p Prophylactic (preventive) work is regarded as the most important part in health protection in the USSR. This is natural, since more than 50 years of Soviet medical experience have confirmed the old truth, known even to the physicians of antiquity, that an ounce of prevention is worth a pound of cure. But the great medical men of the past— Hippocrates, Galen, Sushruta, Asclepiades, Geratsi and many others—though they stressed the role of prevention, could not, of course, imagine that a time would come when the prevention of disease would be an efficient and most important instrument in caring for the health of a whole country. Even the outstanding physicians of the 19th century, including well-known Russian scientists, could go no farther than appeal to the public to devote more attention to prophylactic measures. They saw the future of medicine in an all- inclusive prophylaxis practised not only by individual doctors, but also by the entire system of public health. "The future belongs to preventive medicine,” stated the celebrated Russian surgeon N. I. Pirogov. G. A. Zakharyin, one of the most eminent internists of the 19th century, said that "only hygiene can prove victorious against the diseases of the masses”; by hygiene he meant preventive medicine in the broadest sense of the term. It would seem that such statements and appeals should have had their effect as public health services developed and the nature of many infectious 55 diseases which at that time constituted a primary public health problem discovered. But with the social and political system of pre-revolutionary Russia prophylaxis could not develop to the level of nation-wide, state measures, and the matter stopped at individual prophylactic measures. It should be added that prophylaxis has not become a state function in any of the capitalist countries to this day.

p As early as the 1920s Z. P. Soloviov, an eminent theoretician and organiser of the public health service in the USSR, emphasised that the main difference between Soviet medicine and that of the capitalist countries is that the latter cannot embark on the path of prevention without thereby infringing upon the very foundations of the capitalist system.

p In emphasising the importance of the social, state system in the development of prophylactic work it should be noted that prevention does not mean merely measures of individual sanitary and technical protection like, for example, in preparation of a surgeon’s hands before an operation. Z. P. Soloviov, N. A. Semashko and other theoreticians and organisers of the Soviet public health service, who elaborated the theory of prophylaxis as the main line of development of Soviet medicine, often had to explain this to a number of well-known clinicists of their time, who reduced prophylaxis to mere technical cleanliness.

p Nor should be prophylactic trend be identified with broader medical measures of controlling a number of infectious diseases, although this is still the way in which prophylaxis is conceived by the medical people and hygienists in capitalist countries. It was for this reason that all measures for controlling infectious diseases, including campaigns for vaccinations, were long since given the name of prophylactic or preventive medicine, as opposed to curative medicine. It is well known, that despite this enlarged concept of prophylaxis, medical treatment of diseases is still divorced from prophylactic medicine in many capitalist countries and is handled mainly by general practitioners. Even in Great Britain, where there is a state public health service, there is a gap between the organisation of prophylactic service and medical aid. Progressive medical workers are worried about this gap. At the 16th World Health Assembly the need for closely integrating prophylactic and clinical medicine came under special discussion. Doctor A. Shousha, 56 a prominent public health worker, emphasised in his report the urgent need for doctors to study the social aspects of medicine. He said that a modern physician had to be a social worker capable of making a "social diagnosis" and administering "social therapy”. He also assigned an important role to preventive measures understood as extensive social prophylaxis.

p H. E. Sigerist, an outstanding medical theoretician and historian, has repeatedly insisted on the necessity of broadly conceived prophylactic measures. He maintains the aim of medicine is social and future doctors must need be social physicians. He highly appraised the development of prophylactic work in the USSR (he made two special visits to the Soviet Union in order to study the public health system). In his books dealing with public health in the Soviet Union he wrote: "And I have come to the conclusion that a new period in the history of medicine has been inaugurated in the Soviet Union. All that had previously been achieved in 5,000 years of world medicine represents only the first epoch, that of curative medicine. Now a new era, that of preventive medicine has come of age and passed the stiffest test that could be devised.”  [56•* 

p It follows that the prophylactic trend in health protection could not be implemented in pre-revolutionary Russia, nor can it be implemented even in developed capitalist countries today, because the most that can be achieved there is separate hygienic measures, including campaigns for vaccination and sanitation of the external environment. The prophylactic trend, as the basis of public health in the USSR, is the aggregate of social-economic and medical measures aimed at preventing disease and, zvhat is even more important, at eliminating the causes of disease. The overall prophylactic measures coincide with the work of remaking man’s environment, changing the conditions of life so as to guarantee people joyous labour, valuable rest and recreation, strengthen the people’s health and ensure them a long, active life, the work of improving the well-being of the people, raising their material and cultural standards and promoting the harmonious development of their physical and spiritual faculties. The prophylactic trend in health protection is, 57 consequently, regarded as an expression of the basic economic laws of socialism, i.e., the maximum satisfaction of the growing material and spiritual needs of the working people.

p It stands to reason that this conception of prophylactic work is untenable unless the public health system is made an inseparable part of the state system. In other words, the prophylactic trend is impossible where health protection does not have a state character, where the state is not concerned about or responsible for the health of its citizens.

p The section on public health in the Programme of the Communist Party adopted back in 1919 at its 8th Congress emphasised the importance of developing the prophylactic trend in health protection. It read: "As the basis of its activities in public health the Russian Communist Party proposes to carry out primarily extensive hygienic and sanitary measures aimed at preventing disease.”  [57•* 

p The special importance of prophylactic work is emphasised in the Programme of the Communist Party of the Soviet Union adopted by its 22nd Congress. The Programme states that the socialist state works to improve the health of the people by social-economic and medical measures aimed at preventing and decisively reducing the incidence of disease.

p Consequently, the prophylactic trend as the basis of health protection in the USSR, is expressed in social-economic measures carried out by the state with the aim of improving the conditions of life, work and recreation, raising the living standards and spiritual level of the people, as well as in specific medical measures of prophylaxis. There is no need to dwell in detail on the social-economic measures carried out by the state, on the social policy aimed at improving the well-being and furthering the cultural development of the Soviet people, because this was treated in sufficient detail in the preceding chapters. It is perfectly clear that all measures connected with social maintenance, social insurance, improvement of the material conditions, diet, housing, increased incomes, elc., have a most favourable effect on the health of the people. Moreover, these measures carried out by the state serve as the necessary background for the 58 implementation of the prophylactic trend in health protection.

p While it is hardly feasible to dwell in detail on all the measures that make up the prophylactic work of medical institutions, we feel it necessary to emphasise certain aspects of medical prophylaxis which are compulsory for all the medical institutions of the USSR regardless of their purpose and constitution. It is no accident that hospitals, polyclinics, dispensaries, so-called medical and sanitary centres at industrial enterprises, etc., are referred to as therapeutic and prophylactic institutions, which emphasises the most important aspect of prophylaxis in the USSR—the synthesis of curative, sanitary and hygienic activities.

p The idea that it is necessary to introduce prophylactic principles into all forms of medical activity is gradually winning over the minds of our foreign colleagues. It also finds expression in the activities of medical international organisations, including the World Health Organisation. Thus in considering the role of the modern hospital in public health services one committee of experts came to the conclusion that "in hospitals prophylaxis must keep abreast with the development of the curative services in various specialities . .. , the hospital cannot be an isolated institution, but must be a part of a social and medical organisation concerned both with treatment and prevention”.

p The members of the Committee of Experts of the World Health Organisation examining the question of teaching pathology stated that "prophylaxis may and must permeate all activities in the field of medicine”.

p Prevention work is the duty and daily concern of all medical institutions in the USSR, whether a hospital, a polyclinic, a dispensary, or a sanitary-epidemiological centre, etc. It is therefore impossible to list briefly the most important forms of direct prophylactic work. It includes enforcement of hygienic norms at industrial enterprises, and in daily life in town and country, checking the observance of state sanitary legislation on labour protection, and against pollution of atmospheric air, soil, water reservoirs, and foodstuffs, mass and individual prophylactic inoculations and many other sanitary, hygienic and antiepiclemic measures.

p The following example gives some idea of the concrete sanitary and hygienic functions of some medical institutions. 59 Soviet scientists-hygienists, physiologists, toxicologists, etc.— have established the maximum permissible concentrations of various substances in the soil and air, beyond which they may prove harmful to health. These maximum permissible concentrations are legislatively established as legal limits which may not be exceeded. Such maximum permissible concentrations have been established in the Soviet Union for more than 70 substances that pollute atmospheric air and close to 100 substances which pollute water. Moreover, maximum permissible concentrations have been established for a number of substances or radiations at industrial enterprises. For example, for people employed at enterprises of the atomic industry or working on X-ray installations, which are not safe from the point of view of irradiation, the level of irradiation has been established at 5 rem/year. Maximum permissible concentrations have been established for more than 230 radioisotopes which may find their way into the air and water.

p These limits established in the Soviet Union with due regard for international experience are, as a rule, much lower than those accepted in the USA and a number of other capitalist countries. For example, in the USA a concentration of 100 mg/m^^3^^ of lead is allowed in the air of industrial enterprises, while in the USSR the maximum permissible concentration of lead is 10 mg/m^^3^^. In the air of inhabited localities the maximum permissible concentration of lead in the USSR is 0.7 mg/m^^3^^. This concentration is even somewhat lower than the safe concentration, which is 1 mg/m^^3^^. Scientists have demonstrated that a concentration of 2-5 mg/m^^3^^ of mercury in the air causes a number of disturbances in the health and behaviour of experimental animals and leads to an accumulation of this metal in their bodies. Taking this factor into consideration the maximum permissible concentration of mercury in the air in the USSR has been set at 0.3 mg/m^^3^^.

Without dwelling in greater detail on this most important question connected with the protection and sanitation of the environment, since medical people are familiar with these activities, we should only like to note that in the USSR preventive vaccination for a number of diseases is compulsory and is administered by medical workers under control of sanitation agencies and institutions. Thus sanitation laws cover all aspects of prophylactic activity.