Many noted men of letters, medical doctors by profession, have put themselves on record in world and Russian literature. The great Chekhov, whom Leo Tolstoy called a "Pushkin in prose", is among them. In his work Anton Chekhov the writer drew upon his medical experience gained in psychology and psychiatry, and in his clinical practice as G.P. He confided that this activity greatly influenced him as a writer. "Had I not been a doctor..., I would have hardly devoted my free time to literature," he said.

by Mariya SAPRYKINA, journalist

M.D. THESIS CONCEPTUALIZED

Usually we perceive Anton Pavlovien Chekhov as the author of short and long stones, humoresques and plays, but not as a medic. Graduating from the Medical Department of Moscow University in 1884, he planned to write a thesis and even made some steps in this direction: the writer's papers (now kept at the Russian State Archives of Literature and Arts, Moscow) shed new light on his scientific pursuits. This fact is examined by Nikolai Belchikov in the article "Scientific Experience of Chekhov". He is a well-known literary critic, elected to the USSR Academy of Sciences in 1953 (he discovered the manuscript of Chekhov's doctoral thesis). Mark Mirsky, Dr. Sc. (Med.) also mentions that in his book Doctor Chekhov (M.: Nauka Publishers, 2003). In fact five or six years before his famous account The Sakhalin Island (1893), the writer had devoted two years researching into the history of national medicine. It was his second research experience; although Chekhov kept silent about his first attempt, his manuscripts betray his plans: he intended to publish the treatise Medical Industry in Russia, 1884, 1885 as his doctoral thesis. In 46 hand-written sheets Chekhov collected excerpts from various works—from chronicles to folk medicine handbooks. He took this work in good earnest and put down many interesting cases, recipes, and the like. He made a list of more than 100 books he had to read. The manuscript is dated 1884 and 1885, when Chekhov graduated from the university and began his work as G.R in the Moscow Region. In his letters Chekhov never said a word about his fundamental treatise, even though it took much time and effort. The materials collected for the thesis contain methodological approaches showing that Chekhov wanted to become a historian of Russian medicine conversant with its past. The writer was certainly expert in data collection and management.

Unfortunately, Chekhov did not finish his work, though he collected a lot of materials that could be divided into several parts (documents on medical practices in the ancient times, in the 17th century, etc.). As

we have already said, he made no mention about this work in the many letters of that period (even his next of kin knew nothing about it); however, it meant good spadework for The Sakhalin Island, a fact-finding narrative in which Chekhov revealed his talent both as a novelist and as a shrewd analyst.

Later, in his letter of December 20, 1884, to Sergei Dyagilev, the theatre and arts maître, Chekhov confided he wrote The Sakhalin Island instead of the thesis... which he was going to complete after 1884, i.e. upon graduation. Probably Chekhov intended to return to his work on the history of medicine: he did not destroy the manuscript as he was wont to do in getting rid of the drafts and extra staff. Consequently, Anton Pavlovich found it valuable and necessary for the future effort. Although he did not become a historian of medicine, he got a priceless experience as story teller.

THE SAKHALIN ISLAND

So, in 1890 Chekhov traveled to the Far East, to the Sakhalin Island. Once there, he took an active part in a census of the local population, studied morbidity rates as recorded in clinical "True Books" and entries in the church registers. He also worked as a general practitioner—received patients and operated on them at an out-patients' clinic. Chekhov was all set on scientific methods—indeed, the census carried out in 1890 on Sakhalin was the first selective census of the Russian population based on scientifically validated statistic techniques.

As a medical man, Chekhov collected and evaluated much information on the local population—these very data formed the basis of his famous travel notes The Sakhalin Island (1893), which the author himself considered a research work. It was written as a doctoral thesis [later on, a well-known St. Petersburg neurologist, friend and classmate of the writer Gregory Rossolimo (1860-1928) offered his help to make this work accepted for defense, but the whole thing did not pan out]. In this work Chekhov combined clinical thinking, deep knowledge of his subject and writing skills. He employed a scientific statistical method, which among other things, made the publication of this capital work an event in Russia's social life (the work was published in installments (chapters) in the Russkaja Aysl journal). The Sakhalin Island had broad public repercussions, and the czarist government had to set up a special commission to look into the condition of the prisoners there. No doubt, this work shall live on as a monument to the literary and medical achievements of Chekhov.

Graduation certificate awarding Chekhov the title of a rural physician, 1884.

Such eminent writers of the next generation as Ilya Ehrenburg and Yevgeny Zamyatin spoke highly about it, too.

MEDICINE, LITERATURE, LIFE

What did Chekhov think about practical medicine that took so much of his time? It's a fact that it enriched him with a scientific understanding of human psyche, the most intimate and sacramest sides of the human soul. In his letter to doctor Ivan Ostrovsky dated February 1893 the writer said: "Medicine is my lawful wife, literature, my unlawful wife. Of course, both interfere with each other, though not so much as to exclude each other." Chekhov told his relatives and friends about his medical practice now in earnest, now with humor.

An eloquent phrase from the essay To the Memory of Chekhov (1904) by another medic and writer Alexander Kuprin: "If he had not been such a brilliant writer, he would have made an excellent doctor. Doctors, who sometimes asked him for advice and consultations, characterized him as a serious-minded observer and a quick-witted and shrewd diagnostician. No wonder if his diagnose happened to be more accurate than that of some young medical celebrity. Chekhov saw and heard in man—in his face, voice and gait-what was hidden from others, what escaped an average observer. In rare cases, when Chekhov was asked for advice, he preferred well-proven and simple 'home' remedies. By the way, he was very good in treating children. He had an abiding faith in medicine, and nothing could shake this faith."

Chekhov's vision of the world started to take form in during his studentship. He was an industrious student, regularly visited lectures, passed exams successfully and at the same time worked a lot for comic magazines. He was lucky to have among professors such luminaries as Grigory Zakharyin and Alexei Ostroumov (general medicine), Nikolai Sklifosovsky (surgery), Alexei Kozhevnikov (diseases of the nervous system), Vladimir Snegirev (gynecology), Alexander Vocht (pathoanato-my), Fyodor Erisman (hygiene)... In the fourth year of his university course, in 1883, Chekhov and his brother planned to write a "History of Sex Authority" based on the natural scientific and historical point of view, but then gave up the idea.

In November 1884 Anton Pavlovich got a graduation certificate awarding him the title of a rural general prac-tioner by decision of the university council dated September  15,   1884.  Soon,  a plate with his name

Anton Chekhov during the first year of his medical practice, photo. 1885.

MEDICAL INDUSTRY IN RUSSIA Handwritten cover of Anton Chekhov's unfinished historical study. 1884-1885.

appeared on the door of his apartment: "Doctor A. Chekhov". Chekhov began to work as G.P. at the Chi-kino country hospital already known to him (today the Gatchina District, Leningrad Region); then for a time he headed the Zvenigorod hospital in the Moscow Region. That very year he wrote to Nikolai Leikin, editor of the Oskolki (Fragments) comic magazine in St. Petersburg, that he served as a country doctor and spent half the day consulting patients (30 to 40 a day). Chekhov had little time to spare: he doubled both as a hospital clinician and as a district doctor, made postmortem examinations at forensic medicine autopsies, fulfilled commissions of the local administration, and acted as an expert in the court.

Chekhov attached much significance to dissemination of sanitary information among population; he stood for further education of medical doctors, hoped to have an advanced training institute for them, took to heart the condition of the medical press in Russia (in particular, he encouraged country doctors to actively participate not only in the specialized, but also in the public media). He worked hard to save the Surgery Chronicle and the Surgery journals.

As physician Anton Chekhov was most active at Melekhovo*, a country estate south of Moscow, where he moved with his family in 1892—he worked as a doctor there all year round. During the all-Russia census of 1897 Chekhov was much active as a census-taker as well, and merited a medal—"For Work in the First General Census of Population".

In 1897, due to his ailing health, the writer had to give up his medical practice and received patients but occasionally. And yet medicine continued to dog him. Thus, when moving from Melikhovo to Yalta, Chekhov sent his vast library to Taganrog, his home town, but kept medical books and even university lectures for himself. At Yalta he kept consulting townspeople, college students and the poor.

* See: Yu. Balabanova, "Seven Years in Melikhovo". in this issue of magazine.—Ed.

Chekhov before departure for Sakhalin. 1890.

Anton Chekhov's job reference, 1893.

Anton Pavlovich was a real expert and wrote mostly about the killer diseases of that time, namely about tuberculosis, consumption (drama piece Ivanov, stories Gusev, The Wife, The Wedding, Late Flowers). True-to-life psychological portraits of people suffering from fever are also found in other works—the long story The Steppe, the short stories Rothschild's Violin, The Mirror. Let us note: Chekhov paid special attention to psychiatry and psychology. In one of the conversations (in the mid-1890s) with writer leronim Yasinsky he uttered an interesting thought: " Had I not become a writer, I would have made a psychiatrist." He gained a deep understanding of this branch of medicine both from specialized works, and from his own observations. Thus, according to some literary critics, Chekhov's famous stories Ward Six, A Boring Story as well as The Grasshopper and The Fit are written as "model psychological diagnoses". In his stories and plays Chekhov depicted both positive and negative characters of medics (mostly country medics whom the author knew personally).

Anton Pavlovich, who has done so much for Russian medicine and was sincerely concerned about people's physical welfare, was not of sound health himself. He paid a dear price for his journey to Sakhalin and his dedication to medicine. In autumn 1903 his health changed for the worse, and he was hardly able to work on. Taken to Germany, Chekhov died there in July 1904.

He was only forty-four. People will always remember Chekhov as a great prose writer, and playwright, and as an excellent medical doctor, too.