As a result of zemstvo district reforms of 1864, Russia saw the formation of zemstvo district medicine, which played an important role in improving the people's health. The main objectives of zemstvo district medicine were fi ghting epidemics, providing vaccinations, and obstetrical and medical help. The organization of medical care was costly. Charity played a huge role. Health issues occupied a prominent place among philanthropists' activities. Three-quarters of zemstvo medicine's funding came from private sources, among which funding from merchants took fi rst place. Members of the nobility played a leading role in the development of zemstvo district medicine. Prominent cultural fi gures held charity concerts in aid of zemstvo district hospitals. Philanthropy provided substantial support for health care and charity institutions (construction and maintenance of hospitals, shelters for the disabled, the elderly and orphans).