p Education in hygiene and sanitation, which is the duty of every medical worker and student of a medical college, plays an important role in prophylactic work. Sanitary education is carried out in the most diverse forms. It includes talks at the patient’s bedside at home and special so-called patronage visits of homes by medical workers, particularly where the birth of a child is expected. Special films are shown in apartment house clubs and at industrial enterprises, radio and TV broadcasts are organised, etc.

p So-called health universities, institutes and schools have become very popular during the last few years. Doctors, experienced specialists, scientists and instructors of medical schools lecture to large audiences in accordance with a special programme designed for one year or several years and also conduct classes devoted to medical topics, paying special attention to questions of prevention and hygiene. 63 Such institutions have been established in many towns on a voluntary basis, i.e., the medical workers are not paid for their work there.

p The prophylactic principle underlies the entire system of medical education in the USSR. This is evident not only in the teaching of prophylactic disciplines—general hygiene, epidemiology, social hygiene, public health organisation, etc.—but also in the introduction of the prophylactic aspects into clinical and other work.

p Soviet medicine relies on the progressive doctrine of the paramount importance of the natural and social environment in the origin of diseases. I. P. Pavlov, the great Russian physiologist, said: ”. . . do not the causes of disease usually steal into the organism and begin to act before the patient becomes an object of medical attention? And the knowledge of the causes is, of course, one of the most essential parts of medicine. Firstly, since when we know the cause it is possible to combat it effectively, and, secondly, which is still more important, it is possible to prevent its action, its invasion of the organism. Only by learning all the causes of diseases will present-day medicine become the medicine of the future, i.e., hygiene in the broadest sense of the word.”  [63•* 

p The development of prophylactic medicine has stimulated the emergence of a teaching on so-called premorbid states, i.e., states preceding the onset of disease. This teaching was developed particularly fully in the works of M.P. Konchalovsky, an outstanding Soviet clinicist. It helps in early diagnosis and treatment of diseases.

p Numerous examples could be cited to show the effect of the organisational principles of the Soviet public health system and particularly its prophylactic trend in improving the health of the people and eradicating many infectious diseases. We shall cite only one, namely, the eradication of malaria which until very recently was a real scourge.

p Suffice it to say that after the First World War Russia had, according to incomplete data, several million cases of malaria (at least 5 million in 1919 and 1920). Nor did the incidence of this disease decrease in the 1930s. On the contrary, 9 million malaria cases were recorded in 1934. State organisations, medical institutions, thousands of 64 specialists and the people in general waged a struggle against the disease which was taking a toll of thousands of lives. Institutes of parasitic diseases and malaria and numerous antimalarial centres were established in the country. The government allocated large funds for the production of antimalarial drugs and means of lighting the malarial mosquito. A country-wide plan lor controlling and eradicating malaria was drawn up. The plan envisaged three main directions of attacking malaria: 1) influencing the source of infection, i.e., detection of patients, their active treatment, wherever they might be, and individual prevention (chemoprophylaxis);

p 2) control of the malaria vectors, i.e., extermination oi mosquitoes and their larvae by various methods, and, lastly,

p 3) measures aimed at safeguarding the people against mosquito bites. The plan also provided for the draining of the mosquito breeding grounds. Pharmaceutic factories were built which started manufacturing quinine substitutes—- plasmocide (pamaquine naphthoate), acrichine (quinacrine) and other drugs—as well as effective insecticides and other modern chemicals for controlling the malarial mosquito. The institutes and antimalarial centres trained many specialists and groups of nonmedical people who actively participated in the campaign against the disease. As a result of a complex of antimalarial measures, in which prophylaxis played the decisive role the incidence of malaria sharply decreased. In 1950 only slightly more than 780,000 malaria patients were recorded, i.e., one-fifth of the 1945 and one-twelfth of the 1934 figure. It became apparent that the eradication of malaria was a feasible task. During the subsequent years this disease has been practically wiped out in the USSR. Only 368 cases of malaria were recorded in 1960. Today malaria cases only occur sporadically.

The foregoing figures speak for themselves. Not only have millions of people been rid of a dangerous disease in a historically short period of time, but also vast human resources have been saved to work for the good of the people. Data collected by the World Health Organisation show what economic losses are caused by malaria. Experts of this organisation have calculated that the eradication of malaria costs from 50 to 100 dollars per person living on the territory affected with this disease. According to the latest figures, close to 1,400 million people live in malaria /ones in different parts of the world.