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The results were predictable. Upon arriving at his first posting as a convict doctor in Sevurallag, Isaac Vogelfanger, himself a qualified surgeon, was surprised to find the local feldsher treating scurvy boils—a condition caused by malnutrition, not infection—with iodine. Later, he witnessed a number of patients die because an unqualified doctor insisted upon injecting patients with a solution made of ordinary sugar. ¹⁰⁴

None of this would have come as a surprise to the Gulag bosses, one of whom complained, in a letter to his Moscow boss, of a doctor shortage: “In several lagpunkts, medical help is given by self-taught nurses, prisoners without any medical qualification whatsoever.” Another wrote of a camp medical system which defied “all principles of the Soviet health service.” ¹⁰⁵ The bosses knew they were flawed, the prisoners knew they were flawed— and yet the camp medical services went on functioning all the same.

Even with all of their faults—even when doctors were venal, wards were poorly equipped, medication was scarce—so attractive did life in the hospital or the infirmary seem to prisoners, that to get there they were willing not only to injure or threaten doctors, but to hurt themselves too. Like soldiers trying to avoid the battlefield, zeks also engaged in samorub (self-mutilation) and mastyrka (faking illness) in desperate attempts to save their lives. Some believed they would eventually receive an invalid’s amnesty. So many belived this, in fact, that the Gulag on at least one occasion issued a declaration denying that invalids would be freed (although they were, occasionally).¹⁰⁶ Most, however, were simply glad to avoid work.

The punishment for self-mutilation was particularly high: an extra camp sentence. This reflected, perhaps, the fact that a disabled worker was a burden to the state and a drag on the production plan. “Self-mutilation was punished viciously, like for sabotage,” wrote Anatoly Zhigulin. ¹⁰⁷ One prisoner tells the story of a thief who cut off four fingers of his left hand. Instead of being sent to an invalid camp, however, the invalid was made to sit in the snow and watch as others worked. Forbidden to move around, on pain of being shot for attempted escape, “very soon he himself requested a shovel and, moving it like a crutch, with his surviving hand, poked at the frozen earth, crying and swearing.”¹⁰⁸

Nevertheless, many prisoners thought the potential benefits made the risk worth taking. Some of the methods were crude. Criminals in particular were famous for simply cutting off their three middle fingers with an ax, so they could no longer cut trees or hold a wheelbarrow in the mines. Others cut off a foot, or a hand, or rubbed acid into their eyes. Still others, upon departing for work, wrapped a wet rag around one foot: in the evening they returned with third-degree frostbite. The same method could be applied to fingers. In the 1960s, Anatoly Marchenko watched a man nail his testicles to a prison bench.¹⁰⁹ Nor was he the first: Valery Frid describes a man who nailed his scrotum to a tree stump.¹¹⁰

But there were subtler methods used as well. The more daring criminal would steal a syringe and inject melted soap into his penis: the resulting ejaculation looked like venereal disease. Another prisoner found a way to fake silicosis, a lung disease. First, he filed a small quantity of silver dust from a silver ring which he had managed to keep among his personal belongings. He then mixed the silver dust with tobacco, and smoked it. Although he felt nothing, he then took himself to the hospital coughing in the way that he had seen silicosis victims cough. On the subsequent X ray, a terrible shadow appeared on his lungs—enough to disqualify him from hard labor and get him sent to a camp for the incurably ill.¹¹¹

Prisoners also attempted to create infections, or long-term illnesses. Vadim Aleksandrovich treated a patient who had infected himself with a dirty sewing needle.¹¹² Gustav Herling watched one prisoner thrust his arm in the fire, when he thought no one was looking; he did it once every day, the better to maintain a mysteriously persistent wound.¹¹³ Zhigulin made himself ill by drinking ice water and then breathing cold air. It gave him a temperature high enough to allow him to be excused from work: “Oh happy ten days in the hospital!” ¹¹⁴

Prisoners also faked insanity. Bardach, during his career as feldsher, worked for a time in the psychiatric ward of the central Magadan hospital. There, the primary method of unmasking fake schizophrenics was to put them on a ward with real schizophrenics: “Within hours, many prisoners, even the most determined, knocked on the door to be let out.” If that failed, the prisoner was given a camphor injection, which induced a seizure. Those who survived rarely wanted the procedure repeated. ¹¹⁵