Leon Trotsky: The Ordinary Village

(More on "district" medicine. What can congresses of district doctors give? And the muzhik still beats his wife. "The master" corrects manners with good examples. Pia desideria (pious wishes), as a conclusion)

[my own translation of the Russian text in “Vostnochnoe Obozrenie” {Eastern Outlook} No. 117, 30 May/12 June 1901, reprinted in Sochineniya, Vol. 4, Moscow-Leningrad 1926, compared to the German translation. Corrections by English native speakers would be extremely welcome]

People complain about village doctors very often and both with good reason and without sufficient reason. Doctors rarely complain about their fate (at least in print), and yet there is something to complain about.

An intelligent person, often just emerging from the so-called temple of science, is thrown into the wilderness, into the depths of the taiga, where there are no intelligent people, no books, where the population is extremely ignorant and hostile towards non-village medicine, where there are insufficient means (medicines, instruments ...) making him enter into offensive deals with his medical conscience hourly and daily.

With those huge plots allotted to our village doctors, who are also burdened with the performance of forensic medical functions, they (the doctors) naturally and necessarily develop extremely simplified methods of medical practice. All scientific "ballast" is gradually eroded during hasty travels to distant taiga settlements, only the most elementary practical techniques and information are preserved. This extremely, of course, undesirable "democratisation" of village medicine is facilitated by one very significant circumstance.

The city-dweller, presenting heightened demands to all the "moments" of the life situation, including medicine, demands from the doctor both the diagnosis and prognosis of the disease; this circumstance forces the doctor to always be “on guard”, because an unjustified prognosis based on an incorrect diagnosis naturally hurts the doctor's ego and undermines his reputation.

A native village patient – a muzhik – is incomparably simpler than a city patient. Unlike the latter, he almost never asks what kind of illness he has, and only in rare cases asks about the likelihood of its outcome, and is quite satisfied with an answer of this kind: "It happens according to God's will" ...

Thus, a young doctor, placed in the living conditions of a village doctor, is inevitably in danger of "sinking", of falling behind both in the field of medical theory and in the field of medical practice. Due to the lack of external stimuli to invigorate the energy, he develops some moral negligence; the consciousness of moral responsibility is gradually dulled and deafened.

The general conditions in which village medicine is placed – poverty and lack of culture of the population – are obviously not of the kind that could be changed by any special measures. But some corrections could still, I think, be found at hand.

First of all, congresses of district doctors could serve as such a correction.

There is, of course, no need to say much about the fact that such congresses, convened periodically, would have extremely versatile and very favourable results. Communicating with people of the same scientific and professional interests, reading papers, debates – all this would have an extremely beneficial social and moral influence on the village doctor, it would play the role of a life-giving mental shake-up for him, make him, so to speak, "pull himself up", it would save him in this way from the demoralising influence of those conditions that allow him, and sometimes downright force him to make a diagnosis from the words of a third person, and instead of making a prognosis, limit himself to the proposal to rely on God's grace ...

In addition to these general influences that defy exact observation, the congresses would have produced a great many particular, purely practical results. One can and should, of course, rebel against simplified medicine for a muzhik, this “simplified” person par excellence (for the most part), but since the village doctor is placed in a “simplified” environment and is provided with “simplified” means, then this fact must be reckoned with – first of all, of course, by the doctor himself. And he considers: he tries to heal without proper drugs (in the absence of such); in the absence of the most necessary dental instruments, he tears patients' teeth in ways that, one must think, were considered obsolete even in the time of Hippocrates – in general, he tries in every possible way to pull the stubborn medical theory by the hair into an even less malleable rural environment. The most successful results of such efforts, i.e. the happiest compromises between demanding medical theory and the truly pitiful cash resources of rural medical practice, the compromises reached in one particular case or another by one of the doctors, would become common property at congresses.

The creation of several paramedic stations in different parts of the plot; more expedient distribution of the plots themselves; relative advantages of "stationary" and "anti-stationary" systems and their most favourable combinations, depending on local conditions and characteristics; a more rational arrangement of village smallpox vaccination; appropriate and locally accessible ways of dealing with epidemics; more perfect methods of delivery of medicines, instead of the methods that are now practiced and completely unsatisfactory^* – all these and many other questions would, I think, have received the most correct formulation and competent resolution at the provincial and district congresses of district doctors.

Tax inspectors, peasant leaders, priests, teachers of parish and ministerial schools are gathering, but for some reason doctors are left to themselves, to their personal knowledge and practical resourcefulness.

As far as we have heard, among doctors, at least in Irkutsk governorate, the extreme importance, one might say the urgent need for joint discussion of some pressing issues is fully realised – and the whole matter, therefore, is left to a competent initiative.

★

If a very definite “competent initiative” can be called upon to help some particular “defect” of the village mechanism (even if it did not respond to the call), then there is still some consolation. But the village reality presents many such gloomy phenomena, in front of which the enlightened initiative of the most enlightened of the departments will be powerless – there is even no one to call upon. And one of the darkest spots on the gloomy colouring is still the lot of the peasant woman. The hand does not rise to write about this, for it means repeating and repeating itself – but why, why is life itself repeating itself so mercilessly and torturously?!

For a long time now we have learned by heart:

Your lot, Russian female lot!

Hard to find a harder one!

and further:

He did not carry a heart in his chest,

Who did not shed tears over you.

We recite these verses and put them to music, but, really, it seems that behind the sounds of familiar words and with the long-familiar melody, we have forgotten how to understand the content hidden in them, which to this day is full of unchanging, inescapable grief.

Centuries passed – everything strove for happiness,

Everything in the world has changed several times,

God forgot to change one thing

The harsh lot of a peasant woman.

And to this day, this lot on the part of family relations is often formulated in terms of ... forensic medicine. Here is half a page of this woman's martyrology:

1. Akulina O.^** The left shoulder area is a continuous bruise; the left shoulder bone is fractured in the middle third; the debris is highly displaced; the skin of the buttocks and back of the thighs is a continuous bruise.

2. Marya V. In the parietal region, in the middle, a skin wound covered with a blood scab; on the back of the head on the left there is a swelling the size of a silver ruble, the hair near the wound is soiled with thickened blood. The left buttock is a continuous bruise. There are bruises on the forehead, on the right eyebrow and somewhat higher, etc.

3. Martha P. In the left temporal region there is a bruise passing to the face; there are bruises in the thickness of the eyelids of the left and right upper; the face is soiled with blood, there is a wound on the upper lip, 1½ centimetres long, and the whole lip is very swollen; there is a bruise in the area of ​​the right scapula, in the form of blue-purple stripes; the same (numbering 6-7) in the area of ​​the left buttock; the area of ​​the right buttock is a continuous bruise. She has a depressed state of mind, she fainted during the examination.

Enough of these examples, which fully characterise the heavy muzhik's hand. In no way should one think that the cases cited are beyond the ordinary in their extremely cruel forms – not at all: if they differ from hundreds of other cases of the same order, it is only by those side circumstances, thanks to which they received a forensic formulation ... Yes, the muzhik is still beating his wife, beating with a heavy, bloody, disfiguring fight ...

But does only the muzhik beat his wife? No, she is also beaten by the "cultured" man, even one deliberately called upon to plant this very culture in a dark muzhik environment. Here's an example. In the village of Ignatieva (Volost of Nizheilimsk, Kiren county), in the house of the merchant Chernykh, lived until March of the current year Mr. B., who was very famous in these places, who subjected (probably he does the same now, but in another place) his wife to systematic torture. This was not a secret for anyone, the entire surrounding population was talking about it, since beatings were often carried out in public, in the street, with a significant crowd of curious people. The instruments of beating were sticks, a revolver, even shafts, in general everything that came to hand. In January last year, Mr. B. kicked his wife out of the house in a 40-degree frost without shoes, as a result of which Mrs. B. froze her feet. At the end of last year, Mrs B. was beaten in the street, in the presence of a large number of peasants, by Mr. B. himself and his coachman Yegor; Mrs. B. knocked the shaft away and shouted: "Help, save me!", but no one dared to save her, because it was risky. After the severe beatings, Mrs. B. was tied hand and foot by Yegor, of course, by order of Mr. B., who then dragged her tied up by her hair across the floor and then threw her somewhere in the closet. Mrs. B. freed herself somewhat and, with her hands tied and legs half-tied, bloody, half-dressed, made her way to the peasant Nikolai K., with whom she lived for several days.

Obviously, such "examples" are not very capable of instilling respect for the female personality among the peasants. And in general, this area of ​​relations, taken in isolation, does not lend itself to external influences; it is too complex, too diversely connected with the whole complex of conditions of peasant existence, so that something could be done here by means of "examples", even of those worthy of all kinds of imitation. No, more radical measures are needed here ...

It is necessary, first of all, as a guarantee of respect for someone else's personality, to raise self-respect in the peasant himself, to awaken in him a consciousness of personal dignity, which would not allow him to bend submissively, holding his hat in the hand as he walks away, not only in front of each coloured uniform cap band, but also in front of a swollen fist from exiled settlers. And for this, the peasant must stop feeling over himself the legalised rod and the illegal, but completely real fist emanating from the uniform cuff. And this requires a general change in the peasant legal order, in which there are many purely pre-reform vestiges^***. And for that, etc. ...

Or, on the other hand: for the cultural upsurge of the peasant, a material upsurge is necessary, which, in turn, is inconceivable, on the one hand, without a complete refreshing of the legal atmosphere of peasant life, on the other, without a wide influx of knowledge into the peasant environment – both general and special, agricultural. And for this purpose it is necessary, as in any other matter, to open the gates of public and private initiative wide, to sweep away all the obstacles blocking its path. And for this ...

The continuation of this logical chain is the personal thought of the reader.