Law in 1838 set some basic standards for all physicians. Important changes, however, occurred in the second half of the 19th century with the Zemstvo reforms of the 1860’s and the founding of the Pirogov Society in 1885. The Zemstvo movement was an attempt by Alexander II to improve the lot of rural Russia. The Zemstvo reform decentralized controls and brought physicians to the rural areas. A paradoxical effect of this movement, it is said, was to make physicians more independent and professionally more autonomous.

The Pirogov Society, founded in honor of Nicholas I. Pirogov, sought to enhance the professional prestige of physicians and create a “semi-autonomous corporate identity” (2).