Book Review

Doctor Chekhov

N Engl J Med 1998; 339:1335-1336October 29, 1998

Article

Doctor Chekhov
By John Coope. 159 pp. Chale, United Kingdom, Cross, 1997. £15. ISBN: 1-873-295-21-9

Simon Leys recently wrote in the New York Review of Books, “When you come to think of it, between two doctors whose medical qualifications are otherwise equal, I believe I would rather trust the one who reads Chekhov” (“The Imitation of Our Lord Don Quixote.” 1998, vol. 55, pp. 32–34). Anton Chekhov, the son of a bankrupt small-town grocer, began his medical studies at Moscow University at the age of 19 under miserable conditions of poverty. He lived with his family in a squalid section of Moscow, 1 of 10 people crammed into four rooms. To supplement his meager scholarship, he wrote short stories and comic sketches, often using a pen name. At the medical school, he was influenced by Gregory Zakharin, a brilliant lecturer who emphasized the value of the patient's history, and the eponymous neuropsychiatrist Sergei Korsakoff, who initiated the formal teaching of psychiatry in Moscow.

Chekhov graduated in 1884 and started a general practice in Moscow. Six years later he embarked on a four-month-long trip to Sakhalin, 5000 miles from Moscow, in a primitive horse-drawn carriage. He also began to cough up blood, and for this reason, he was in no condition for such a journey. But Chekhov felt impelled to see for himself the Siberian penal island, a forerunner of the infamous gulag. Coope tells us that Chekhov wanted to base a doctoral thesis on his investigation of the cruel prison and that social issues, such as the fate of prisoners, were considered a legitimate part of medicine in the 19th century. Chekhov conducted extensive interviews with the Sakhalin prisoners, compiling in the process 10,000 data cards on the basis of which he wrote Sakhalin Island. The book condemns the appalling conditions of the prisoners, the barbarous disciplinary measures, and the primitive medical facilities (and physicians) of Sakhalin. Sakhalin Island sparked a government investigation, but the dean of the Moscow Medical School refused to consider it as a doctoral thesis.

Chekhov returned from Sakhalin and set up a general practice in Melikhova, 50 miles from Moscow. During the seven years he was there, Chekhov fought against cholera epidemics and illiteracy, saw hundreds of dispensary patients, and made over 1000 house calls. He also wrote 27 stories and two plays, The Seagull and Uncle Vanya. In March 1897, Chekhov collapsed with a massive pulmonary hemorrhage due to extensive pulmonary tuberculosis. He traveled to Nice, seeking warmth and rest, and the following year he bought a house in Yalta, on the Black Sea, where he remained until his death in 1904. Despite obvious signs that his own case was worsening, Chekhov made considerable efforts to aid the thousands of patients with tuberculosis who flocked to the resort. In Yalta he wrote The Three Sisters and The Cherry Orchard, and to oversee the production of these plays he traveled frequently to the Moscow Arts Theater, over the protests of his doctor. Harried by extensive tuberculosis, Chekhov attended the premiere of his last play, The Cherry Orchard, directed by Konstantin Stanislavsky, in January 1904. It was the 25th anniversary of his literary career. Chekhov died six months later in a spa in Badenweiler, Germany. The funeral procession in Mosow was immense.

That is the bare outline of the life of an extraordinary physician who wove the facts of his own life into art. The passion that boils up in Uncle Vanya, the unfulfilled dreams of The Three Sisters, and the irony of “The Lady with the Dog” draw their credibility from Chekhov's own experience. According to Coope, Chekhov's early plays and stories deal with depression in ways that represent an attempt to fuse literature and science. Coope emphasizes that one of Chekhov's great gifts was the combination of inside information and imagination. When Astrov, the doctor in Uncle Vanya, says, “On my feet from morning to night with never a moment's peace, and then lying under the bedclothes afraid of being dragged out to see a patient. All the time we've known each other I haven't had one day off,” we hear the authentic voice of a country doctor in the late 19th century. In contrast to his contemporary, Leo Tolstoy, who utterly rejected science and technology, believing that only moral progress was possible, Chekhov embraced medicine with enthusiasm and believed that “there is more love for mankind in electricity and steam than in chastity and abstention from meat.” But perhaps Tolstoy had the last word, for no science can explain Dr. Chekhov, whose star is as brilliant today as it was an age ago.

Coope, who was himself a country doctor in Cheshire, England, has written a vivid, brief account of Chekhov as a doctor and an analysis of how being a country doctor influenced Chekhov's art. Coope's book is well written, consistently interesting, and peppered with revealing quotations from Chekhov and his contemporaries. I recommend it highly.

Robert S. Schwartz, M.D.