In September, 1830, cholera engulfed the Russian provincial capital of Kazan, as part of the disease's first global pandemic. It was a moment charged with drama: residents descended into terror and turmoil, local leaders fumbled helplessly for an effective response, while the disease scythed remorselessly through the population. Similar scenes were re-enacted, with variations, across Europe and North America between 1830 and 1832, and reprised frequently in succeeding decades when fresh outbreaks erupted. The emotional intensity of such episodes made them indelible for contemporaries – and this same intense quality has driven historians, since the late 1950s, to ponder the disease's social, cultural and policy implications. One of the founding studies of this field, Asa Briggs’ article, ‘Cholera and society in the nineteenth century’, called on scholars to develop a ‘systematic comparison of the role of cholera in modern social history’ across various places and time-periods.Footnote 1 Briggs proposed that cholera could provide a useful (though not all-encompassing) perspective on the major issues faced by the cities and nations of the nineteenth century, if it was considered through the intersection of demography, social organization and class structure, medical knowledge, local politics and cultural beliefs. This was an ambitious agenda, and one that historians have continued to wrestle with in the decades since.
Toward this end, historians have most often used cholera to explore national and local identity, social dynamics and cleavages of class and race. Charles Rosenberg's pioneering work, for example, followed the first outbreaks of cholera in North America as a way of illuminating the social evolution of the United States. He offered a basically optimistic argument, that responses to successive waves of cholera demonstrated America's shift during this period from an ostensibly classless society, to one that had acknowledged its growing social stratification and turned its moralistic proclivities to comparatively productive ends.Footnote 2 Roderick McGrew, similarly, used cholera to modify then-prevailing views of Russian social stagnation, concluding that the disease actually demonstrated a surprising professional and scientific vitality in the Russian empire, alongside the familiar evils of an ossified and overly centralized bureaucracy.Footnote 3 Tracking developments in the discipline, historians have, over time, given progressively heavier weight to cholera's cultural impact in their analysis. François Delaporte took contemporary cultural understandings (and misunderstandings) of the disease in Paris to heart, as a way of exploring class conflict and the growing assertiveness of the bourgeoisie.Footnote 4 Pamela Gilbert has described how the disease was ‘“used” by various groups in Britain to advance their arguments’ regarding the relationship between disease and poverty, and the applicability of race- and gender-inflected corporeal metaphors to society.Footnote 5 And, rather than deploying cholera as a lens on particular social or cultural formations, Christopher Hamlin has flipped the model by seeking to show how perceptions of cholera itself changed through time, in response to prevailing currents in the areas of hygiene and class status, race and empire, and knowledge and science.Footnote 6
Urban histories of cholera have followed similar lines, focusing on the nexus between politics (both local and national), social conflict and public health, with particular emphasis on whether bouts of cholera prompted lasting and meaningful municipal responses. Historians of the early outbreaks have generally concluded that they rarely led to practical reforms. Michael Durey, for example, found that although the first epidemic in York demonstrated the insufficiency of local institutions – tottering under the burden of class discord and scientific disagreement – to respond to the crisis, the evident need for a more robust public health apparatus at the national level remained unmet after the crisis had subsided.Footnote 7 By late century, with modern concepts and practices of sanitation gradually taking hold in European cities, bouts of cholera were more likely to have lasting impacts. Richard Evans has argued that because it was not part of a general, continent-wide epidemic, the 1892 outbreak in Hamburg spurred significant social, political and public health changes.Footnote 8 Similar but more complicated findings come from Frank Snowden, who showed that cholera in Naples in 1894 also prompted sweeping improvements to the sanitary infrastructure of the city, and yet did not fundamentally reform administrative responses to the disease, which were warped by the vagaries of national politics well into the twentieth century.Footnote 9
This question of how, when or even whether cholera has sparked advancements in public health was taken up in a broader way by Hamlin, who fears that scholars of modern health policy are too eager to believe that cholera ‘forced’ nineteenth-century public health reforms, in hopes that present-day health crises will do the same. He draws on urban studies to stress that meaningful changes only ever happened ‘as a result of a confluence of multiple – and possibly transitory – historical factors’, and that among the most important of these factors were ‘money, politics, and administrative stability and expertise’.Footnote 10
This article will place Kazan's moment of crisis in 1830 into dialogue with its longer and more prosaic experience of endemic disease. In so doing, it will engage Hamlin's challenge, by demonstrating how the emotional power of cholera combined with the particularities of Kazan's political and intellectual life to encourage specific advances in the city's approach to public health. This article will also seek to contribute to the larger, ongoing work of creating a composite, comparative picture of the disease, in all its varying manifestations and effects, by considering why this prosperous Russian provincial capital did not shatter along its social, ethnic and religious fault-lines when disaster struck.
The physical, social and institutional setting
Early nineteenth-century Kazan was, in many respects, typical of Russia's major provincial metropoles. Though modest by the standards of provincial Europe, it was one of Russia's largest cities outside St Petersburg and Moscow. Like most Russian cities, Kazan was also experiencing rapid growth: between 1800 and 1830, the city's official population figures nearly doubled, to some 40,000, amid scenes of widespread overcrowding.Footnote 11 Physically, the city was distinguished by its hydrology. Kazan was situated at the confluence of the Volga and Kazanka rivers, which provided vital communications and trade links to north, east and south. The city also lay astride the Bulak Canal and Lower Lake Kaban, which offered convenient sources of fresh water. Rivers were crucial to Kazan's prosperity, but they were also the source of vast snowmelt flooding every spring, which inundated large sections of the city and cut off access to outlying suburbs for weeks at a time. As a result, Kazan's development had been dictated by a seesaw contest between water and land. Only discrete areas that lay above the level of the floodplain were suitable for building, which encouraged the fragmentation of the city's outskirts into a patchwork of isolated suburban neighbourhoods.Footnote 12
Although Kazan had ancient roots, the current city had been founded as a Muscovite military and administrative base, designed to control and tax the surrounding province, and these functions still generated a sizeable share of local economic activity. Over time, however, it had also gained a thriving private economy, judged by one historian to have the highest level of ‘industrial-commercial development’ of any provincial city in mid-nineteenth-century Russia.Footnote 13 Kazan was best known as a hub for profitable empire-wide and Asian trade; but it had become home to a growing number of low-technology, often ‘dirty’ industries as well. To serve this economy, the city had a socially diverse populace, which included a small elite of officials, merchants and clergy (roughly 10 per cent of the population); significant numbers of skilled artisans and craftsmen, petty traders, shopkeepers and government clerks (35 per cent); and an even larger number of conscript soldiers, manual labourers, factory workers and domestic servants (55 per cent).Footnote 14 Trading venues and upper-class residences huddled around the central kreml, while a mix of middle- and lower-class housing, factories and transportation facilities filled the suburban neighbourhoods beyond.
The local social order was similar to that of other large provincial cities in Russia, albeit somewhat more professionalized. However, one thing that clearly set Kazan apart from its peers in the Russian heartland was its considerable ethnic and religious diversity. The Muscovite conquest of the Kazan Khanate, centuries earlier, had bequeathed the city a substantial Muslim Tatar minority, which constituted roughly 15 per cent of the population in the early 1800s.Footnote 15 Muslims were excluded from the nobility and Orthodox clergy, but filled every other slot in the social hierarchy; and though, on average, they seem to have been less prosperous than their Russian compatriots, some were exceedingly wealthy. Muslims worshipped in a number of mosques scattered across town; and in an effort to reduce the perceived danger of religious conflict, the state had long segregated Muslims into particular residential suburbs.Footnote 16 Still, in the city's commercial areas, people of all faiths and social stations mixed freely. Imperial policies since Catherine II had encouraged (and often compelled) the arrival of other minorities as well, so that in addition to Tatar Muslims, early nineteenth-century Kazan was also home to a smattering of German Lutherans, Russian dissenters and Polish Catholics and Jews.Footnote 17
With regard to public health in Kazan, the city's institutional landscape was in flux during this period, sometimes producing confused and overlapping responsibilities. In the eighteenth century, the Russian state had attempted to manage the health of the nation from the twin capitals of St Petersburg and Moscow, through the work of the Academy of Sciences, and the College of Medicine at Moscow University.Footnote 18 By the turn of the nineteenth century, however, it was clear that this centralized system no longer had either the scale or the responsiveness to meet the state's growing expectations. As a first, tentative response to these challenges, Catherine II and Paul I ordered a major expansion of the civil service positions for doctors and pharmacists in Russia's provincial cities, and the creation of county medical boards.Footnote 19 For years, these posts were known for their chronic vacancies, but gradually the provincial administration in Kazan began to assemble a meaningful cadre of medical professionals. Over the first half of the nineteenth century, the Kazan Medical Board was overseen by two long-serving inspectors, both of whom had previously been army physicians. The first, Ivan (Genrikh) Langel, was a German, who accepted the position in 1798 at the age of 44 and remained there until the mid-1820s. He was succeeded by Vasilii Tile, also German by family background but Russian by birth and upbringing.Footnote 20 By 1840, Tile led a staff of 14 medical providers, including doctors and surgeons, pharmacists, midwives, a dentist and a veterinarianFootnote 21 – a collection that, although woefully inadequate for the demands on the office, still represented a vast improvement over the situation a few decades earlier.
A second – potentially wider-reaching – step forward in provincial medicine was set in motion by Alexander I, with the establishment of regional universities and their attendant medical schools.Footnote 22 Among the vanguard of these was Kazan University, founded in 1804 as the first provincial university in the Russian heartland. Over time, the new university would do much to raise the volume and sophistication of scientific and medical discourse in the city, and to integrate Kazan into larger European networks of intellectual exchange.Footnote 23 The development of the university's College of Medicine helped to spur these changes. Its first professor, clinician Feodor Erdman, was hired in 1804; and by 1814, the college had a staff of four educators, who (at least on paper) ran six pedagogical divisions, devoted to anatomy, clinical medicine, pharmacology, surgery, obstetrics and veterinary practice. The medical faculty continued to grow, so that during the 1830s, it averaged nine members.Footnote 24
While the Medical Board and other medical professionals provided care, ran local hospitals and offered expert guidance, their authority with respect to public health policy was extremely limited. Traditionally, as befit an autocratic state, executive power in the provincial capital had lain with the imperial governor and the regional administrative apparatus that served him. The Medical Board fell under this purview, but so, too, did the Police Office. When Catherine II decreed the system of provincial policing, in the late eighteenth century, it was called the ‘office of decency’ (uprav blagochiniia) and followed earlier European models with its military ethos and broad, ill-defined mandate to preserve ‘decency, morality, and order’. By 1830, when Russia's first modern legal codification was published, the metropolitan police were gradually becoming more professionalized, and more specifically focused on law enforcement. Still, Kazan's 100 or so policemen remained a force for generalized and often arbitrary order-keeping – and, for good or ill, they would inevitably play a leading role in the oversight, implementation and enforcement of virtually any public health policy.Footnote 25
One other factor complicating public health decision-making during this period was the emergence of local self-government. This, too, was set in motion by Catherine II. Her 1781 provincial reform – anticipating the Charter to the Cities a few years later – directed Kazan to form an elected city council, or Duma. The Duma was made up of a mayor and five councillors, selected from among the city's Russian merchants by their peers, and confirmed by the governor. This Duma was neither broadly representative, nor truly independent of the provincial administration; and yet, for all that, it was unique and important as a power-centre that reflected local, rather than imperial, interests. The Duma's chief responsibilities in this period included assessing local fees and taxes, and using them to maintain the city's urban infrastructure, such as commercial venues, transportation networks and public amenities.Footnote 26 Urban self-government had few antecedents in Russia, and it would take decades for the Duma to develop the habits and procedures necessary to function effectively; however, by the 1820s, it had at last begun to hit its stride. Notably, the Duma was a strictly Russian institution. Tatar merchants had access to a conceptually analogous organization, the Tatar Ratusha, but it had none of the executive powers of the Duma.Footnote 27
Endemic disease and the transformation of Kazan into a site of medical intervention
Over the first decades of the nineteenth century, any public health programme that might emerge in Kazan would be shaped by the interplay of powers and duties parcelled out across the provincial administration, its constituent Medical Board and Police Office, and the elected Duma. As late as the end of the eighteenth century, however, it would not have been possible for local leaders to even imagine such a programme. Prevailing scientific opinion perceived little connection between the city and the health of its inhabitants; and until these attitudes changed, public health would not appear on the agenda. Representative of this earlier mode of thought was the first topography of Kazan, A Topographical Description of the City of Kazan and its County, published in 1788 by author, amateur scientist and sometime government servitor Dmitrii Zinovev. A slender volume dominated by eclectic observations on the city's physical, social, economic and religious landscapes, Zinovev's Topographical Description is remarkable chiefly for its complete omission of the city's health. Topics which, three decades later, would have raised inevitable medical concerns – climate, moisture, water quality – were presented here in purely functional terms. Zinovev described the weather, for example, blandly: ‘The climate in Kazan…is moderately warm in the summer, and in the winter it varies, but severe frost is most common.’ Missing here were the pestilential mud of spring and billowing dust of summer that would so alarm future observers. Likewise, in discussing Kazan's physical topography, where ‘half the city is located along the ridge of a low hill and its ravines, and the other half in the valley of the hill on a level plain’, he avoided the language of meadows, bogs, wet-areas and low-spots that later commentators would use to connote the sources of dangerous miasmas. Even his discussion of water supplies was purely superficial, summarizing the physical characteristics of Kazan's lakes and rivers (such as size, location and surroundings), without reference to their quality.Footnote 28
By the first decades of the nineteenth century, however, urban discourse in Kazan had changed dramatically, reimagining the city as a space of medical dangers and prophylactic possibilities. Zinovev himself, for example, penned a newspaper article in 1817 called ‘A few words on the quality and characteristics of water in Kazan, on the diseases befalling people, livestock epidemics, etc.’. This time, Zinovev focused on ranking and evaluating the city's water supplies from a health perspective, rather than merely describing their physical attributes. Moreover, his broader commentary now positioned Kazan as a defined space in which physical and climatic forces combined to foster particular ailments. ‘The primary local diseases of the city’, he wrote, ‘are intermittent fevers, and aqueous and scorbutic diseases; in the month of March acute colds spread wildly; and at the end of July and for all of August typhus frequently appears.’ Also notable is Zinovev's occasional shift into a proto-epidemiological register. ‘Although the water [in the Kazanka] is clear’, he observed, ‘it contains a large quantity of mineral solids, so it is not suited for consumption. Those living in Zasypkinaia and Lower Fedorovskaia neighbourhoods, who use it, suffer blockages more often than other residents.’ Finally, the new field of statistics offered graphic evidence of the stakes involved for city dwellers. ‘Among the 40 thousand Kazan residents of the Greco-Russian faith’, Zinovev reported, ‘for every thousand of them, 36 people of both sexes die each year.’Footnote 29 Whether objectively accurate or not,Footnote 30 these cold figures conveyed to residents, in the language of scientific precision, that the city was a place of medical risks, which demanded public attention, and perhaps public responses.
Nor was Zinovev alone, for Kazan's medical professionals were beginning to deploy their scientific authority to make similar points as well. Ivan Langel, head of the Kazan Medical Board, published the city's first medical topography in 1817, and continued to expound on local medicine in the pages of the Kazan Herald for most of the 1820s. The medical topography was a relatively new scientific genre that gave expression to the emerging European conceptualization of a nexus between space, disease and public health. The first medical topographies appeared in Germany and France during the 1780s and 1790s, and subtypes soon emerged which focused on specific nations, regions and individual cities.Footnote 31 Within a few years, Russian authors had begun to adopt this innovation as well. Langel's Short Medico-Physical and Topographical Survey of Kazan Province and the Provincial City of Kazan was admired locally, and generated sufficient interest to merit a second printing in 1829.
Medical professionals like Langel aspired to do more than simply tally Kazan's ills. Instead, following the lead of western European commentators, they coupled their observations with recommendations for action: collective responses which, they argued, had the potential to reduce or eliminate many of the health hazards of living in the city. Before they could make such prescriptions, however, these experts first needed to diagnose clearly the issues to be addressed. In this regard, there was consensus among virtually all observers in these early decades of the nineteenth century – Kazan's twin problems were ‘muck’ (and the resulting pestilent miasmas) on the one hand, and unsuitable water supplies on the other. From the beginning of his book, Langel laid out these challenges clearly: ‘Of this city, it is not unknown that in many places it becomes extremely muddy in fall and spring; that several streets become submerged underwater, that its residents suffer a great insufficiency of clean and healthy water; and that at various times of the year there arise local diseases, particular only to this city.’Footnote 32
On the issue of muck (griaz), experts were less concerned with the offal, raw sewage and animal waste that were ubiquitous in the city (and that we now know played a crucial role in undermining public health), than with the meltwater and flooding that turned the streets into rivers of mud for much of the year. Journalist Mikhail Rybushkin drew heavily on Langel to emphasize this point. ‘The time of year has a very direct influence on human health [in Kazan]’, wrote Rybushkin, ‘particularly in spring, because the water left after the flooding of the Kazanka forms swamps, which rot and contaminate the air.’Footnote 33 The pervasiveness of this muck brought medical professor and physician Karl Fuks to the verge of despair: ‘as long as the streets in Kazan are muddy, there is almost nothing her healers can do’.Footnote 34 The only silver lining to all this was that prevailing views on miasma, with their focus on dampness, heat and decay, prompted far less clinical concern regarding the oft-mentioned counterpart to Kazan's muck – the choking, blinding dust that arose once the streets dried out.
When it came to local water quality, medical commentators were also pessimistic. Langel cast serious doubt on the suitability of the city's major water supply, Lake Kaban, observing that it remained murky far out into the middle.Footnote 35 A revision of Zinovev's article on water quality which appeared in the Kazan News in 1818 agreed, noting with distaste that ‘the water would have been better if the lake…was maintained in such a way as to exclude impurities’ – impurities ‘which arise from people gathering there to do laundry and water cattle, and from the hundreds of people and horses bathing there every day during the summer’.Footnote 36 In these early decades of the century, the proposed remedies for such issues were rudimentary in nature. It often seemed more feasible to disseminate medical advice to individuals than to promote large-scale public health initiatives. ‘There are limits to human strength, and to suddenly embrace every measure and try to remedy everything at the very same time is impractical’, Langel cautioned.Footnote 37
Still, local experts were starting to think that Kazan's health hazards might be mitigated through collective action. Vasilii Tile, for one, advanced a pair of such measures in 1824, shortly before succeeding Langel at the Medical Board. His plan envisaged the construction of a metropolitan-scale water filtration system, based on a Parisian model, coupled with police surveillance to prevent further contamination of Lake Kaban.Footnote 38 Other commentators felt that the key was better management of the land surrounding the city's lakes and rivers. If the shore areas were paved, landscaped and gardened (so this line of reasoning went), then filth would be prevented from flowing into the water, the air would be cleaned by the plantings and the city's water supplies would remain healthy. One contributor to the Kazan News imagined:
how good it would be…if, along the shores [of the Bulak Canal], we constructed alleys for walking and recreation: how very attractive, and how useful for dealing with muck, [and] for ensuring health by cleansing the air…Having cleaned the Bulak and opened up fresh springs and allowed water in from Lake Kaban, it might have good water in it suitable for any application.Footnote 39
The notion that the city's lakeshores and riverbanks played an important role in determining water quality was closely linked with the universally approved solution to its muck: paving. At the beginning of the nineteenth century, paving represented an innovation in Kazan. To cosmopolitan newcomers, this signalled that the place remained provincial in every sense of the word: upon taking a post at the university in 1807, medical professor Ivan Braun reported sourly that ‘only in the fortress (kreml) is there a short paved stretch, all the other streets are unpaved…the muck rises to the very axles of a carriage’.Footnote 40 Over the first few decades of the century, the paving of the city advanced at an agonizing crawl – by the start of the 1830s, the Duma had managed to surface no more than short stretches of a few main streets in the city centre.
The journalist Rybushkin, for one, chose to interpret these meagre results optimistically. ‘In recognition of the difficulties [raised by Kazan's muck]’, he reported, ‘the current government has taken measures; streets that were once muddy are now paved with stone, and in the future, no doubt, others will be similarly clad.’Footnote 41 Still, the most significant development of the early decades of the nineteenth century had simply been to reconceptualize Kazan as a space that shaped the health of its residents. Experts had connected particular endemic diseases with the city, diagnosed these health issues as rooted in the twin local dilemmas of muck and water quality and begun to propose public health interventions in response. The real work of implementing public health solutions, however, was only just beginning in the 1830s, and would take decades to come to fruition. Before that could happen, the city would first have to survive an acute health crisis which temporarily pushed questions of chronic and endemic illness to the side: cholera.
Cholera in Kazan
Cholera was the first new epidemic disease to capture the European consciousness in the modern era of global journalism and medical science. Unlike earlier plagues and scourges, which terrified by their unpredictability and ominous air of mystery, the pall cast by cholera had a different quality. The disease had been identified in India in 1817, allowing experts to observe the 1817–23 pandemic from afar as it raged through Asia, the Middle East and East Africa, and even touched the southern frontiers of the Russian empire.Footnote 42 What they saw inspired a sense of horrified fascination. Indifferent to the muddled theories offered by medical science, cholera seemed to follow frightful ‘scientific laws’ of its own – advancing remorselessly from city to city and town to town; striking down the infected with clockwork precision; and ending their lives in horrifying scenes of squalor and degradation.Footnote 43 Thus it was with dread that people across Europe heard, in 1829, that the disease had erupted in the Russian frontier city of Orenburg, heralding the onset of a new, worldwide pandemic.Footnote 44
Between the autumn of 1829 and the summer of 1830, Kazan faced the looming threat with grim determination. The central government hoped to assert control over the course of affairs, and the provincial chancery was inundated with a flood of Interior Ministry circulars and memoranda. The ministry also began requisitioning local doctors for service elsewhere, a disruptive habit that would plague Kazan officials throughout the crisis. Still, Governor Ivan Zhevanov had substantial autonomy within his domain, and it was he who crafted the local response. ‘To prepare for every hazard’, Zhevanov ordered, ‘a cordon must be established along the entire length of the border between Kazan Province and Orenburg.’ Accordingly, the province's resources were dispersed to its remote frontier counties – troops and officials were sent to enforce transit restrictions, while doctors from Tile's Medical Board and the university were dispatched to ferret out early signs of disease.Footnote 45 It was a bold gambit, which held little back to confront the epidemic if it should reach the city. And this is exactly what happened; for, as it turned out, the greatest danger did not lie in the direction of Orenburg at all. In July, Astrakhan was struck by cholera, and by early August, the sickness was appearing up the Volga.Footnote 46 Kazan's blind-sided bureaucrats ordered city police to set up a dockyard quarantine on river traffic, but this measure came too late and proved ineffective.Footnote 47 At the beginning of September, cases broke out on the Kazan wharves, and then, on 10 September, the first victim was reported in in the urban core – a bread-seller who had been trading at the docks. Chaos descended on the city.Footnote 48
Cholera inspired terror in city dwellers by its then-indeterminate mode of transmission, by the high mortality rate among those who contracted it and by the sheer speed with which it killed. ‘Once the disease cholera strikes’, one local witness reported, ‘in the course of [five or six] hours the victim will be beyond help, or even have died.’Footnote 49 Moreover, although cholera did the greatest harm to Kazan's poorest, most deprived and weakest citizens, it claimed victims from all parts of the city, all social strata and every demographic group. Under such conditions, blind fear, too, quickly became contagious. ‘Terror spilled out along every street’, Fuks recalled. ‘Not a single carriage could be seen; everywhere the gates were shut, and only a solitary old lady, not apprehending the danger, continued to walk the streets.’Footnote 50 There seemed nothing to do but hide, yet this did not protect residents from the shadow of death hovering over the city. ‘Every hour they were carrying corpses off on stretchers…many houses were completely boarded up – a sign that everyone inside had passed away.’Footnote 51 By the last week of September, official statistics showed an average of over 30 people dying every day – nearly 10 times the normal mortality for the season.Footnote 52 Unofficial estimates suggested that the actual death rate may have been 3 to 5 times higher still.Footnote 53
An infection of this sort was inherently unsettling; but the government's botched early response raised additional disturbing questions about Governor Zhevanov's administration. Accusations of bribe-taking were rampant – it was said that anyone with the money could pay the provincial secretary and other officials to circumvent the quarantine measures. Then, too, it was claimed that many of Kazan's medical professionals, falling prey to panic and cowardice, had shirked their duty by refusing to care for the stricken. There were reports that the hospitals were undersupplied, that their assigned physicians were absent and that Zhevanov and his staff had neglected to provide them with meaningful attention or oversight.Footnote 54 Underlying and compounding these specific allegations of wrongdoing and neglect were structural flaws in the government's approach to the crisis. The administration had made the Police Office the centrepiece of its response effort. Each of the city's five wards was to be divided into several districts. Each district would be overseen by police officers, who would watch for signs of cholera, and call in medical personnel and implement quarantine measures if it was detected. To the greatest extent possible, the sick were to be concentrated in three hospitals, situated at a remove from Kazan's core population centres.Footnote 55 This plan may have appeared orderly, but it was also brittle – when the moment of crisis arrived, its dispositions were easily overwhelmed by the scope and speed of the emergency. More importantly, the plan failed to enlist Kazan's citizenry as partners in the disease response, but rather positioned the bulk of the city's population as a passive and undifferentiated mass, to be managed, controlled and moved across the urban chessboard by imperial officers.
Partially as a result, the first two weeks of the outbreak were a blur, with the district police overwhelmed, the internal quarantine measures haphazard and ineffective, senior officials struggling simply to discover what was happening and the death toll steadily climbing. By 23 September, prompted by a directive from Interior Minister Arsenii Zakrevskii, provincial administrators decided it was time to reassess their strategy. To this end, they formed the Temporary Provincial Committee to End Cholera in the city of Kazan, consisting of not only the governor, vice-governor, regional military commander and head of the local nobility, but also Nikifor Chizhov, merchant and elected mayor of the Duma, and Vasilii Tile of the Medical Board. Zakrevskii's circulars had continued to envision the disease response as a precise machine, directed by central authorities; but the new Temporary Committee laid out a substantially different programme, better suited to engage Kazan's urban population in the struggle. It revised the procedures for curfews and inspections, providing the option to quarantine the sick either in hospitals or in their own homes. The system of wards and districts was retained, but now a staff of four to six individuals was designated in every district to oversee the new measures. The head of each district staff (the ‘commissar’) was chosen ‘from the nobility’ – typically an active or furloughed civil servant of middling rank – while his several assistants came ‘from among the merchants’. All medical practitioners who had either remained in the city or returned from the hinterland were also formally allocated to posts in the city's districts and hospitals. The police were relegated to a supporting role.Footnote 56 This system was both more organized and more inclusive than what had come before; so that although it remained tied to the empire's formalized social hierarchies, it nevertheless opened up new opportunities for the citizenry to become active participants in the eradication campaign.
The practical effects of the Temporary Committee's efforts are difficult to gauge. Keeping infected residents closer to home may have helped them receive better care, but may also have increased the risk of widespread water contamination. The truth is that in 1830, no expert in the world had the knowledge necessary to master cholera. At a minimum, the committee's work kept Kazan's metropolitan society from descending still further into helplessness and disorder, and at best it may have played a part in turning the tide. By most measures, the outbreak peaked in Kazan on 29–30 September, though even then a long slog remained before the disease would be fully contained.Footnote 57 One challenge that plagued the committee throughout the crisis was a pervasive shortage of responsible officials and physicians. Dozens of them died, right up to Governor Zhevanov himself, who fell ill on 3 October and passed away on the 21st.Footnote 58 Each loss unravelled another strand in the city's web of governance and sent another wave of fear washing over the victim's compatriots. Very quickly, the line between shirkers and sufferers became hard to discern. The Temporary Committee's correspondence was laden with commissars’ requests to be released from duty for health reasons, notifications that their merchant assistants had been taken ill, investigations into medical officers struggling to fulfil their responsibilities and physical examinations of individuals from all these groups seeking to ascertain whether they were actually sick or not.Footnote 59 The extent of the resulting churn can be judged from a 9 October report, which stated that since the last roster had been circulated one week earlier, ‘subsequent changes to the housing assignments – due to doctors requisitioned [by the Interior Ministry], deaths, and new arrivals – have been so great, that in the committee lists it is difficult to determine who is in which place, in which ward, or in which district’.Footnote 60
Though an undeniable improvement over what had gone before, the Temporary Committee still left residents with grounds for dissatisfaction with the government's efforts. As they worked against a backdrop of death, fear, staffing turmoil and miscommunication, the district commissars and their merchant-assistants struggled to address even the most basic needs – making sure that every doctor had a horse, for example, or that each hospital had enough beds, or even that they themselves had the paper and candles necessary to do their work.Footnote 61 So, without waiting any longer for the imperial government to provide solutions, Kazan's private citizens began working to create their own string of cholera hospitals, scattered across the city's most densely populated areas. The first of these private hospitals opened in the city's Muslim Tatar quarter on 28 September. It was organized and funded by Gaibadully Iunusov (elected head of the Tatar Ratusha), with the aid of ‘other conscientious citizens of the Muslim religion who joined with him’. Within a few days, three comparable initiatives had emerged from the city's Orthodox community as well. First, a merchant named Anasim Mesetnikov opened a small hospital of six beds. Then two pairs of merchants (including one city councillor) each proposed their own infirmaries, in adjoining districts. These four men eventually pooled their efforts, establishing a large hospital in a house owned by a merchant named Vargin. For a centralized state like the Russian empire, the private initiative displayed by these undertakings is noteworthy. The merchants were careful to notify the district officials of their intentions, and certainly did not want to run afoul of the authorities. But the details which contemporary reports and letters provided – sketching out the merchants’ early deliberations, their site searches and their efforts to provision the new clinics – make it clear that they acted without official prompting. In fact, full awareness of these hospitals did not bubble up to the level of the Temporary Committee until some days after they had begun operations.Footnote 62
The merchants justified their private hospitals with clear and compelling logic that highlighted the inadequacies of the provincial administration's crisis management. The government had attempted to segregate the sick in remote hospitals at the edge of town. Given the time and risk associated with moving deathly ill patients to these far-off sites, and the separation from family and friends that would ensue, city residents simply chose not to use the hospitals. In response, the Temporary Committee had instead begun to quarantine individual houses in which the sickness had appeared. This, in turn, raised a different set of problems, for now the city's overstretched medical professionals became hard to find and even harder to summon as they spent their days making house calls. Patients contracting the disease were dying long before a doctor could be found to treat them. The private neighbourhood hospitals represented an optimal compromise. They were close enough to be attractive to residents of the surrounding streets, but offered a concentration point where medical aid could be deployed more efficiently and reliably.Footnote 63 In the coming weeks, these temporary hospitals would serve dozens and likely hundreds of patients. Still, for the most part they were never filled to capacity, because even as they started operating, the outbreak had peaked and begun to taper off. By the end of October Kazan was nearly free of cholera, and in November the cordon around the city was lifted.Footnote 64
Official statistics reported that about 500 people had died in less than eight weeks; however, Fuks put the actual number at 1,500. Later writers quoted even higher figures, up to the astronomical sum of 3,000 fatalities, or roughly 7 per cent of the population.Footnote 65 Whatever the precise toll, Kazan's experience of the 1830 epidemic was wrenching; yet the city never fractured along its social, ethnic or religious fault-lines. Unlike many cities in Russia and beyond, Kazan did not witness rioting; and, although rumours and tales abounded, these generally channelled frustration against state officials, rather than venting overt class antagonisms.Footnote 66 Historians have often noted that, as a rule, a ‘light touch’ with respect to coercive quarantine measures has tended to produce more positive local outcomes,Footnote 67 and this certainly seems to have been the case in Kazan. Ironically, Governor Zhevanov's ineffectiveness, the onset of his fatal illness in early October and the several weeks delay before Minister Zakrevskii finally arrived to pick up the pieces may all have been fortuitous, to the extent that they left a power vacuum in which the comparatively collaborative and inclusive efforts of the Temporary Committee and private citizens could flourish. At the very least, the response to cholera in Kazan serves to demonstrate both the existence and the potential impact of local civic initiative in early nineteenth-century provincial Russia.
Another noteworthy feature of cholera in Kazan was the absence of both ethnic conflict and the kind of racialized contagion rhetoric – vilifying minorities as congenitally ignorant, backward and ‘dirty’ – that would appear in the Russian empire and elsewhere with increasing frequency as the nineteenth century progressed.Footnote 68 One medical student did conclude that a Tatar preference for unleavened bread had aided the spread of the disease; and his notes also echoed more widely held fears that ‘because of their fanaticism’, the Tatars might ‘conceal the sick and not request medical aid’.Footnote 69 However, such concerns were more the exception than the rule. Records from the outbreak rarely drew distinctions of ethnicity or religion; and few locals would likely have disputed the claim that Kazan's Tatars ‘enjoy[ed] better health than the Russians’, due to their ‘temperate and steady way of life’.Footnote 70 Even so, the Tatar experience should not be idealized. As we have seen, Muslims were excluded from local executive decision-making and segregated in often marginal suburban neighbourhoods. During the crisis, ethnic differences undoubtedly exacerbated the general level of administrative incompetence. ‘I have found’, one nonplussed inspector wrote to the Temporary Committee, ‘that in the third district of this ward, the residents are in large part Tatars, but the commissar…and all the persons assigned to assist him are Russian, and do not know the Tatar language.’ Tatar-speaking intermediaries were soon identified, but the fact remained that Muslims were an afterthought, at best, in the provisioning of medical care.Footnote 71 Given these disparities, it is perhaps unsurprising that the first of the private hospitals was established by local Tatar leaders, before the idea spread to take hold in Russian Kazan. We might even speculate, albeit with limited evidence, that Kazan's diverse, divided and inequitable ethnic landscape in some ways encouraged the broader embrace of private civic initiative that characterized the emergency.
Tackling public health with newfound urgency, ambition and agency
As in many other places, cholera receded from the forefront of public discussion with surprising speed. Physicians went back to treating the usual ailments of typhus, fevers, dysentery and flu, while urban commentators resumed their fretting over water quality and unhealthy muck. Yet, although the echoes were subtle, the trauma of 1830 does seem to have had enduring resonance, among health professionals and local politicians alike. For medical experts, the outbreak had been a humbling experience, which drove them to pursue Kazan's well-being with greater urgency and a broader perspective. In the wake of the disease, they revisited the old questions of muck and water quality with a heighted sense of resolve. Medical Professor Adam Arngoldt's 1832 assessment of Lake Kaban, for example, reached new levels of candour in detailing its ‘muddiness’, ‘unpleasant odour and taste’, ‘disgusting colour’ and the ‘thousands of insects, which can now be seen in a single glass, even with just the naked eye’.Footnote 72 In 1833, Tile, similarly, coupled a new slate of proposals against ‘the pernicious effects of swampy vapours’ with an unprecedented condemnation of the current state of affairs: ‘Kazan [is] such an unhealthy city, that the number dying each year now exceeds the number of new-borns by an incredible number.’Footnote 73 The stridency of such expert testimony – along with its implicit criticism of the imperial status quo – was new and bold, and it made continued inaction in the face of Kazan's medical dangers increasingly untenable.
Moreover, medicos also gradually began to integrate cholera into visions for urban health that were more comprehensive and ambitious. Among these reformers was a well-liked young medical professor named Nikanor Skandovskii, whose 1841 public lecture, ‘On the causes of intermittent fevers in Kazan’, offered a searching reassessment of the city's health challenges. Elements of Skandovskii's critique were numbingly familiar. ‘Many streets remain unpaved’, he noted, ‘[so that] the rapid surfacing of streets is, without a doubt, among our most important undertakings. It is impossible to calculate all the benefits which the city will gain from the completion of the street paving.’ Similarly, the problem of water quality continued to fester. ‘Every resident of our city knows that we are in utmost need of good water. For ages we have talked about it in meetings, written lengthy treatises, proposed various remedies…but let us be dispassionate and admit that our need for good water is simply growing with every year.’Footnote 74
However, Skandovskii also articulated other concerns – concerns that were quite novel in Kazan – about the nature of city life in general, and about its particular manifestations in this provincial capital. Unlike earlier local commentators, Skandovskii feared that urban living, in itself, carried inherent, deleterious health implications. The reasons were both legion and self-evident: ‘overcrowding, tall and close-packed buildings, stifling air, the inability of some to access good water, an unnatural way of life, poverty, anxiety over employment, and the prevailing fashions that city dwellers venerate to the detriment of their own health’. In Kazan, topography and rapid growth combined to magnify these problems. ‘Unfortunately the terrain of the city does not allow it to spread out…But since the number of residents in Kazan grows every year, and they must therefore expand their homes by adding storeys or building over their courtyards, this necessarily increases the crowding in the city, which in turn adds to the corruption of the air.’Footnote 75
Skandovskii gave cholera a prominent place in this more expansive conception of urban health, for he believed the city's periodic bouts of epidemic disease and persistent endemic maladies were intimately related. Because he saw the 1830 outbreak as stemming from the same structural health problems as chronic fevers, his engagement with cholera dwelt on neither the medical and bureaucratic failures that attended it, nor the indiscriminate horror it inflicted. Instead, he suggested that the affliction had been opportunistic, picking off those unfortunates who were already weakened by the mortifications of urban life. ‘Cholera was, in Kazan, a foreign disease, fleeting…Two-thirds of the three thousand people who died here from cholera, we can reasonably suggest, were those who already had a strong predisposition to fevers, and who were liable to fall ill from them, when exposed to the most minor and incidental adverse stimulus.’Footnote 76 To Skandovskii, then, the vital mission of public health was to address the fundamental hazards that undermined residents’ well-being. Both endemic and epidemic disease revealed Kazan's medical shortcomings, and both would yield to Kazan's physicians only when these shortcomings had been addressed.
Yet, while this surge in the energy and ambition of scientific health discourse in Kazan was all well and good, the truly pressing question after 1830 was whether the schemes and dreams of Kazan's medical reformers would ever be translated into tangible action. This is where the second, more concrete, legacy of cholera comes into focus. For the dramatic crisis had not only injected fresh urgency into the city's public health debates, it had also exposed the inadequacies of imperial governance, and demonstrated that private citizens (and their elected local representatives) had the capacity to chart their own responses to the city's problems. It was in the aftermath of cholera, therefore, that city councillors finally began the work of reshaping Kazan to promote the health of its inhabitants. These politicians’ efforts were prosaic and imperfect. Lagging the grand vision of reformers like Skandovskii, they were guided by the tenets of local endemic disease discourse as it had evolved over the first three decades of the century – that is, against the dangers of impure water and muddy streets. Even so, the shift toward action that took place after 1830 was striking. Back in 1800, not even the most progressive resident had conceived of Kazan as an object of medical intervention and public health investment. By the time cholera arrived, any number of ideas were in circulation, but precious little had been done. Now, in the early 1830s, expensive and complex projects were finally set in motion, to address the generally acknowledged threats to local well-being.
Kazan's winding path to securing a healthy and reliable water supply has been traced by Alison Smith. She describes two major approaches to providing water to the city during this period. First, in 1832, the city Duma contracted an engineer named Nei to oversee a mechanized deep-bore well project. Ultimately, this effort was an abject failure – over the course of a decade, Nei dug down over 130 metres, at a cost of nearly 25,000 roubles, without striking a steady flow of drinkable water. And second, city leaders also sought to bring water from healthier sources, via aqueduct. Beginning in 1837 and continuing throughout the 1840s and 1850s, various proposals were taken up to access water from distant Lake Arkhiereiskoe, only to be foiled by excessive costs, technical complexity and political indecision. Eventually, in the late 1850s, a joint-stock water utility company was formed, in partnership with the Duma; and after further travails, in 1875, clean water at last began flowing through miles of iron pipe to reach the long-suffering residents of Kazan.Footnote 77 For Smith, the four decades that elapsed between the first serious efforts to address the water crisis and the implementation of a workable solution illuminate the inadequacies of autocratic governance.Footnote 78 Yet successful or not, the fact that 1832 marked the beginning of costly and sustained projects to secure clean water highlights clearly the post-cholera shift toward tangible, large-scale local investment in public health.
And if the councillors struggled to bring water to Kazan, they fared somewhat better in the less technologically demanding battle against muck. As we have seen, the city's streets had begun to be surfaced during the 1820s, but the rate of progress had been painfully slow. Only a tiny handful of the major thoroughfares were hardened when the epidemic struck, totalling perhaps a mile in length. The pace of work began to accelerate dramatically, however, starting in 1833. In less than a decade, Kazan's Duma would plan, fund and execute 35 distinct paving projects, each representing a substantial investment of time and money. As a result of these efforts, by 1842, the city could boast of roughly 10 miles of paved streets – covering most of the central district and major commercial arteries, while stretching fingers out into the rest of the city.Footnote 79
Undertakings of this magnitude demonstrated a serious public health commitment on the part of civic leaders – a commitment that blossomed in the wake of cholera. Skandovskii, for one, recognized the significance of this shift, despite his reform-minded impatience with the work still to be done. Looking back from 1841, he marked the year of the epidemic as the crucial inflection point when the city had begun its journey toward health. The key physical indicator he linked with this transformation was, unsurprisingly, paving. ‘Whoever can remember Kazan back to 1830 will be justifiably surprised at the speed with which we have paved the streets, and with the beauty that has resulted…Let us recall that 10 years back, not a single stone had yet been placed for street paving.’ But more importantly, Skandovskii connected this particular achievement to broader improvements in the state of local health. ‘[T]he citizens of our time exhibit a much greater degree of hygiene (opriatnost) than before. Every local resident, and every traveller arriving in our city looks with particular satisfaction on the increase in cleanliness (chistota) that comes with each passing day.’ To Skandovskii, the decade of tangible improvements that had followed cholera provided an optimistic counterweight to Kazan's manifest shortcomings – giving him hope that his broader vision, of a city where every resident experienced ‘comfort, and the blessing of a long life’, might ultimately come to pass.Footnote 80
Conclusion
The study of cholera in Kazan sheds light on an urban society that certainly had its flaws and failings, yet could still muster unlooked-for resiliency in the face of emotional turmoil and medical hazard. Despite glaring power inequalities between state and individual, rich and poor, Russian and Tatar, the city benefited from countervailing and unifying forces: a growing cadre of educated professionals; a sense of civic initiative; an outlet like the Duma which (whatever its imperfections) was mandated to advance local interests; and comparatively benign ethnic and confessional relations. In the moment cholera struck, these factors helped Kazan weather the storm with greater success than many cities in Russia and worldwide. Furthermore, once the storm had passed, it was a similar set of external factors – the concept of the city as a site of health intervention, the advocacy of university medial professors, the existence of a city council with access to revenues and responsibility for the urban infrastructure – which allowed Kazan to channel the emotions generated by cholera into preventative action against endemic disease. Without cholera, it is unclear when Kazan would have taken its first tentative steps toward implementing a public health agenda; but without the necessary expertise, institutions and ideas, the trauma of cholera alone certainly could not have produced lasting change.
