Medicine, Law and the State in Imperial Russia by Elisa M. Becker (review)

Prior Western scholarship on Russian physicians before the 1917 Revolutions has focused upon the zemstvo community medicine movement and its allied Pirogov Society as both undermining the authority of the old regime and providing a new degree of professional autonomy. However, all Russian doctors prior to 1917 remained servitors of the state. Elisa M. Becker achieves many things in her fine monograph, but the most significant is to illuminate this neglected but vital subject of Russian doctors as state officials. Very broadly, she shows Russian doctors as they actually were rather than how some of them wished to be.

Becker’s focus, that of forensic medicine, is also innovative because she chooses to study a body of expertise that bridges the disciplines of medicine and law. As a result, “the state’s broader objective of administering social order” (8) comes into close view as well as the place of the expert within the state, perspectives that were harder to expose with earlier studies of individual professions and specializations. In addition to breaking down the study of professions in isolation from one another, Becker extends the chronology of her story well before the Great Reforms of the 1860s. By starting with Peter the Great’s Military Statute of 1716 and analyzing the medicine of the politically conservative reign of Nicholas I (r. 1825–55) in depth, Becker destroys the assumption that pre-Reform physicians were degraded and peripheral to the Russian state, instead showing them to be essential and authoritative. The key, she argues, was their forensic role. Under the pre-Reform inquisitorial system of law, medical evidence was among the highest form of proof, and the medical practitioners who provided it were beyond reproach. Before the advent of medical specialization, forensic work also encompassed all physicians, thereby sanctioning solidarity and prestige across the profession.

Sociologists of the professions outside Russia have long conceded that “the state” was essential to their development because laws provided the regulatory framework through which the profession could make its claim to special status. Historians have started to reexamine the relation of the state to the professions, but few have gone as far as Becker who identifies the distinctive outlook that the relation produced. According to Becker, Russian physicians came to crave their state service functions.

The book is structured around five lengthy but tightly argued chapters. Throughout the book, Becker has a great deal to say about the evolving conceptualization of forensic medicine, but her book pivots around its third chapter on legal mechanics. Here she challenges, largely successfully, the conventional view of aspirations to professional autonomy born and encouraged by the liberalism of the 1860s. Having already established that Russian physicians found an unchallenged space as forensic medical authorities well before the Great Reforms, Becker here shows how leading physicians sought to retain that authority amidst the uncertainties of trial by jury and through the new figure of the scientific medical expert.

Primarily, because forensic medicine is her focus, Becker can see professional development in Russia from a radically new angle. She is quite right to expose and challenge the anti-statist assumptions of the Anglo-American understanding of professionalization. This assumption, however, is not just an imposition of Western historians. Soviet authorities for decades after 1917 were shaped by confrontation in the early revolutionary years with the Pirogov Society, assuming that any separate institutional arrangement for doctors in the future would be anti-statist and anti-Soviet.

There is more discourse than practice in this book. Becker describes the perspectives of various leading doctors on forensic medical expertise, and the occasional jurist, as well as highlighting various laws and statutes governing the field. Becker quite rarely uses archival sources. She does, however, analyze several legal cases at length, the most famous being the trial of D.V. Karakazov, the would-be assassin of Tsar Alexander II in 1866. Because of...