The Pavlov Response

September 1763

Catherine II's coronation took place in Moscow in September 1762. Although Russia's rulers had taken up residence in St. Petersburg a half-century earlier, the entire court relocated to the "first capital" (первопрестольная) for coronations, as settings such as the Kremlin and the Dormition Cathedral (also called Assumption Cathedral or Успенский Собор), built in the late fifteenth century, imbued the confirmation of royal power, the desired aura of divinity.

For Catherine, the symbolism of this event was particularly important – and not primarily because of her gender. By the mid-eighteenth century, a woman on the throne was no novelty in Russia – Peter I's widow Catherine I had ruled after him, as did his niece Anna Ioannovna and daughter Elizabeth. But Catherine II had been born a minor German princess, without a drop of Romanov blood. Furthermore, she had gained the throne by overthrowing her husband, Peter III, a direct descendent of "the Great," and, on top of that, Peter had subsequently died under mysterious circumstances while held captive in a little house in Ropsha outside St. Petersburg. The emperor had been killed by close associates of the empress, probably on her verbal orders. Few knew for sure whether Peter had actually been murdered, but the unexpected death of the 34-year-old, newly deposed sovereign was bound to provoke suspicions. Anyone wishing to challenge Catherine's claim to the throne would have plenty of ammunition.

There was another factor undermining Catherine's claim to the throne. She had a son, Paul. Although Paul was only eight, he was (supposedly) a direct Romanov heir. Recent Russian history had already seen minor children on the throne. Peter the Great's grandson, Peter II, was only 13 when he became emperor. And baby Ivan Antonovich was all of two months old when he was given this honor, only to be overthrown at the age of one and kept in strict isolation for the rest of his short life, never learning that he had "ruled" his vast land. So in theory young Paul (Pavel Petrovich) was fully eligible to be crowned emperor.

His mother, however, had other ideas. Once power was within her reach, Catherine had no desire to share it with anyone else. Her son would grow up to be a wistful, poetic youth who eventually turned into a disillusioned and irritable adult. He never knew what happened to his father and had to endure hints dropped by his mother that he was not, in fact, Peter's son. Finally, after his mother's death, he gained the throne at 42 only to be killed by conspirators four years later.

But Paul's brief rule lay far in the future. For now, he was an eight-year-old boy unaware of the fact that his mother had deprived him of both his father and the throne. He was being carefully tutored by the best of teachers, including one of the most enlightened people of his day, Nikita Ivanovich Panin, who strove to instill noble ideas in the young heir.

Yet no sooner had the court made its ceremonious entry into Moscow for the coronation than Paul fell grievously ill. No one knows how the course of Russian history might have changed had Paul died in childhood. Catherine had no other legitimate children. But fortunately the boy was restored to health and his mother decided to celebrate this happy occasion with the founding of a hospital for the poor in Moscow.

There was more to this decision, of course, than simple maternal joy at her son's recovery. Any Russian ruler born with a name like Sophia Augusta Fredericka Anhalt-Zerbst would have wanted to make a special effort to show her subjects how devoted she was to the Russian people and its Orthodox religion. Catherine does not appear to have been a deeply religious person, but she was extremely conscientious about attending services. She spoke Russian with a German accent, but made up for this with her tireless defense of Russian interests, pilgrimages to Russian Orthodoxy's holy places, and charitable works.

This is not to accuse the empress of cynical hypocrisy. She did sincerely immerse herself in the life of her new homeland, truly lived and breathed its interests, and understood the importance of schools and hospitals, of which she built many. But at the same time her charity was, inevitably, partially influenced by her concern for public relations. Catherine had to constantly underscore how much better she was than her late husband, who, she claimed, had flirted with other women during church services, wanted to confiscate church lands (heaven forefend!), and generally had given little thought to the wellbeing of his subjects. Upon Peter's death, Catherine immediately revoked his decree secularizing church property (yet just two years later she would issue a virtually identical one and deal ruthlessly with members of the clergy who tried to object).

But this did not stop her from performing many acts of piety. The 1763 establishment of Moscow's Pavlov Hospital for the poor was one of these. The hospital was named for the little heir, and it was even proclaimed that "indigent people of the male and female sex shall be supplied with medicines and care, as well as food, clothing, linens, and all other sustenance from His Highness' own funds without requiring that they pay for anything either during the term of their illness there or after their recovery." To commemorate Paul's munificence, a medal was issued with his image and the words "Freed of his own illness, he gives thought to the sick."

At first the hospital contained a mere 25 beds and was housed in a decrepit old building. It was later repeatedly renovated and expanded, with Paul maintaining an ongoing interest in the facility. Finally, in the early nineteenth century, the renowned architect Matvei Kazakov transformed this hospital for the indigent into a true palace, with a beautiful classical portico, although this achievement did not bring him good fortune. His construction supervisor misappropriated funds and a court charged the architect with failing to exercise proper oversight. He was banned from working on any other government buildings.

Years and decades passed, and the hospital born at least partly out of political expediency continued to fulfill its mission of curing the poor and sick. Over its history it attracted many talented doctors. At one point Dr. Friedrich Haass (1780-1853) worked there. He was one of the most esteemed men of his time, and labored tirelessly to treat the poor and alleviate the plight of prison inmates. It was probably here, at the Pavlov Hospital, that Haass famously kissed a cholera patient on the mouth to show that the infection was not transmitted by contact.

With the arrival of the twentieth century, the hospital was rocked by other political storms. It was here that the renowned cardiologist Yakov Etinger worked before being swept up by Stalin's Doctor's Plot and dying in prison while under interrogation.

Since its first patients were seen in September 1763, the Pavlov Hospital has always felt the forces of history. By now the institution – which today goes by the generic name of Municipal Clinical Hospital No. 4 – has been healing the sick for two and a half centuries.

Whatever Catherine's true motives may have been in founding it, she deserves thanks.