Introduction

Globally, the regulation of medicine has been a high priority for governments (see, for instance, Kuhlmann and Saks, 2008). Classically in the modern developed world – and especially in the Anglo-American context – this has taken the form in occupational terms from a neo-Weberian perspective of exclusionary social closure, legally sanctioned by the state (Saks, 2016). Although this has been subject to dilution in some countries with growing corporatisation and concern about the protection offered to citizens, the general template of social closure in the field of medicine has involved the creation of self-regulated professional monopolies in the market (Saks, 2015). Russia, however, stands out as a society that has never had a fully autonomously regulated profession of medicine in this sense, with state-sanctioned insiders and outsiders, independent self-control of practitioners and all the income, status and power with which this is typically associated. As such, it is an interesting international case from the viewpoint of professional health regulation in the public interest, especially given the frequent current association of professions in general and the medical profession in particular in neo-Weberian work with the pursuit of self-interests at the expense of the overall welfare (see, among others, Saks, 1995). This is not to say, of course, that there are no regulatory controls over physicians, nor that there have not been shifts in the nature of these over time. Indeed, this chapter seeks to chart both these controls and the changes in these historically and contemporaneously – including through the tumultuous impact of the Russian Revolution on the incipient medical profession and the founding of the Soviet Union in the early 20th century.

Medical regulation in early modern times

At the start of the early modern period from the 17th century onwards in the vast expanse of Russia, the country was characterised by the more or less unfettered operation of traditional practitioners of folk medicine such as herbalism and bone setting competing in a relatively open market – much like the parallel position in countries such as Britain and the United States (US) (Porter, 2002). Such practitioners did not typically have university education and their craft was self-taught or based on apprenticeships. Physicians, however, gradually began to be drawn from abroad to minister to members of the court and nobility.