Anton Chekhov studied medicine at the University of Moscow, graduating in 1884. He had already published a short story Dragonfly in 1880 whilst he was a medical student and in the year of his graduation published The Tales of Melponeme. He moved to Melikhovo, an estate 45 miles from Moscow in 1892. This was also the same year of the cholera epidemic that is estimated to have claimed 267,890 Russian lives. This was a lesser epidemic compared to the 3rd cholera pandemic (1846-1860) that originated in India and which claimed 1 million people in Russia alone. In London, 10,000 people died and in Great Britain 23,000 people in total died. It is a famous pandemic in Britain because it is associated with Jon Snow’s discovery of the role of a single water pump in one neighbourhood in Soho in the spread of cholera.
Chekhov’s role in the fight against the 1892 pandemic is described in letters to his friend and publisher Alexey Suvorin. These letters show Chekhov the doctor and not Chekhov the writer. It is worth remarking that Chekhov suffered from TB of the lungs practically all of his adult life. The symptoms became obvious in 1884 as he was graduating from medical school but he ignored the symptoms, if not denied them. In a letter to Alexey Suvorin on 20 May 1890, he wrote
I shall nevertheless start from the beginning. They told me in Tyumen that there would be no steamer to Tomsk until 18 May. I had to take horses. For the first three days every joint and tendon in my body ached, but then I got used to it and had no more pain. But as a result of the lack of sleep, the constant fussing with the luggage, the bouncing up and down and the hunger, I suffered a haemorrhage that rather spoilt my mood, which was not in any case particularly sunny.
Earlier that month, on the 16 May, he had written to his sister, Misha, from Tomsk
From the first three days of my journey my collarbones, my shoulders and my vertebrae ached from the shaking and jolting. I couldn’t stand or sit or lie…But on the other hand, all pains in my head and chest have vanished, my appetite has developed incredibly and my haemorrhoids subsided completely. The overstrain, the constant worry with luggage and so on, and perhaps the farewell drinking parties in Moscow, had brought on spitting of blood in the mornings […]
These two letters were written whilst Chekhov was travelling to Siberia, specifically to the convict camps at Sakhalin, in order to study the life and health of convicts. This was a journey of thousands of miles. But the point is, he was already suffering from TB. In other words, he was not physically robust yet had taken on a physically demanding task. Surprisingly, for a doctor he seemed not to be aware of the real cause of his coughing up of blood, nor its real significance, despite it being a well-known sign of severe lung infection with TB. What is important is that despite this disease and the known adverse effects on stamina, energy and motivation he wrote and published the stories and plays that he is rightly recognised for today. Importantly, he also worked jointly with others to try to limit the effects of the cholera epidemic in 1892.
He wrote to Alexey on 1 August 1892
[…] there is cholera in Moscow and about Moscow, and it will be in our parts some day soon. In the second place, I have been appointed cholera doctor, and my section includes twenty-five villages, four factories, and one monastery. I am organizing the building of barracks, and so on, and I feel lonely, for all the cholera business is alien to my heart, and the work, which involves continual driving about, talking, and attention to petty details, is exhausting for me. I have no time to write. Literature has been thrown aside for a long time now; and I am poverty-stricken, as I thought it convenient for myself and my independence to refuse the remuneration received by the section doctors. I am bored, but there is a great deal that is interesting in cholera if you look at it from a detached point of view […] At the fair at Nizhni they are doing marvels which might force even Tolstoy to take a respectful attitude to medicine and the intervention of cultured people generally in life. It seems as though they had got a hold on the cholera. They have not only reduced the number of cases, but also the percentage of deaths. In immense Moscow the cholera does not exceed fifty cases a week, while on the Don it is a thousand a day- an impressive difference. We district doctors are generally ready; our plan of action is definite, and there are grounds for supposing that in our parts we too shall decrease the percentage of mortality from cholera. We have no assistants, one has to be doctor and sanitary attendant at one and the same time. The peasants are rude, dirty in their habits, and mistrustful; but the thought that our labours are not thrown away makes all that scarcely noticeable. Of all the Serpuhovo doctors I am the most pitiable; I have a scurvy carriage and horses, I don’t know the roads, I see nothing by evening light, I have no money, I am very quickly exhausted, and worst of all, I can never forget that I ought to be writing, and I long to spit on the cholera and sit down and write to you, and I long to talk to you. I am in absolute loneliness […] Nothing has been heard of cholera riots yet. There is talk of some arrests, some manifestoes, and so on […]
On 16 August, Chekhov wrote
[…] Well, I am alive and in good health. The summer was a splendid one, dry, warm, abounding in fruits of the earth, but its whole charm was from July onwards, spoilt by news of the cholera […] While you were inviting me in your letters to Vienna, and then to Abbazzio, I was already one of the doctors of the Serpuhovo Zemstvo, was trying to catch the cholera by its tail and organizing a new section full steam. In the morning I have to see patients, and in the afternoon drive about. I drive, I give lectures to the natives, treat them, get angry with them, and as the Zemstvo has not granted me a single kopeck for organizing the medical centres I cadge from the wealthy, first from one and then from another. I turn out to be an excellent beggar, thanks to my beggarly eloquence, my section has two excellent barracks with all the necessaries and five barracks that are not excellent but horrid. I have saved the Zemstvo from expenditure even on disinfectants. Lime, vitriol and all sorts of stinking stuff I have begged from the manufacturers […] My soul is exhausted. I am bored. Not to belong to oneself, to think about nothing but diarrhoea, to start up in the middle of the night at a dog’s barking and a knock at the gate … to drive with disgusting horses along unknown roads; to read about nothing but cholera, and to expect nothing but cholera, and at the same time to be utterly uninterested in that disease, and in the people whom one is serving […] The cholera is already in Moscow … one must suppose that it is already declining, and that the bacillus is losing its strength. One is bound to think too, that it is powerfully affected by the measures that have been taken in Moscow and among us […] I was overwhelmed with enthusiasm when I read about the cholera. In the good old times, when people were infected and died by thousands, the amazing conquests that are being made before our eyes could not even be dreamed of. It is a pity you are not a doctor and cannot share my delight – that is, fully feel and recognize and appreciate all that is being done. But one cannot tell about it briefly. The treatment of cholera requires of the doctor deliberation before all things – that is, one has to devote to each patient from five to ten hours or even longer. As I mean to employ Katani’s treatment- that is clysters of tannin and sub-cutaneous injection of a solution of common salt – my position will be worse than foolish; while I am busying myself over one patient, a dozen van fall ill and die […]
On 18 October Chekhov wrote
I have undertaken to be the section doctor till the fifteenth of October – my section will be officially closed on that day […]
It is apposite to read Chekhov’s account of the part he played during the cholera epidemic of 1892. Much has changed since his time, in terms of our approach to an epidemic or indeed to a pandemic but much too remains the same. It is salutary to note that as we face this new pandemic, COVID-19, that our predecessors too faced the most trying, threatening and supremely dangerous adversaries.
The human and emotional responses of the doctor, particularly the lone doctor acting with little support or resources, but with an incredible sense of responsibility and against the odds, are unvarying. This will be the challenge for a lot of doctors in the developing world as we face this Coronavirus pandemic. But, everywhere too, irrespective of wealth, there will be exhaustion, there will be doubt about the efficacy of the methods, but hope too, in the face of the grim reality of death and suffering, and then the belief in medicine, often illusory, as an agent for good.
It is very easy, far too easy, to think that the adversary we face today is exceptional, more apocalyptic, and portentous of our extinction, but we need not look very far back to discover immense suffering, extraordinary altruism, and the unbelievable capacity to survive in hopeless situations.
Photos by Jan Oyebode