From the beginning of black women’s professional involvement in medicine, public health marked a central component of the scope of their practice. Rebecca Cole, the second black woman physician in the United States, began her career as the “sanitary visitor” in the late 1860s for the New York Infirmary for Women and Children run by two of the first women physicians, famous sisters Elizabeth and Emily Blackwell. Elizabeth recalled that: “With tact and care,” Cole provided “simple, practical instruction to poor mothers on the management of infants and the preservation of the health of their families.”¹ After spending much of the rest of the Reconstruction era practicing in South Carolina, Cole returned to her native Philadelphia and opened the Women’s Directory with white woman physician and fellow WMCP alumna, Charlotte Abby. In this work, Cole likely continued to hone an interest in public health while still treating individual patients, a balance that would become common among African American women physicians engaged in public health work.

Anton Chechov (1860–1904) is Russia’s most famous literary doctor, but another of Russia’s great twentieth century authors also practised medicine. Mikhael Bulgakov (1891–1940) was the banned author of The Master and Marguerita, first published twenty-six years after his death, a novel credited as a progenitor of magic realism and as the inspiration of both Salmon Rushdie’s Satanic Verses and Mick Jagger’s Sympathy for the Devil. Bulgakov qualified in 1916 and at age twenty-four found himself in sole charge of a country clinic 32 miles from the nearest town, the roads to which were frequently impassable. Czarist Russia, despite its ramshackle absolutist monarchy, had a rural medical service (provided by the local government “zemstvo” councils and financed from local taxation) that many countries would envy today. Bulgakov found himself treating the local peasants, in charge of a facility with beds, an operating theatre, a staff of two midwives, and a feldsher (physician’s assistant). In the collection of short stories he wrote about his early isolation in that country clinic (A Country Doctor’s Notebook), he dwelt often on the terrors induced by the combination of total clinical responsibility and utter inexperience.

All of these stories describe effects that are real and meaningful for the patients involved. Yet in today’s medical terminology these effects would easily be labeled placebo effects, suggesting that the patients did not receive real or specific treatment. They accordingly illustrate why the term is unhelpful and misleading in the context of clinical reality. Moreover, while the term placebo refers to inert drugs or treatments, no such inert substances or fake treatments were used in two of the four preceding stories. Dr. Koryolov, in A Case History, did not provide drugs, but only his words and his presence, and, in The Tongue Set Free, the key person provoking the healing effect was not a physician, but instead the little boy’s father. According to today’s standards, the powder and pills given to Natasha in a pretty box in War and Peace were probably more harmful than helpful as such, and the ink dissolved in wine in The Egyptian was by no means biologically inert, although Waltari hints that Senmut did not actually believe the solution as such would be helpful.

Throughout his life, Anton Chekhov was often faced with the reality of suffering in human existence. His family’s bankruptcy and life of poverty in Moscow influenced young Anton’s thoughts about suffering and degradation in society, and his brief period of medical practice in Moscow provided him with enough experience to write over 150 short stories. These stories were heavily influenced by his perception of the effects of suffering on those he encountered. His journey to the Russian penal colony of Sakhalin influenced the short story Ward No. 6, which examines the idea that suffering is an inevitable part of human existence.

Chekhov repeatedly satirizes the belief that suffering is intrinsic to human existence and should be accepted as inevitable and ignored, portraying the stoical view of suffering as a means some people use to ignore or dismiss the suffering of others. In the story Misery,¹ a sledge-driver who has recently lost his son tells a passenger of his loss and the simple response is: “We shall all die.”¹ This story explores a belief that society when unchecked can drastically increase the suffering of those humans it is supposed to protect. When describing the hard life of the sledge-driver and his mare he suggests that the dumb animal is “probably lost in thought,”¹ because anyone who faces the tumultuous degradation of life in the city would be “bound to think.”