal to their annual salary (700 and 800 rubles), soon Orlov, probably as the best specialist, was returned "on the occasion of the cholera that opened in Kazan."
Several temporary hospitals were opened in Taganrog: one intended for Christians, one for Jews or people not belonging to the naval department. The city was divided into 6 quarters, where medical supervision was carried out. The department of the fleet, the general staff of the doctor, noted that this division did not depend on the real need, but on the number of available doctors.
Special attention was paid by the medical services of the navy to St. Petersburg. There were joint actions by military and civilian forces. "From all the infirmaries, hospitals and hospitals in this capital, those who were located, were delivered to the Governor-General of the daily statements." Additional doctors to suppress the epidemic were allocated by the Medical and Surgical Academy (2 per quarter) and maritime hospitals.
The population reacted very badly to the epidemic: “Residents are afraid of loss in almost every house, they become weak, sad and crying; hospitals for the helpless are left without servants, physicians, being engaged in continuous use of the sick, made everyone sick themselves."
In 1830, in the case "On precautions against the spread of cholera in St. Petersburg in case of its occurrence" it was noted that "the crowding of people in dwellings is recognized as one of the main reasons for the spread of this disease. The chief caretaker of one of the St. Petersburg hospitals complained in 1830 that "people in the most desperate situation are being brought from Okhta and other parts of the city." Until the last moment, the population was drawn to calling doctors. This circumstance further increased mortality.
After the first year of the epidemic, the main symptoms of cholera were identified: convulsions, diarrhea, constipation, vomiting, anemia, thirst, and nausea. In 1831 the most complete description of the disease was given in the Navy. “Patients rush from place to place, from side to side, writhing suddenly with shouts of 'ah', as if they prick and jump up, limbs become numb and cold, eyes become sunken, half-open, vessels of the cornea fill with blood, the entire surface of the body becomes lethargic and dark pale, lips, arms and legs turn blue, pulse is calm, very depressed or not at all sensitive. Excessive sweating was considered a sign of a speedy recovery. All descriptions recorded severe convulsions in patients. Orenburg doctor Sokolov was the only one who noted postmortem convulsions in the deceased,which lasted up to 10 minutes and terribly frightened the population, the Naval Department, unlike civilian doctors, also gave a pathological and anatomical picture. They could do autopsies without the permission of relatives, therefore, it is better to know the disease. “The meninges are unusually filled with blackish blood. Heart, stomach, intestines are inflamed. Among the features of cholera, it was indicated that it affects the majority of people who are completely healthy.
The causes of the disease in 1830, the General Staff of the doctor named the fleet management bad food and water, cramped holds, "damp dew and cold air." Preventive instructions were given to protect against cholera. The sailors had to dress well, not use incompatible foods for food, replace drinking with kvass, it was forbidden to drink cold water and alcoholic beverages, swim, sleep in the open air.
Doctors suggested cleansing the body with bloodletting, vomiting, warm baths for perspiration. Leeches were used as a blood purifier, therefore, with the expanding epidemic in the country, a census was undertaken not only of physicians, but also the collection of information about barbers and leeches. They used irritating poultices of garlic, pepper, camphor, mustard plasters from bread with vinegar or grated horseradish.
The issue of taking baths with a lack of personnel in hospitals was originally resolved in the Petersburg port. A boiler with hot water was placed in the center of the chamber. The beds were covered with linen, creating something like tents, hoses were supplied to the beds and hot air was released to "the sick lying on the beds." Also in St. Petersburg, air purification with chlorine was introduced in hospitals. The best temperature for keeping patients was 15-17 degrees Celsius. Opium and mercury, which were very popular in the 19th century, were widely used as medicines.
The question of the infectivity of the disease was revised. The naval doctors noted that it was the East Indian cholera, which “without medical assistance stops life for several hours, there is a disease similar to the plague. The disease differs significantly from ordinary cholera, sporadically, the action of the liver is intensified there, here, on the contrary, it is noticeable that it is completely deficient. Later, in 1832, Dr. Barr wrote: "If no effective measures are taken against cholera, then in two years it will turn into the plague." For civilians, even the very name of cholera was new (the documents also used the common name "dog death"). At the same time, marine doctors, having constant contacts with other countries, had an idea of its differences and different forms.
The experience of fighting cholera in 1830 proved to be extremely important. This year, the French Academy of Sciences turned to Moscow University for a method of combating cholera, and not to English doctors who had faced this disease much earlier in India. In 1830, the Medical Department of the Ministry of Internal Affairs published the book "Announcement of the Ministry of Internal Affairs on the Signs of Cholera, Ways to Prevent Cholera and Its Treatment". It gave the symptoms of the disease and recommended methods of first aid. The Maritime Department, together with the Ministry of Internal Affairs, proposed to collect all the manuals published in different regions of the country and "print again with additions of various observations by the maritime department" 400 copies.
Thus, at the beginning of the nineteenth century. Russia met with a new epidemic disease - cholera. Border areas, both on land and at sea, were the first to face the epidemic. The epidemic of 1823 allowed the medical services of the navy to determine the main parameters of the disease and the fight against it. The basis was taken measures to combat the plague. The compactness of the population, strong disciplinary motives made it possible to quickly cope with the epidemic. At the same time, the position of Russia's national security played an important role.
In subsequent years, during the pandemic of 1829-1832. the fight against the disease involved large areas with a predominant population of civilians, which are worse amenable to quarantines. The Quarantine Charter itself was developed already in the course of a massive epidemic. The measures prescribed by the Charter made it possible to effectively protect the country, but the requirement to maintain open trade relations reduced its effectiveness. If at the beginning of the epidemic in 1829 the governors were given the right to declare an epidemic, then in 1830 this action required government approval. Long time of approvals affected the increase in mortality, which reached 50% among the civilian population. The same series of events includes the discussion about the infectiousness of cholera, where the authorities, unlike doctors, insisted that the disease was not epidemic.
The measures worked out by the fleet during the epidemic of 1829-1862 proved to be effective and were applied during the subsequent epidemic of 1848, which also left Russia for Europe.
Shestova Tatiana Yurievna