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ABSTRACT
By the middle of the XIX century, the Central Asian khanates fell into a serious socio-economic crisis due to mutual
wars and the weakness of the central government. As a result, during the years 1864-1895, the land of Turkestan
became a colony of the Russian Empire. The Bukhara Emirate and the Khiva Khanate lost their large territories and
became vassals of the Russian Empire, while the Kokan Khanate was completely abolished and Fergana Province was
established in its place. Along with Russian officials and soldiers, Russian doctors also entered the country. This article
examines the entry of Russian doctors into the Fergana region, the activities of Russian medical institutions, and the
attitude of the local population to modern medicine.
KEYWORDS
Colonial medicine, public health, Fergana region, outpatient
clinic, city hospital, women’s and children’s hospital,
paramedic station, rural district hospital.
INTRODUCTION
Infectious-parasitic diseases such as malaria, syphilis,
gonorrhea,
smallpox,
measles,
dysentery,
leishmaniasis, gout, flu were widespread among the
residents of Fergana region. There was also a risk of
cholera and plague epidemics entering through
Afghanistan, Iran and Kashgar. The administration of
the Russian Empire had to seriously approach the
spread of malaria, syphilis, and smallpox, as well as the
Research Article
HEALTH CARE SYSTEM IN TURKESTAN REGION: FERGANA PROVINCE
AS AN EXAMPLE (END OF THE XIX CENTURY - BEGINNING OF THE XX
CENTURY)
Submission Date:
January 20, 2023,
Accepted Date:
January 25, 2023,
Published Date:
January 30, 2023
Crossref doi:
https://doi.org/10.37547/ajsshr/Volume03Issue01-04
Rukhiddin Kh. Pathiddinov
Namangan State University, Namangan, Uzbekistan
Journal
Website:
https://theusajournals.
com/index.php/ajsshr
Copyright:
Original
content from this work
may be used under the
terms of the creative
commons
attributes
4.0 licence.
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introduction of epidemics of plague and cholera from
neighboring countries. First of all, this was caused by
the fact that the Russian army, officials, and the
displaced population suffered serious damage from
these diseases, and the Russian government could lose
the economic income it intended to receive from the
local population due to epidemics. Although Russian
medicine entered Turkestan, its spread among the
local population was very slow. According to statistics,
less than 10 percent of the population of Fergana Valley
applied to Russian medicine, the local population
continued to use traditional medicine.
MATERIAL AND METHOD
The article is covered on the basis of generally
accepted historical methods - historicity, scientificity,
comparative-logical analysis, sequence, principles of
objectivity.
DISCUSSION
The history of the health care system has been the
focus of many researchers as an important part of
socio-economic life. Among the authors, the works of
Russian doctors V. Kushelevsky, A. Shishov, G. Kolosov,
I. Pokrovsky, who worked in the country during the
studied period and were well acquainted with the
health care system of the region, are of particular
importance. In their research, the introduction of
Russian medicine to the Fergana region, local
medicine, widespread diseases in the country and the
fight against them are highlighted. During the Soviet
Union, modern medicine was opposed to religion and
folk medicine, and the history of medicine was
illuminated from the perspective of communist
ideology. Among the authors of the Soviet Union
period, A.K. Khusanboeva studied the introduction of
medicine in villages, A. Pogosyants the history of the
healthcare system of the Turkestan region, A. Karasev
studied the activities of female doctors. In recent
years, scientists such as S. Shodmonova, M.
Mahmudov have been conducting scientific research
on the history of medicine in Turkestan.
RESEARCH RESULTS
In 1867, by order of Emperor Alexander II, the General
Governorate of Turkestan and the Military District of
Turkestan were established to manage the lands
occupied by the Russian Empire. According to the
Regulation on the administration of the Turkestan
region adopted on July 14, 1867, one doctor and one
midwife were appointed to each uezd in Syrdarya
region. In order to reduce the costs of the health
sector, the management of the medical part of the
Turkestan region was assigned to the district military
sanitary inspector, and the control of the regional
medical part was entrusted to the regional military
doctor. (Report, 1884:157) In 1876, when the Koqan
khanate was terminated and Fergana province was
established in its place, which is part of the general
governorate of Turkestan, this order was introduced to
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Fergana province as well. As a result, the medical-
sanitary part of Fergana region had the following
structure: one uezd doctor and midwife worked for
each uezd, and a city doctor and midwife worked in the
city of Yangi Margilon. Also, 1,000 rubles were
allocated to hire 2 paramedics for each doctor. The
medical and sanitary department of Fergana region
was supervised by the regional doctor. The regional
doctor is subordinate to the military governor of the
region and the military sanitary inspector of the region.
It should be noted that in the 70s and 80s of the XIX
century, uezd doctors in Fergana region never worked
on a full-time basis. This was mainly due to the
recruitment of uezd doctors for military purposes. For
example, the doctor of Kokan district was assigned the
sanitary control of the city battalion, the doctor of
Margilon uezd was assigned the sanitary control of the
army units in Andijan uezd, the doctor of Isfara uezd
was the doctor of the Margilon hospital. As a result,
uezd doctors have no time left to perform their main
duties. In Chust uezd there was no doctor at all in 1879-
1881. Uezd doctors are given the following: 1) to
provide medical assistance to the local residents and
provide them with free medicines; 2) implementation
of sanitary control among the population and
establishment of medical-police control to stop
contagious infectious diseases, especially fight against
natural smallpox and syphilis; 3) study the lifestyle and
economy of the local population, local diseases and
traditional ways of their treatment, create a medical-
topographical description of the uezd, determine areas
with a good climate for the deployment of troops and
the construction of sanitary stations; 4) great
obligations were imposed, such as conducting a
forensic examination (NA Uz, 15: 21-24). As a result of
the large number of responsibilities of uezd doctors
and their involvement in work beyond their authority,
the hospital practically has no time left to treat
patients, and it was necessary to introduce a separate
doctor’s staff to the cities. In 1890, the doctor of Kokan
uezd K. Schultz also wrote that he would be traveling
for several days to perform a forensic examination and
would not be able to come to the hospital. At that time,
the hospital was managed by a paramedic
(Makhmudov, 2015: 76). According to the report of the
Fergana regional administration on May 28, 1893, not
only remote villages, but also urban residents could not
always use the services of one doctor and paramedic
attached to the uezds (NA Uz, 99: 1). Only by 1895, the
Minister of War Vannovsky issued a decision to
introduce the status of city doctor and paramedic in
the cities of Kokan, Andijan and Namangan of the
Fergana region (Volkov I, 2019). From October 1896,
the Governor-General of Turkestan allows to allocate
180 rubles for a translator and 120 rubles for a city
paramedic to the city hospital in the cities of Andijan,
Namangan and Kokan (Na Uz, 32614: 20). Hospitals in
Margilon, Chust and Osh were left under the control of
the uezd doctor. Although the hospital in the city of
Margilon was headed by the head physician of the
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uezd, due to his residence in New Margilon, his
busyness with forensic examination, vaccination
against smallpox and other work, the hospital was
actually managed by a paramedic (Turkestan Gazette.
No. 14, 1898).
By 1882, 5 hospitals with 115 beds were operating in
Fergana region. In particular, 35-bed hospitals were
established in New Margilon, 20-bed hospitals in Kokan
and Namangan cities, 15-bed hospitals in Andijan and
Margilon, 5-bed small emergency rooms in Osh and
Chust (Makhmudov, 1992: 116). The economic part of
the hospital and emergency rooms was managed by a
special committee under the supervision of the
Fergana regional administration, and the medical part
was managed by uezd or city doctors under the
supervision of the regional doctor (Review of the
Fergana region, 1900: 117). Hospitals were located in
private houses, and only in 1885 in Ko’kan and
Namangan, and in 1887 in Andijan, the construction of
separate buildings for hospitals began. The conditions
created in the hospitals were not so good. According
to the official report of the Kokan city doctor on
February 17, 1901, the Kokan city hospital consisted of
3 men’s rooms and 2 women’s rooms, each room
accommodated 4 patients. It was not possible to place
patients according to the type of disease. Due to the
large number of patients, they had to sleep in an
unheated hall. The hospital did not have operating
rooms, washrooms, kitchens, and separate rooms for
servants (Pogosyants, 1958).
City hospitals served men only. As a result, there was a
need to establish a separate hospital for women. In
1887, the first outpatient clinic for women and children
was opened in the city of Kokan in the Fergana region.
In 1890, a 4-bed, 10-bed inpatient was established
under the ambulatory. In 1887-1897, 34,680 people,
including 22,613 women and 12,067 children, were
treated at the outpatient clinic. Similarly, women's and
children’s clinics were opened in Andijan on February
9, 1888, in Namangan on September 23, 1889, and in
Margilon on April 1, 1891 (Karasev, 1961). Namangan
women’s and children’s outpatient clinic was opened
in the “old” part of the city due to the lack of a suitable
building in the Russian part. In the early days, due to
local people's lack of trust in Russian doctors and
traditions, women did not allow themselves to be
touched and heard, did not show their venereal
diseases to a doctor, and resisted burning their eyes
and instilling medicine. During the 16 months from
September 23, 1889 to January 1891, 3,401 patients
visited the Namangan women’s and children’s
outpatient clinic 9,688 times (Turkestan Gazette. 1892
g. № 45.).
The local population’s appeal to women’s and
children’s hospitals gradually increased. The fact that
treatment is free also played a big role in this.
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The rate of referral to women’s and children’s hospitals
in 1897-1900 (NA Uz, 32651: 18 ob).
Andijan Women’s Hospital
Stationary
Ambulatory
Years
Number of patients
Days of treatment
Patients
Appeal
1897
11
293
7401
11662
1898
10
192
6750
10752
1899
85
1034
8578
12721
1900
66
898
8008
11562
Namangan Women’s Hospital
1897
103
1230
3437
6907
1898
157
2134
4077
8231
1899
172
1878
4599
7512
1900
213
2215
5537
10329
Kokan Women’s Hospital
1897
149
2363
4434
7283
1898
204
3163
7179
10865
1899
194
3197
6814
11585
1900
198
4407
7427
13740
Margilon Women’s Hospital
1897
4
47
4745
8957
1898
21
210
5478
8873
1899
24
233
6443
10011
1900
20
315
5119
6271
Taking into account the increase in the number of
applications to women’s and children’s hospitals, on
March 9, 1901, by the order of the Governor-General of
Turkestan № 2336, 1000 rubles were allocated annually
from the budgets of the cities of Namangan, Andijan,
Kokan, and Margilan for women’s and children’s
hospitals for medicines and other supplies ( NA Uz,
32651: 21).
Initially, Russian medical institutions operated only in
cities. Due to the lack of hospitals, the villagers could
turn to military infirmaries and hospitals. However,
they were often refused due to lack of space, and the
cost of treatment was very high (Kolosov, 1903: 98). In
1898, a plague epidemic spread in the village of Anzob
of Samarkand uezd seriously frightened the local
authorities. This epidemic put the issue of non-
organization of medical services in the villages on the
agenda. As a result, on December 3, 1898, the Council
of the Governor General of Turkestan decided to
establish paramedic clinics in the villages of Fergana
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region. By 1900, a total of 11 paramedic clinics were
operating in the villages of Chimyon, Kuva, Rus in
Margilon uezd, Sultanabad, Bozorkurgan, Butagora
villages in Andijan uezd, Konibodom, Rishton villages in
Kokhan uezd, Koson and Asht villages in Namangan
uezd, Pokrovsky village in Osh uezd by 1900 in Fergana
region. In paramedic clinics, medical advice and
medicines are provided free of charge at the expense
of uezd funds (NA Uz, 32651: 133. 135). But the allocated
funds were not enough. In particular, according to the
report of Andijan uezd doctor on March 18, 1901, in
1900, 8,070 patients applied to the district medical
center, of which 2,387 were malaria patients. 300
rubles per year were allocated for medicine to 3
paramedics in Andijan district. If it is taken into account
that 10 grands 3 powders of quinine are needed to
treat each malaria patient, 5 kilograms of quinine were
needed to treat 2387 patients. This year, the price of 1
kg of quinine was 54 rubles. Therefore, 270 rubles of
the 300 rubles allocated to paramedics were used only
for the purchase of necessary quinine (NA Uz, 32653: 9
ob).
Although paramedics were not as skilled as doctors,
they were more successful in treating malaria, skin
diseases, and other common ailments. In 1904, out of
102,149 patients who applied to Russian medical
institutions, 35.4 percent were treated by paramedics
(Pogosyants, 1958). The condition of paramedics was
dire. Due to the enormous size of the service area of
the paramedics, a large part of the population could
not use them. In particular, in 1898, 10 paramedic clinics
served 1,274,042 people in the villages of Fergana
region. An average of 127,404 residents corresponded
to each paramedic clinic (Turkestan Gazette. 1898. №
84). Most of the paramedics were former company
paramedics who did not graduate from paramedic
school. Due to the lack of medical education of the
paramedics, lack of knowledge of the language and
customs of the local population, the lack of control
over them, and the fact that the annual budget of 150
rubles allocated to the outpatient clinics did not reach
even the most necessary drugs, it was difficult for the
paramedic clinics to provide the population with
quality medical services (Kolosov, 1903: 41). According
to the report written by the doctor of Andijan district
Nesmelov to the doctor of Fergana region, the
paramedic clinics were located in the houses rented
from the residents and were in a bad condition due to
repairs. The roof of the paramedic clinic in Sultanabad
village of Andijan uezd will collapse due to lack of
repair. As a result, outpatient paramedic Ignatyuk
moves to an empty prison with medicines
(Khusanbaeva, 1964).
Paramedic clinics could not provide the villagers with
full medical service. For this reason, the issue of
establishing medical centers in villages was also raised.
On December 25, 1905, a special law was passed and it
was established that 44 village medical centers would
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be established in 3 regions of Turkestan, including 16 in
Fergana region.
Distribution of district hospitals in Fergana region (Na
Uz, 849: 131-132; 405: 155-156).
№
Medical
departments
Volosts who entered the medical section
Total
populat
ion
Appeal in
1907
Expl
anati
on
Margilon uezd
1
Shahri Khan
Shahrikhan, Asaka, Karatepa-Chaukent,
Segazin, the northern part of Yozyovan,
Baliqchi
142291
5177
2
Vodil
Chimyon, Auval, Aukesek-Boston,
Naiman, Altiarik volosts, the southern part
of Margilon
95908
6150
3
Rus village
Aravan, Ichtiklik, Kuli, Markhat, Nowkat
48736
7529
4
Quva
Kuva, Kokangqishlaq, Yakkatut, the
southern part of Yozhiovan, Margilan and
the northern part of Faiziabad.
108372
4091
Andijan uezd
5
Izboskan
Izboskan, Maili-Soy, Khakkulabad, Norin,
Kanol-Karagir
-
10436
6
Bazar Kurgan
Bozorkurgan, Kokangishlak,
Naukentskaya, Maygirskaya
-
3660
7
Kurgantepa
Korgontepa, Yorboshi, Jalaguduq,
Karasuv, Khakent
-
2510
8
Jalalabad
Jalalabad, Aim, Yasin, Kogart
-
3358
Kokan uezd
9
Rishton
Rishton, Karakalpak, Naiman,
Yangikorgan, Ultarma, Zadian, Buvaida,
Kenagas
-
6481
10
Besharik
Beshariq, Kaynar, Aravon, Ganjiravon,
Kudash, Kipchok, Janjal, Yaipan
-
5166
11
Isfara
Isfara, Konibodom, Makhram, Laylak,
Naygut-Kipchak, Sokh
-
1549
Namangan uezd
12
Zarkent
Nanay, Bayaston, Baghish, Chotkal, Sarui,
Pishkurgan, Yangikurgan
74924
1140
13
Pop
Pop, Almas, Varzik, Asht Bobodarkhan,
Chodak
83634
2619
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14
Kososn
Koson, Tergachi, Torakurgan, Kutlug-
Said, Kyrgyzkurgan, Shahand
84323
3932
15
Chortok
Susamir, Kirkogul, Arim, Chortoq,
Khanabad, Uychi, Kepi
82406
9932
Osh uezd
16
Pokrovsky
Gurshab, Gulchin, Aloy, Turuk,
Bulagboshi, Ozgan, Manyak, Akburi,
Kashgarqishloq
121000
2252
Due to the small number of hospitals, they had to serve
very large areas. For example, the Shahrikhan plot has
1,422,391 inhabitants in an area of 250 square meters,
and the Kuva plot has 300 square meters. 108,372
inhabitants in the verst area, the plot of the village of
Rus is 500 sq. 48736 inhabitants in verst area, Vodil
area is 500 sq. served 95,908 inhabitants in the verst
region (NA Uz, 405: 155).
According to the report of the governor of Fergana
region, not a single suitable building has been found for
the 16 district hospitals to be built in the region. The
issue of building a new building by the local population
was also rejected due to the lack of rent paid to the
hospitals (300 rubles). For this reason, the governor of
Fergana region asks the governor general of Turkestan
to allocate 10,000 rubles for the construction of each
hospital (NA Uz, 849: 325-326). As a result, although 6
beds were allocated to each of the 16 district hospitals,
due to the lack of a building, only outpatient care was
provided to patients (Static review of the Fergana
region, 1909: 164). Only by March 5, 1908, the estimate
for the construction of the building for the district
medical offices was approvedAccording to him, in the
villages of Vadil, Rus village, Kuva, Shahrikhan of
Margilon uezd, Chortok, Zarkent, Koson, Pop villages
of Namangan uezd, Izboskan, Jalalabad, Bazarkurgan,
Korgontepa villages of Andijan uezd, Serovo station,
Beshariq and Isfara villages of Osh uezd, 337176 rubles
were allocated from the local budgets for the
construction of 16 precinct medical centers in the
village. (NA Uz, 208: 66). In November 1911, an
additional 198,729 rubles were allocated for the
construction of hospitals in Vadil, Shahrikhan,
Bazarkurgan, Jalalabad, Izboskan, Isfara, Zarkent,
Chortok, Pokrovsky and Rus villages of Fergana region.
In December 1912, hospitals were completed in Vodil
and Shahrikhan, in the summer of 1913 in Bazarkurgan,
Izboskan, Zarkent and the village of Rus. In January
1914, the Council of the Governor-General of Turkestan
allocated 134,015 rubles for the construction of Isfara,
Chortok, and Pokrovsky district hospitals. In July 1914,
permission was given to build district hospitals in
Jalalabad, Kurgantepa, Kuva, Rishton, Beshariq, Pop
and Koson (Makhmudov, 1992: 124). The disadvantage
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of the newly implemented health care system in the
Turkestan region was the destruction of medical
centers. As a result, the provision of medical care to
rural areas decreased (Turkestan Gazzette. 1906 g. №.
16). Due to the fact that densely populated areas were
taken into account when placing the 16 precinct
hospitals allocated for Fergana region, the nomadic
areas with scattered population were located very far
from the hospitals. In particular, the hospital located in
Pop volost served a very large area (NA Uz, 849: 130).
CONCLUSION
Unlike other gubernias of the Russian Empire, the
Turkestan region was subordinated to the Ministry of
War. As a result of the military rule established in the
country, the health care system was also managed by
military doctors. This made it difficult to provide
medical services to the local population. Although
Fergana region brings a lot of income to the treasury of
the Russian Empire, not enough funds are allocated for
health care expenses. The number of doctors was very
small, and the population continued to use traditional
medicine.
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B.K. Medical assistance to the population in
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Volkov I.V. Social policy of the tsarist
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Girs F. Report of the Auditor, by the Highest
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Karasev A.Ya. On the activities of Russian
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I
MPACT
FACTOR
(2021:
5.
993
)
(2022:
6.
015
)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
12.
Static review of the Fergana region for 1908. -
Novy Margelan: printing house of the Fergana
regional government, 1909.
–
P. 164.
13.
Turk
estan Gazette.1906. №16
14.
National archive of Uzbekistan. Fund I.19,
description 1, file 32614, sheet 20.
15.
National archive of Uzbekistan. Fund I.19,
description 1, file 32631, sheet 133, 135.
16.
National archive of Uzbekistan. Fund I.19,
description 1, file 32651, sheet 18.
17.
National archive of Uzbekistan. Fund I.19,
description 1, file 32631, sheet 21.
18.
National archive of Uzbekistan. Fund I.19,
description 1, file 32653, sheet 9.
19.
National archive of Uzbekistan. Fund I.19,
description 4, file 15, sheet 21-24.
20.
National archive of Uzbekistan. Fund I.1,
description 11, file 99, sheet 1.
21.
National archive of Uzbekistan. Fund I.1,
description 5, file 849, sheet 130.
22.
National archive of Uzbekistan. Fund I.1,
description 5, file 849, sheet 325-326.
23.
National archive of Uzbekistan. Fund I.1,
description 7, file 405, sheet 155.
24.
National archive of Uzbekistan. Fund I.1,
description 8, file 208, sheet 66.
25.
Khusanbayeva A.K. Medical assistance to the
rural population in pre-revolutionary Turkestan
// Questions of the organization of health care
and the history of medicine in the Uzbek SSR.
Collection
of
works.
Volume
1.
–
Тashkent:,1964.
