By Michael Glenny
There have been several doctor-writers, Russian and English, in recent times—Chekhov, Somerset Maugham and A. J. Cronin are perhaps three of the best known—and with this collection of stories Mikhail Bulgakov is revealed as another writer who gained his earliest and perhaps his deepest insights into human nature through the practice of medicine.
Born in 1891, Mikhail Bulgakov was the eldest of the six children of a professor at Kiev Theological Academy. He studied at Kiev University and qualified in medicine in1916. After eighteen strenuous months in general practice (the subject-matter of most of this book) he decided to specialise, and set up in Kiev as a venereologist. Another eighteen months or so later, the upheavals of the Civil War caused Bulgakov to move to the Caucasus, where he resolved to give up medicine in favour of writing. One
of his brothers, Nikolai Bulgakov, was also a doctor, but whereas Mikhail practised only for a few years, stayed in Russia and died there, Nikolai emigrated to France after the revolution and made a distinguished career in Paris as a cardiologist.
By 1916, despite heavy losses from two years of fighting, the Russian army was only capable of absorbing a marginal increase in manpower. This factor, together with the strain placed on civilian medical resources by mobilisation, meant that Bulgakov and many of his fellow graduates of that year were not conscripted as army doctors. Without doing the normal hospital internship on qualifying, they were instead drafted to local government clinics and country hospitals all over Russia. It is perhaps not generally realised that pre-revolutionary Russia possessed a very creditable rural medical service, financed and managed by the provincial government authorities or Zemstvos. These were elective bodies, of which the nearest British equivalents are perhaps the County Councils, and they were responsible for such matters as education, roads and public health.
Since there were too few incentives or facilities for general practitioners to function outside the larger towns, the medical care of the peasantry in the outlying countryside was chiefly undertaken by the Zemstvo, through a network of polyclinics or small one-doctor hospitals of about forty beds. The standard of this service varied from province to province according to the relative wealth, zeal and efficiency of the different Zemstvos. Bulgakov served his medical apprenticeship near the village of Nikolskoye in the province or guberniya of Smolensk, one of the northwestern regions of European Russia, and to judge by his description of the facilities and equipment available to him, the medical services of this Zemstvo were among the best.
Even so, it is very clear from these stories that as a means of initiation into medicine, Bulgakov’s assignment to this remote country practice was much like learning to swim by being thrown into the deep end of the pool. Nowadays it can only be in some of the remoter parts of the ‘third world’ that totally inexperienced young doctors find themselves ‘thirty-two miles from the nearest electric light’, entirely cut off from the outside world for long spells, or obliged to keep a pack of wolves at bay with a pistol while driving back from a night call. Perhaps most demoralising for a nervous beginner were the primitive communications: carts or sleighs the only transport, roads that were poor at the best of times and often impassable in the springtime thaw or the winter blizzards, erratic mails or none for weeks on end and above all—no telephone. The effects of this isolation and confinement on anyone of less than robust and balanced temperament is grimly illustrated in the story called ‘Morphine’.
For Bulgakov, however, the greatest underlying source of unease, amounting at times to despair, was something less tangible though very real to him, since it occurs as an ever-present refrain throughout these stories. This was the sense of being a lone soldier of reason and enlightenment pitted against the vast, dark, ocean-like mass of peasant ignorance and superstition. Again and again Bulgakov stresses what it meant to experience in physical reality the moral anomaly which for a century and more before the revolution had caused such agony to the liberal, educated elite of Russia: that intolerable discrepancy between the advanced civilisation and culture enjoyed by a small minority and the fearsome, pre-literate, mediaeval world of the peasantry. Although his patients are his contemporaries and fellow citizens of what purports to be a modern state, Bulgakov is constantly haunted by an awareness that in dealing with them he is actually at the point of contact between two cultures which are about five hundred years apart in time. It is books like this which make one appreciate the tremendous achievements of the Soviet education programme since 1917.
It will not escape the reader’s notice that much of Bulgakov’s narrative dwells on night, winter, blizzards and gales. This is not just a literary device to heighten the sense of drama, urgency and danger: it expresses the author’s profound feeling that in the rural Russia of his early career, a doctor was literally someone fighting an elemental force. The dominant, recurrent image in his stories is that of light and dark: the light over the gateway to his little hospital, the welcoming green-shaded lamp in his study, the single light burning in an otherwise darkened, stormswept building. these brave pinpoints of light—the light of reason—are always contrasted with the vast, malevolent, surrounding darkness which threatens to engulf them yet never succeeds in putting them out.
Despite this background intimation of an almost mythic conflict between enlightenment and unreason, Bulgakov’s writing in A Country Doctor’s Notebook is thoroughly down-to-earth, realistic, and far removed from the grotesque fantasy that was the distinctive style of much of his other work in the mid-twenties. This contrast is so marked that it is hard to credit ‘Dr Bulgakov’ as being also the author of such fierce, surrealistic satire as The Heart of a Dog and the diablerie of The Master and Margarita. These date from Bulgakov’s richly productive period of 1924 - 1927, when the publication of his first novel, The White Guard, and the overnight success of its subsequent stage version, The Days of the Turbins, were making it possible for him to give up hack journalism for a living and turn to full-time writing for the theatre. Yet at the same time Bulgakov would, as it were, regularly lay aside the sardonic persona of the satirist and put on again the white coat he had finally doffed some five or six years earlier and would recreate, with keen, fresh observation and gentle self-deprecating humour, the agonies and triumphs of a medical novice pitched into a job of terrifying responsibility.
The result was a collection of partly fictional, partly autobiographical stories; between 1925 and 1927 they were published serially in two monthlies, Krasnaya panorama and Meditsinsky rabotnik, the former being a magazine with a general readership, the latter meant particularly for the medical profession. When the series was finished, Bulgakov intended to collate and edit its parts for publication as a separate book to be entitled The Notes of a Young Doctor (Zapiski yunovo vracha). But this plan was never realised, and the stories passed into oblivion along with the magazines in which they had appeared. Almost forty years later and long after Bulgakov’s death (he died in 1940), they were unearthed and some of them published in the magazine Ogonyok. This was followed in 1966 by the appearance of six of these stories in an edition of Bulgakov’s Collected Prose. It is this book which has provided the text of two-thirds of the present collection; the remaining three stories—‘The Murderer’, ‘Morphine’ and ‘The Speckled Rash’—were translated from photostats of copies of Meditsinsky rabotnik found in Moscow archives. For kindly making the latter available to me I am greatly indebted to Mr Peter Doyle of the University of Manchester. My gratitude for her assistance with the texts is due to Miss K. Costello. I also wish to express particular thanks to the two medical men, Dr Hope St John Brooks and Dr Robert Salo, who have so kindly cast their keen professional eyes over the translation and corrected the terminology of a mere layman.