The two Grand Embassies to Europe and his view on the world helped Peter the Great to start reforms. Already as a child, he had a broad interest in medicine. Peter often followed a two-track policy. One for immediate application in the current practice and one for the development of specialists in collaboration with science. Peter established a medico-surgical hospital school in Moscow to prepare the students to become doctor medicinae and learn to make their own medical instruments along the line of the Leiden medical school. In Saint Petersburg, he opened a navy and an army hospital, intended to train students as a barber-surgeon for the army and navy. Also in Saint Petersburg Peter built the first factory for "mass" production to provide the military with medical instruments. His successors followed his two-track policy. Catherine the Great started to merge the two tracks. During the reign of Tsar Aleksander I and his brother Nicholas I, the merger came together and was further developed. They understood that strong cooperation between a physician and a designer is essential to create and produce useful medical instruments. If correctly designed, medical instruments and devices increase safety for the patient. We will shed light on the development and manufacture of medical instruments and appliances in Imperial Russia, an underdeveloped subject in the world medical history.