1 Frieden, Nancy, Russian Physicians in an Era of Reform and Revolution, 1856–1905 (Princeton, 1982), 21–22CrossRefGoogle Scholar.

2 The name of these organizing bodies, “zemstva,” is the plural of zemstvo, from the Russian noun zemlia, or land, which highlights their relationship to defined spatial areas.

3 Ramer, Samuel C., “The Zemstvo and Public Health,” in Emmons, Terence and Vucinich, Wayne S., eds., The Zemstvo in Russia: An Experiment in Local Self-Government (New York, 1982), 281Google Scholar.

4 Frieden, Russian Physicians, 47.

5 Ibid.

6 Donald Rayfield, Anton Chekhov: A Life (New York, 1997), 69.

7 This humorous work, “Pis’mo k uchenomu sosedu,” is one of Chekhov’s earliest publications.

8 Cathy Popkin investigates some implications of Chekhov’s dual professional identities during his early years in Moscow in “Doctor without Patients/Man without a Spleen: A Meditation on Chekhov’s Practice,” in Michael C. Finke and Julie de Sherbinin, eds., Chekhov the Immigrant: Translating a Cultural Icon (Bloomington, 2007), 219–22.

9 This comes at the end of Chekhov’s often cited statement that, “medicine is my lawful wife; literature is my mistress. When one gets tiresome I spend the night with the other. Though it’s disorderly, it’s hardly dull and neither loses anything from my perfidy. If I didn’t have medicine, it’s unlikely that I would give my spare time or thoughts to literature.” Anton Pavlovich Chekhov, Polnoe sobranie sochinenii i pisem (PSS), 30 vols. (Moscow, 1974–83), Pis’ma 2:326. Subsequent references to this edition indicate PSS for the eighteen volumes of Chekhov’s writings and PSSP for the twelve volumes of letters and will be offered in the body of the article. All translations from the Russian are mine.

10 Vladimir Kataev offers some analysis of how Grigorii Zakharin’s methods of clinical observation influenced Chekhov’s thought in his Proza Chekhova: Problemy interpretatsii (Moscow, 1979) 87–97. Michael Finke demonstrates how Chekhov critiques medical theories of degeneration popular in Europe in his Seeing Chekhov: Life and Art (Ithaca, 2005), 98–138. Cathy Popkin examines Chekhov’s approach to the epistemological paradigm of nineteenth-century positivism in three works: “Chekhov as Ethnographer: Epistemological Crisis on Sakhalin Island,” Slavic Review 51, no. 1 (Spring 1992): 36–51; “Chekhov’s Corpus: Bodies of Knowledge,” Essays in Poetics, 18, no. 1 (1993), 44–72; and “‘A Talent for Humanity’: Teaching Chekhov and the Medical Humanities,” in Michael C. Finke and Michael Holquist, eds., Approaches to Teaching the Works of Anton Chekhov (New York, 2016), 151–62. Other studies of Chekhov that touch on medicine include John Tulloch, Chekhov: A Structuralist Study (New York, 1980) and Stephen Harrigan, “The Case History in Chekhov, Freud and Conan Doyle,” (PhD diss., Yale University, 1991). Studies in Russian medical history that mention Chekhov include David Joravsky, Russian Psychology: A Critical History (Oxford, 1989), esp. 119; Frieden, Russian Physicians, 206–7; Laura Engelstein, The Keys to Happiness: Sex and the Search for Modernity in Fin-de-Siècle Russia (Ithaca, 1992), esp. 152; and Daniel Beer, Renovating Russia: The Human Sciences and the Fate of Liberal Modernity, 1880–1930 (Ithaca, 2008), esp. 69–70. Medical biographies such as E. Meve, Meditsina v tvorchestve i zhizni A.P. Chekhova (Kiev, 1961) and I. M. Geizer, Chekhov i meditsina (Moscow, 1964), and those by physicians such as M. Mirskii, Doktor Chekhov (Moscow, 2003) and John Coope, Doctor Chekhov: A Study in Literature and Medicine (Chale, Isle of Wight, 1997) include some descriptions of Chekhov’s medical training, but remain primarily biographical. Donald Rayfield’s Anton Chekhov: A Life and his study Understanding Chekhov: A Critical Study of Chekhov’s Prose and Drama (Madison, 1999) are the most complete resources to date on Chekhov’s medical writings and education in the context of his biography and creative prose.

11 I borrow the term transcoding, or “the strategic choice of a particular code or language, such that the same terminology can be used to analyze and articulate…two different structural levels of reality,” from Jameson’s analysis of mediation in dialectical social thought. Fredric Jameson, The Political Unconscious: Narrative as a Socially Symbolic Act (London, 1981), 40.

12 For statistics that compare Russian mortality rates over time to those of several European countries see Osipov, E. A., Popov, I. V., and Kurkin, P. I., eds., Russkaia zemskaia meditsina: Obzor razvitiia zemskoi meditsiny v Rossii voobshche i otdiel’no v Moskovskoi gubernii s kratkim statisticheskim ocherkom strany i eia sanitarnogo sostoianiia (Moscow, 1899), 25–27Google Scholar.

13 F. F. Erisman, Kurs gigieny (Moscow, 1887), 7.

14 Frieden, Russian Physicians, 100.

15 N. A. Semashko, “Na zare russkoi gigieny i sanitaria (F. F. Erisman),” in P. I. Kal’iu, ed., Izbrannye proizvedeniia (Moscow, 1967), 316.

16 F. F. Erisman, Isbrannye proizvedeniia, 2 vols. (Moscow, 1959), 1:331, and 2:205.

17 While practicing in a zemstvo clinic in 1894, Chekhov met Erisman through their mutual acquaintance and zemstvo doctor Pavel Arkhangelskii; see Mirskii, Doktor Chekhov, 24.

18 Erisman, Kurs gigieny, 21.

19 For the history of the term “environment,” see Ralph Jessop, “Coinage of the Term Environment: A Word Without Authority and Carlyle’s Displacement of the Mechanical Metaphor,” Literature Compass 9, no. 11 (November 2012): 711–13.

20 See Dostoevskii’s deterministic interpretation in relation to crime in his article “Sreda” in A Writer’s Diary; F. M. Dostoevskii, Sobranie sochinenii v 15 tomakh, tom 12: Dnevnik pisatelia: 1873; Ctat’i i ocherki: 1873–1878 (St. Petersburg, 1994), 14–27.

21 Erisman, Kurs gigieny, 9.

22 Ibid., 2.

23 Chekhov participated in data collection projects in the Moscow region, but also extended this research on his own during his trip to Sakhalin in 1890 (PSS 14/15).

24 Erisman uses these categories in his introductory remarks and devotes chapters to each through his course. Erisman, Kurs gigieny, 11. For description of the private practices inside homes and attention on everyday life as strategies of European realism see Peter Brooks, Realist Vision (New Haven, 2005), 3 and 7.

25 In an October 15, 1889 letter to his editor Aleksei Suvorin, Chekhov draws parallels between the clinical physician Sergei Botkin and Ivan Turgenev in literary stature, adding, “Zakharin I liken to Tolstoi, in terms of talent” (PSSP 3:264).

26 Grigorii Antonovich Zakharin, Klinicheskiia lektsii (Moscow, 1889), 18.

27 G. A. Zacharin (Zakharin), Clinical Lectures Delivered Before the Students of the Imperial Moscow University, 5 ^th Edition, trans. Alexander Rovinsky (Boston, 1899), vii.

28 Zakharin, Klinicheskii lektsii, 31.

29 Ibid., 3, 36, and Kataev, Proza Chekhova, 91. Chekhov puts Zakharin’s method of individualizing every case into the 1898 story “O liubvi” (“About Love”), with Alekhin’s opening statement about the relationship between Pelageia and Nikanor (PSS 10:66).

30 Zakharin, Klinicheskiia lektsii, 35–36 and 38.

31 Ibid., 2 and iv.

32 Ibid., 15.

33 Zacharin (Zakharin), Clinical Lectures, v.

34 In the story and discourse contrast I adapt Jonathan Culler’s formulation, intending story to mean the accurate chronological unfolding of real events with the existents of characters and setting and discourse to mean both how these events are discursively narrated by the patient and then how they are presented in the standardized medical form. Jonathan Culler, The Pursuit of Signs, (Ithaca, 2001), 169–70.

35 Zakharin, Klinicheskiia lektsii, iv.

36 The anamnesis is the patient’s account of his or her medical history recorded by the physician, the status praesens is the current state of the patient based on the physician’s observation, and the decursus morbi is the course or trajectory of the illness and treatment in the clinic.

37 For more on the psychiatric case history as a form, see Cathy Popkin, “Hysterical Episodes: Case Histories and Silent Subjects,” in Laura Engelstein and Stephanie Sandler, eds., Self and Story in Russian History (Ithaca, 2000), 194.

38 Chekhov phrases these problems elegantly in a May 7, 1889 letter to his editor Suvorin: “Psychological phenomena are so strikingly similar to physical phenomena that it is impossible to tell where one begins and the other ends,” he argues, “and if you knew how great the similarities between physical illnesses and mental illnesses, and that each of these types of illness is treated with the same medicine, willy-nilly you don’t want to separate the soul from the body” (PSSP 3:208).

39 Martin A. Miller, Freud and the Bolsheviks: Psychoanalysis in Imperial Russia and the Soviet Union (New Haven, 1998), 10. Merzheevskii was professor of psychiatry at the Military Medical Academy in St. Petersburg and editor of the first journal of psychiatry, The Messenger of Clinical and Forensic Psychiatry and Neuropathology. Chekhov mentions Merzheevskii by name in his early one-act comedy The Involuntary Tragedian (PSS 12:104).

40 I. P. Merzheevskii, Ob usloviiakh, blagopriiatstvuiushchikh razvitiiu dushevnykh i nervnykh boleznei v Rossii, i o merakh, napravlennykh k ikh umen’sheniiu: Rech’ proiznesennaia pri torzhestvennom otkrytii Pervago S”iezda Otechestvennykh Psikhiatrov v Moskve 5-go ianvaria 1887 goda predsedatelem ego (St. Petersburg, 1887), 8.

41 For the debate on non-restraint in Russian medical institutions, see Julie Brown, “Heroes and Non-Heroes: Recurring Themes in the Historiography of Russian-Soviet Psychiatry,” in Mark S. Micale and Roy Porter, eds., Discovering the History of Psychiatry (New York, 1994), 298–99.

42 Julien Bogousslavsky, Olivier Walusinski, and Denis Veyrunes, “Crime, Hysteria and Belle Époque Hypnotism: The Path Traced by Jean-Martin Charcot and George Gilles de la Tourette,” in European Neurology 62 (2009): 195. For a concise history of Charcot’s work see Judith Lewis Herman, Trauma and Recovery: the Aftermath of Violence—from Domestic Abuse to Political Terror (New York, 1997) 10–13.

43 P. Rozenbakh, review of Hack Tuke, “On the Mental Condition in Hypnosis,” in Vestnik klinicheskoi i sudebnoi psikhiatrii i nevropatologii 1 (1883): 245–6.

44 Popkin, “Hysterical Episodes,” 193.

45 For a case of such an accusation involving a patient suffering from a pain in the ovaries, see an 1880 series of articles in The Physician, especially “From the Current Press,” Vrach 49 (1880): 816.

46 On drug treatments, especially when hysteria was in combination with epilepsy or other conditions, see Dokhmana, A., “Ob odnom sluchae isterii,” Vrach 10 (1881): 153–54Google Scholar.

47 William Brown, “Theories of Suggestion,” Proceedings of the Royal Society of Medicine (January 1928): 573–75.

48 Vladimir Mikhailovich Bekhterev, Vnushenie i ego rol’ v obshchestvennoi zhizni (St. Petersburg, 1908), 5.

49 Popkin, “Hysterical Episodes,” 195.

50 Ibid., 196.

51 The original copy of this case history is located in the Medical History Museum of the First Sechenov Moscow State Medical University, Moscow (accessed October 2015). The narrative is written on a form used for constructing illness histories. A Russian transcription of the case with several transcription errors can be found in Fedorov, I.V., “Kuratorskie kartochki Chekhova-studenta,” in Klinicheskaia meditsina 38:1 (1960): 148–49Google Scholar.

52 William Strunk and E. B. White, The Elements of Style (New York, 2000), 23.

53 For example, Nabokov writes of Chekhov’s distinctive style that his “exact and rich characterization is attained by a careful selection and careful distribution of minute but striking features, with perfect contempt for the sustained description, repetition, and strong emphasis of ordinary authors.” See Nabokov, Vladimir, Lektsii po russkoi literature: Chekhov, Dostoevskii, Gogol’, Gor’kii, Tolstoi, Turgenev (Moscow, 2001), 163Google Scholar.

54 These were prescribed visits to prostitutes. Rayfield ascribes this treatment plan to Chekhov, but it was clearly given by a previous doctor. Rayfield, Understanding Chekhov, 15.

55 Rossiiskii gosudarstvennyi arkhiv literatury i iskusstva (RGALI) fond 549, opis 1, delo 10. This microfilm document is Chekhov’s handwritten case history of Aleksandr Bulygev. My transcription and translation.

56 Other titles include: The Handbook for Men Suffering from Weakness of the Genital Organs Caused by Premature and Excessive Sexual Indulgence and Onanism, Extreme Old Age, or the Effects of Illness. For the role of these books in the sexual discourse of late nineteenth-century Russia see Engelstein, The Keys to Happiness, 226.

57 Quoted in Mirskii, Doktor Chekhov, 23.

58 See in particular “Sluchai mania grandiose” (1883), “Novaia bolezn’ i staroe sredstvo” (1883), “Khirurgiia” (1884), “U posteli bol’nogo” (1884), “Simulianty” (1885), and “Vrachebnye sovety” (1885). Other stories from Chekov’s works before 1888 that feature physician characters or references to medical themes include “Aniuta” (1886), “Aptekarsha,” (1886), “Khoroshie liudi” (1886), “Doktor” (1886), “Temnota” (1887), “Vragi” (1887), “Sledovatel’ ” (1887), and “Intrigi” (1887). “Aniuta,” “Doktor,” “Vragi,” and “Intrigi” begin to portray medicine more seriously and by his writing of “Tif” in 1887 his exploration of problems shared by medicine and literature had fully developed.

59 For a physician’s thoughts on Chekhov’s investment in hypnosis, see Burno, M. E., “A. P. Chekhov i gipnoz,” Kul’tura i psikhoterapeia 53 (2007): 3–4Google Scholar. I find Burno’s argument that Chekhov was not interested in hypnosis unconvincing in light of Chekhov’s story and statements on the topic and its connection to the mind-body problem.

60 Dmitrii Grigorovich, Slovo: Sbornik vtoroi (Moscow, 1914), 200.

61 For other rhythmic aspects of the story see Katyk-Lewis, Nadezhda, “‘Agaf’ia’—A Song About a Song,” Canadian Slavonic Papers 42, no. 3 (September 2000): 332Google Scholar.

62 Further, the adjective unmoving (nepodvizhnii), is applied to both Savka and Agaf’ia’s husband Yakov, working to create a particularly stark contrast that indicates these poles are also wholly irreconcilable.

63 My conceptualization of details reconsiders Alexander Chudakov’s ideas about the randomness of Chekhovian details; see Alexander Chudakov, Poetika Chekhova (Moscow, 1971), 173 and 187. It also extends Radislav Lapushin’s notion of details as constitutive of “integral associative fields”; see Radislav Lapushin, “Dew on the Grass”: The Poetics of Inbetweenness in Chekhov (New York, 2010), 60–61.

64 From Nabokov’s analysis of “Dama s sobachkoi” (1899) in Lectures on Russian Literature, 160.

65 Several of Chekhov’s later works also experiment with the structure of the case history as a narrative form. See in particular “Pripadok” (1888), “Palata No. 6” (1892), “Chernyi monakh” (1894), and “Sluchai iz praktiki” (1898).

66 Patterson, K. David, “Typhus and its Control in Russia 1870–1940,” in Medical History 37, no. 4 (October 1993) 364–65Google ScholarPubMed, 368.

67 See Polakiewicz, Leonard, “Cexov’s ‘Tif’: An Analysis,” Russian Language Journal / Russkii iazik 33, no. 116 (Fall 1979): 93Google Scholar.

68 Patterson, “Typhus and its Control in Russia,” 367. This implied lesson contests Polakiewicz’s reading of disease in “Tif” as random and bound to accidental fate. Polakiewicz, “Cexov’s ‘Tif,’” 104.

69 Lapushin notes too how this “unpleasant clang” vacillates between literal and figurative connotations. Lapushin, Dew on the Grass, 4.