Profile: James Wylie, The Scot who became the Russian army's favourite doctor

Until James Wylie, only wounded officers received treatment, the common soldier being left to die of his wounds where he fell on the battlefield. Yet, for all his success, shadows followed Sir James Wylie throughout the 64 years he spent in his adopted homeland. Did he really help cover up the murder of one tsar and lie about the death of another to allow him to live in anonymity? From the little we know about him - his autobiography was destroyed by the last tsar he served, the brother of the tsar he is alleged to have helped "disappear" - Sir James Wylie seems to have been a man who lived on the edge, unafraid from childhood to risk everything in pursuit of his ambitions.

Growing up in Kincardine in the 1770s it had seemed that the sea and not medicine would be where Wylie would make his name. He was more likely to be found at the harbour listening to the sailors' stories of adventure than attending school, but his parents were determined that their second son would have a profession and apprenticed him to a Dr Meldrum. But Wylie had other plans and promptly tried to run away to sea, boarding a ship in Crammond. But his mother followed him and Wylie was physically dragged home by the collar. Whether it was Mrs Wylie's fury or this youthful brush with death - the ship Wylie had signed on with sank the very next morning with the loss of all hands - Wylie went meekly back to Dr Meldrum and completed his apprenticeship, going on to study medicine at Edinburgh University in 1786. He made excellent progress in his studies at what was one of the foremost medical schools in the world, but even here Wylie couldn't keep out of trouble. Legend has it that he had to leave Edinburgh without graduating - for sheep rustling - and was smuggled aboard a ship at Leith in a cart of hay.

Having a price on his head doesn't seem to have daunted Wylie, though, for this was a time when there was money to be made and adventure to be had abroad. Since the days of Peter the Great, Russia had welcomed medically minded Scots with open arms. Peter's granddaughter-in-law, the extraordinary and dynamic Catherine the Great, actively encouraged the tradition to the extent that it was claimed, with some justification, that every pharmacy in Russia was run by a Scotsman, "men of professional skill and acknowledged superiority".

On his arrival in Riga, Latvia, Wylie enlisted as a surgeon in the Eletsky Regiment, serving in Russia's war with Poland.It was during the siege of Warsaw in 1794 that the injustice of only wounded officers receiving medical treatment became apparent to Wylie for the first time, and he vowed to change it. Then he was only a lowly army surgeon who'd gambled away everything but his mattress, but his life was about to change radically.

It began with the Dutch ambassador's bladder stone, which Wylie successfully removed, bringing him to the attention of several distinguished patients. Promotion to staff surgeon was soon followed by the news that he'd been granted his medical degree, despite not graduating. Wylie promptly resigned from the army and set up in private practice. His reputation grew quickly until he found himself medical attendant to the family of Prince Golitsyn, best friend to Grand Duke Alexander, the grandson and preferred heir of Empress Catherine herself. It looked as if Wylie was on the fast track to fame and fortune.

He would soon learn, though, that nothing is certain in Russia. Empress Catherine died suddenly without changing her will and Alexander's father, Paul, promptly marched into the Winter Palace with his soldiers. Paul was a mentally unstable tyrant who would fly into violent black rages so that even his closest family and friends lived in terror of offending him.

Even when the Tsar's closest confidant Count Kutaisof - a barber ennobled by Paul - was dying of a throat abscess and Wylie thought he could help, it took a member of the poor man's desperate family risking their own life to call him. Wylie took one look at the sick man and performed a laryngotomy - making a hole in his windpipe below the abscess so he could breathe again. Wylie's bravery - it's possible this was the first time this kind of operation was performed in Russia - could have cost him his life, but for once the Tsar overlooked the breach of protocol and, in gratitude at saving his favourite's life, appointed him his personal doctor. Wylie had made it, but his position was anything but secure.

Tsar Paul became increasingly paranoid and began turning the new Mikhailovsky Palace into a fortress while proposing a hare-brained joint invasion of India with Napoleon Bonaparte. A plan was hatched to replace him with his son Alexander, and on the night of 12 March 1801 a group of army officers strangled him. Probably afraid for his own life, although some have suggested that he went along with the plan to advance himself, Wylie signed the Tsar's death certificate giving apoplexy as the cause of death. Had the truth come out then, it could have been the end of Wylie's career just as it was beginning. It wouldn't be the last time that his signature on a death certificate would be controversial.

With his friend Alexander now Tsar, Wylie was finally in a position to fulfil his promise to get medical help for the common soldiers, not just officers. His influence meant that field stations were built to which the wounded were carried in primitive ambulances.Wylie was present at the battles of Austerlitz, Jenna and Borodino, where he is alleged to have carried out 200 operations. His actions there came to the attention of the Russian novelist Tolstoy, who is thought to have made him the doctor who appears in War and Peace, calling him Villier, the Russian spelling of his name.

Now one of the foremost medical men in all Russia, Wylie went on to establish colleges for training doctors in both St Petersburg and Moscow. His Handbook on Surgical Operations, published in 1806, was the first of its kind in Russia and The Pharmacopoeia Castrensis Ruthiena remained the standard textbook on the subject for more than half a century. On a visit to England with the Tsar in 1814 his success seemed to have reached its height when he was knighted by the Prince Regent at the request of the Tsar, becoming Sir James Wylie. But trouble was never far away and Wylie was about to become embroiled in a situation that would haunt him forever.

Throughout his 24 years' service to Tsar Alexander, Wylie had had to deal with his friend's recurrent bouts of depression. Alexander had become increasingly religious and when he died in 1824 while visiting a remote area of the Crimea, the rumour soon spread that Wylie had faked his death for him so he could live as a hermit monk. It is a legend that, despite being highly improbably, persists in Russia even to the present day. The Soviet government appeared to confirm the rumour when it announced that Tsar Alexander's coffin was empty when it was opened in the 1920s.

The truth will never be known as Wylie's journals were destroyed by Alexander's successor, his brother Nicholas I, fuelling the rumours. What is known for sure is that when Wylie died in 1854 aged 87, he was loaded with honours from the tsars of Russia and other European monarchs and left enough money to build a hospital, one that is still in use and which is still visited by Scottish doctors today. Had his autobiography survived he may well have been better known in Scotland, even if it was for the wrong reasons.

• The Tsar's Doctor: The Life and Times of Sir James Wylie by Lady Mary McGrigor, published by Birlinn, 9.99