Formation of System of Medical Institutions in Tobolsk North in XIX - Early XX Centuries

The history of the creation and development of the system of medical institutions on the territory of the Tobolsk North (within the modem borders - the Khanty-Mansiysk and Yamalo-Nencts Autonomous Okrugs) in the pre-revolutionary period is studied. It is noted that since the mid-1830s, a network of medical centers has been organized in the region: three hospitals, up to a dozen paramedical stations, medical barracks in fishing fields and steamship piers. The state played the main role in this. It financed medical institutions, provided personnel, necessary equipment and medicines, regulated activities through legislation and bylaws, and controlled the organization of medical care by entrepreneurs. Particularly rapid growth in the network of hospitals and feldsher stations was observed at the end of the 19th and beginning of the 20th centuries, which was facilitated by the involvement of the region in market relations, the intensification of the resettlement process, and the implementation of the legislative act of May 10, 1888 "On the arrangement of a rural medical unit in the provinces of Tobolsk and Tomsk". It is indicated that in matters of providing medical care, the indigenous population was in a privileged position in comparison with the Russians, since they received it free of charge. Difficulties in creating a system of modern medical institutions in the Tobolsk North were noted: a shortage of personnel not only for doctors, but also for paramedical personnel, especially in rural areas; the extreme dispersion and rarity of villages, which made it difficult to regularly monitor the health of local residents, the slow pace of modernization. It is concluded that the opinion about the extremely low level of development of medicine in the region is not fully fair.