Sergey Botkin was more than a physician; he was a man who reformed Russian medicine. Looking at his legacy, it is hard to believe that this gifted and hard-working man ended up in medicine by chance rather than by vocation.
A Reluctant Physician
Sergey Botkin was born to a big family of tea merchant Pyotr Botkin and had 13 siblings. At first, he was educated at home by Arkadi Merchinsky, a student of the Imperial Moscow University, and later entered the Ennes boarding school, one of the best schools in Moscow. While he was tutored by Merchinsky, Sergey became passionate about math and dreamed of being admitted to the Department of Mathematics and Physics of the Moscow University. But in 1850, the year Botkin finished the school, Emperor Nicolas I forbade non-nobles from getting into any university departments, with the exception of the Department of Medicine. Perhaps if not for this edict, the world would have known Botkin the mathematician rather than Botkin the physician. Forced to give up his dream of becoming a man of numbers, Sergey got into the only department that would admit a merchant’s son.
His student years were a time of harsh discipline (in his first year, Sergey spent a whole day in solitary confinement for an unclasped uniform collar), intensive practical training (in his fourth year, he helped fight a cholera outbreak in Moscow) and friendship with fellow-student Ivan Sechenov, a future renowned physiologist. In 1855, Botkin graduated with distinction. Right after graduation, he took part in the Crimean War as a doctor; he worked in a field hospital under the command of famous surgeon Nikolai Pirogov. Toiling on the front lines for 20 hours a day, Botkin polished his skills. After the war, he continued his education abroad: in Berlin, Vienna and Paris. In 1860, Botkin defended a PhD thesis in St. Petersburg. A year later, he earned the title of Professor and got a job at the Academic Internal Medicine Clinic of the Imperial Medical-Surgical Academy. It was Botkin who introduced practical training for students, which is a staple of medical education today: his students watched on as he examined day patients and noted what questions he asked and what aspects he paid attention to.
Reforms and Discoveries
Botkin’s contribution to medicine is huge. Not only did he initiate the establishment of an epidemiological society to fight the spread of epidemic diseases but he was also the first to describe the disease that is known as Hepatitis A today (or Botkin’s disease). It was previously thought that the disease was linked to poor digestion. But Botkin found out that it was caused by an infection.
The administration of St. Peterburg asked Botkin to curate the Alexandrovskaya Municipal Hospital for infectious patients. Under his leadership, the institution underwent a major transformation: Botkin used his own money to equip a laboratory to analyze city water, introduced patient records which helped gather statistics, equipped a disinfection cabinet. Moreover, Botkin inspired the invention of a specialized ambulance for infectious patients. Traditionally, patients were transported by regular carriages and infected the coachman and other passengers along the way. In the cargo area of the new ambulance, there were two reclining rattan chairs which could be unhinged and used as a stretcher to carry seriously ill patients. Once the patient was delivered, the ambulance was disinfected. Under Botkin’s leadership, the hospital became the first medical institution to hire female doctors — nothing short of a revolution at the time. Botkin generally advocated for women in medicine: in 1874, he founded a school for registered nurses followed by the Women’s Medical Courses in 1876.
Botkin summed up his practical experience to formulate three rules for physicians which are still relevant today: 1) help the patient get in a recovery mindset; 2) treat the whole patient; 3) look for external causes of diseases — from the quality of rest and recreation to the relationship with family.
A Celebrity Doctor
Botkin was such a big name in medicine that he was asked to become Physician-in-Ordinary to Emperor Alexander II and his family. His other celebrity patients included poet Nikolai Nekrasov (who dedicated the third part of his poem “Who Lives Well in Russia” to Botkin), painter Ivan Kramskoy (who painted the physician’s portrait), writers Fyodor Dostoevsky and Mikhail Saltykov-Shchedrin. He was friends with many of his patients. Saltykov-Shchedrin even appointed him the custodian of his children. Perhaps it was not only Botkin’s professional reputation that drew talented people to him, but also the feeling that he was a soulmate. Botkin had an artistic side: he played the cello every day and took lessons from a Conservatory professor three times a week. But his poor eyesight stopped him from making greater progress in music: often he could not see what’s in the sheet and fell out of step. Ivan Sechenov, Botkin’s friend, made an interesting observation: “There was no such thing as a healthy person for Botkin; he saw a patient in everyone he met. He would watch closely the person’s gait, mimics, manner of speaking. Diagnostics was his passion, and he practiced it as conscientiously as artists like pianist Anton Rubinstein practice their skills before a concert.”
Celebrating the Memory
Sergey Botkin died at 57 from a massive heart attack. When his coffin arrived in St. Petersburg from Menton, France, where Botkin spent his last days, it was met by a crowd. Grateful citizens carried the coffin from the railway station to the Novodevichy Cemetery nearly 5 km away. Two years later, the Alexandrovskaya Hospital was named after Botkin (it is the Botkin Clinical Infectious Diseases Hospital today). In 1920, the Municipal Clinical Hospital in Moscow was named after Botkin. Streets in St. Petersburg and Krasnoyarsk bear his name. Stamps featuring the famous physician’s portrait were issued in the USSR (1949) and Russia (2007). But Botkin’s best legacy is generations of his students and followers. As brilliant Russian biologist Ilya Mechnikov noted, “Sergey Botkin left his mark in history by founding a prominent school of Russian clinicians.”