Within the ever-flourishing field of research on the Russian Empire over the last decades, most notably in American research and scholarship, the history of imperial Russian medicine has been strikingly ignored by both historians of Russia and of medicine to date. While post-soviet scholarship has only recently begun to embrace the history of medicine as an academic discipline, historians from the west have turned their attention to a considerable range of topics in Russian and Soviet medicine. Distinguished scholars, including John T. Alexander, Nancy M. Frieden, Roderick McGrew, John F. Hutchinson, and Susan Gross Salomon among others, have made important contributions in exploring the emergence of medical science and the medical profession, of public health institutions, poor relief, epidemic combat, and disease control. Such pioneering and substantial research notwithstanding, historical scholarship still has to outline a methodological and analytical trajectory with which to examine Russian medical history in its imperial dimension as well as in its wider European and international contexts.

Daria Sambuk's “Wächter der Gesundheit,” a revised PhD dissertation from the University of Jena, therefore is a welcome contribution to much-needed research in a largely underexplored field of study. Examining the evolution of Russia's medical administration, its civilian medical services and public health care during the period from 1762–1831, Sambuk aims to uncover the institutional mechanisms and human interactions that in effect implemented governmental medical policies at the local level at a time when Russia's provinces still lacked fundamental administrative structures. Toward this purpose, she chooses to focus her research on the provinces of Jaroslavl', Tambov, and Voronez as representative of the core of Russia's uniquely diverse fabric.

The book is divided into five chapters. The first chapter provides an overview of medical administrative reforms under Catherine II and Paul I. Sambuk surveys the cameralist and physiocratic ideas that influenced Catherine's civilian-oriented medical policies. She delineates the beginnings of local health administration during Catherine's reign as embodied in the provincial charitable boards (prikaz obshchestvennogo zreniia), and outlines its expansion into an increasingly rationalized and professionalized medical administrative system at the turn of the century. The next chapter shifts the focus away from state structures and investigates the educational background and social origins of native medical practitioners in Russia‘s provinces who, according to Sambuk, functioned as key agents in propagating European academic medicine beyond the capitals. The third and fourth chapters examine the role of local initiative and participation in financing, implementing, and running state medical institutions and governmental schemes by looking at the buildup and management of provincial and municipal hospitals as well as the administration of plague inoculation. As Sambuk argues, public health provided a platform for the tsarist government to create society as a local project (Veranstaltung) by devolving responsibility for the civilian population to regional and local estate groups. As she concludes somewhat sketchily in her final chapter, Russia's first encounter with cholera in 1830–31 proved not only the considerable quantitate and qualitative improvements in local medical administrative structures, institutions, and personnel since the start of Catherine II's reign, but also showed the increasing voluntary involvement of the local nobility and mercantile community in providing medical care as well as organizing public relief.

Sambuk draws on extensive research in both central and local archives, and she has thoroughly evaluated a broad array of published and unpublished sources, including the instructions (nakazy) submitted to Catherine's Legislative Commission, topographical descriptions, medical statistics and reports from provincial hospitals, as well as correspondence between local and central representatives of the state administration and society. Her research interest and historical argument need to be seen within the context of German historical scholarship's specific concerns to link Russia's regional history to the investigation of provincial sociability and the rise of local society. Making allowance for a discussion of the imperial dimension of Russia's medical reforms, however, would have offered the opportunity to engage in, as well as build on, far wider scholarly debates in both the history of the Russian Empire and the history of medicine: by way of example, recent important works by Paula Michaels, Eliza Becker, or Anna Afanasyeva are not referenced in the book. Nevertheless, through the investigation of largely uncharted territory and the assessment of a broad range of not easily accessible material, Sambuk's book is an informative and useful contribution to a field that will be of interest to historians specializing in Russia's and Europe's history of medicine.