The Tsar's Doctor (9 page)

Invidious as was his own position, Wylie, through his proximity to the tsar, must have known that despite their outward cordiality Alexander was undeceived as to the French emperor’s intentions. The two had spent long hours studying maps while Napoleon explained the frontiers of the Europe he envisaged, while at the same time it had been obvious that from the Prussian part of Poland, now as a French protectorate renamed the Grand Duchy of Warsaw, war against Russia could swiftly be renewed.

‘
Dieu nous a sauvé
,’ he wrote to his favourite sister Catherine.
²⁹

She replied with a verbal bombardment. ‘While I live I shall not get used to the idea of knowing that you pass your days with Bonaparte . . . for the man is a blend of cunning, ambition and pretence.’

More clearly than her brother, she saw that by pledging Russia to Napoleon’s Continental System, he had made a gross mistake. A breach with Britain and a war in the Baltic would have a drastic effect on Russian trade. The country would face bankruptcy.

‘We shall have made huge sacrifices and for what?’ his sister demanded to know.

Once returned to his capital the tsar, at Wylie’s instigation, began visiting the hospitals in St Petersburg that had been founded by his grandmother Catherine. Sometimes he gave prior warning so that dignitaries, in their finery, waited his approach. More often, to catch them unawares, he arrived completely unannounced.

In the May of that year of 1808, both Alexander and his wife Elizabeth endured a personal tragedy which drove them near to despair. Already they had lost their eldest daughter as a baby. Now, suddenly, their second child, a little girl they had called Lisinka, died of convulsions brought on by teething, in her mother’s arms.

Her parents were inconsolable. Wylie, trying to offer sympathy, told Alexander that there was absolutely no reason why he and Elizabeth should not have other healthy children who would survive.

‘No, my friend. God does not love my offspring,’ was the tsar’s sad reply.

Wylie was now to witness how the loss of their child, which might have united them, instead drew the royal couple still further apart. Elizabeth remained in mourning for two years while Alexander returned to his Polish mistress, Maria Naryshkina.

Again, in this relationship, misfortune seemed to haunt him. Of the three children she bore him, all of them girls, only one survived. Despite Wylie’s assurance that this was through no fault of his own, Alexander was thrown into deep despondency, believing that his progeny were cursed.

CHAPTER TWELVE

Head of the Russian Military Medical Services

The year 1808 was to prove a landmark for Wylie, for at this time he first published his famous Russian military pharmacopoeia, the
Pharmacopoeia castrensis Ruthena
, on which he had been working over the last three years. While providing a full coverage of pharmacy and pharmacognosy, it also included the new pharmaceutical nomenclature. Known as
Pharmacopoeia castrensis Wylie
, it ran through four editions and was replaced only twelve years after his death, in 1866. Other publications of Wylie’s included the first Russian medical manual for in-field use and the translation of a book by James Johnson about the influence of hot climate on health.

It was in January 1808 that Wylie became President of the Medical Chirurgical Academy, a post he was to hold for twenty years. As such he was placed in charge of the Academy established by a decree of Tsar Paul, when it had been realized that the few medico-chirurgical schools in St Petersburg, Moscow, Kronstadt and Elizavetgrad were unable to keep pace with the demand for doctors, especially in the army and navy.

Primarily the academy was intended to become a central educational institution for military surgeons and to have sufficient capacity to offer standards of teaching comparable to the state of science abroad. Opened in 1800, it developed into a highly significant medical school in Russia and in the present day, as the Military Medical Academy in St Petersburg, it remains prestigious.

Initially there were many problems of organization to be overcome as the Academy was placed under the control of the newly created Ministry of Internal Affairs. Also the vast influx of students from the now dissolved Moscow Medico-Chirurgical Academy and the merger with the Medico-Chirurgical Kalinkin Institute, meant that both management and training had to be based on improvised instructions only. Legal regulations, comprising the foundations of the Academy, were later adopted in 1808.

Starting in 1805, a search was put in motion for a specialist who could be recognized internationally as being capable of developing a plan of reform which would establish the Academy as being among the best medical schools in Europe. The choice finally fell on Johann Peter Frank, renowned as a clinician, as the creator of the ‘medical police’ and as a public health care organizer. Already connected with reforms of medical education in Pavia, Vienna and Vilna, Frank was invited to come from that city to St Petersburg to become Surgeon in Ordinary and rector of the Academy. By the end of 1806 he had submitted his comprehensive reform plan to the Minister of Internal Affairs, Count Kochubei. The document was reviewed by Alexander Crichton, General Staff Doctor for Civilian Healthcare, James Wylie, the Surgeon in Ordinary, and Count Zavadovsky, the Minister of Public Education. Frank’s plan was expressly geared to the needs of the army and the military character of the Academy. He did not want, however, to create a mere ‘vocational’ school for military medicine, but a true higher school with a weighty scientific reputation. In spite of some major alterations and high costs, his proposal was accepted and adopted as the Academy’s new regulations.

Wylie, like a cat watching its prey, was waiting to pounce. Frank had endangered his own plans. Asked to review the reform projects, he produced several critical appraisals of all that he had suggested. He then drew up an alternative proposal, which the emperor immediately sanctioned. Thus, two days after the publication of the Regulations, Alexander, to everyone’s confusion and disappointment, declared it invalid ‘due to expected changes based on some reasons produced by the Surgeon in Ordinary Wylie’.

Frank, mortified and declaring himself ‘ambushed’, did keep his post of lecturer and rector before returning to Vienna in March 1808. Conveniently, and perhaps tactfully, he left just before, after two years of deliberations, Wylie’s Regulations were approved on 28 July 1808.

Frank did have cause to feel injured but nonetheless Wylie’s plan was superior to his in terms of Russia’s urgent needs. His draft does not bear the touch of a scholar but evinces the confident tone of a military and practical man. Wylie’s strict and succinct concept worked better in the time of constant devastating wars when the country required a reliable institution to provide the army and navy with doctors who would have received at least standard training and, more importantly, would be familiar with field surgery. This plan was also well suited to the Russian mentality.

The provisions of the Regulations should be discussed from this point of view. The mission and structure of the Academy were conceived on a grand scale; quite appropriately, maintenance, according to Wylie, should cost 386,000 roubles per year whereas Frank suggested ‘only’ 170,000. As well as human medicine, departments for veterinary medicine and pharmacy were also to be set up.

Most importantly, at least as far as the ordinary man was concerned, Wylie insisted that all lectures were to be given in Russian instead of the scholarly Latin, as had hitherto been used. In doing so he took into account the current needs, in particular the awakening nationalist tendencies in Russia. Management of the Academy began more and more to resemble military discipline. It was no longer headed by a rector but by a president with wide-ranging powers, who would be supported by a vice-president in charge of the Moscow branch, an academic secretary, and a managing director. As president, James Wylie (appointed three days after the approval of the Regulations, on 1 August 1808) also became the Chief Inspector of Army Healthcare, emphasizing the military nature of the institution founded by the Ministry of Internal Affairs.

The faculty consisted of twenty-four full professors and twenty-four assistant professors. The studies were controlled by the ‘conference’ chaired by the president and composed of full academic members, i.e. professors and secretariat. The assistant professors attended the conferences without a right to vote. The applicants for full professorship had to deliver a test lecture in front of the conference; assistant professors also had to pass a written and oral examination before the test lecture. The professors had to submit the books on which they based their teaching for the conference’s approval to allow changes to be made in their own books. The Regulations no longer mentioned professors’ rights, as had Frank’s document, but only responsibilities, obedience coming to the foreground.

The remaining fourteen sections of the Regulations dealt with the rights of the Academy, given the ‘imperial’ title immediately, the business management, the three departments, the students, the curriculum, the examinations and the academic degrees. With these Regulations, the institution acquired foundations for its work which remained valid until the end of the nineteenth century with relatively few changes.

Due to his attendance on the emperor, Wylie could only seldom perform the office of the ‘conference’ chairman. Nevertheless he was informed in detail about all the proceedings at the institution and reserved his final word even for minor issues, insofar as teaching, the faculty and the students were concerned. He cared less about the economy, so much so that the first years of his office witnessed some serious irregularities in the Academy’s housekeeping. In most cases Wylie treated members of the ‘conference’ in a considerate manner. He supported all professors and students who distinguished themselves with special achievements and diligence. The best graduates of the Academy were allowed to choose jobs by themselves: the way to privileged guards troops was open to them, or they would receive bursaries to travel abroad.

As president, Wylie worked tirelessly for the Academy. He saw that the authority of the medical profession could be enhanced only by broadening and improving education, especially for military surgeons.

Wylie made sweeping reforms. He tried to improve the academic and legal status as well as the authority of the military surgeon. In addition he issued many important directives concerning the care of the wounded in war, organization of hospitals, recruitment and disablement of soldiers, essential surgical operations and the order and cleanliness of hospitals.
³⁰

Now given a free hand he showed his real genius for administration, reforming – and in many cases creating – army medicine.

Methods of treatment in the hospitals of the early nineteenth century have been described as a cross between learning and witch-craft. The medical treatment of patients was most severely limited, both by the lack of accurate knowledge of the actual cause of disease, and because of the lack of almost all the effective drugs known to us today. Certainly Wylie was advanced by the standards of his time.
Descriptions of his insistence on ventilation and cleanliness and of space between patients’ beds show that he was aware of the dangers of infection through contagion, although obviously not from the still undiscovered existence of germs. Nonetheless the importance of diet was recognized, as was ‘the goodness of the air’.

Much reliance was placed on the treatment known as ‘salivations of mercury’ for which special warm rooms were provided. The treatment was unpleasant, with mercury being administered until symptoms of poisoning occurred. Absorption of the element, when applied as an ointment to the skin, was more rapid when the skin was warm, hence the need for heated rooms. Increased secretion of saliva was produced, two to three pints a day being thought ideal. But this often resulted in side-effects such as ulcers on the tongue and in the mouth, loss of weight, weakness and tremor. Nevertheless, despite the pain and disorientation endured by the sufferers, it was firmly believed that the evil tumours of the disease were excreted in the saliva, and so (at least in some instances) a cure was achieved. A hundred years were to pass before this plainly barbaric treatment was used only for the treatment of syphilis, in which it seems to have had some effect.
³¹

Nitric acid was also much used, both as a tonic and a means of subduing stomach upsets. Although in its natural form a deadly poison, when greatly diluted with water to the proportion of one fluid ounce of the strong acid to nine fluid ounces of distilled water, it was safe enough that when sweetened with syrup it formed ‘an agreeable potion, which was seldom objected to by the patients’. Nitric acid was also used extensively in the treatment of purpura (blood vessels bursting to form purple bruises, as its name implies), for application to ulcers and even as a gargle in cases of tonsillitis, in which it was especially helpful.

Muriatic or hydrochloric acid was also used as a common palliative, especially in cases of typhus fever, then so common among soldiers living in close proximity. Described as ‘a powerful tonic’ and also as ‘an excellent application to the gangrenous ulcers’, it too was used as a gargle when combined with tincture of capsicum in infusion of roses.
³²

Doctor Rogerson’s panacea, in addition to laxatives, was ‘James’s Powders’, the nostrum employed by all English doctors of the period, as well as Wylie, we can presume. In addition he relied upon bleeding, then the most widely used form of medical treatment, in Russia as throughout the world. Because it reduces the temperature, bloodletting was one of the oldest therapeutic manoeuvres known to medicine. Originally this involved opening a vein in the cubital fossa and allowing the blood to run into a bleeding bowl. Then, over the course of the seventeenth, eighteenth and nineteenth centuries, a technique was refined which involved the use of cupping glasses. The glasses were warmed before being applied to the patient’s skin, where they became firmly attached because of the partial vacuum created as the air inside the glass cooled. Blood was thus dawn to the patient’s skin for the treatment to begin. The scarificator is a metal instrument punctuated with a series of slots through which project several metal blades which cut the skin to a depth determined by a screw mechanism. The lancets were discharged by a trigger and the blood drained into a bowl. Although it may sound barbaric, the technique was not considered painful and anaesthetics, even when later invented, were very seldom used.