Russia Chapter V - A Medical Consultation eText

Chapter V - A Medical Consultation

In enumerating the requisites for travelling in the less frequented parts of Russia, I omitted to mention one important condition: the traveller should be always in good health, and in case of illness be ready to dispense with regular medical attendance. This I learned by experience during my stay at Ivanofka.

A man who is accustomed to be always well, and has consequently cause to believe himself exempt from the ordinary ills that flesh is heir to, naturally feels aggrieved--as if some one had inflicted upon him an undeserved injury--when he suddenly finds himself ill. At first he refuses to believe the fact, and, as far as possible, takes no notice of the disagreeable symptoms.

Such was my state of mind on being awakened early one morning by peculiar symptoms which I had never before experienced. Unwilling to admit to myself the possibility of being ill, I got up, and endeavoured to dress as usual, but very soon discovered that I was unable to stand. There was no denying the fact; not only was I ill, but the malady, whatever it was, surpassed my powers of diagnosis; and when the symptoms increased steadily all that day and the following night, I was constrained to take the humiliating decision of asking for medical advice. To my inquiries whether there was a doctor in the neighbourhood, the old servant replied, "There is not exactly a doctor, but there is a Feldsher in the village."

"And what is a Feldsher?"

"A Feldsher is . . . . is a Feldsher."

"I am quite aware of that, but I would like to know what you mean by the word. What is this Feldsher?"

"He's an old soldier who dresses wounds and gives physic."

The definition did not predispose me in favour of the mysterious personage, but as there was nothing better to be had I ordered him to be sent for, notwithstanding the strenuous opposition of the old servant, who evidently did not believe in feldshers.

In about half an hour a tall, broad-shouldered man entered, and stood bolt upright in the middle of the room in the attitude which is designated in military language by the word "Attention." His clean-shaven chin, long moustache, and closely-cropped hair confirmed one part of the old servant's definition; he was unmistakably an old soldier.

"You are a Feldsher," I said, making use of the word which I had recently added to my vocabulary.

"Exactly so, your Nobility!" These words, the ordinary form of affirmation used by soldiers to their officers, were pronounced in a loud, metallic, monotonous tone, as if the speaker had been an automaton conversing with a brother automaton at a distance of twenty yards. As soon as the words were pronounced the mouth of the machine closed spasmodically, and the head, which had been momentarily turned towards me, reverted to its former position with a jerk as if it had received the order "Eyes front!"

"Then please to sit down here, and I'll tell you about my ailment." Upon this the figure took three paces to the front, wheeled to the right-about, and sat down on the edge of the chair, retaining the position of "Attention" as nearly as the sitting posture would allow. When the symptoms had been carefully described, he knitted his brows, and after some reflection remarked, "I can give you a dose of . . . ." Here followed a long word which I did not understand.

"I don't wish you to give me a dose of anything till I know what is the matter with me. Though a bit of a doctor myself, I have no idea what it is, and, pardon me, I think you are in the same position." Noticing a look of ruffled professional dignity on his face, I added, as a sedative, "It is evidently something very peculiar, so that if the first medical practitioner in the country were present he would probably be as much puzzled as ourselves."

The sedative had the desired effect. "Well, sir, to tell you the truth," he said, in a more human tone of voice, "I do not clearly understand what it is."

"Exactly; and therefore I think we had better leave the cure to Nature, and not interfere with her mode of treatment."

"Perhaps it would be better."

"No doubt. And now, since I have to lie here on my back, and feel rather lonely, I should like to have a talk with you. You are not in a hurry, I hope?"

"Not at all. My assistant knows where I am, and will send for me if I am required."

"So you have an assistant, have you?"

"Oh, yes; a very sharp young fellow, who has been two years in the Feldsher school, and has now come here to help me and learn more by practice. That is a new way. I never was at a school of the kind myself, and had to pick up what I could when a servant in the hospital. There were, I believe, no such schools in my time. The one where my assistant learned was opened by the Zemstvo."

"The Zemstvo is the new local administration, is it not?"

"Exactly so. And I could not do without the assistant," continued my new acquaintance, gradually losing his rigidity, and showing himself, what he really was, a kindly, talkative man. "I have often to go to other villages, and almost every day a number of peasants come here. At first I had very little to do, for the people thought I was an official, and would make them pay dearly for what I should give them; but now they know that they don't require to pay, and come in great numbers. And everything I give them--though sometimes I don't clearly understand what the matter is--seems to do them good. I believe that faith does as much as physic."

"In my country," I remarked, "there is a sect of doctors who get the benefit of that principle. They give their patients two or three little balls no bigger than a pin's head, or a few drops of tasteless liquid, and they sometimes work wonderful cures."

"That system would not do for us. The Russian muzhik would have no faith if he swallowed merely things of that kind. What he believes in is something with a very bad taste, and lots of it. That is his idea of a medicine; and he thinks that the more he takes of a medicine the better chance he has of getting well. When I wish to give a peasant several doses I make him come for each separate dose, for I know that if I did not he would probably swallow the whole as soon as he was out of sight. But there is not much serious disease here--not like what I used to see on the Sheksna. You have been on the Sheksna?"

"Not yet, but I intend going there." The Sheksna is a river which falls into the Volga, and forms part of the great system of water- communication connecting the Volga with the Neva.

"When you go there you will see lots of diseases. If there is a hot summer, and plenty of barges passing, something is sure to break out--typhus, or black small-pox, or Siberian plague, or something of the kind. That Siberian plague is a curious thing. Whether it really comes from Siberia, God only knows. So soon as it breaks out the horses die by dozens, and sometimes men and women are attacked, though it is not properly a human disease. They say that flies carry the poison from the dead horses to the people. The sign of it is a thing like a boil, with a dark-coloured rim. If this is cut open in time the person may recover, but if it is not, the person dies. There is cholera, too, sometimes."

"What a delightful country," I said to myself, "for a young doctor who wishes to make discoveries in the science of disease!"

The catalogue of diseases inhabiting this favoured region was apparently not yet complete, but it was cut short for the moment by the arrival of the assistant, with the announcement that his superior was wanted.

This first interview with the feldsher was, on the whole, satisfactory. He had not rendered me any medical assistance, but he had helped me to pass an hour pleasantly, and had given me a little information of the kind I desired. My later interviews with him were equally agreeable. He was naturally an intelligent, observant man, who had seen a great deal of the Russian world, and could describe graphically what he had seen. Unfortunately the horizontal position to which I was condemned prevented me from noting down at the time the interesting things which he related to me. His visits, together with those of Karl Karl'itch and of the priest, who kindly spent a great part of his time with me, helped me to while away many an hour which would otherwise have been dreary enough.

During the intervals when I was alone I devoted myself to reading-- sometimes Russian history and sometimes works of fiction. The history was that of Karamzin, who may fairly be called the Russian Livy. It interested me much by the facts which it contained, but irritated me not a little by the rhetorical style in which it is written. Afterwards, when I had waded through some twenty volumes of the gigantic work of Solovyoff--or Solovief, as the name is sometimes unphonetically written--which is simply a vast collection of valuable but undigested material, I was much less severe on the picturesque descriptions and ornate style of his illustrious predecessor. The first work of fiction which I read was a collection of tales by Grigorovitch, which had been given to me by the author on my departure from St. Petersburg. These tales, descriptive of rural life in Russia, had been written, as the author afterwards admitted to me, under the influence of Dickens. Many of the little tricks and affectations which became painfully obtrusive in Dickens's later works I had no difficulty in recognising under their Russian garb. In spite of these I found the book very pleasant reading, and received from it some new notions--to be afterwards verified, of course--about Russian peasant life.

One of these tales made a deep impression upon me, and I still remember the chief incidents. The story opens with the description of a village in late autumn. It has been raining for some time heavily, and the road has become covered with a deep layer of black mud. An old woman--a small proprietor--is sitting at home with a friend, drinking tea and trying to read the future by means of a pack of cards. This occupation is suddenly interrupted by the entrance of a female servant, who announces that she has discovered an old man, apparently very ill, lying in one of the outhouses. The old woman goes out to see her uninvited guest, and, being of a kindly nature, prepares to have him removed to a more comfortable place, and properly attended to; but her servant whispers to her that perhaps he is a vagrant, and the generous impulse is thereby checked. When it is discovered that the suspicion is only too well founded, and that the man has no passport, the old woman becomes thoroughly alarmed. Her imagination pictures to her the terrible consequences that would ensue if the police should discover that she had harboured a vagrant. All her little fortune might be extorted from her. And if the old man should happen to die in her house or farmyard! The consequences in that case might be very serious. Not only might she lose everything, but she might even be dragged to prison. At the sight of these dangers the old woman forgets her tender-heartedness, and becomes inexorable. The old man, sick unto death though he be, must leave the premises instantly. Knowing full well that he will nowhere find a refuge, he walks forth into the cold, dark, stormy night, and next morning a dead body is found at a short distance from the village.

Why this story, which was not strikingly remarkable for artistic merit, impressed me so deeply I cannot say. Perhaps it was because I was myself ill at the time, and imagined how terrible it would be to be turned out on the muddy road on a cold, wet October night. Besides this, the story interested me as illustrating the terror which the police inspired during the reign of Nicholas I. The ingenious devices which they employed for extorting money formed the subject of another sketch, which I read shortly afterwards, and which has likewise remained in my memory. The facts were as follows: An officer of rural police, when driving on a country road, finds a dead body by the wayside. Congratulating himself on this bit of good luck, he proceeds to the nearest village, and lets the inhabitants know that all manner of legal proceedings will be taken against them, so that the supposed murderer may be discovered. The peasants are of course frightened, and give him a considerable sum of money in order that he may hush up the affair. An ordinary officer of police would have been quite satisfied with this ransom, but this officer is not an ordinary man, and is very much in need of money; he conceives, therefore, the brilliant idea of repeating the experiment. Taking up the dead body, he takes it away in his tarantass, and a few hours later declares to the inhabitants of a village some miles off that some of them have been guilty of murder, and that he intends to investigate the matter thoroughly. The peasants of course pay liberally in order to escape the investigation, and the rascally officer, emboldened by success, repeats the trick in different villages until he has gathered a large sum.

Tales and sketches of this kind were very much in fashion during the years which followed the death of the great autocrat, Nicholas I., when the long-pent-up indignation against his severe, repressive regime was suddenly allowed free expression, and they were still much read during the first years of my stay in the country. Now the public taste has changed. The reform enthusiast has evaporated, and the existing administrative abuses, more refined and less comical than their predecessors, receive comparatively little attention from the satirists.

When I did not feel disposed to read, and had none of my regular visitors with me, I sometimes spent an hour or two in talking with the old man-servant who attended me. Anton was decidedly an old man, but what his age precisely was I never could discover; either he did not know himself, or he did not wish to tell me. In appearance he seemed about sixty, but from certain remarks which he made I concluded that he must be nearer seventy, though he had scarcely a grey hair on his head. As to who his father was he seemed, like the famous Topsy, to have no very clear ideas, but he had an advantage over Topsy with regard to his maternal ancestry. His mother had been a serf who had fulfilled for some time the functions of a lady's maid, and after the death of her mistress had been promoted to a not very clearly defined position of responsibility in the household. Anton, too, had been promoted in his time. His first function in the household had been that of assistant-keeper of the tobacco-pipes, from which humble office he had gradually risen to a position which may be roughly designated as that of butler. All this time he had been, of course, a serf, as his mother had been before him; but being naturally a man of sluggish intellect, he had never thoroughly realised the fact, and had certainly never conceived the possibility of being anything different from what he was. His master was master, and he himself was Anton, obliged to obey his master, or at least conceal disobedience--these were long the main facts in his conception of the universe, and, as philosophers generally do with regard to fundamental facts or axioms, he had accepted them without examination. By means of these simple postulates he had led a tranquil life, untroubled by doubts, until the year 1861, when the so-called freedom was brought to Ivanofka. He himself had not gone to the church to hear Batushka read the Tsar's manifesto, but his master, on returning from the ceremony, had called him and said, "Anton, you are free now, but the Tsar says you are to serve as you have done for two years longer."

To this startling announcement Anton had replied coolly, "Slushayus," or, as we would say, "Yes, sir," and without further comment had gone to fetch his master's breakfast; but what he saw and heard during the next few weeks greatly troubled his old conceptions of human society and the fitness of things. From that time must be dated, I suppose, the expression of mental confusion which his face habitually wore.

The first thing that roused his indignation was the conduct of his fellow-servants. Nearly all the unmarried ones seemed to be suddenly attacked by a peculiar matrimonial mania. The reason of this was that the new law expressly gave permission to the emancipated serfs to marry as they chose without the consent of their masters, and nearly all the unmarried adults hastened to take advantage of their newly-acquired privilege, though many of them had great difficulty in raising the capital necessary to pay the priest's fees. Then came disorders among the peasantry, the death of the old master, and the removal of the family first to St. Petersburg, and afterwards to Germany. Anton's mind had never been of a very powerful order, and these great events had exercised a deleterious influence upon it. When Karl Karl'itch, at the expiry of the two years, informed him that he might now go where he chose, he replied, with a look of blank, unfeigned astonishment, "Where can I go to?" He had never conceived the possibility of being forced to earn his bread in some new way, and begged Karl Karl'itch to let him remain where he was. This request was readily granted, for Anton was an honest, faithful servant, and sincerely attached to the family, and it was accordingly arranged that he should receive a small monthly salary, and occupy an intermediate position between those of major-domo and head watch-dog.

Had Anton been transformed into a real watch-dog he could scarcely have slept more than he did. His power of sleeping, and his somnolence when he imagined he was awake, were his two most prominent characteristics. Out of consideration for his years and his love of repose, I troubled him as little as possible; but even the small amount of service which I demanded he contrived to curtail in an ingenious way. The time and exertion required for traversing the intervening space between his own room and mine might, he thought, be more profitably employed; and accordingly he extemporised a bed in a small ante-chamber, close to my door, and took up there his permanent abode. If sonorous snoring be sufficient proof that the performer is asleep, then I must conclude that Anton devoted about three-fourths of his time to sleeping and a large part of the remaining fourth to yawning and elongated guttural ejaculations. At first this little arrangement considerably annoyed me, but I bore it patiently, and afterwards received my reward, for during my illness I found it very convenient to have an attendant within call. And I must do Anton the justice to say that he served me well in his own somnolent fashion. He seemed to have the faculty of hearing when asleep, and generally appeared in my room before he had succeeded in getting his eyes completely open.

Anton had never found time, during his long life, to form many opinions, but he had somehow imbibed or inhaled a few convictions, all of a decidedly conservative kind, and one of these was that feldshers were useless and dangerous members of society. Again and again he had advised me to have nothing to do with the one who visited me, and more than once he recommended to me an old woman of the name of Masha, who lived in a village a few miles off. Masha was what is known in Russia as a znakharka--that is to say, a woman who is half witch, half medical practitioner--the whole permeated with a strong leaven of knavery. According to Anton, she could effect by means of herbs and charms every possible cure short of raising from the dead, and even with regard to this last operation he cautiously refrained from expressing an opinion.

The idea of being subjected to a course of herbs and charms by an old woman who probably knew very little about the hidden properties of either, did not seem to me inviting, and more than once I flatly refused to have recourse to such unhallowed means. On due consideration, however, I thought that a professional interview with the old witch would be rather amusing, and then a brilliant idea occurred to me! I would bring together the feldsher and the znakharka, who no doubt hated each other with a Kilkenny-cat hatred, and let them fight out their differences before me for the benefit of science and my own delectation.

The more I thought of my project, the more I congratulated myself on having conceived such a scheme; but, alas! in this very imperfectly organised world of ours brilliant ideas are seldom realised, and in this case I was destined to be disappointed. Did the old woman's black art warn her of approaching danger, or was she simply actuated by a feeling of professional jealousy and considerations of professional etiquette? To this question I can give no positive answer, but certain it is that she could not be induced to pay me a visit, and I was thus balked of my expected amusement. I succeeded, however, in learning indirectly something about the old witch. She enjoyed among her neighbours that solid, durable kind of respect which is founded on vague, undefinable fear, and was believed to have effected many remarkable cures. In the treatment of syphilitic diseases, which are fearfully common among the Russian peasantry, she was supposed to be specially successful, and I have no doubt, from the vague descriptions which I received, that the charm which she employed in these cases was of a mercurial kind. Some time afterward I saw one of her victims. Whether she had succeeded in destroying the poison I know not, but she had at least succeeded in destroying most completely the patient's teeth. How women of this kind obtain mercury, and how they have discovered its medicinal properties, I cannot explain. Neither can I explain how they have come to know the peculiar properties of ergot of rye, which they frequently employ for illicit purposes familiar to all students of medical jurisprudence.

The znakharka and the feldsher represent two very different periods in the history of medical science--the magical and the scientific. The Russian peasantry have still many conceptions which belong to the former. The great majority of them are already quite willing, under ordinary circumstances, to use the scientific means of healing; but as soon as a violent epidemic breaks out, and the scientific means prove unequal to the occasion, the old faith revives, and recourse is had to magical rites and incantations. Of these rites many are very curious. Here, for instance, is one which had been performed in a village near which I afterwards lived for some time. Cholera had been raging in the district for several weeks. In the village in question no case had yet occurred, but the inhabitants feared that the dreaded visitor would soon arrive, and the following ingenious contrivance was adopted for warding off the danger. At midnight, when the male population was supposed to be asleep, all the maidens met in nocturnal costume, according to a preconcerted plan, and formed a procession. In front marched a girl, holding an Icon. Behind her came her companions, dragging a sokha--the primitive plough commonly used by the peasantry--by means of a long rope. In this order the procession made the circuit of the entire village, and it was confidently believed that the cholera would not be able to overstep the magical circle thus described. Many of the males probably knew, or at least suspected, what was going on; but they prudently remained within doors, knowing well that if they should be caught peeping indiscreetly at the mystic ceremony, they would be unmercifully beaten by those who were taking part in it.

This custom is doubtless a survival of old pagan superstitions. The introduction of the Icon is a modern innovation, which illustrates that curious blending of paganism and Christianity which is often to be met with in Russia, and of which I shall have more to say in another chapter.

Sometimes, when an epidemic breaks out, the panic produced takes a more dangerous form. The people suspect that it is the work of the doctors, or that some ill-disposed persons have poisoned the wells, and no amount of reasoning will convince them that their own habitual disregard of the most simple sanitary precautions has something to do with the phenomenon. I know of one case where an itinerant photographer was severely maltreated in consequence of such suspicions; and once, in St. Petersburg, during the reign of Nicholas I., a serious riot took place. The excited populace had already thrown several doctors out of the windows of the hospital, when the Emperor arrived, unattended, in an open carriage, and quelled the disturbance by his simple presence, aided by his stentorian voice.

Of the ignorant credulity of the Russian peasantry I might relate many curious illustrations. The most absurd rumours sometimes awaken consternation throughout a whole district. One of the most common reports of this kind is that a female conscription is about to take place. About the time of the Duke of Edinburgh's marriage with the daughter of Alexander II. this report was specially frequent. A large number of young girls were to be kidnapped and sent to England in a red ship. Why the ship was to be red I can easily explain, because in the peasants' language the conceptions of red and beautiful are expressed by the same word (krasny), and in the popular legends the epithet is indiscriminately applied to everything connected with princes and great personages; but what was to be done with the kidnapped maidens when they arrived at their destination, I never succeeded in discovering.

The most amusing instance of credulity which I can recall was the following, related to me by a peasant woman who came from the village where the incident had occurred. One day in winter, about the time of sunset, a peasant family was startled by the entrance of a strange visitor, a female figure, dressed as St. Barbara is commonly represented in the religious pictures. All present were very much astonished by this apparition; but the figure told them, in a low, soft voice, to be of good cheer, for she was St. Barbara, and had come to honour the family with a visit as a reward for their piety. The peasant thus favoured was not remarkable for his piety, but he did not consider it necessary to correct the mistake of his saintly visitor, and requested her to be seated. With perfect readiness she accepted the invitation, and began at once to discourse in an edifying way.

Meanwhile the news of this wonderful apparition spread like wildfire, and all the inhabitants of the village, as well as those of a neighbouring village about a mile distant, collected in and around the house. Whether the priest was among those who came my informant did not know. Many of those who had come could not get within hearing, but those at the outskirts of the crowd hoped that the saint might come out before disappearing. Their hopes were gratified. About midnight the mysterious visitor announced that she would go and bring St. Nicholas, the miracle-worker, and requested all to remain perfectly still during her absence. The crowd respectfully made way for her, and she passed out into the darkness. With breathless expectation all awaited the arrival of St. Nicholas, who is the favourite saint of the Russian peasantry; but hours passed, and he did not appear. At last, toward sunrise, some of the less zealous spectators began to return home, and those of them who had come from the neighbouring village discovered to their horror that during their absence their horses had been stolen! At once they raised the hue-and-cry; and the peasants scoured the country in all directions in search of the soi-disant St. Barbara and her accomplices, but they never recovered the stolen property. "And serve them right, the blockheads!" added my informant, who had herself escaped falling into the trap by being absent from the village at the time.

It is but fair to add that the ordinary Russian peasant, though in some respects extremely credulous, and, like all other people, subject to occasional panics, is by no means easily frightened by real dangers. Those who have seen them under fire will readily credit this statement. For my own part, I have had opportunities of observing them merely in dangers of a non-military kind, and have often admired the perfect coolness displayed. Even an epidemic alarms them only when it attains a certain degree of intensity. Once I had a good opportunity of observing this on board a large steamer on the Volga. It was a very hot day in the early autumn. As it was well known that there was a great deal of Asiatic cholera all over the country, prudent people refrained from eating much raw fruit; but Russian peasants are not generally prudent men, and I noticed that those on board were consuming enormous quantities of raw cucumbers and water-melons. This imprudence was soon followed by its natural punishment. I refrain from describing the scene that ensued, but I may say that those who were attacked received from the others every possible assistance. Had no unforeseen accident happened, we should have arrived at Kazan on the following morning, and been able to send the patients to the hospital of that town; but as there was little water in the river, we had to cast anchor for the night, and next morning we ran aground and stuck fast. Here we had to remain patiently till a smaller steamer hove in sight. All this time there was not the slightest symptom of panic, and when the small steamer came alongside there was no frantic rush to get away from the infected vessel, though it was quite evident that only a few of the passengers could be taken off. Those who were nearest the gangway went quietly on board the small steamer, and those who were less fortunate remained patiently till another steamer happened to pass.

The old conceptions of disease, as something that may be most successfully cured by charms and similar means, are rapidly disappearing. The Zemstvo--that is to say, the new local self- government--has done much towards this end by enabling the people to procure better medical attendance. In the towns there are public hospitals, which generally are--or at least seem to an unprofessional eye--in a very satisfactory condition. The resident doctors are daily besieged by a crowd of peasants, who come from far and near to ask advice and receive medicines. Besides this, in some provinces feldshers are placed in the principal villages, and the doctor makes frequent tours of inspection. The doctors are generally well-educated men, and do a large amount of work for a very small remuneration.

Of the lunatic asylums, which are generally attached to the larger hospitals, I cannot speak very favourably. Some of the great central ones are all that could be desired, but others are badly constructed and fearfully overcrowded. One or two of those I visited appeared to me to be conducted on very patriarchal principles, as the following incident may illustrate.

I had been visiting a large hospital, and had remained there so long that it was already dark before I reached the adjacent lunatic asylum. Seeing no lights in the windows, I proposed to my companion, who was one of the inspectors, that we should delay our visit till the following morning, but he assured me that by the regulations the lights ought not to be extinguished till considerably later, and consequently there was no objection to our going in at once. If there was no legal objection, there was at least a physical obstruction in the form of a large wooden door, and all our efforts to attract the attention of the porter or some other inmate were unavailing. At last, after much ringing, knocking, and shouting, a voice from within asked us who we were and what we wanted. A brief reply from my companion, not couched in the most polite or amiable terms, made the bolts rattle and the door open with surprising rapidity, and we saw before us an old man with long dishevelled hair, who, as far as appearance went, might have been one of the lunatics, bowing obsequiously and muttering apologies.

After groping our way along a dark corridor we entered a still darker room, and the door was closed and locked behind us. As the key turned in the rusty lock a wild scream rang through the darkness! Then came a yell, then a howl, and then various sounds which the poverty of the English language prevents me from designating--the whole blending into a hideous discord that would have been at home in some of the worst regions of Dante's Inferno. As to the cause of it I could not even form a conjecture. Gradually my eyes became accustomed to the darkness, and I could dimly perceive white figures flitting about the room. At the same time I felt something standing near me, and close to my shoulder I saw a pair of eyes and long streaming hair. On my other side, equally close, was something very like a woman's night-cap. Though by no means of a nervous temperament, I felt uncomfortable. To be shut up in a dark room with an indefinite number of excited maniacs is not a comfortable position. How long the imprisonment lasted I know not--probably not more than two or three minutes, but it seemed a long time. At last a light was procured, and the whole affair was explained. The guardians, not expecting the visit of an inspector at so late an hour, had retired for the night much earlier than usual, and the old porter had put us into the nearest ward until he could fetch a light--locking the door behind us lest any of the lunatics should escape. The noise had awakened one of the unfortunate inmates of the ward, and her hysterical scream had terrified the others.

By the influence of asylums, hospitals, and similar institutions, the old conceptions of disease, as I have said, are gradually dying out, but the znakharka still finds practice. The fact that the znakharka is to be found side by side not only with the feldsher, but also with the highly trained bacteriologist, is very characteristic of Russian civilisation, which is a strange conglomeration of products belonging to very different periods. The enquirer who undertakes the study of it will sometimes be scarcely less surprised than would be the naturalist who should unexpectedly stumble upon antediluvian megatheria grazing tranquilly in the same field with prize Southdowns. He will discover the most primitive institutions side by side with the latest products of French doctrinairism, and the most childish superstitions in close proximity with the most advanced free- thinking.