In Russia in the late 19th to early 20th centuries, along with the university (clinical) surgery, zemstvo district (rural) surgery began to play to a major role in the development of medical science. State reform of medical higher education in the 1840s–1860s was an important prerequisite for this development – it eliminated an acute shortage of Russian scientifi c and medical staff , thereby ensuring a signifi cant expansion of medical research and the emergence of a new and original form of national health care in the form of the zemstvo district medicine and the zemstvo district surgery.