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The Background of Soviet MedicineFrom Medicine and Health in the Soviet Union
Henry E. Sigerist
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WITH THE COOPERATION OF JULIA OLDER
To understand the organization of medical services in any country, it is essential to know its social and administrative structure, and the general principles which guide its national life. This is particularly true in the case of the Soviet Union, where society is constructed on organizational principles uniquely different from those of any other country. The basic medical problems are the same everywhere, but the special problems vary a great deal with the physical and social conditions of each country. It is relatively easy to control health conditions in a small territory in habited by a homogeneous population of even cultural development; the same conditions are usually much more difficult to handle in a large territory with a heterogeneous population.
The Soviet Union is the largest country in the world. Its land area covers more than 8.5 million square miles, more than one-seventh of the total land area of the earth, one-sixth of the inhabited earth/ It is surpassed in size only by the British Empire with all its dependencies. From the Arctic regions, Soviet territory extends south to the subtropical Caucasus and Central Asia, a distance of 4,500 km. (about 2,800 miles); from the Baltic Sea and Carpathians, it sweeps east about 8,500 km.(about 5,300 miles) to the Pacific. The Urals, stretching almost directly from north to south, divide the USSR into European and Asiatic sec tions. Both are immense plains, both contain large mountain ranges and are crossed by powerful rivers flowing in north-south and south-north directions through vast stretches of land. The thinly settled Asiatic USSR, covering an area nearly four times as large as the European section, represents a huge land reserve for a growing population.
The natural resources, the potential wealth of the country are un limited. The mountains are rich in mineral ore. The oil resources of Baku, Grozny, and other districts are estimated at 4.6 billion tons. The coal deposits in the Ukraine, the Moscow region, the Urals, and certain other areas amount to more than 1,654 billion tons. The rivers pro vide water-power and ways of communication, the value of which is enhanced by a system of canals. In the north is a belt of marshy plains, the tundra, bordering on the Arctic and rich in fur-bearing animals. Following south is a forest belt (taiga) which covers half of the entire area of the country and is a tremendous source of timber.
The steppe belt, wooded in the north, grassland in the south, provides rich agricultural soil. A desert and semi-desert grazing belt in the southeastern European and southwestern Asiatic areas is used for pasture. And finally, there is the subtropical belt where fruits grow in abundance, where cotton, tea, and tobacco are cultivated, where silk-worms are raised.This great and rich country was inhabited in 1940 by a population of 193 million, about one-third urban and two-thirds rural. That is the latest official figure, but experts believe that war deaths had reduced the population to about 185 million m 1945. The natural population increase is about three millions every year. Over three-fourths of the population live in the European part.
The cities have grown tremendously. Moscow, which had 1.6 million inhabitants in 1914, had over four millions in 1940. In 1914 there were only 16 cities with more than 100,000 inhabitants; in 1935 there were 65, and in 1939 their number had increased to 82.The United States, with a population reflecting perhaps a score of different national strains, is considered a country with a heterogeneous population; the Soviet Union is inhabited by 175 distinct nationalities large or small, the majority of which speak their own language or dialect. The 49 largest groups ;represent more than 99 per cent of the population. In 1938 newspapers were published in 68 languages besides Russian. Books and pamphlets have been published since the Revolution in n5 different languages.
When the Soviet system was established, after seven years of war, the country was a wreck. Society had taken over the means of production, distribution, and transport, but what it had taken over was in ruins. The country had to be rebuilt from the bottom up-rebuilt along socialist lines. It soon became apparent that, under the circumstances, it would be impossible to establish integral socialism all at once.
However, within the brief period of a quarter of a century, the Soviet Union had become, in actuality as well as theory, a socialist state. A new social order has been established. It is the medical and health aspects of this new social system with which we are concerned in this book.
Before we can discuss the principles, achievements and aims of the Soviet medical and health program, we must look into its antecedents.
The Revolution made it necessary to reconstruct the medical services of the country, to build these services along new lines. Obviously, it had to start from the existing conditions; it had to use the materials, the medical institutions, and the medical personnel it found. What was Russian medicine like at the time of the Revolution? We have to know this to understand the development of Soviet medicine.The history of Russian medicine 2 is a tale of terrific plagues and famines, of some brilliant achievements in a few centers, and of utter inadequacy in the open country. The beginnings were the same in Russia as they were elsewhere. For centuries Russian medicine was primitive medicine, folk-medicine, a combination of empirical knowledge and of magical and religious beliefs. As a matter of fact, at the time of the Revolution there were still groups of the population, particularly among the national minorities, that had never seen a physician but were treated in case of illness by medicine-men and witch doctors. It was not an easy task to change the attitude of these people, to make them ready to accept scientific medicine.
[...]It should now be apparent that Soviet medicine was not created from air; there were foundations to build upon. There was a scientific tradi tion in Russian medicine. It is always good to have traditions for a foundation so long as one is aware that traditions oblige one to look into the future, not backward. There were universities training good physicians. There was a medical organization giving service to the rural population.
And yet, in 1914, when the World War broke out, medical conditions were far from satisfactory. The number of universities was much too small and, as a consequence, there was a tremendous shortage of physicians. Their number was entirely out of proportion to the vastness of the territory. Zemstvo medicine after half a century of development was still in a rudimentary state. There was no central medical authority in the country; public health was administered by not fewer than eleven government departments. An economic system that gave wealth to a few and poverty to most, a government system that gave privileges to a few and handicaps to most, a bureaucracy that impeded and obstructed the whole life of the nation-all these factors prevented the people from receiving what medical science could have given them.
Consequently, health conditions in Russia were very bad. The death rate for every 1ooo inhabitants averaged 28.4-30 from 1904 to 1914. The infant mortality per 1,000 births from 1901 to 1914 averaged 244-terrifying figures. Russia still was the playground of contagious diseases. In 1914, 11,843,088 cases of acute infectious diseases were reported. How many more cases were not reported? ( All these figures from N. A. Semashko, Health Protection tn the U.S.S.R.,London, r934, pp. I2-I4.)If anyone had undertaken to reorganize the public health system of Russia in 1914, he would have had to face tremendous difficulties. After eight years of imperialist and civil war, when nearly all medical facili ties of the country were broken down, when famine and epidemics were ravaging the land with unheard-of violence, the task seemed almost hopeless.The Soviets undertook it, and they did it with full confidence in the ultimate success of their efforts. This confidence was justified because, in applying the principles of socialism to the field of public health, they were creating the social organization of medicine that permitted making the widest possible use of its new technology.