The government of Tsar Alexander III had shown itself to be no friend of local autonomy or the aspirations o Russia’s small but growing body of zemstvo professionals-among whom were physicians and various ancillary medical personnel. The terrible famine of 1891/92 and the ensuing cholera epidemic of 1892/93 provided chillingly conclusive evidence the Russian government was considerably better at exacerbating than relieving the country’s health problems.