By the end of the nineteenth century, social hygiene was a topic of great importance for states experiencing fears of national degeneration. The health of children was of particular concern, as it was thought to reflect the future health of the nation. Although this prompted nation-states like France, Germany, the United Kingdom, and the United States to develop intricate theories about the prevention and treatment of childhood illnesses, it was imperial Russia that became an unacknowledged trailblazer in the institutionalization and implementation of school hygiene measures. As this article will show, autocratic Russia's institutions and ideology allowed the tsarist state to surpass its Western neighbors in the drawing up and application of school hygiene measures.