Y. Lisitsin
__TITLE__ HEALTH PROTECTION IN THE USSR __TEXTFILE_BORN__ 2007-07-29T19:59:56-0700 __TRANSMARKUP__ "Y. Sverdlov" Progress Publishers Moscow [1]Translated from the Russian by David Myshne
Designed by V. Korolkov
K). PI. JlHCHUHII 3/IPABOOXPAHEHHE B CCCP Ha H-MKC __COPYRIGHT__ First printing 1972CONTENTS
Foreword
Chapter 1. The Soviet Union and Its People ......
Territory. Population ...........
The Economy and Living Conditions .....
Chapter 2. The Great October Revolution and Public Health Public Health in Russia before the October Revolution ..............
Formation of the Soviet Public Health System . The Great Patriotic War ........
Public Health Services in the USSR since 1945 .
Chapter 3. "Health Index" ............
Decrease in Mortality ..........
Decrease in Disease Incidence .......
Improvement in Physical Development ....
Social Homogeneity in the General Health Improvement in the USSR ........
Chapter 4. Basic Principles of the Soviet Health Protection . State Socialist Character of Health ......
Free and Generally Available Medical Aid . . Unified and Planned Public Health .....
Prophylactic Work ...........
Dispensary Service ...........
Divisional Organisation .........
Education in Hygiene and Sanitation .....
Connections Between Medical Science and the Practical Work of Public Health Services . . . Participation of the Population in Public Health Work ................
Chapter ">. Public Health Services ..........
Main Curative anil Prophylactic Institutions. The Problem o( Specialisation .......
Page 5 9 10 33 34 37 41 43 46 46 48 51 54 60 61 62 66 70 72 3Medical Care for Industrial Workers . Medical Care in the Countryside . Medical (``arc for Women and Children . Sanitary and Kpidciniological Services Health Resorts and Sanaloi iiniis ....
SI S3
N7
Chapter 6. People in White Clowns........
Chapter 7. Health Industry...........
Chapter 8. Medical Science, a Branch of Public Health . Conclusion. "Health Vaccine"..........
98 106 110 120
[4] __ALPHA_LVL1__ FOREWORDAccording to official data, in 1970, the Soviet Union had about 700,000 doctors, while the number of persons with a secondary medical education (nurses, technicians and other personnel) exceeded 2 million. Reference books on medical education show that increasingly more doctors and other medical workers are being trained in the USSR with each passing year. For example, more than 30,000 doctors have graduated annually from medical colleges in the last four years. Some foreign readers of this book may wonder why the Soviet Union needs so many physicians and other medical and auxiliary personnel in the health services, since the Soviet Union already has more than a quarter of the total number of the world's doctors and more than half the total number of Europe's doctors, whereas the population of the USSR, which numbered 243.9 million in 1971, constitutes only one-fifteenth of the world's population.
Other facts about public health in the Soviet Union may also seem puzzling. For example, it was reported that in 1969 some 9.5 million people had a rest and received medical treatment at health resorts and in sanatoriums, holiday homes and boarding houses, including more than 7 million industrial and office workers, who received accommodation wholly or partly at the expense of the state or special social insurance funds. This figure appears particularly large, since in many countries sanatoriums and health resorts are too expensive to be afforded by more than a limited part of the population.
The uninformed reader will be astonished by the facts about the improvement of public health in the Soviet Union. They are indeed amazing. In only some 50 odd years, out of which 20 were spent in wars to defend our country's freedom and independence and in restoration of its economy, general and child mortality have decreased severalfold, many formerly widespread infectious and parasitic diseases have been wiped out, and the health of Soviet citizens is on a par with the world's highest standards.
To gain an insight into this and many other questions, those who are interested in Soviet public health and medicine would, of course, do well to see the country for themselves and acquaint themselves with the work of the health services, with the doctors, nurses and other Soviet medical 5 workers. Naturally, no printed matter can take the place of personal impressions, although it can provide answers to many questions.
It is this purpose---to furnish the reader with information on the Soviet health protection system, medical science, the changes that have taken place in public health and the training of doctors and other medical personnel---that this book is meant to fulfil. We hope, moreover, that it will give some idea of the historically unique social experiment carried out in the USSR, the experiment that has transformed the country into one of the world's leading industrial powers with a progressive system of public health services.
At the end of June 1968 a session was held in Moscow of the Supreme Soviet of the USSR---the country's highest body of state power. The session paid special attention to the question of the medical care of the population. The Supreme Soviet of the USSR and, later, the Central Committee of the Communist Party of the Soviet Union and the Council of Ministers of the USSR passed resolutions aimed at further developing and improving medical care and public health services in the USSR. These documents are indicative of the solicitude displayed by the state power for safeguarding and improving the health of all Soviet people and of the importance attached to health protection as a significant branch of the national economy.
``As a result of the construction of a socialist society in the USSR, the consolidation of its economic power, the steady rise in the material and cultural standards of the people and the progress of science, a great deal has been successfully achieved in the preservation and improvement of public health. The socialist principles of health protection---free and universally available skilled medical aid and extensive preventive measures against disease---are being consistently put into effect.'' These words from the resolution of the Supreme Soviet of the USSR can serve as a key to understanding how it was possible to improve the state of public health in so short a period of time.
The Principles of Legislation on Health Protection for the USSR and the Union Republics adopted by the Session of the Supreme Soviet of the USSR held in December 1969, embraced the most important propositions connected with the protection of public health, as a task of the socialist state, and of the whole of socialist society. This document conforms 6 to the spirit of socialist democracy and emphasises the need for the most extensive participation of the population in the public health protection. It is well known that Lenin, whose 100th birthday was celebrated in 1970 by all progressive mankind, attached decisive importance to the participation of the masses of the population in the construction of socialism. Tn his work, 'flic Slate and Revolution, he emphasised that "only socialism will be the beginning of a rapid, genuine, truly mass forward movement, embracing first the majority and then the whole of the population, in all spheres of public and private life.''^^*^^
This legislative act on public health helps to give the entire population a better insight into the public health system and the role of the state and of society in improving the health of the people, it acquaints them with their rights to medical care and the need for active participation in the health protection measures. It is particularly important that the Principles emphasise not only the duty of the state to provide free medical aid to the entire population, but also the duty of each citizen to take care of his own health and be considerate to the health of other members of society. This follows from the duty of each citizen to regard his own health as social property, as society's main wealth.
In addition to extensive factual material and statistics on the development of the public health services and the health of the population, this book also deals with the most important theoretical principles that have made it possible to build a modern health protection system in the USSR.
_-_-_^^*^^ V. I. Lenin, Collected Works, Vol. 25, p. 472.
[7] ~ [8] __NUMERIC_LVL1__ Chapter 1 __ALPHA_LVL1__ THE SOVIET UNION AND ITS PEOPLE __ALPHA_LVL2__ [introduction.]Even the reader who is totally uninformed on questions of medicine and public health, must realise that the health of the population and the available medical services are very largely dependent on a country's economy, science and culture. Moreover, many medical specialists working in the developing countries say that the main enemy of the people's health is not so much the causative agents of infectious and parasitic diseases or other direct causes of ailments as the low level of economic development. The position can be stated quite simply: a weak economy is an enemy of health. This thesis could be directly applied to pre-revolutionary Russia. This vast country covering a large part of the world's territory and inhabited by industrious and talented people was dependent on more developed capitalist countries. No wonder, therefore, that the standard of health of its people was considerably lower than that of the people of many other countries.
Although books dealing with public health and medical science do not usually dwell on special problems of economics, welfare, culture and science, we think it to the point to start our narrative about Soviet medicine with at least a brief outline of these problems.
In October 1917 a gunshot from the Cruiser Avrora heralded the beginning of a new era in Russia---the era of socialism. Theses of the Central Committee of the Communist Party of the Soviet Union On the Centenary of the Birth of V. I. Lenin read:
``The Great October Socialist Revolution gave the world an example of how to solve fundamental social problems: the 9 overthrow of the power of the exploiters and the establishment of the dictatorship of the proletariat, the turning of the private property of the bourgeoisie and landlords into public socialist property, the just solution of the agrarian problem in the peasants' favour, the liberation of the dependent peoples from colonial and national oppression, and the creation of the political and economic prerequisites for the building of socialism.''^^*^^
For the first time in history, the new socialist stale upheld (he interests of the working people as its main concern, and provided the necessary economic, social and political conditions to put this idea into practice. The socialist state was built according to the plans and under the leadership of the party that expresses the hopes and aspirations of the industrial workers, peasants and all working people----the Party of Communists headed by V. I. Lenin.
Under the extremely hard conditions of the economic chaos and famine caused by the war, armed foreign intervention and internal counter-revolution the Communist Party and the Soviet Government led the people in their efforts to reconstruct the economy on socialist principles.
To build socialism was neither simple nor easy. The Soviet people were able to build a socialist state only at the cost of privation and rigorous economy.
The following very brief information on the Soviet socialist state should give the reader an idea of the multiformity and complexity of the problems Soviet medicine has to tackle.
__ALPHA_LVL2__ Territory. PopulationThe Soviet Union covers a vast area on two continentsEurope and Asia. From east to west it stretches for more than 9,000 km and from north to south---for more than 4,500 km. The territory of the USSR is 22.4 million sq. km. which is one-sixth of the earth's surface. Of course such vast spaces include most of the known climatic zones.
The USSR is a multinational socialist state with more than 100 nationalities living in a friendly, fraternal union. It is _-_-_
^^*^^ Lenin's Ideas and Cause Are Immortal. Theses of the Central Committee of the Communist Party of the Soviet Union on the Centenary of the Birth of V. I. Lenin, Moscow, 1970, pp. 17--18.
10 composed of 15 Union Republics. The most typical administrative territorial unit is a region usually having a population of one million or more. Regions are divided into districts with a population of 20,000 to 100,000 or even more.On January 15, 1970 the population of the USSR numbered 243.9 million. The majority of the population (56 per cent, according to the figures of the 1970 census) lives in towns and urban-type settlements. The rural inhabitants account for 44 per cent of the country's population. These two simple figures evidence the truly immense leap forward made in the country's industrial development. Pre-- revolutionary Russia was characterised by a great predominance ol rural over urban inhabitants; in 1913 the former accounted for 82 per cent of the country's population.
According to the 1968 figures of the Central Statistical Administration, 77.7 per cent of the population are industrial and office workers, 22.27 per cent are collective farmers and co-operative artisans, and only 0.03 per cent are individual peasants and artisans not united in co-operatives.
Socialism has done away with the exploiter classes. In the USSR there are no bourgeois, landowners or private businessmen. There are two friendly classes---workers and collective farmers. The intelligentsia---brain workers---- constitutes a fairly large part of the population and numbers more than 30 million.
The people of the Soviet Union endured the terrible sufferings during the Civil War and the Great Patriotic War against the nazi invaders. Even today, nearly 30 years after the end of the Second World War, it would be hard to find a family that did not lose a dear one. During this war alone the USSR lost at least 20 million people---officers, soldiers and civilians. This ordeal, courageously endured by the Soviet people has unfavourably affected the age and sex composition of the population. It has resulted in a considerable sex disproportion, i.e., in a substantial predominance of women in the population. The 1959 census, the first since the Great Patriotic War, showed that 45 per cent of the population of the Soviet Union were men and 55 per cent were women. This disproportion still persists, although in a somewhat attenuated form. It stands to reason that this unfavourable ratio particularly affected those who at that time were in their prime. Today there are still twice as many women aged 45 and older as there are men oi that age.
11Pre-revolutionary Russia was characterised by what is called frequent change of generations, caused by a high birthrate (45.5 per 1,000 in 1913), high general mortality (29.1 per 1,000 population) and particularly high child mortality---of 1,000 newborn children 269 died before reaching one year of age. Average life expectancy, which is a comprehensive index of the health of the population and demographic phenomena, was only 32 years for both sexes, in most gubernias (regions) of Russia at the end of the 19th century. Despite the high mortality rate, especially of children, the high birthrate compensated, in large measure, for the human losses caused by disease, injuries and other factors. According to statistics, the population of pre-revolutionary Russia increased at a comparatively high rate; in 1913 it was 16.4 per 1,000.
The radical changes that have taken place in the country in Soviet times---the creation of a modern industry, the development of culture, science and technology and a sharp rise in the living standards of the population---have greatly altered demographic processes and phenomena. The very pattern of population turnover has changed and is no longer characterised by a frequent change of generations. On the contrary, generations are replaced now at a slow rate. This means that general and child mortality has sharply decreased and life expectancy has grown. According to official data, in 1968 life expectancy was 66 years for men and 74 for women.
Characteristic of the age structure of the Soviet population today is the so-called ageing of the population, which manifests itself in an increased proportion of people aged 60 years or more and a relatively lower proportion of younger people. Whereas, according to the 1939 census, people 60 years old and older accounted for just over six per cent of the population, the 1959 census showed that this figure had grown to 9.3 per cent. The proportion of elderly and old people has increased still further and, as the 1970 census showed, about 11--12 per cent of the population are 60 years old or older.
The population of the Soviet Union is increasing annually by about 3 million. Since the 1959 census it has increased by more than 35 million (as of January 15, 1970).
However, an increasing population is no cause for alarm in the Soviet Union as it often is in countries with a large 12 population but without an adequate economic potential. Both control and family planning, i.e., in the final analysis, measures aimed at curtailing the natural increase in population, have never been encouraged in the USSR. On the contrary, all social policy, since the very first days of Soviet power, has favoured a high natural increase in the population. The content of Soviet demographic policy has always been the same---the encouragement of childbirth and state protection of mothers and young children.
We shall have further cause to dwell on this question and on the system of medical care for women and children, which has contributed much to improving the health of the Soviet population. We shall just note here that the fact that abortions are permitted in the USSR does not mean an attempt to reduce birthrate. It merely gives the women themselves, and their families the right to decide how many children they wish to have.
The Soviet state is interested in increasing the population since everybody in the Soviet Union is guaranteed work and normal conditions of life. The distressing effects of the capitalist economic system---unemployment and poverty among the working people---have long since been abolished in the USSR.
__ALPHA_LVL2__ The Economy and Living ConditionsThe October Revolution not only delivered the people of Russia from exploitation and backwardness, but also started the country on the wide road of scientific and technological progress. We need only refer to the figures of the national income (a highly significant economic index) to see the fast rates of Soviet economic development. Between 1913 (before the revolution) and 1970 the national income increased 46 times. In the postwar years the Soviet people effected a speedy restoration of towns and villages which had been distroyed by nazi invaders. They have achieved, to date, an 8-fold increase, as compared to 1940, of the social product and have carried out a technical re-equipment of the national economy. Powerful industry built up in Soviet times has made it possible not only to develop the means of production, but also to produce consumer goods at a fast rate. Industry and agriculture have developed much faster than in economically developed capitalist countries. For example, 13 the average annual rate of increase in industrial output in the USSR hetwcen 19.51 and I96S was 10.4 per cent, whereas in the USA, during the same period, it was 4.5 per cent, in Britain---2.9 per cent, in France---.5.4 per cent, and in the FRG 7.3 per cent.
But the Soviet Union not only has a higher growth rate than most of the economically developed capitalist countries but also a greater absolute industrial output and is second in certain indices only to the USA. For example, in 1970 the USSR produced 740,000 million kwh of electric power, extracted 353 million tons of oil, mined 624 million tons of coal and smelted 85.9 million tons of pig iron and 116 million tons of steel.
By concluding the eighth five-year period successfully, the Soviet people made another step forward to the creation of the material and technological basis of communism. The 24th Congress of the CPSU adopted Directives for the new Five-Year Plan of Economic Development for 1971--1975. The main task of the new five-year period is to achieve another considerable rise in the material and cultural level of the people on the basis of a fast rate of development of social production, its higher efficiency, scientific and technological progress and a rapid rise in labour productivity. The welfare of the people is the primary concern of the Communist Party.
The development of the economy has led to a considerable rise in the living standards of Soviet citizens. Huge sums from the state budget are spent on satisfying the material and cultural needs of the population. The real incomes of workers have increased 8-fold and those of collective farmers 12-fold. Directives of the 24th Congress of the CPSU envisage a further rise in the people's welfare. Between 1971 and 1975 the real incomes of the working people will grow by an average of 30 per cent. Three quarters of this rise will be accounted for by wage rises. The planned wage rises will affect nearly 90 million people. In addition to wage rises social consumption funds will also grow considerably, as was stated in the Report of the Central Committee of the CPSU to the 24th Party Congress. Their volume will be increased by 40 per cent and reach 90,000 million rubles in 1975. These funds will be used to implement a broad social programme. The amounts spent by the state on social and cultural purposes may be judged by the figures of the 1970 USSR state 14 budget; allocations for the above purposes amounted to 56,000 million rubles, which is nearly as much as was spent on the development of industry and agriculture and much more (3 times as much) than was spent on defence. Expenses on social and cultural measures are increasing with each passing year. In addition to the state budget funds, large sums are also allocated to the public consumption funds by state and co-operative institutions. Including these sums the total amount spent on social and cultural purposes in 1970 exceeded 70,000 million rubles.
We have dealt with this question in such detail because a considerable part of the above-mentioned funds are allocated to the development of the public health service in the USSR; this will be dealt with in more detail below.
In 1970 a considerable proportion of all the money spent on social and cultural purposes---more than 21,000 million rubles---was used for social insurance and social maintenance. The larger part of this money goes for various pensions, including old age pensions. In 1970 the total number of pensioners in the Soviet Union was 41.6 million, including 12.3 million collective farmers; 36 million of these were old age pensioners, invalids, etc., and 5 million were former servicemen. According to Soviet law, pensions are granted to men at the age of 60 and to women at the age of 55. Moreover, a large group of the population---workers in difficult trades, women employed in certain enterprises and several other categories of workers---are granted pensions 5-10 years earlier.
The following figures may be cited by way of comparison: in the USA, for example, the pensions for men begin at 65 and for women at 62; in the FRG, the Netherlands and Finland the pension age is 65 for both men and women; in Switzerland it is 67, and in Canada, Ireland and Norway--- 70. In the USSR, besides the comparatively early pension age, old age pensions are between 50 and 100 per cent of a person's working wage. Considerable changes in social insurance and social maintenance are to take place within the next five years. As of July 1971 the minimum old age pension to workers, office employees and collective farmers went up by 50 per cent. Invalidity pensions will be increased, as will those granted on the loss of the breadwinner. The paid leave to take care of a sick child will be enlarged, and the network of old age and invalid homes will be extended.
15The Soviet system of state pensions, as well as paid leave in cases of temporary disability (illness or injury), looking after a sick child or relative, quarantine, etc., not only contributes to the material welfare of the people, but helps to maintain their health.
It is also important to note that in the USSR the pensions and other allowances are granted entirely from state funds (not.through deductions from personal incomes as is the case in many capitalist countries) and that the state has placed all the funds allocated for social insurance at the disposal of the trade unions which effect their distribution.
If we add up all the gratuities and allowances the people receive from the public consumption funds we lind the total sum to be quite imposing; in 1970 these grants amounted to 262 rubles per head. In addition, the state and the collective farms spend about 150 rubles a year per family on the construction of houses, municipal services, and cultural and medical institutions.
The working hours have been significantly shortened in the USSR and the working conditions improved. Today most of the working people have a 40.7-hour week and most of the industrial enterprises and offices work 5 days a week; this allows the working people to make fuller and better use of the two free days for rest, recreation, and for their cultural development.
The problems of food and modern housing are being successfully solved. Valuable foodstuffs rich in proteins, vitamins
__PARAGRAPH_PAUSE__Table 1 Consumption of basic foodstuffs (kg per capita, per annum) Foodstuffs 1913 1968 Meat and fat 29 48 Fish and fish products 6.7 14.3 Milk and dairy products (in terms of milk) 154 285 Eggs (in tens) 4.8 14.4 Breadstuffs 200 149 Potatoes 114 131 Vegetables and melons 40 79 Sugar S.I 37.4 16 and other necessary ingredients occupy an ever increasing place in the diet. Increasingly more meat, milk, eggs and sugar arc consumed, and less bread and cereals, which used to be the mainstay of the diet for the majority of Russia's working people (Table 1).
More and more houses are built every year. During the last 10 years half the country's population has been given new dwellings or otherwise improved their living conditions.
In rates of housing construction the USSR has outstripped the economically developed capitalist countries. This is evidenced by the following table.
Table 2 Number of flats built per 1,000 population in 1968 Country Number of Hats USSR Britain USA France Italy 9.4 7.9 7.7 8.3 4.9We must also remember that in the USSR the rent does not, as a rule, exceed 5 per cent of the wages of industrial and office workers, whereas in capitalist countries it amounts to one-fourth and, not infrequently, one-third of the total personal income of the working family.
Fundamental changes have taken place in Soviet education, science and culture. Illiteracy was wiped out during the first two decades of Soviet power. Science and the arts were brought within the reach of millions of people. During the 1969--1970 school year the higher, general educational and other schools were attended by almost 79 million people.
An extensive network of research institutions uniting hundreds of thousands of scientific workers in all fields of knowledge has been set up in the USSR. The general headquarters of Soviet science is the Academy of Sciences of the USSR. In addition to this central academy there are also socalled branch academies, including the Academy of Medical Sciences of the USSR.
__PRINTERS_P_17_COMMENT__ 2---1065 17The national policy of the Soviet state provides every opportunity to all peoples within the Soviet Union for the development of science, culture and education. The former outlying, backward districts of tsarist Russia have become prosperous, industrially developed, sovereign republics with an advanced science and culture. Peoples such as the Komis, Mordvinians, Adygeyans, Altaians, Khakasses, etc., who formerly did not even have a written language, now take pride in their doctors, engineers, scientists, writers and artists.
This is just a brief outline of the development of the country's economy and the improvement of the well-being and culture of the Soviet people, but we hope it will be useful for the understanding of the problems tackled by the Soviet public health service, considering the direct dependence between the level of health protection and the country's social conditions.
[18] __NUMERIC_LVL1__ Chapter 2 __ALPHA_LVL1__ THE GREAT OCTOBER REVOLUTIONMany books have been written on life in pre-revolutionary Russia, and most of them speak about the poverty of the people of this great state.
The low living standards and culture of the people of the multinational Russian Empire could not fail to affect their health. The state of the people's health was such that even government bodies had to admit the grievous condition of the country's health protection and sanitation. The official, interdepartmental commission chaired by Professor G. Y. Rein, a well-known medical scientist, which was specially set up in 1912 to elaborate and submit proposals for reconsidering medical and sanitary legislation, arrived, after a study of public health in the empire, at the following conclusion: "A vast part of Russia has as yet absolutely no provisions for medical aid, the result of which is a distressing sickrate and mortality from communicable diseases, as well as generally very low health standards.'' Even according to the official statement of the State Duma (parliament), Russia was ridden with all possible contagious diseases; almost 20 per cent of workers permanently employed in towns and 28 per cent of temporary workers received no medical aid from the enterprises in which they worked.
Many such facts attesting the highly insanitary living conditions in tsarist Russia could be cited. But the two statements given above are convincing enough evidence of the low health standards and organisation of medical aid in prerevolutionary Russia. Indeed, in 1913, the year most satisfactory, from the point of view of the country's economic development and sanitation, general mortality in Russia was __PRINTERS_P_19_COMMENT__ 2* 19 some 2-2.5 times as high as in the economically developed countries (Britain, USA, Germany, France, etc.). More than one-quarter of children born died of various diseases and abnormalities before reaching one year of age. These were the mean figures. Obviously, there were areas and vast territories with much higher mortality indices; even in Moscow Province, the country's central area, child mortality was as high as 300 per 1,000 newborn.
In old Russia, as in most economically underdeveloped countries, high mortality was paralleled by a high birthrate (45.5 per 1,000 population in 1913) which resulted in a comparatively large natural increase in population---15--17 per 1,000. At the same time the mean life expectancy was very low---32 years, according to the 1896--97 census.
The poor sanitation also accounted for the high incidence of infectious and parasitic diseases, including those requiring quarantine---cholera, smallpox, plague, typhus and typhoids. According to very incomplete data, more than a million typhus cases were recorded during the 10 years that preceded the First World War. It is but natural that social diseases--- tuberculosis, venereal diseases and alcoholism---should have found a fertile soil for their development. More than 30 persons out of 1,000 applying to physicians during that period were infected with syphilis or gonorrhea. The medical examinations of recruits, young and, one would think, the healthiest people, showed that 50 to 100 per 1,000 had pulmonary tuberculosis.
Infectious diseases annually carried to the grave more than one million adults, while two million children died every year primarily of infectious and parasitic diseases.
It goes without saying that this picture was evidence of the extremely bad living stttndards of the people.
``Thousands and tens of thousands of men and women, who toil all their lives to create wealth for others, perish from starvation and constant malnutrition, die prematurely from diseases caused by horrible working conditions, by wretched housing and overwork.''^^*^^ V. I. Lenin thus determined the social causes of the poverty and diseases of Russia's working people.
Pre-revolutionary literature contains hundreds and perhaps thousands of pages about the really terrible living _-_-_
^^*^^ V. I. Lenin, Collected Works, Vol. 5, p.
20 conditions of the working people. Leaflets put out by revolutionary-minded workers, who called for the overthrow of autocracy, described with wrath and grief the unbearable working conditions in plants and factories, the frequent mutilations, short life span, weak health and poor physical development of the workers. It stands to reason that the working people could not but take action against these inhuman living conditions.Progressive doctors and other medical workers fought together with the workers and the working-class party for a better life, social justice, freedom and equality of the working people, as well as against their unbearable living conditions and poor health. They demanded more hospitals and medical personnel and bigger government allocations for medical aid to the population. They dreamt of providing free medical aid for all people. Many dedicated doctors went to work in Zemstvo medical institutions, i.e., the few hospitals and dispensaries which were built for peasants in rural areas. But the dedicated doctors and other medical workers were too few to bring about any radical changes in the country's public health system, because this could be done only by a cardinal change in the entire state system of tsarist Russia. By 1913 all the departments of Russia employed just over 28,000 doctors and 46,000 junior medical workers, i.e., there was one doctor per 5,665 population (1.8 doctor and about 3 junior medical workers per 10.000 population). In this respect Russia was in a somewhat better position than the colonial and scmicolonial countries, but lagged far behind the USA and West European countries. Many regions of Russia had no doctors at all, while in a number of outlying national areas there was one doctor per scores of thousands of people. Moreover, the few doctors who worked in the provinces lived in towns so that the rural population was practically deprived of skilled medical aid.
The number of medical institutions was also very small. For example, all Russia's hospitals numbered a total of 208,000 beds or 13 beds per 10,000 population (1913).
The country had scarcely any medical or pharmaceutical industry and no sanitation or epidemiological services; there were very few sanitary inspectors---only a few dozens in all. Another unfavourable factor was the absence of any centralised medical state organisation. Nearly every ministry and every department had its own medical division. Besides, 21 numerous philanthropic, religious and public organisations had their own medical institutions. Even the military medical services were not controlled from a single centre. True, not long before the revolution of 1917 an attempt was made to organise a chief administration of state public health system, a kind of ministry with Professor G. Y. Rein at the head, but this attempt failed.
In analysing the causes of this poor situation in public health and organisation of medical aid in Russia it must be pointed out that not only was it due to the weakness and inadequate development of Russia's economy, but also to the criminally heartless, bureaucratic attitude of the tsarist government to the needs of the working people. Miserably small sums were allocated from the state budget for medical aid; the largest allocations were made in 1913, but even they did not exceed 91 kopeks (in comparable prices) per head the population. Of these sums only 5 kopeks were detailed for sanitation and anti-epidemic measures which required the most attention. Recalling his work as a Zemstvo doctor, A. P. Voskresensky, one of the most experienced physicians of the time, said at one of the medical congresses held after the October Revolution: "Under the curse of tsarism there was only one doctor for every two provincial towns. In the villages there were no doctors at all. It was a mere caricature of medical aid. There was practically no organisation of sanitation. The nobles in Zemstvos feared health education, regarding it as something revolutionary.''^^*^^
The acute shortage of medical personnel could not be made up by the training of doctors, surgeons' assistants and other medical workers because there were far too few higher medical schools. In 1913 Russia had 16 medical colleges, including ten medical faculties in universities, the so-called higher women's courses in some universities, a Military Medical Academy and a psychoneurological institute which, in addition to conducting research, also trained physicians.
These institutions served as the main base for medical research because there were very few special research bodies _-_-_
^^*^^ As was already noted, Zemstvo medical institutions were organisations maintained at the expense of so-called Zemstvo self-government bodies which were like municipalities, but were designed to cater for the rural population. Their functions included maintenance of schools, district hospitals and dispensaries. The Zemstvos were, as a rule, in the hands of the nobility, landlords, and rich peasants (kulaks).
22 and laboratories. There was only one comparatively important research centre---the Institute of Experimental Medicine founded in St. Petersburg (now Leningrad) in 1890. There were also several laboratories and small research centres in the system of the Russian Academy of Sciences.Despite all this, the works of Russian medical scientists were well known abroad. The schools of professors I. M. Sechenov, S. P. Botkin, I. P. Pavlov, N. Y. Vvedensky, V. M. Bekhterev and many others won world renown.
However, the scientists had no means at their disposal to carry their achievements into effect because they had neither an adequate research base nor enough money. Only a social revolution could ensure fundamental changes in the public health system and medical aid. It was no accident that the Programme of the Russian Social-Democratic Labour Party elaborated by V. I. Lenin and adopted by the Second Congress of this party in 1903 advocated the overthrow of autocracy "to safeguard the working class from physical and moral degeneration, and also to raise its fighting capacity in the struggle for its emancipation. ...''^^*^^
The historical situation made it clear that "outside socialism there is no deliverance of humanity from wars, from hunger, from the destruction of still more millions and millions of human beings".^^**^^
__ALPHA_LVL2__ Formation of the Soviet Public Health SystemOn the night of October 24 and the early hours of October 25 (November 7, Gregorian calendar) 1917 there was an armed uprising in Petrograd of the city's workers, Baltic Fleet and Petrograd garrison. The victorious Great October Socialist Revolution ushered in a new epoch in the history of man. Soviet power was established and literally at once began to reorganise society on a socialist basis in the interests of the working class and the toiling peasantry. During the very first days of the Revolution the 2nd Congress of Soviets, as the supreme body of state power, adopted the decrees on peace and land. The land, plants and factories, mines, banks and railways became the property of the people. Everything possible was done to improve immediately the _-_-_
^^*^^ V. I. Lenin, Collected Works, Vol. G, p. 30.
^^**^^ Ibid., Vol. 24, p. 37.
23 lot of workers and peasants. The first state enactments included the law On the 8-hour Working Day, the Duration and Distribution of Working Time, the law On Social Insurance, the law On Placing All Medical Institutions under the Jurisdiction of the Workers' Illness Insurance Funds and many other laws which fundamentally altered everything concerned with medicine in the Land of Soviets.The Communist Party and the Soviet Government devoted a great deal of attention to organising medical aid for the people. V. I. Lenin personally signed nearly 100 decrees on medical aid, illness insurance, etc.
The socialist state of workers and peasants began organising a new public health system. New and unprecedented organisations and institutions of the public health system were set up under the appalling conditions of the Civil War unleashed by counter-revolutionary forces in Russia and complicated by the famine that involved vast territories of the country, and economic dislocation. These were medical and sanitary boards under local government bodies. A Medical and Sanitary Department headed by Doctor M. I. Barsukov was organised under the Revolutionary Military Committee in Petrograd on October 26, 1917, immediately after the armed uprising. This department, which became the first central public health body of the Soviet Republic was charged not only with administering medical aid to the insurgents, but also with reorganising all matters of public health.
Soon, in January 1918, a so-called Council of Medical Boards was organised as the country's supreme public health body by a special government decree. It was thus named because the People's Commissariats (ministries) that were being organised had medical or medical and sanitary boards. The Council of Medical Boards united the work of all of these boards.
It should be noted that at the outset there was no people's commissariat of health. The reason for this was that for some time after the revolution not all the doctors sided conclusively with Soviet power. Some of them failed to grasp the aims of the revolution, did not understand the essence of the democratic reorganisation carried out by the Government and the Communist Party and opposed the undertakings of the young Soviet state.
And only after the first and most representative congress 24 of public health workers---the Congress of Medical and Sanitary Boards---met in June 1918 and passed a special resolution on the expediency of establishing a People's Commissariat of Health was a decree issued and signed by V. I. Lenin. This decree dated July 11, 1918, set up the first, central, state body of public health not only in the Republic of Soviets, but in the world,---the People's Commissariat of Health. N. A. Scmashko, a prominent theoretician and organiser of health protection, was appointed People's Commissar and Z. P. Soioviov his deputy. The first members of the Board of the People's Commissariat of Health included such eminent physicians as V. M. Bonch-Bruyevich (Velichkina), A. P. Golubkov, P. G. Dauge and Y. P. Pervukhin.
A Central Medical and Sanitary Council under the People's Commissariat of Health was established by a government decree, with representatives of various public organisations, as well as of workers, peasants and other sections of the population, taking part in the discussion of questions concerning the development of health protection. A Scientific Medical Council under the chairmanship of Professor L. A. Tarasevich, an outstanding microbiologist, was organised as an advisory body of the People's Commissariat of Health. This council played a notable role in rallying the country's scientific medical forces for the purpose of solving urgent practical problems of public health.
During the same period a number of medical research institutes and laboratories were founded by decision of the Government.
It should be noted that a number of well-known Russian scientists, including V. M. Bekhterev, D. K. Zabolotny, A. N. Sysin, A. N. Bach, P. N. Diatroptov, Y. I. Martsinovsky, N. I. Shaternikov, etc., supported the revolutionary workers and peasants from the first and their tireless work greatly helped the public health bodies of the Republic.
The 8th Congress of the Russian Communist Party ( Bolsheviks) held in March 1919 was of historical importance in the development of health protection in the USSR. The Congress discussed a number of urgent military and agricultural problems and adopted the Party Programme. Elaborated under V. I. Lenin's leadership the Party Programme became the document that determined the main trends of development in all spheres of political, economic and social life, including the sphere of public health. It was the first time in 25 history that a party programme contained a special article on public health. The article defined not only the objectives of health protection, but also the ways and means of achieving these objectives. However, the organisation of a public health system, the construction of medical, sanitary and antiepidemic institutions, and the training of doctors and other medical workers were hampered by the Civil War which had been unleashed by the enemies of socialist state.
The medical personnel of the country had to administer aid to the fighting men of the revolutionary Red Army and organise a nationwide struggle against the epidemics raging in the country. Despite the lack of skilled personnel they managed to mobilise all of the country's forces to stem the spread of epidemic diseases, increase the number of beds in hospitals for wounded and sick fighting men and carry on educational work in sanitation and hygiene among the population. Special commissions were set up in government bodies, the People's Commissariat of Health in particular, to mobilise all resources for the purpose of preventing the spread of epidemic diseases, especially epidemic and recurrent typhus. The decree on compulsory smallpox vaccination was issued in 1919. Urgent measures adopted in connection with it were largely instrumental in stopping the spread of smallpox.
The government decree (September 1922) on sanitary bodies of the Republic was particularly important to the carrying out of antiepidemic and sanitary measures. This decree laid the foundation of the country's sanitary and antiepidemic organisation. The first special state institutions to control current sanitation and antiepidemic measures were founded.
Subsequently, beginning with the government enactment on sanitary bodies of the Republic (February 1927), not only current, but also preventive sanitary control was exercised in the country, by the special sanitary and antiepidemic institutions, the so-called sanitary and antiepidemic stations. The All-Union State Sanitary Inspection was organised.
The primary task after the victorious conclusion of the Civil War was a speedy restoration of the national economy, including the network of medical institutions, disrupted during the war. It was necessary not only to expand this network and increase the number of doctors and other medical workers, but also to make an historically unprecedented leap 26 from backwardness and poor health of the population to a socialist system of health protection which would ensure a rapid improvement of all the indices of social health. The USSR entered a period of reconstruction of the national economy based on industrialisation of the country and collectivisation of agriculture. During this period, while a powerful base was being built for socialism, medical aid to the workers and collective farmers acquired particular importance. A special decision adopted by the Central Committee of the Communist Party in December 1929 not only mapped out definite tasks involved in the solving of this problem, but also defined practical means of its solution. It was precisely during this period that new forms of medical care and new medical institutions were developed. These included primary medical centres at industrial enterprises, administering medical aid to workers on the job. Rational organisation of medical aid made it possible to reduce considerably the sickrate of industrial and office workers and thus to provide the national economy with additional labour power.
Many medical institutions were developed in those years. The principles of the dispensary method were laid down; this method combines both therapeutic and prophylactic work. It will be dealt with in detail below. It is a complex overall service catering to a specific group of the population and involving early and active detection of disease through systematic medical examinations, the summoning of patients to medical institutions, timely and complete treatment, as well as rational employment and improvement of working and living conditions, in accordance with medical indications. This method naturally requires a large number of medical institutions and many specialists. That is why it could not be fully implemented at that time. Only several decades later could the task providing dispensary service for all of the urban and rural population be posed. However, some medical organisations, for example, those of Moscow and Leningrad, tried even at that stage to provide the service for the whole population of their cities.
The system of rural public health was essentially reorganised. The main stress was laid on the organisation and active functioning of rural district hospitals. A large number of doctors and other medical workers was sent to the countryside where appropriate living and working conditions were created for them.
27It was also at that time that an efficient sysiem ot mother and child protection incorporating an extensive network of children's polyclinics and consultation centres, maternity consultation centres and hospitals was set up.
The Constitution of the Soviet Union adopted in 1936 contained articles which not only declared, but also guaranteed the right of all Soviet citizens, regardless of nationality, religious denomination, social and material status, to rest and material security in old age, as well as in cases of sickness and disability. The Constitution also guaranteed equal rights for men and women and state protection for mother and child.
As a result of important measures aimed at developing the system of Soviet public health, by 1940 the number of doctors increased to 155,000, that of the junior medical personnel, to 472,000, and the number of hospital beds, to 791,000.
The improvements in health protection were particularly noticeable in the former outlying districts of Russia where new modern medical institutions were established and staffed with doctors, nurses and medical technicians of local nationalities. This is evidenced by the following figures: in 1940, as compared with 1913, the number of doctors and hospital beds had increased more than 20-fold in Uzbekistan, nearly 15-fold in Kazakhstan and more than 35-fold in Kirghizia. In the Tajik Republic the number of doctors had increased 45-fold and that of hospital beds 46-fold. In Armenia, Azerbaijan and other republics the number of doctors and hospital beds had increased many times over. Before the outbreak of the Second World War all the Union Republics already had their own medical colleges and schools for junior medical personnel and began to turn out medical scientists. Between 1929 and 1939 twenty-four new medical institutes were set up and began graduating large numbers of medical specialists.
__ALPHA_LVL2__ The Great Patriotic WarThe Soviet people suffered bitter trials during the Great Patriotic War against nazi Germany which had treacherously attacked the USSR. The Soviet public health system withstood these trials honourably. All reserves were mobilised for the purpose of organising an efficient system of specialised 28 medical aid as close to the field of battle as possible, evacuation hospitals and medical aid for the people in the rear. Special attention was devoted to providing food and medical care lor women and children. Naturally, all necessary measures were taken to prevent epidemics.
Thanks to these and other urgent measures the spreading of infectious diseases was avoided which saved the lives of hundreds of thousands of servicemen and civilians. For the first time in the history of war on the territory of the Soviet Union, there were no epidemic outbreaks of any appreciable size. The percentage of officers and men returned to the ranks was unusually high---more than 72 per cent of the wounded and 90 per cent of the sick.
A sizeable contribution to the victory over the aggressor was made by medical scientists. It was no accident that during the Great Patriotic War (in 1944) a decision was taken to organise a single medical research centre---the Academy of Medical Sciences of the USSR. Academician N. N. Burdenko, outstanding scientist and Chief Surgeon of the Soviet Army, was elected its first president.
The war inflicted immeasurable losses on the Soviet people. These included 20 million servicemen and civilians killed and millions of mutilated, sick and disabled; 1,710 towns and more than 700,000 villages, 40,000 hospitals, polyclinics, dispensaries, sanitary and antiepidemic centres and other medical institutions were completely or partly destroyed. A tremendous amount of work had to be done to restore the economy ruined by the war. Already the 1946--1950 FiveYear Plan adopted by the Supreme Soviet of the USSR in March 1946 provided not only for restoration of the prewar level of public health, but also for a considerable increase in the number of medical institutions and the size of personnel; the number of hospital beds was to be increased to one million and that of doctors severalfold. The medical and pharmaceutic industries established before the Second World War were to be expanded.
__ALPHA_LVL2__ Public Health Services in the USSR since 1945By 1950 these objectives of the Five-Year Plan had been attained and the number of medical institutions, hospital beds and doctors exceeded the pre-war number.
The next Five-Year Plan contained provisions for further 29 consolidating and expanding the material and technical base of public health and for enhancing the quality of medical aid by speeding up specialisation.
In 1955, as a result of the successful fulfilment of the five-year plans, the country already had more than 340,000 doctors, close to one million junior medical workers and almost 1,300,000 hospital beds.
The important organisational measures of that period included the unification of dispensaries and polyclinics witli hospitals. Since then (1947--48) the so-called unified hospital consisting of a hospital proper and a polyclinic has become the basic medical institution in the USSR. This has made it possible not only to improve the quality of medical aid, but also to enhance the skills of the physicians.
During the same period the administration of health protection was also reorganised in the countryside. The district public health boards were abolished as the basic administrative bodies in rural areas, and all organisational and economic functions connected with managing public health institutions were transferred to unified district hospitals. The doctor in charge of such a district hospital became the chief physician of the district and was responsible for the work not only of the hospital, as the chief medical institution, but also for that of all the other medical institutions of the district.
Particularly important in improving the health of the population were the decisions of the Party and Government on increasing social aid. The 1956 Session of the USSR Supreme Soviet passed a law on state pensions, which considerably increased the pensions and reduced the pensionable age. At the same time a decision was taken to reduce the workday preceding restdays and holidays by 2 hours; subsequently this decision was followed by the introduction of the 5-day workweek in the majority of enterprises. Also very important to public health were the enactment on increasing maternity leave from 77 to 112 days and other decisions that contributed to raising the living standards of the people and improving public health.
The postwar period has been characterised by increased international activity of Soviet public health workers. It is well-known that the Soviet Union was one of the founders and has been one of the most authoritative members of the World Health Organisation founded after the Second World 30 War. The Soviet medical people have expanded their international contacts. More and more of them are taking part in national and international scientific medical congresses and symposiums.
One of the most important events in the development of Soviet health protection was the 22nd Congress of the Communist Party of the Soviet Union (1961) which adopted a new Programme of the Communist Party in which questions of public health occupied an important place. The public health objectives envisaged in the New Programme logically ensued from those set up by the Party before, the prophylactic trend given first priority. The construction of a substantial material and technical base of public health made it possible to achieve such aims as providing all the population of the towns and countryside with highly-skilled and specialised medical care and dispensary services.
Special importance is now attached to developing specialised medical aid and to establishing large medical treatment and research institutions with up-to-date equipment.
At its session in June 1968 the USSR Supreme Soviet considered the problem of the further development of public health services in the USSR. Concrete measures aimed at attaining the objectives posed were elaborated.
The Decision adopted by the Central Committee of the Communist Party of the Soviet Union and the USSR Council of Ministers on July 5, 1968, On Measures for Further Improving Public Health and Developing Medical Science in the Country gave special attention to further improving the quality of medical aid and health protection. The tasks set include a decrease in general and infectious disease incidence and traumatism, improvement of the living and working conditions, an improvement of general sanitation and of the work of hospitals, and sanitary and prophylactic institutions, and introduction of the latest achievements of medical science and scientific organisation of labour into public health practices. With this end in view, an expansion of the material and technical base of public health is envisaged and the construction of large specialised hospitals and medical centres planned. Interregional and republican centres of most important forms of specialised medical care will be built and further enlargement and modernisation of city and rural hospitals, polyclinics and dispensaries carried out. The sanitary and antiepidemic centres, and also the research 31 institutions, are likewise to be enlarged and provided with up-to-date'equipment. Considerable attention is given to working out long-term plans for developing the most important brandies and trends of medical science (prognosis). The Decision contains provisions for increasing state allocations for medical aid and medical science. Improvement of medical aid, further development of specialisation, the construction of large hospitals and first aid centres, both in towns and rural localities, further expansion in the production of medicines and various medical equipment, such are the main tasks as regards public health posed by the 24th Congress of the Communist Party of the Soviet Union.
[32] __NUMERIC_LVL1__ Chapter 3 __ALPHA_LVL1__ "HEALTH INDEX" __ALPHA_LVL2__ [introduction.]In the preceding chapters it was shown that, as a result of the rise in the living standards of the Soviet people and the development of culture and the economy, the general health of the people has greatly improved. General and child mortality have sharply decreased, while the average life expectancy has more than doubled. The changes in the health of the Soviet people have been so great that it would not be wrong to speak of a transformation of the type or profile of pathology, i.e., fundamental changes in mortality indices and disease incidence. Whereas before the Great October Socialist Revolution the type or profile of pathology was characterised by a prevalence of infectious diseases, including acute communicable epidemic diseases, i.e., was essentially epidemic, today it may be called nonepidemic. This is to say that infectious and parasitic diseases have been ``superseded'' in the structure of disease incidence and especially of mortality by nonepidemic disorders which usually run a chronic course. It was owing to this and other factors that general and child mortality has gone down, the average life expectancy has increased, and the other health indices and demographic phenomena have changed. In particular, the accelerated change of generations that was observed in pre-revolutionary Russia has given place to a reduced change of generations.
Obviously we need to go into the above processes in greater detail because they are of considerable importance not only in analysing the state of the people's health, but also in evaluating the work of the public health services.
__PRINTERS_P_33_COMMENT__ 3---1065 33 __ALPHA_LVL2__ Decrease in MortalityIt is well known that the frequently used index of general mortality, i.e., the number of deaths per 1,000 population in a year, is not a sufficiently flexible and all-round index of the state of the people's health. Nevertheless, it offers an idea of the changes in the level of health, especially over long periods of time. It is also a very valuable index of the state of health in countries with widespread infectious and parasitic diseases which often have a lethal outcome.
Today most of the economically developed countries have a general mortality index of between 7 and 12. This has also for many years been the stable index of general mortality in the Soviet Union. Moreover, general mortality figures in the Soviet Union during the last few decades reveal a clear tendency towards a decrease. For example, in 1940 the general mortality index was 18, in 1950 it was 9.7, in 1955 it went down to 8.2, while today it is about 7.9. Admittedly, of late (since about 1960) there has been no appreciable decrease in this index, which seems to be due to the influence of various factors, including the process of ageing of the population which is also observed in most economically developed countries. Nevertheless, the general mortality index in the Soviet Union is the lowest among economically developed countries.
Child mortality has decreased even faster in the Soviet Union. Whereas, as was noted above, before 1917, 269 children per 1,000 newborn died before reaching one year of age in Russia, today the Soviet Union has a very low index of child mortality. The rate at which this index has decreased is particularly important in characterising the state of general health. In 1940 the index of child mortality had dropped to 182, remaining, as we see, very high; ten years later, in 1950, it was already down to 81; in another 5 years it dropped to 60; by 1960 it came down to 35 and in 1970 it was 25. It follows that in the years of Soviet power it decreased to less than one-tenth of the pre-revolutionary and to less than one-seventh of the 1940 figure.
As a result of such sharp changes in the mortality rate including the considerable decrease in such a particularly inert index as pre-natal mortality (stillbirth and child 34 mortality in the first week of life),^^*^^ the average life expectancy has appreciably increased and is now, we have already seen, 70--71 years for both sexes or 74 years for women and 66 for men. It should also be noted that the average life expectancy has increased quite rapidly since 1917. In 1926--27 it was 44 years for both sexes and in 1958--59, 69 years.
Despite the considerably diminished birthrate in the USSR---from 45.5 in 1913 and 31.2 in 1940 to 17.4 in 1970--- the country has retained a relatively high natural increase in population owing to the appreciable decrease in mortality. During the last 5 years the increase has ranged from 9.2 to 11 per 1,000 population. The following table represents the main demographic indices in the USSR.
Table 3 Birthrate, mortality and natural increase in population Per 1,000 population Children dying Years before reaching one year of age Birthrate Mortality Natural increase per 1,000 newborn 1913 45.5 29.1 16.4 269 1940 31.2 18.0 13.2 182 1950 26.7 9.7 17.0 81 1960 24.9 7.1 17.8 35 1970 17.4 8.2 9.2 25Such are some of the general indices of the state of the people's health and some demographic phenomena. However, they cannot furnish a complete idea of the changes in the state of the people's health in the Soviet Union. The mere mortality indices are not so significant as the structure of mortality, i.e., the share of different causes of death, especially the major ones.
As is the case in most economically developed countries, the major causes of mortality in the Soviet Union today are chronic, nonepidemic diseases, primarily cardiovascular _-_-_
^^*^^ In most economically developed countries this index is 18--20 per 1,000 newborn. In the USSR the index of pre-natal mortality does not exceed this figure; moreover, according to specially conducted research, in a number of towns, particularly newly-built since the October Revolution, pre-natal mortality is lower, its index ranging from 11 to 14.
35 disorders and malignant neoplasms. The two aforesaid groups of diseases alone account for half and even more of all the deaths. For example, according to the data of recent years, diseases of the circulatory system and vascular diseases of the central nervous system are responsible for 44--45 per cent of all the deaths, while malignant neoplasms cause 18--19 per cent of the deaths. These mortality figures, especially those for cardiovascular diseases are quite high, although they are somewhat lower than in other economically developed countries. Soviet statisticians note a relative increase in mortality caused by the two groups of diseases in recent years, but there would be no increase in deaths from cardiovascular diseases, were it not for the changes that have taken place in the age and sex structure of the population. This factor emphasises once again the significance of the changes in demographic phenomena, especially that of the ageing of the population. This tendency towards ageing of the population can also be observed in the proportional mortality coefficients which have recently come into practice. These coefficients indicate the share of deaths at a certain age in relation to all mortality. Most commonly it is the age of 50 years and older that is taken and the corresponding proportional mortality coefficient is calculated, this coefficient in most economically developed countries now amounting to 80 and more per cent. In other words, more than three-quarters of the entire population die at the age of 50 years and older. But even if we take the mortality rate among people 70 years of age and older, which in Russia in 1910 was only 8 per cent of the total mortality, in 1960 it was already 32 per cent.In considering other causes of death it should be noted that they are more or less the same in most economically developed countries; the cardiovascular diseases and malignant tumours are followed by traumas, influenza, pneumonia, diseases of metabolism, including diabetes mellitus, diseases of the liver, tuberculosis and inborn developmental defects, etc. The share of infectious and parasitic diseases, including tuberculosis, in the mortality structure is usually 1-4 per cent.
The situation is closely similar in the Soviet Union, where in the mortality structure cardiovascular diseases and malignant tumours are followed by traumas, respiratory diseases, diseases of the newborn, diseases of the digestive organs and, lastly, infectious diseases, including tuberculosis.
36 __ALPHA_LVL2__ Decrease in Disease IncidenceThe data on the structure of mortality causes in some measure reflect the situation with regard to disease incidence, i.e., the prevalence of various diseases among the population as a whole or in its different groups.
In view of the difficulties of taking stock of all disease incidence we shall confine ourselves to some information on general disease incidence. Compared with 1926--28, when mass investigations into the general disease incidence were carried out, this highly significant and most important index of the state of the people's health has now decreased by more than 50 per cent. Obviously, the most important reason for this reduction was a sharp decrease in the occurrence of infectious and parasitic diseases which were the main causes of death in the not so distant past. The decrease in the prevalence of infectious diseases, and especially those which were responsible for extensive early mortality among children, is evidenced by the following few figures: in 1966, as compared to 1940 the mortality rate among urban children under one year of age went down in the case of diphtheria by 402 times, in the case of scarlet fever by 347 times, __PARAGRAPH_PAUSE__ Table 4 Infectious Diseases Incidence (per 100,000 population) in 1940--68 Disease 1940 I960 1965 1966 1967 1968 Typhoid fever and paratyphoids A1? Bx and C 62 22 11 12 10 10 Scarlet fever 129 313 230 297 254 211 Diphtheria 91 25 2 1.3 1.1 0.9 Whooping cough 232 259 82 63 49 50 Tetanus 1.1 0.6 0.6 0.5 0.4 Poliomyelitis (acute) ' 0 . 7 3.3 0.13 0.12 0.06 0.05 Measles 605 972 923 750 769 664 Infectious hepatitis (Botkin's disease) 239 204 00 158 156 Epidemic typhus (in-- cluding Brill's disease) 25 2.9 1.6 1.5 1.4 1.3 Malaria 1,637 0.17 0.14 0.13 0.11 0.4 37 __PARAGRAPH_CONT__ whooping cough---139 times, tuberculosis---77 times, measles---70 times, toxic dyspepsia, gastroenteritis and colitis--- 38 times, dysentery---20 times and pneumonia----7 times. An idea of the disease incidence is furnished by Table 4.
Considerable success in wiping out a number of widespread and acutely contagious diseases was achieved in the USSR because of social-economic and medical reforms. As late as 1922 more than 76,000 cases of smallpox were recorded on the territory of the USSR. By 1936 smallpox had been eradicated through compulsory vaccination, begun after the Government had issued a special decree in 1919. Close to 1,400,000 cases of typhus were recorded on the territory of the USSR in 1922, whereas in 1940 there were only occasional cases of the disease. In 1940 the incidence of typhoid fever decreased to less than one-third of its 1922 level. Besides smallpox, other serious diseases such as plague and relapsing fever have been wiped out. Control of malaria in the Soviet Union was an outstanding achievement; no less significant was the practical eradication of trachoma in the RSFSR and many other parts of the country.
The incidence of diphtheria and other infectious children's diseases has decreased sharply in recent years; poliomyelitis, which was still very dangerous in the 1950s, has now been almost completely controlled. Only 120 cases of this disease were recorded in 1968. The following figures may give some idea of the fast rate of decrease of the incidence of infectious diseases in the USSR: in 6 years since 1960 the incidence of poliomyelitis decreased by 98 per cent, of diphtheria, by 97 per cent, of tularemia (which had gone down to 0.1 per cent of the 1940 level) by another 76 per cent, of tetanus, by 52 per cent and of brucellosis, by 61.5 per cent, etc.
Viral diseases, especially influenza, are still widespread. Influenza, angina and other catarrhal diseases come high on the list of disease incidence in the USSR, as they do in many economically developed countries. In this respect the structure of disease incidence does not coincide with that of mortality where, as was noted above, the major part is played by nonepidemic diseases.
In the Soviet Union the general disease incidence is studied mainly by means of an analysis of the people's requests for treatment at medical institutions. Most of these calls, it has been shown, are connected with influenza, angina 38 and upper respiratory catarrh. These disorders hold first place in the structure of general disease incidence in the Soviet Union. They are followed by various traumas. Next in importance in the structure of general disease incidence, are ear, nose and throat diseases, especially chronic otitides, gastrointestinal diseases (gastritides, colitides, gastric and duodenal ulcers) and eye diseases (primarily conjunctivitides). After these come various cardiovascular disorders. The above diseases usually account for 70--80 per cent of the general disease incidence.
The foregoing list indicates the approximate succession in the prevalence of diseases revealed mainly by the requests for treatment at medical institutions. According to specialists who study the prevalence of diseases among different groups of the population, a somewhat different pattern of diseases is observed among the people living in the countryside. For example, an extensive study of the disease incidence among the rural population carried out by workers of the All-Union Research Institute of Social Hygiene and Public Health Organisation, has shown influenza, catarrh, angina and a number of other disorders, mainly of an infectious character to be on top of the list in the countryside. The second place is held by diseases of the digestive organs, oral cavity and teeth, the third place, by diseases of the heart and blood vessels, the fourth, by traumas and the fifth, by respiratory diseases.
Naturally, people do not always seek medical aid, especially in cases of chronic disease; to reveal these cases, researchers have to resort to such methods as the examination of groups of the population by teams of specialists and the careful study of each case by experts. Such examinations lead to the detection of quite a large number of disorders which require medical aid. For example, a study conducted under the supervision of Professor I. D. Bogatyryov revealed 500 cases of protracted diseases per ] ,000 of population, a figure amounting to one-third of all the people's requests for medical aid at medical institutions. It follows that all recorded cases of disease may be figuratively compared with an iceberg, its above-water part being the cases of disease revealed when the people request help at medical institutions and its under-water part being the diseases, mainly chronic for which people do not ask for medical aid. The task of the researcher is to study the whole 39 iceberg, in order to reveal genuine picture of the people's health.
According to reports of Soviet statisticians, the general disease incidence of different groups of the population ranges from 1,100 to 1,400 cases per 1,000 population in a year. In analysing these seemingly high figures we must take into account the fact that with the development of the public health services the number of recorded diseases increases. This may result in an erroneous impression of an increasing rate of disease incidence. Actually, however, the incidence of disease in the USSR, especially that of infectious and parasitic diseases, has considerably decreased compared with the 1920s.
And, although studies of the general incidence of disease are still the most complex and difficult part of medical statistics, on the basis of several random studies, we may judge of the generally high incidence of disease in capitalist countries. For example, according to official figures published in the USA,^^*^^ 223 cases of acute diseases were recorded per 100 population in 1962, more than two-thirds of these cases having an infectious character (infectious and parasitic diseases, influenza, upper respiratory catarrh, etc.). One extensive random study conducted in the USA (in 1961--1962) revealed a large figure---401,851,000 cases of disease in a year, of which 49,123,000 cases was of infectious and parasitic diseases, and 230,805,000 of upper respiratory diseases, including influenza.^^**^^
One of the most important problems of public health services in many economically developed capitalist countries are mental diseases which show a distinct upward trend. In the USA mental health is now considered problem No. 1 of public health. The incidence of mental diseases (all cases, including those newly recorded) in most capitalist countries has been estimated by a number of prominent authorities at between 40 and 150 cases per 1,000 population.
In the USSR, as in a number of other socialist countries, the problem of mental diseases is not so acute. Moreover, according to several studies conducted in recent years, the incidence of some mental disorders is tending to decrease.
_-_-_^^*^^ Statistical Abstract of the United Slates 1963, Washington, 1963.
^^**^^ Acute Conditions, Incidence and Associated Disability. United States, July 1961-June 1962. Vital and Health Statistics, U.S. Department of Health, Education and Welfare, Washington, May, 1963.
40In the USSR the incidence of mental diseases among both urban and rural population is only one-third or even onequarter of that registered in several economically developed capitalist countries. This essential difference in mental health is hard to explain; it requires special studies. At any rate, it is clear that the explanation must be sought mainly in the fundamental differences in the social conditions and in the social policy pursued by the socialist state which is aimed at ensuring the well-being of the people and care of their health.
This chapter is entitled the "Health Index''. For people familiar with medical statistics these words signify a definite index of the state of health, representing' the percentage of people who never fell ill in the course of a year. Obviously, this coefficient is one of the most vivid indices of social health, although it has not as yet been widely used in scientific literature. In the Soviet Union this coefficient is used increasingly more often, particularly in characterising the state of health in children. According to a number of studies conducted in recent years, the "health index" is constantly rising. A special study carried out in Moscow in 1953 showed the "health index" of children in the first year of life to be about 14 per cent. Recent studies have yielded a much higher index. In one of these studies conducted in the city of Kaluga (1964--1966) the "health Index" was found to be 26.9 per cent, which means that in this city one-fourth of all the children under one year of age were never ill.
The "health index" is also used increasingly more often to determine the state of health of adults. For example, a study of the health of the workers in a number of Moscow factories (1965 and 1966) revealed that in the course of a whole year, between 25 and 30 per cent or even more of the workers never called at medical institutions.
The "health index" is important not only as a precise statistical index, but also as a symbol of the magnificent improvements achieved in the state of Soviet public health.
__ALPHA_LVL2__ Improvement in Physical DevelopmentConsidering the health of the population is a concept which embraces not only mortality and disease incidence, but also physical development. Numerous studies conducted 41 in the Soviet Union at different times attest an all-round improvement in the physical development of children, adolescents and other age groups of the population. Especially valuable are the studies that make it possible to compare the anthropometric data obtained at different periods in the same parts of the country. The following are the results of one of these studies. According to F. F. Erisman, a prominent Russian scientist who studied the physical development of adolescents in Glukhovo, a small workers' settlement near Moscow, in 1880 the height of 15-year-old boys averaged 141 cm, while, according to G. P. Salnikova et al., Soviet researchers who studied the physical development of adolescents in the same settlement 82 years later, in 1962, the height of 15-year-old boys already averaged 162 cm. During that period they had thus ``grown'' 21 cm taller. According to Erisman, the boys outstripped the girls in height only at the age of 16, according to Salnikova---at 14. Contrariwise, according to Erisman, the girls outstripped the boys in height at 12 years of age, according to Salnikova---at 10.
Similar data may be cited with respect to other parameters ---weight, chest girth, etc. It seems to us, however, that the few facts cited above are enough to show the considerable improvement in the physical development of children and adolescents. Even if we take shorter periods of time we can observe an appreciable improvement in all parameters of physical development, and not only in the central parts of the country, but also in outlying districts with rigorous natural conditions. For example, studies conducted beyond the polar circle, in Murmansk, in 1964, showed that 15-- yearold boys were 12.31 cm and girls of the same age 12.7 cm taller than in 1947; during the same period the boys of this age had ``gained'' in weight 8.35 kg and the girls 11.4 kg. Analogous figures were furnished by a study of the physical development of children and adolescents in the city of Norilsk and other parts of the Soviet Far North.
The increase in the major parameters of physical development in children and adolescents during a comparatively short period of time has been so appreciable both in the USSR and abroad that it is referred to as the acceleration phenomenon. More and more studies are now being devoted to this phenomenon and increasingly more hypotheses are being advanced to explain it.
42Without dwelling on this problem in detail (for it needs special consideration) we should like to mention that, according to most studies of the physical development of the Soviet people, there are no essential differences relating to financial position or social status. All groups of the population--- workers (both industrial and office) and peasants, wherever they may live, show clear signs of improved physical development.
No such conclusion can be made as regards a number of capitalist countries where the effects of the difference in the social status can be observed in the physical development of the population.
__ALPHA_LVL2__ Social HomogeneityMedical scientists from several countries, including the USA have had to admit that differences in the state of mental health follow a distinct social pattern. Studies of foreign scientists have revealed considerable differences in the occurrence of mental diseases among representatives of different "social classes" (bourgeois researchers refer in this way to groups of the population with differing incomes). For example, studies on the mental health of the population conducted in Baltimore, New York and other cities have brought to light an essential difference in the mental health of the ^so-called first (richest) and fifth (poorest) "social classes'', the incidence of mental diseases being 7 or 8 times as high in the latter category as in the former. According to the study of the population of Chicago carried out as late as the end of the 1930s, the incidence of psychosis among the poor was 362 per 100,000 population and only 55.4 among the rich. A similar study conducted in Baltimore in the 1940s and 1950s, revealed that the rich were found to give 302 cases of psychosis per 100,000 people and the poor 653 cases. Researchers at Cornell University (USA) have discovered mental disorders in 13 per cent of the examined people from the so-called "lower classes" and in 3.6 per cent of the "upper classes''.
A similar picture is observed as regards other diseases. For example, in the USA and other capitalist countries the 43 incidence of acute diseases is 50 per cent higher among the unemployed and those living on relief than it is among families with annual incomes of 3,000 dollars and more, and the incidence of chronic disease is most 100 per cent higher among the former.''^^*^^
A study of child mortality in France has shown that it is higher where the parents belong to the lower 'social class''. In families belonging to the "upper class it was 17 per 1 000 children born alive, while in families belonging to the "lower classes" (unskilled workers, etc.) the figure was 61 per 1,000.
Similar data have been recorded in Great Britain where child mortality in families of the "lower classes" is 2-3 times as high as it is in those belonging to the upper social classes.''
In the USSR there are no such sharp social distinctions in the health of the population. The numerous statistical studies, including those conducted with due regard lor the effects of the living conditions (work, income, housing, rest and recreation, etc.), reveal no great distinctions in the state of health of the different social groupings. This does not mean of course, that there is no difference whatsoever in the general health and its various indices depending on various occupational factors, material well-being, cultural level etc. But this difference is not so great as it is in capitalist countries. It is not so essential and, therefore, allows us to assume a social homogeneity of the peoples health in the Soviet Union, while the health in most capitalist countries, including economically developed ones, is characterised by sharp social distinctions. This phenomenon is very important because it testifies in favour of the social and economic system of the Soviet Union.
Further evidence of the advantages of socialist society are the faster rates of improvement of the mam indices ol the people's health in the USSR as compared even with the economically developed capitalist countries.
The following table gives some idea of the changes in some of the health indices in the USSR and a number of economically developed capitalist countries.
_-_-_^^*^^ F. H. Landis and P. K. Hatt. Population Problems. A Cultural Interpretation. N.Y., 1954, pp. 143--144.
44 Table 5 Changes in the indices of general and child mortality, and of average life expectancy in the USSR and some capitalist countries during the last 50--60 years^^*^^ USSR USA Britain France Index 1913 1906 1910 1906 1910 1966 1910 1966 General mortality per 1,000 population 29.1 7.3 15.0 9.5 13.5 11.7 17.7 10.7 Decreased during the aforesaid period to 25 per cent to 63 per cent to 86 per cent to 60 per cent Child mortality (per 1 ,000 born alive) 2G9 26.1 86^^**^^ 23.4 105.0 19.0 111.0 21.8 Decreased during the aforesaid period to 9 per cent to 27 per cent to 18 percent to 19 per cent Average life ex-- pectancy 32^^***^^ 70 --- 70 48 71 47 71 Increased during the aforesaid period by 1 18 per by 48 per by 47 per cent cent cent _-_-_^^*^^ Supplement to the Third Report on the World Health Situation, 1965--1906. WHO. Geneva, 1968, and national reference books.
^^**^^ Data for 1920.
^^***^^ Data for 1896--189S.
[45] __NUMERIC_LVL1__ Chapter 4 __ALPHA_LVL1__ BASIC PRINCIPLES OF THE SOVIET HEALTHIn the Soviet Union health protection is regarded as one of the most fundamental functions of the state on a par with guaranteeing the citizens the right to work, rest and education. In the USSR public health is based on an extensive system of social, economic and medical measures carried out by state and public organisations. This chapter will deal with the most important principles of socialist health protection.
The Programme of the Communist Party of the Soviet Union adopted by the 22nd Congress reads: "The socialist state is the only state which undertakes to protect and continuously improve the health of the whole population. This is provided for by a system of socio-economic and medical measures.''^^*^^
These lines are not a mere political declaration, for every word in them is confirmed by the practical activities of all public health services and institutions of the USSR. But the readers who are familiar with public health in other countries, especially Great Britain, may argue that these countries, too, have, for a comparatively long time, also had a state or governmental public health service, for which reason one may not justifiably speak of state health protection in the Soviet Union as a unique phenomenon. However, such reasoning is disproved upon closer acquaintance with Soviet reality.
When we speak of the state character of public health in the USSR we imply not only the activities of public _-_-_
^^*^^ The Road to Communism, Moscow, p. 542.
46 health bodies and institutions, not only those of the medical services, but emphasise that all links of the socialist state system, including the public health services, take part in caring for and improving the health of all the people. Herein lies the profound significance of the above-quoted words from the Programme of the Communist Party of the Soviet Union.The state character of public health in the USSR is an expression of socialist democracy which, unlike bourgeois democracy, not only declares the rights of the people, but also guarantees their realisation. It is the socialist state that fulfils the function of implementing the fundamental democratic, social rights of the Soviet people. It was the socialist state that assumed immediately after the Great October Socialist Revolution, the responsibility of caring for and improving the health of the people, and built up the most extensive system of public health with free, generally available and highly-skilled medical aid.
As was already stated above, immediately after the armed uprising in October 1917 the Revolutionary Government of the Soviet Republic issued several decrees (laws) aimed at organising public health services.
These decrees laid the foundation for Soviet, socialist health protection. In the summer of 1918, when the first congress of medical and sanitary boards was convened, the basic organisational principles of the new system of Soviet public health were already clearly defined, namely, free, generally available and planned medical aid, a single system of state public health and extensive participation of the people in sanitation and health protection. This was discussed at the congress by N. A. Semashko and Z. P. Soloviov, the leaders of the first state central public health body---the People's Commissariat of Health. The principles of organisation of the public health service formulated in those years still retain their significance, the most important of them being, as was already noted, its state character.
State health protection, considered as one of the functions of the socialist state, as its duty to ensure each Soviet citizen's right to health, also means that the health of each citizen is regarded not only as his personal affair, but as public property as well. In this sense the state care for the health of the people, i.e., the state character of public health, is opposed to the principles of the private capitalist system 47 which proclaims medical business to be a most important principle in relations between physician and patient and the main principle of the public health policy as it is pursued in capitalist countries. It is well known, for example, that the leaders of the American Medical Association, one of the largest corporated organisations in the USA, have repeatedly declared that the basic principle of public health in their country is the responsibility ol the individual for his own health and that of his dependents.
What, in concrete terms, does the state character of health protection in the USSR mean? What functions and duties of the state and its public health system are included in this conception?
__ALPHA_LVL2__ Free and Generally Available Medical AidWhen we speak of the state character of public health we mean, in the first place, that medical aid is administered to the entire urban and rural population regardless of social, political, racial and all other factors. This, in its turn, implies that the medical aid is free and that the state provides for the population a sufficient number of medical institutions and skilled medical personnel.
Free and generally available medical aid is ensured by state allocations for public health. The funds provided by the state budget of the USSR for medical aid and the development of public health institutions are growing every year. Table 6 gives some idea of the USSR state budget outlays for public health.
__CAPTION__
The first months of the
Table 6
Allocations for public health
Years
Sums allocated by
the state budget in
millions of rubles
Expenditures
per capita
(in comparable prices)
(in rubles)
1913
14.5
0.91
1940
860.0
4.70
1955
3,490.6
17.22
1960
4,759.0
22.60
1965
6,610.7
28.59
1966
6,997.0
29.86
1967
7,350.0
31.22
48
__CAPTION__
The Great Patriotic War of
__CAPTION__
An operation in progress.
__CAPTION__
Workers of the U/lovaya
__CAPTION__
Sanitary inspectors making
__CAPTION__
A new fangothcrapeutic centre
__CAPTION__
The workers of the Saratov
__CAPTION__
S. Zubarcva, divisional
In 1972 the state allocations for public health and physical culture exceeded 9,700 million rubles. Not only are the absolute allocations for public health increasing, but also their share in the state budget has increased.
In addition to the above appropriations medical institutions receive large sums of money from their lunds from various industrial enterprises, collective farms, co-operatives and other establishments. These sums exceed, in tot, 1,000 million rubles a year.
No small part of the funds allocated for social maintenance and social insurance is also used for health protection. These allocations exceeded 21,000 million rubles annually in recent years. They were spent among other things on allowances for temporary disablement, quarantine and to working mothers caring for their sick children, on grants to pregnant women for maternity leave, on the maintenance of sanatoriums, kindergartens, creches and Young Pioneers' camps, etc. Taken together the share of all expenditures on public health defrayed by the social consumption funds reaches 25 per cent of these funds.
Besides the aforesaid expenditures on public health we must also take into consideration the considerable state expenditure on the development of medical science and medical education, which are not included in the public health and physical culture item, but come under science and education in the state budget.
The situation is different in a number of capitalist countries where only a comparatively small part of the cost of health protection is defrayed by the state budget. In these countries the working people pay the bulk of the expenses on medical aid. The personal expenditure of U.S. citizens on medical treatment exceeds two-thirds of all the funds used for health protection. Despite all attempts to introduce various systems of public aid, including the so-called Medicare and Medicaid systems, the patients or their families have to pay large sums of money to medical institutions or medical personnel for the aid rendered. Suffice it to say that, according to official data, the price of one day's hospitalisation in the USA now exceeds 50 dollars, a visit to a general practitioner costs 6 to 10 dollars, the expenses on obstetric aid range from 150 to 400 dollars, the price of filling a tooth is 5 to 10 dollars, etc. Even U.S. presidents have repeatedly referred to the exorbitant "cost of health''.
__PRINTERS_P_49_COMMENT__ 4---1065 49The general availability of medical aid in the USSR is also ensured by the extensive material and technical base of public health and medical science. Had not a sufficient number of hospitals, polyclinics, dispensaries, research institutions, medical schools, etc., been built under the Soviet Government, the general availability of medical aid, as a clear expression of the state's responsibility for public health, would have been an empty phrase.
We have already noted that before the October Revolution Russia was at the bottom of the list as regards the number of medical institutions and medical personnel. For example, in 1913 the country had 13 hospital beds per 10,000 population. In the outlying national districts there were either no hospitals at all or there were very few, and only in the towns. Thus on the territory of the present-day Republics of Turkmenia, Uzbekistan, Kirghizia and Kazakhstan there were no more than 1-3 hospital beds per 10,000 population and only 28,100 doctors, that is, 1.8 per 10,000 population. The bulk of the rural population had practically no skilled medical aid at all.
According to the 1970 figures, the USSR had 26,500 various hospitals with a total of 2,663,300 beds, i.e., 109.2 beds per 10,000 population. Soviet Union is now one of the world's leading countries in providing hospital accommodation. As regards the so-called somatic beds, i.e., hospitals for the treatment of all patients, except mental cases, the Soviet Union is ahead of the USA, Great Britain, France and other economically developed countries.
A veritable army of doctors has been trained in the country in Soviet times; in 1970 it numbered nearly 675,000, i.e., 27.6 per 10,000 or one per 400 population. The USSR has more doctors than any other country in the world.
The number of medical workers with a secondary medical education (nurses, technicians and surgeons' assistants) has also increased severalfold. Today this number exceeds 2 million.
Particularly great changes in health protection have taken place in Russia's former outlying national regions. For example, in the Uzbek SSR the number of doctors increased from 139 in 1913 to 21,100 in 1968. In Kirghizia the number of doctors increased from 21 in 1913 to 5,700 in 1968, in Turkmenia (during the same period)---from 70 to 4,400 and in the Tajik SSR---from 19 to 4,300.
50At the present time even the remotest towns and villages in all the republics have their own hospitals, polyclinics, dispensaries, pharmacies and oilier medical institutions which administer highly-skilled medical aid. Table 7 presents some of the main indices of the development of health protection, i.e., figures attesting the building up and expansion of the material and technical base of the public health system.
Table 7 Number of doctors and hospital beds (at the end oi the year) 1913 1940 1950 I960 1965 1970 Number of doctors of all specialities, in thousands 28.1 155.3 265.0 431.7 554.2 679 Number of doctors per 10,000 population 1.8 7.9 14. G 20.0 23.9 27.6 Number of hospital beds in thousands 208 791 1,011 1,739 2,226 2,663.3 Number of hospital beds per 10,000 popu-- lation 13 40.2 56 80.5 96 109.2 __ALPHA_LVL2__ Unified and Planned Public HealthThe concept of the state character of public health also includes the idea of a unified public health system.
The unity of public health in the USSR means that the country has a single system of medical services subordinated to a single central body---the USSR Ministry of Health. All public health institutions---from the smallest medical agencies supervised by surgeons' assistants and midwives, and district hospitals in rural districts, to the largest city hospitals and research institutes---are under the jurisdiction of the USSR Ministry of Health which controls the activities of all these services and plans all measures connected with health protection in the country. In the USSR there are also so-called departmental public health services, i.e., medical institutions administratively subordinated to other ministries, such as, for example, the Ministry of Transport, the Ministry of 51 Waterways, the Ministry of Civil Aviation, and other central bodies. However, all medical institutions, regardless of their departmental subordination, have to be guided by the instructions of the USSR Ministry of Health with respect to the discharge of their direct medical functions. The Ministry of Health is thus the single co-ordinating and controlling centre.
Every republic has its own ministry of health which oversees all health protection work in the republic. In regional and territorial centres public health problems are dealt with by public health boards which are departments of the corresponding executive committees of Soviets. While subordinated to the local Soviets, the public health institutions in the districts and regions are also guided in their activities by the instructions of the ministries of public health. It follows that in the activities and management of the public health bodies and institutions the principle of centralisation is combined with that of decentralisation and these two principles not only do not contradict each other, but, on the contrary, presuppose the unity of the public health system in the USSR as its distinctive feature. This viewpoint is correct also because the unity of Soviet public health must be conceived in a much broader sense than that of mere administration and management, because it means a unity of purpose, practical methods and general doctrines by which all medical personnel is guided in its multifarious health protection activities.
Thus public health in the USSR is managed along two lines---the line of public health bodies and institutions under the jurisdiction of the USSR Ministry of Health and the line of state power of which the USSR Supreme Soviet is the highest legislative body and the USSR Council of Ministers is the highest executive body. As has already been noted, the Ministry of Health discharges its administrative functions through the system of health ministries of the Union Republics and their subordinate regional, territorial and city boards of health, district departments of health of large cities and head doctors of central district hospitals in the countryside. The public health bodies are, in their turn, controlled by corresponding bodies of state power. Local public health bodies and their subordinate institutions are, as a rule, run on local budgets, i.e., receive their allocations from the state budget. The ministries of health (of the USSR 52 and the Union and Autonomous Republics) are accountable to the corresponding councils of ministers.
The state character of health protection in the USSR is also expressed in the planned development of all its services. The planned development of public health means that it is subject to the laws of planned development of the entire system of the USSR national economy. Planned development also makes it possible to avoid disproportions between health protection and the other branches ol the national economy.
Like all the other branches of the single national economy of the USSR, health protection is being developed on the basis of state plans. There are current plans (for one year) and long-term plans determining further development of health protection as regards most important indices, such as improvement of the people's health, expansion and improvement of medical institutions, training of medical personnel, production of medical goods, etc. The five-year plans for the development of the national economy and consequently, five-year plans for the development of public health have become a tradition. All the boards of health---from the district, i.e., small, rural hospital to the USSR Ministry of Health---take part in drawing up both the current and longterm plans. The general trend of the plan for the development of the national economy in the nearest future is elaborated by the State Planning Commission of the USSR. After approval by a session of the USSR Supreme Soviet the plan becomes law. For example, the law for all medical people of the Soviet Union, as well as for the organisations and institutions having anything to do with public health, during the past five years was the 1966--1970 Plan for the Development of Public Health.
The 24th Congress of the CPSU summed up the fulfilment of the Eighth Five-Year Plan of Economic Development for 1966--1970 and adopted Directives for the next five years (1971--1975). Between 1966 and 1970 more than 440.000 beds were added to the country's hospital fund. Today there are 10 beds per every 1,000 of the population. The number of doctors of all specialities grew to almost 700.000. During this period the production of the medical and pharmaceutical industries was greatly raised, and the number of hospitals, polyclinics, sanatoriums, holiday-homes, health-resort boarding houses and sports facilities greatly increased.
53Particular importance is attached to the further development of specialised medical aid in order to improve the quality of medical service. In accordance with this, large hospitals with various well-equipped departments are being built, specialised offices in polyclinics are being organised, dispensaries set up, physiotherapeutic services expanded, and other measures envisaged. The plan also determines the most important, urgent and practically necessary long-term trends of medical research, and provides the required means, research institutions and specialists.
Such are some of the concrete expressions of the state character of health protection in the USSR, which are inseparably connected with its other features, above all with prophylactic work.
__ALPHA_LVL2__ Prophylactic WorkProphylactic (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 54 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.
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.
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.
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, 55 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.
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.''^^*^^
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, _-_-_
^^*^^ H. K Sigerist. Medicine and Public Health in Ilia Soviet Union. New York, 1907, p. 299.
56 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.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.
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.''^^*^^
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.
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 _-_-_
^^*^^ 7 he Communist Parly of llie Soviet Union in the Resolutions anil Decisions of the Congresses, Conferences and Plenums of Its Central Committee. Part I, 19.">4, p. 42!). In Russian.
57 implementation of the prophylactic trend in health protection.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.
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''.
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''.
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.
The following example gives some idea of the concrete sanitary and hygienic functions of some medical institutions. 58 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.
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.
59 __ALPHA_LVL2__ Dispensary ServiceAt the dawn of Soviet power N. A. Semashko referred to the dispensary service as the most important method of achieving the synthesis of prevention with treatment. The dispensary service is now in operation in hospitals, polyclinics and other curative and prophylactic institutions.
On the surface, the dispensary observation seems to consist in the application of routine medical measures. However, the dispensary service, if it is to be practised on a really all-embracing scope, requires vast resources and a large number of doctors and other medical personnel; it implies a considerable additional expenditure of effort and money. That is why not all Soviet people as yet come within the reach of the dispensary service, especially if we consider that not only sick people, but also healthy ones come within its scope.
The dispensary service is now administered to large contingents of the population---children and adolescents, school pupils, students of secondary specialised and higher schools, office and industrial workers of a number of industries, especially at industrial enterprises with harmful working conditions, war invalids, athletes, scientists, people of a number of agricultural occupations, pregnant women, etc. In addition to the foregoing categories, evervone in town and country suffering from one of the specified group of diseases is subject to dispensary observation regardless of occupation. This group includes tuberculosis, all tumour, cardiovascular disorders (coronary disease, heart failures, hypertensive vascular disease, rheumatic infections, thrombophlebitides, varicose veins and other vascular lesions, etc.), gastric and duodenal ulcers, nephritis, diabetes mellitus, certain liver diseases, mental disorders, fungus and other skin diseases, etc. It follows that the number of people subject to dispensary observation is very large (according to some authors, it comprises nearly 100 per cent of the children and not less than 20 per cent of the healthy adult urban population, not counting the patients suffering from one of the above-listed diseases).
What, then, is this dispensary service which, as was noted above, does not include any unusual, unknown measures? The dispensary service comprises a complex of various diagnostic, curative, prophylactic proper and social 60 functions. These include active systematic observation, detection ol early Jonns of disease^^1^^, timely treatment, and prophylactic measures aimed at preventing the onset or development of diseases, including the transfer of patients to other, more suitable work and a change in their living and working conditions. Active observation, which we regard as the leading feature of the dispensary service, implies that doctors and other medical workers visit the patients, summon them for consultation to medical institutions, keep strict records and control of the systematic examinations and implementation of the requisite preventive curative measures.
__ALPHA_LVL2__ Divisional OrganisationThe synthesis of curative and prophylactic principles manifests itself not only in the dispensary service, but also in the divisional organisation of administering aid to the people. This organisation is employed throughout the Soviet Union. It means that both towns and countryside are divided into medical divisions with no more than 4,000 people (3,000 adults and 1,000 children) per division in towns and usually somewhat more in the countryside. At industrial enterprises there are so-called shop divisions, which means that the doctors employed at a particular enterprise administer medical aid to a certain number of workers in definite shops or other departments of the enterprise. Shop divisions differ in size, depending on the working conditions, from 600 to 2,000 workers. According to the norms adopted in the USSR, each urban territorial division must have at least 6 doctors, including two so-called divisional internists and a pediatrician; each division is also served by surgeons, obstetricians, gynecologists, neuropathologists and other specialists. The divisional doctors visit the patients at their homes or receive them in polyclinics, i.e., outside the hospitals where the main laboratory services arc concentrated and doctors of all specialities are employed. Most of the home visits are made by divisional internists and pediatricians who discharge the functions of home or family doctors since they are familiar with the living conditions and state of health of each of their patients. In complex cases the divisional internists refer their patients for consultation to specialists and, if necessary, arrange for a hospital accommodation. The divisional 61 doctors not only treat their patients, but also perform a number of prophylactic functions. For example, they see to it that vaccinations are administered in due time and that the sanitary norms are observed. They are also responsible for sanitary education, for which so-called prophylactic days are set apart (usually one day a week) on which the divisional physicians engage mainly in sanitary and health education activities.
The divisional principle of service brings skilled medical aid closer to the patient and his home, as well as to his place of work. In the USSR the medical division is an inalienable part of the polyclinic and hospital. Divisional doctors are staff workers of district polyclinics and hospitals.
Moreover, divisional doctors, including internists and pediatricians, have to work for certain periods in hospitals. Most commonly, a divisional doctor works for six months in a hospital and for 18 months in his division, i.e., visits the patients in their homes and receives them in the nearest district polyclinics. In this way, the Soviet divisional organisation of medical service effects the unity of hospital and outpatient service, as distinct from Great Britain, for example, where there are separate organisations for general practitioners and hospital doctors.
__ALPHA_LVL2__ Education in Hygiene and SanitationEducation 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.
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. 62 Such institutions have been established in many towns on a voluntary basis, i.e., the medical workers are not paid for their work there.
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.
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.''^^*^^
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.
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.
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 _-_-_
^^*^^ I. I'. Pavlov, Collected Works, Moscow and Leningrad, 1951, Vol. II, Part 2, p. 270. In Russian.
63 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);2) control of the malaria vectors, i.e., extermination oi mosquitoes and their larvae by various methods, and, lastly,
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.
64 __ALPHA_LVL2__ Connections between Medical ScienceWe shall yet have a chance to dwell on the development (ii medical science in the USSR and describe the main trends and leading schools of Soviet medical scientists. Here we only intend to show that a close daily contact is maintained in the USSR between medical research establishments and practical institutions concerned with public health.
The introduction of the results of scientific research into public health practice has become one of the most important criteria of its effectiveness. Publication of the scientific studies and systematically held congresses, theoretical conferences and symposiums facilitate the utilisation of scientific achievements in the practical work of curative and prophylactic institutions. It should be emphasised that, in addition to scientific congresses and seminars attended by scientists, there are convened so-called scientific-and-practical congresses, conferences, etc., also attended by medical practitioners. Moreover, conferences are held systematically in hospitals and polyclinics at which information on the latest scientific achievements is given and the results of scientific studies in the hospital concerned, discussed.
The principle of unity of theory and practice underlies the very system of medical research in the USSR. As we have already noted, the activities of both practical, curative and prophylactic, and research institutions, are supervised by a single body---the Ministry of Health. Even the country's highest scientific medical centre---the USSR Academy of Medical Sciences---is under the jurisdiction of the USSR Ministry of Health.
Questions of medical research are under the jurisdiction of scientific medical councils of the ministries of health of the USSR and the Union Republics. The ministries pose the medical research scientists the most important public health problems and supervise the introduction of scientific discoveries into the practical work of public health institutions.
Moreover, many scientific problems are studied jointly by research institutions in co-operation with the practical public health workers.
No small role in realising the unity of theoretical science and practical public health work is played by the institute __PRINTERS_P_65_COMMENT__ 5---1065 65 of principal specialists. These are highly skilled physicians who work in ministries, or in regional and city boards of public health. Their main function is to promote the development of specialised forms of medical aid and the introduction into the practical work of medical institutions of the latest methods, and means of diagnosing, treatment and prevention.
Research institutions and higher medical schools, which conduct the major part of scientific studies, render daily help to medical practitioners and public health bodies and institutions, providing consultations of experienced specialists on specific problems delivering cycles ot lectures and conducting studies aimed at improving the skills of general practitioners.
__ALPHA_LVL2__ Participation of the PopulationAt the session of the USSR Supreme Soviet held in June 1968, the deputies heard, in addition to the report of the Minister of Health devoted to the development of health protection in the USSR, two reports made by the Chairmen of the Commissions of the Soviet of the Union and the Soviet of Nationalities on public health and social insurance. These latter reports set forth the opinions of the members of these commissions on some major problems of public health in the USSR. Many of the proposals submitted by these commissions were adopted and incorporated in the decision of the; Supreme Soviet.
This example illustrates one way in which the people's representatives participate in health protection. It should be noted, however, that in addition to the USSR SupremeSoviet where there are permanent commissions of deputies dealing with public health questions, there are public health commissions in all local Soviets composed of deputies, to these Soviets (republican, regional, city or district). The main purpose of these commissions is to help the public health bodies and institutions improve the working of the health service. These commissions exercise effective control over many medical institutions, and have the right to demand accounts from public health administrators having direct links with various public organisations and 66 with all sections of the population, whose interests they represent.
But the commissions of deputies are not the only organisational form through which people can participate in health protection work. In the Soviet Union life itself has suggested numerous ways in which working people can voluntarily participate in sanitation and other health protection work.
For example, both during and immediately after the Great Patriotic War the population had to work strenuously to prevent outbreaks and the spread of epidemics. At certain times the participation of the urban and rural population in public health activities became so extensive that it was rightfully referred to as a popular movement for sanitary culture, sanitation of the environment and improvement in people's health.
The many-sided involvement of the people in health protection is also characteristic of today. Public councils are organised in many curative and prophylactic institutions, as well as pharmacies. Among their members are representatives of trade union and public organisations, workers of industrial enterprises, collective farmers or tenants of nearby blocks of Hats, including pensioners, housewives, etc. These public councils help public health institutions in their day-to-day work.
The Red Cross and Red Crescent societies are mass public organisations which also render help to public health bodies and institutions. Today these societies have a membership of more than 80 million. They organise the training of people in first aid methods and also form sanitary posts in industrial enterprises, collective farms and offices, whose job is to see that the working places are kept in a sanitary condition and to assist medical workers.
These societies also train special nurses who look after lonely, sick and aged people in their homes on a voluntary basis. Members of these societies act as public sanitary inspectors, i.e, see to it that the streets and backyards are kept in good sanitary order.
Every year Health Day is observed all over the country. The tradition started several years ago, on July 11, the day when V. I. Lenin signed the decree establishing the People's Commissariat of Health, when, on the initiative of public organisations of the city of Tula and some other towns, the activities of all medical institutions and public organisations __PRINTERS_P_67_COMMENT__ 5* 67 concerned witli health protection were brought under review. Since then physicians and public health organisers annually, on this day, give the population an account of their work in health protection and the sanitation of the environment, while the inhabitants of towns and villages, under the supervision of medical workers, carry out various practical measures contributing to the sanitary welfare of their localities. It has already become a tradition to plant gardens and parks on this day, and to give lectures and talks on medical and sanitary subjects. Health Day is not limited to specific, even if very important and interesting medical measures, which are carried out only on this day. As was mentioned above, this is a day for the reviewing and assessment of the work of both public health institutions and the public organisations concerned with health protection and sanitary culture.
By an edict of the Presidium of the Supreme Soviet ot the USSR (1966) one of the Sundays in June has been proclaimed the Day of Medical Workers. This day is a festival not just for all the medical workers in the Soviet Union, but for all Soviet people, since the extensive participation in health protection of all sections of the population has become one of the country's basic principles.
These are just a few of the ways in which people participate in health protection. We must add that these activities, like the participation of industrial and office workers and collective farmers in other forms of association, help to develop a sense of collectivism, to unite people in the accomplishment of necessary tasks and to create a favourable ``psychological'' climate.
Numerous examples of the participation of various sections and groups of the population in health protection could be cited, but we shall limit ourselves to one---that of Salavat, the town of engineers and chemists. We have chosen it because today there are numerous multi-storied blocks of ilats where only 20 years ago there was a bare and deserted stretch of the Bashkirian steppe. Salavat is a new development and a coeval of many such towns that have sprung up since the war. In 1964, on the initiative of the town's public organisations, a popular movement was started for making Salavat a town of sports and health. Since then the numbcr of regular medical institutions has been considerably increased and new health education schools where both young 68 and old arc taught the basic rules of sanitation and hygiene ---have been established. One example is the school for young mothers and fathers which has been opened in the maternity centre; here medical workers teach expectant parents how to look alter the newborn; give them sets of physical exercises for children, etc.
This comparatively small town has a health university with 18 laculties. The course of training consists of 8 lectures during which the ``students''' are informed about the ABCs of human anatomy and physiology; the effects of physical exercise on the healthy and sick body; methods of hardening of the organism and the influence on health of well-- organised work, rational rest and recreation, etc.
Since industrial enterprises now work 5 days a week and factory and office workers have extra leisure-time, special "leisurc-diiy councils" have been organised at many enterprises, their members drawn not only from medical workers, but also from representatives of the trade unions and the general public. The people decided that the town should have four rest and recreation zones, as it were. The first zone consists of athletics facilities in the residential blocks. The second /one is within a radius of 3-5 km. from the town, on the picturesque banks of the Byelaya River. The third zone consists of hiking centres with hotels, cafes and athletics facilities built within a radius of 15--18 km. from the town. Kach of these centres has accommodation for 4,000 people. The fourth zone is about to be built some 100 km. from the town on the shores of the extremely beautiful Nugush artificial lake.
An important role in health education is played by the press. Not only the Medical Gazette, the professional medical newspaper, but also other newspapers and magazines offer their pages to medical scientists and public health workers for publication of scientific articles and advice on questions of public health, sanitation and hygiene. In the working plans of the Ail-Union Znaniye (Knowledge) Society, which has branches in nearly all Soviet towns, questions of health education are one of the priorities.
[69] __NUMERIC_LVL1__ Chapter 5 __ALPHA_LVL1__ PUBLIC HEALTH SERVICES __ALPHA_LVL2__ [introduction.]Recently East-Siberian Publishers released a small and ordinary looking pamphlet entitled From a 'Tent to a Hospital Complex, written by doctors T. A. Larionova and R. L. Moshkovich. This modest pamphlet describes episodes that have already become routine in the Soviet Union, namely, the development of extensive modern medical services in a new town from scratch in a very short period of time. When the construction of the Bratsk Hydroelectric Power Station on the Angara, a Siberian river, was started in 1955, one of the tents in the tent town where the first builders lived housed a medical centre with a dentist, a nurse and a midwife. The tent also housed the first dispensary.
Five young doctors, graduates of the Irkutsk Medical College, arrived to work at the construction site in the autumn of 1955; by the end of the year their number had increased to 12. Before long two polyclinics were built.
The construction of the hospitals followed. In 1957 the first hospital was opened with 25 beds; from then on the number of beds continued to increase, while specialised departments---therapeutic, surgical, pediatric and obstetric--- gradually came into being. In 1958 work was completed on the construction of the hospital complex which, in addition to the afore-mentioned departments had a blood transfusion centre, a dental laboratory, an X-ray room and other services. That year the number of beds in Bratsk reached 725, treatment being now offered to patients with a wide range of diseases.
First aid centres and small medical centres with 15 beds each, for the treatment of tuberculosis, skin and venereal 70 diseases and psychoneurological ailments were opened. In I960 a hospital with 50 beds was commissioned in the vicinity of Bratsk and another hospital with 50 beds was put into operation in a nearby settlement. In September 1961 the main building of a 200-bed hospital in the Gidrostroitel township started admitting patients. A beauty parlour and a physical culture workshop were opened in the town. In 1962, when Bratsk already had quite a representative complex of medical institutions catering for both in- and outpatients, health universities were set up in some of them, open to all for basic health instruction.
It should be noted that the curative and prophylactic institutions built in Bratsk included not only standard hospitals and polyclinics for the population, but also special medical institutions consisting of nonhospital services ( polyclinics with medical centres or primary medical centres at industrial enterprises) and hospitals intended for treat!ng the industrial and office workers of these enterprises.
Because of the influx of a large number of specialists and industrial and office workers to the Bratsk Hydroelectric Power Project the medical institutions in the nearby villages also had to be expanded. Four rural divisional hospitals which formerly had only a few beds each increased the number of their beds to 25 each; today they have up-to-date equipment, and operating and X-ray rooms. Simultaneously with the expansion of the existing rural hospitals five new rural hospitals have been built and put into operation on the territory of the nearest state farms and timber enterprises. These hospitals have 35--50 beds each.
A sanitation and antiepidemic service has also been set up in Bratsk and the neighbouring settlements. By 1966 the number of epidemiologists and sanitary inspectors had reached 29. As for the total of medical personnel (there had been only 5 doctors and nurses in 1955), in 1967 the 60 medical institutions of Bratsk employed 278 specialists with higher medical education, not counting dentists, and 200 junior medical workers. The per capita medical personnel of Bratsk equalled that of the rest of the country.
This is how today's highly-skilled and specialised medical aid in the young Siberian town of Bratsk, the site of one of our largest hydroelectric power stations has been built up. Nor is this an exception, either. Such a rate of constructing medical institutions and establishing complete medical--- 71 prophylactic and curative---services has become customary for the USSR.
If the reader remembers, in describing the medical institutions of Bratsk mention was made of medical centres, health centres, medical and sanitary centres, polyclinics, hospitals, hospital complexes, sanitary and epidemiological services. We are now going to describe the organisation of the medical services in the USSR, giving a general classification of the varied and numerous curative and prophylactic institutions and pointing out the more significant branches of publichealth services in the USSR.
__ALPHA_LVL2__ Main Curative and Prophylactic Institutions.There is a great variety of types of medical institutions in the USSR, their number reaching 100. The most widespread types are hospitals, polyclinics, and dispensaries. That is why, before going on to the characteristics of the public health services intended for different groups of the population, or established under particular economic and geographic conditions, it is worth taking a brief look at the main types of medical institutions.
The leading curative and prophylactic institution in the Soviet Union is the incorporated hospital, i.e., an institution with an inpatient division and a polyclinic for outpatients.
Naturally such hospitals are of different sizes and capacities, depending upon the character and size of the area which they serve. An incorporated hospital may have 100, 200, or 500 and more beds. Usually, however, especially in middle-sized towns, they have from 100 to 200 beds. This is not enough and the capacity of the hospitals must be enlarged because highly-skilled and specialised medical aid can best be provided by institutions which have all the basic specialised departments, which are equipped with up-to-date devices, apparatus and instruments for all forms of diagnostic, curative and prophylactic activity, and employ highlyskilled specialists of various types. Today the Soviet Union has hospital complexes with 600--800 and more beds and it is planned to build still larger hospitals with many specialised departments.
72An incorporated hospital, as was already mentioned, has an inpatient section which, depending on its capacity, has various departments---therapeutic, surgical, obstetric and gynecological, neurological, ophthalmological, otolaryngological, etc. Large hospitals including a number of medical specialities have in addition ncurosurgical, nephrological, curdiological, pulmonological, gastroentcrological and other departments.
Experience and calculations show that in a large hospital (he most rational size of a department in such leading specialities as therapy and surgery, is 60 to 70 beds.
__*_*_*__Considerable importance is also attached to improving the functioning of the hospitals. In large curative and prophylactic institutions (hospitals, institutes, large sanitary and epidemiological centres, etc.) special departments or groups for studying the scientific organisation of work are established. They examine the working day of doctors of various specialities and by junior medical personnel, the distribution of personnel, suggest the optimum methods for the utilisation of material and technical resources, the organisation of the work of the medical staff, etc. An important problem in the organisation of public health work today is that of reducing the time doctors have to spend filling out various medical documents, especially case histories. For this purpose a set of technical innovations has been proposed, which simplify the keeping of the necessary records and save the doctor's time. One of these is the organisation of dictaphone centres in large hospitals. The dictaphone centre receives information from the hospital departments, records it on tape and reproduces it in appropriate documents, most commonly standard case history diagrams. Usually a special system of telephones and tape recorders is employed for this purpose. The dictaphone centres employ medical nurses who type the information into the case histories.
Such a dictaphone centre is operating in one of Moscow's largest mental hospitals---the P. I. Kashchcnko Mental Hospital---which has more than 2,500 beds and a staff of some 2,000 people, including about 200 doctors. Before the establishment of the dictaphone centre, the doctors used to spend 50 per cent of their time keeping medical records. Now, with the dictaphone centre and its 21 tape recorders, the 73 doctors save a lot of time. The experience of this particular dictaphone centre lias shown that it may also be used for making and keeping the medical records of other medical institutions located in the vicinity. For example, it already records the medical documents from another city hospital with 750 beds.
A similar dictaphone centre has been organised in the regional hospital of Podolsk, a town near Moscow. All the departments of this large hospital are connected to the dictaphone centre which receives their information and keeps records. A special study of the effectiveness of this centre has shown that it has cut the time usually required to fill out the case histories and other necessary documents by more than a half. The time thus saved is now used by doctors for tasks requiring their medical skill.
Electronic computers, dictaphone centres and other means of mechanising hospital routine are being introduced on an ever growing scale since they help to save time and rationalise medical work.
__*_*_*__An integral part of an incorporated hospital is the polyclinic or, to be exact, the polyclinical division of the hospital. It should at once be noted that the polyclinic administers the greatest volume of medical aid to the population. The practice of recent years has shown that about 80 per cent of all patients received medical aid in the polyclinics and not more than 20 per cent were hospitalised. Moreover, those patients who are referred to hospitals, go through the polyclinics as well. Thus the polyclinic, which is in most cases considered a structural unit, belonging to an incorporated hospital, plays a very important role in the Soviet public health system. There also exist independent polyclinics, i.e., not attached to hospitals.
The polyclinic is the most important unit in the Soviet health service. Not a single country in the world has, as yet, as many polyclinics as the Soviet Union. Moreover, Soviet polyclinics differ from comparable outpatient departments in other countries in their capacity, structure, the nature of their activities and methods of administering medical aid.
What is a Soviet polyclinic? It is an amalgamation of various outpatient services. It includes offices and 74 departmcnts of different medical specialities (internal diseases, surgery, nervous diseases, diseases of the ear, throat and nose, skin diseases, etc.), and diagnostic laboratories, offices and departments of physical methods of treatment, etc. To some extent the polyclinic resembles in its purpose or, to be exact, in the character of its work the type of group practice being more and more commonly adopted by doctors in the USA, Great Britain, France and other countries. It also resembles the health centres which were organised in Great Britain after the introduction, in 1948, of a state public health system.
The polyclinic, as it exists in the USSR, however, has a number of advantages over the group practice, the health centres and other forms of medical aid available for outpatients abroad. The polyclinic is a very complex institution that has evolved in the Soviet Union over a number of years and earned itself a good reputation. It offers treatment by doctors of various specialities, diagnoses diseases and combines therapy with prophylaxis. It is certain to have the requisite modern diagnostic equipment, a laboratory and apparatus for modern methods of treatment. Moreover, many polyclinics, as was said above, are incorporated with hospitals.
Another special feature of Soviet polyclinics is that they are centres of curative and prophylactic work for a definite area. Most polyclinics, especially in towns, are district polyclinics, i.e., they serve a definite administrative part of the town (in small towns and villages they serve the entire population). This method of territorial distribution of polyclinics is another example of the divisional principle of serving the population discussed in the preceding chapter.
Depending upon its capacity, a polyclinic serves a different number of divisions---up till 20 or even more (it will be remembered that in towns a medical division usually covers an area inhabited by 4,000 people, including some 1,000 children). It is believed that in towns, especially in large ones, a polyclinic should be capable of dealing with 1,600 or more patients a day.
Everything that was said about polyclinics applies both to independent ones and those attached to hospitals. In the USSR hospitals (with polyclinics or having no polyclinical department) are divided into general and specialised hospitals. Specialised hospitals are usually those intended for 75 treating patients with tuberculosis, infectious diseases, mental disorders, etc. This does not mean, however, that there are no separate hospitals or clinics, i.e., medical institutions attached to higher medical schools and medical research institutes, intended for groups of patients with definite types of ailments. There are such clinics or separate hospitals, which may also he called specialised in, practically, all medical fields.
A discussion was recently held in the press about the correlation between specialised hospitals, i.e., those intended for treating patients of one type ol ailment, and general hospitals, i.e., those having various specialised departments. Without going into the details of the discussion, which was started by Academician A. N. Bakulev, a prominent Soviet surgeon, and attracted the attention of many prominent scientists and practical public health workers, it should be noted that most of them were in favour of large hospitals, since there it is possible to combine various forms of medical aid and organise co-operation of various specialists, and since more favourable conditions exist there for setting up centralised diagnostic and therapeutic services in which polyclinics function as hospital departments.
The question of hospitals and polyclinics is, obviously, closely connected with one of the most pressing problems of modern medicine, namely, specialisation. In the USSR specialisation is rightfully considered one of the decisive means of enhancing the quality of medical aid and providing the population with a highly-qualified medical service. The preference given to large (600 and more beds) hospitals will make an essential contribution to the development of specialisation.
We must include as one of the basic public health institutions dispensaries, i.e., institutions for prophylaxis and administration of specialised medical aid in a number of diseases. In the USSR there are skin-and-venereal, oncological, neuropsychiatric, trachoma, goiter and exercise therapy dispensaries. These institutions, some of which have hospital beds, i.e., are in a position to administer both inand outpatient aid, work on the basis of the dispensary methods already discussed above. But, as was noted, the dispensary method is not limited to the work of the dispensaries alone; these are intended to supplement the dispensary services performed by all institutions of the USSR 76 public health system. The dispensaries concentrate their attention on the early detection of certain illnesses, early therapy, social and everyday help and, if necessary, regular visits to patients' homes. Their functions include finding suitable jobs for the chronic patients giving expert opinion on the working capacity of patients and forensic testimony, as well as providing advisory aid to other curative and prophylactic institutions. The dispensaries co-operate with polyclinics and hospitals thereby considerably extending the iunction of the latter in administering the necessary medical aid to particular groups of patients.
In discussing the material and technical base of Soviet public health in the preceding chapters we cited the most important figures including the number of hospital beds in ail the curative and prophylactic institutions. We noted the steady increase in the volume of medical aid provided to the population.
Table 8 shows the growth in the number of hospital beds and (heir specialisation.
``I" able 8 Specialisation of hospital beds (in thousands) Hospital beds 1910 I'J70 Absolute numbers Per 10.000 population Absolute numbers Per 10,000 population Total number of beds 790.9 40.2 2,003.3 109.2 Including: Internal diseases patients 102.1! 5 2 544.0 22 . 3 Surgical patients 99.4 i'') . 1 351.2 14.4 Oncological patients 1.7 0.1 40.0 1.9 Gynecological patients 33.0 1.7 151.5 (i 3 Tuberculosis patients 34.0 1.7 271.9 11.1 Infectious diseases patients 91.3 4.<S 198.3 8.1 Children with noninfectious diseases 52.5 2.7 324 . 8 13.3 I '"ye patients 1:5.4 0.7 39.3 1.6 Otolaryngological patients 6.9 0.4 39 . 7 1.6 Ski n-and- venereal patients 15.4 0.8 52.8 2.2 Neurological patients 10.0 0.5 71.5 2.9 Mental patients 82.9 2.2 207.!) 11.0 Pregnant and parturient women 113.5 5.8 198.0 8.1 77We can see that since 1940 (before the Second World War) there has occurred a rather intensive specialisation of hospital beds. The degree of specialisation was particularly high in surgery. Neurosurgery, oncology, nephrology, etc., were also developing rapidly.
At the same time there has been a further differentiation within the therapeutic disciplines. Specialised cardiological, rheumatological, gastroenterological, pulmonological and other internal disease institutions (hospital departments, clinics, etc.) are being established.
Specialisation also covered the outpatient and polyclinical services. This is most clearly manifested in the organisation of specialised offices and departments in polyclinics and, as was mentioned above, in the establishment of specialised dispensaries.
Among specialised outpatient and polyclinical institutions, either independently or as parts of other institutions, that have become widespread of late are cardiorheumatological offices and dispensaries, offices of intestinal infections in polyclinics, hematological offices, etc.
In addition to specialised offices, dispensaries and other institutions intended to provide the population with skilled medical aid even in the rarer diseases, specialised medical aid centres designed for the population of whole regions or even several regions are now being organised in the USSR.
Usually such centres combine polyclinical and hospital aid. Large specialised hospitals with 600 and more beds are now being built. Among them are hospitals for cardiosurgery, neuro-oncology, nephrology, chronic renal insufficiency, pulmonology, etc. Today, for example, there are more than 80 "renal centres" in the Soviet Union with up-to-date equipment, including such complex apparatus as the artificial kidney. Such centres for the rarer diseases usually arc established on the basis of large research institutes and serve the population of several regions and even republics. Thus, for example, the Institute of Cardiovascular Surgery of the USSR Academy of Medical Sciences is the chief centre of cardiovascular surgery. Thirty cardiosurgical centres have been established on the basis of large clinics and research institutes. The N. N. Burdenko Institute of Neurosurgery of the USSR Academy of Medical Sciences is the basic neurological centre; there are other centres in this speciality based on research institutions in this field, as well as large hospitals 78 and polyclinics. There arc also centres for the treatment of burns; here patients with severe burns receive highly-skilled aid.
Specialised interrepublican, republican and regional centres for various internal diseases are being established. Thus the specialisation of in- and outpatient aid in the Soviet Union is developing through the organisation of specialised departments at large hospitals, some of which simultaneously become centres in the field of medicine and the organisation of specialised complexes consisting of large hospitals and outpatient departments.
__*_*_*__In this small book we cannot possibly hope to mention all the forms of specialisation, but feel bound to dwell on one of its most widespread forms, namely, the Soviet first aid service.
There is a widely ramified system of first aid stations and centres in the USSR. First aid stations are usually set up in cities with a population of 500,000 and more. These stations are well-equipped for rendering urgent, first aid, having a centralised controlling office and specialised conveyances (ambulances). All polyclinics have emergency aid centres, which also have special vehicles for emergency calls. Most of the vehicles are appropriately equipped, and have direct radio-telephone communications with the first aid stations. In large cities the first aid stations have hospitalisation offices which are always informed as to the free beds available in all hospitals, which have the facilities for accommodating and treating patients brought by ambulance.
The ambulances are served by teams of medical workers headed by doctors, while we know some countries, where first aid is administered by policemen, cab drivers and other people who have had no medical training.
Of late specialised first aid teams have been gaining in popularity; these teams are summoned for immediate medical aid and transportation of patients affected with definite diseases. Today there are more than 300 of such teams specialising in resuscitation, aid in heart attack, poisonings, first aid to children, etc.
Urgent problems of emergency aid are studied by three research institutes, in Moscow, Leningrad and Kharkov. The Sklifasovsky First Aid Institute in Moscow has won 79 wide renown; it has a large hospital with various specialised departments and research laboratories.
Since demands for emergency aid are great plans are now under consideration to expand the emergency aid services.
In addition to these services, large, and especially regional hospitals have air ambulance stations. The air ambulances carry specialists to accident victims or patients in very grave condition and requiring highly-skilled aid, or transport the accident victims and patients to hospitals. The air ambulance stations are particularly important and at times indispensable in the Far North and the vast steppes of Central Asia and Kazakhstan.
__*_*_*__Plans for developing health protection and medical science in the USSR provide for organising many new centres of specialised medical aid. For example, large clinical hospitals with polyclinics with 1,000 or more beds each are to be built in 1971--1975. Moreover, oncological dispensaries (450 and more beds each), lirst aid hospitals with resuscitation centres (600-1,000 and more beds each), specialised hospitals for restorative treatment with polyclinics and similar hospitals for children (360--520 beds each) are to be built during the same period.
It may be asked whether such extensive and long-term plans for developing the network of medical institutions in the USSR, including the construction of many specialised departments, hospitals and centres are really called for, seeing that, as has been shown, the health of the Soviet people is constantly improving. It would seem to follow that the need of the population for medical aid should decrease. Yet we speak about the considerable increase in number of the country's different medical institutions as a considerable achievement, and note that the extent of all forms of medical aid administered to the people is growing every year. Whereas in 1955 some 600 million people sought medical aid at polyclinics and other outpatient institutions in Soviet towns, in 1967 the number of applications to these institutions for treatment amounted to nearly 1,250 million. This means that in the towns each person visited outpatient institutions an average of 10 times in 1967, about 7 times in 1955 and about 6 times in 1940 (before the war).
80
__CAPTION__
The USSR has a greater
__CAPTION__
The Republic Mother and
__CAPTION__
Professor G. Speransky, the
__CAPTION__
Physical development is a. sine
__CAPTION__
A new hospital with JOO beds
__CAPTION__
Physical development is a sine
__CAPTION__
In the Pamirs. Cattle--
__CAPTION__
Ka/akh SSR. Aspet
__CAPTION__
A universal ambulance in
institutions indicate a deterioration in the health of the
population? We have already noted that it does not. The
increase in the number of applications to medical
institutions shows that people attach greater importance to
receiving highly competent medical advice and to being treated by
specialists. Moreover, more and more healthy people come
to medical institutions for consultation on problems of
hygiene. Medical institutions are extending their
prophylactic activities, and dispensary work. Our plans envisage
placing the entire population of the Soviet Union under
dispensary observation within the next 20 yeiirs. The
accomplishment of this task requires a sharp increase in the
number of different medical institutions. Hence, the growth
of hospitals, polyclinics, dispensaries and other curative and
prophylactic institutions in the Soviet Union.
__ALPHA_LVL2__
Medical Care for Industrial Workers
We have already dealt with the most important Soviet public health services designed to administer skilled medical aid to all sections of the population. At the same time, attaching particular importance to the health of the workers, the Soviet public health system has additional services designed to administer skilled medical aid to industrial and office workers at their enterprises. Such services are organised with due regard to the specific features of industrial production.
The most typical example of an institution especially designed to administer medical aid to the workers of an industrial enterprise is a medical and sanitary centre, which is a special department of the industrial enterprise in charge of its workers' health.
The first medical and sanitary centres began to be organised before the Second World War, but the need for them manifested itself particularly clearly during the war years when the Soviet people had to endure great hardships. So it was during the war that institutions for in- and outpatients began to be established in large factories.
Essentially there are no special features in the structure and methods of work of the medical and sanitary centres since they are designed to administer all forms of medical aid to the employees of the particular enterprise, though 81 with special regard for dispensary services and other forms and methods of prophylaxis. As a rule, the medical and sanitary centre is an amalgamation of all the medical institutions at the given industrial enterprise. It usually includes a hospital, a polyclinic, medical posts in shops and a socalled prophylactorium, i.e., a night sanatorium in which workers undergo a course of treatment and constant observation by specialists. In addition, the medical and sanitary centre may also include a nursery, a kindergarten, a pharmacy, if the given enterprise has one, a dietetic canteen and other institutions.
The medical and sanitary centre of the Moscow Krasny Proletary Machine Tool Plant provides a typical example, though it has a smaller hospital (only 35 beds) than most institutions of this type.
This medical and sanitary centre includes a polyclinic with the requisite equipment, laboratories and doctors' oflices for administering practically all forms of specialised outpatient aid. The only medical offices the polyclinic lacks are those of urology and psychiatry. When necessary, however, urological and psychiatric patients are referred for consultation and treatment to the nearest specialised institutions in Moscow.
The medical and sanitary centre also includes three shop medical posts, two of which are under the supervision of surgeon's assistants and one of a doctor, a room of women's hygiene, a night sanatorium or prophylactorium with 50 beds and a dietetic canteen for workers who need a special diet.
Medical posts are set up directly in shops and are run either by junior medical personnel---surgeons' assistants and nurses---or by doctors plus junior personnel. The personnel of a medical post administers aid directly at the working place, performs various prophylactic tasks, supervises the observance of the industrial safety rules and norms of hygiene, i.e., is in charge not only of treatment, but also of prophylaxis. In all cases requiring competent medical attention the personnel refers its patients to the polyclinic of the medical and sanitary centre where they are treated by doctors and, if necessary, are sent to the hospital of the medical and sanitary centre or to a specialised city hospital.
The medical and sanitary centre of the Krasny Proletary employs a total of 87 people---22 doctors, 42 trained nurses, 20 hospital attendants and 3 executive workers.
82The polyclinic of the medical and sanitary centre is located within the plant. It has the following doctors' offices---6 for internal diseases, one each for surgery, stomatology, otolaryngology, gynecology, ophthalmology, and for adolescent patients; it also provides physiotherapy and has a pharmacy.
The hospital with all the necessary equipment is located near the polyclinic. On the ground floor of the hospital is the kitchen and therapeutic baths which serve the hospital and prophylactorium patients.
At industrial enterprises medical aid is also administered on the divisional principle, but here the divisions are the different shops of the enterprise each with a specific number of workers. The divisional doctors are usually those of the medical posts and the medical and sanitary centres; these doctors, jointly with the junior medical personnel, the administration and the public organisations, carry out various prophylactic measures. Within the last five-year period (1966--1970) the number of medical and sanitary centres in the USSR grew by 23 per cent, with the corresponding increase of hospitals and beds. The perfection of the curative prophylactic work among the industrial workers is a major task facing the public health services in the new five-year period.
__ALPHA_LVL2__ Medical Care in the CountrysideThe organisation of medical aid for the rural population has some specific features of its own.
The vast territory of the Soviet Union is distinguished for an enormous variety of geographical, climatic and economic conditions which affect the mode of life of the people, especially in the countryside. We have only to consider the factor of distribution of the population, i. e., its density, the size and grouping of villages, the condition of roads and numerous other factors, to gain some idea of the vastly differing conditions of rural life. It would therefore be wrong to apply the same yardsticks and standards to the organisation of medical aid in the different geographical and economic zones of the country; it would be equally wrong to build only small or only large medical institutions. The approach should be flexible and the solutions variegated.
But however much the rural areas of the Soviet Union __PRINTERS_P_83_COMMENT__ 6* 83 may dilier Ironi each other, they still have certain features in common. One of these features is their size. This factor necessitates the bringing of medical aid closer to the habitation of the rural population.
This need is met by primary medical aid centres in rural areas, which have the minimum number of beds (2-3) and are run by junior medical workers---surgeons' assistants, midwives or trained nurses. The premises of such a medical unit usually consist of a few rooms, one where the surgeon's assistant receives the patients, one (or more) with beds lor normal childbirth, one for recently confined women, one for the medical nurse, etc.
One of the most important functions of these medical outposts is outpatient aid to the population. In cases when the professional knowledge of the surgeon's assistant is inadequate he refers his patients to a doctor at the nearest hospital.
Prophylaxis and improvement in the sanitary and hygienic condition of the village are important functions of these medical units. The surgeons' assistants, midwives and nurses are obliged to give the rural people health instruction to train some of them to act as voluntary sanitary inspectors and with their assistance to supervise the sanation of the locality.
Usually these medical units are located in villages where there are village Soviets, i.e., the primary bodies of state power. The units are designed to serve from 300 to 900 people. Consequently, they may administer medical aid to the people not only of the given village, but also, as is most commonly the case, of the nearby ones.
Considerable importance is still attached to these medical units whose number is quite large---more than 90,000.
As for qualified medical aid to the rural people, three levels, so to speak, may be distinguished in it. The first level is the divisional hospital.
As we already noted, the territory of rural areas is divided into medical divisions with a population of from 5,000 to 12,000 in each. A division is served by a divisional hospital with at least 35 beds. At the present moment, it is considered more expedient to have larger divisional hospitals with up to 100 beds, but divisional hospitals with 35--50 beds still prevail in rural areas. Each of these hospitals has both inand outpatient departments. The beds are usually intended for patients with internal, surgical, gynecological and 84 infectious diseases, as well as for parturient women. A divisional hospital requires at least 4-5 doctors---an internist, surgeon, obstetrician and gynecologist, pediatrician and a dentist.
The head doctor of a divisional hospital and his colleagues are responsible for the administration of medical aid to the entire population of the division, which includes the work of the surgeons' assistants' and midwives' units. On certain days (strictly according to plan) they visit these units and attend to patients. Moreover, they go to these units whenever they are summoned by a surgeon's assistant, midwife or nurse in charge.
The second level is the district hospital, the basic medical institution of the district where skilled aid is administered by specialists, including those in the rarer ailments. Today many districts have 2 or 3 hospitals, one of them regarded as the central one and charged with coordinating all public health work in the district.
Like divisional hospitals, district hospitals also have inpatient departments with departments or wards for patients with internal, surgical, gynecological, otolaryngological, and nervous diseases, a children's department and maternity wards. Besides, district hospitals have polyclinics. These not only administer medical aid to outpatients of the village in question, but also serve as consultative centres for the other medical institutions of the district, including the divisional hospitals.
District hospitals usually have 100 or more beds, and are gradually being enlarged. It is intended that the capacity of district hospitals should be increased to 250--400 beds, so that these leading rural medical institutions may provide fully up-to-date, skilled medical aid.
A centra] district hospital (even when it is the only one in the district) is also the administrative centre of all the public health institutions of the given rural district. Its head doctor is at the same time the head doctor of the district, all its medical workers, including the heads of divisional hospitals and other curative and prophylactic institutions of the district being under his jurisdiction.
The third level is the regional hospital. This is usually a large hospital with 500 or more beds. It includes a polyclinic, where doctors administer outpatient aid to rural people usually referred to them from district or even directly from divisional hospitals, and an inpatient department with 85 a practically complete ``set'' of specialised departments, beginning with internal diseases and ending with such narrow specialities as neurosurgery, traumatology, etc.
Regional hospitals, in their capacity of centres of highlyskilled and specialised medical aid for the rural population, serve as bases for the advanced training of doctors working in the medical institutions of the region, particularly, in divisional and district hospitals, and as a training base for secondary medical schools. In regional cities, which have medical colleges, these hospitals also provide practical training for the students, that is, act as clinical hospitals. Since they have highly-skilled specialists with extensive medical experience on their staffs, regional hospitals are also obliged to render assistance to all the medical institutions of their region. Most regional hospitals have air ambulance stations and it is compulsory for all to have emergency aid departments provided with all the necessary sanitary conveyances not only for transporting specialists to the places where they are to administer urgent aid, but also for bringing in the patients.
After this brief acquaintance with the structure of Soviet public health system the reader may form the impression that all the different therapeutic and prophylactic institutions in town and country work in isolation, strictly within their territorial bounds. That, however, is not the case. Very often inhabitants of rural areas are treated in city hospitals. This is an inevitable process since the differences between town and country in the USSR are gradually disappearing. This also applies to health protection. The essential differences in the level of medical aid administered to the urban and rural population are also disappearing. While in 1950 the number of hospitalised cases was 15 per 100 town dwellers and 7.7 per 100 country dwellers, in 1970 it was 19.8 and 19.3 respectively, i.e., nearly the same.
Another expression of this process is the fact that more than 25 per cent of country people are accommodated in town hospitals. We regard this as a very positive phenomenon because the number of doctors and other medical workers is still much larger in towns than in rural areas.
It is safe to forecast that the enlargement of medical institutions, and especially of district hospitals, and the bringing of hospitals and other forms of medical aid closer to the rural population will make it possible to raise the level 86 of rural medical service to that of medical service in the towns.
By way of an example we shall describe just one rural district in the Tuva Autonomous Soviet Socialist Republic which forms part of the RSFSR. Before the Revolution this outlying area had, like many others, practically no medical services. Suffice it to say, that in this area there were only two doctors, two very small hospitals, one medical post and one pharmacy. Today the republic has close on 500 doctors, 42 hospitals and polyclinics, 4 specialised dispensaries, 132 medical units and 172 pharmacies.
The district of the Tuva Republic can be taken as a typical example. The small town of Turan, the district centre, has a central hospital with 100 beds. The hospital has modern equipment and satisfies the needs of the population for skilled medical aid. The hospital and its polyclinic have all the necessary laboratories---clinical, biochemical and bacteriological as well as an X-ray room.
In addition to this central hospital there are several divisional hospitals and 12 medical units in the district. These institutions are particularly necessary in Tuva where the settlements are far apart and there are very few modern roads. When the immediate attention of highly-skilled specialists is necessary patients are either transported by an ambulance to the republican hospital or specialists are brought to the patients. The central hospital provides young doctors (many of them Tuvinians) with a chance to improve their professional skill and increase their knowledge.
__ALPHA_LVL2__ Medical Care for Women and ChildrenThere is no need to explain the truth, obvious to all and in particular to medical workers, that the health of a people is primarily the health of the rising generation. The Soviet power, since its very first years, has devoted particular attention to reducing infant mortality and controlling children's infectious diseases. A special decree on infant mortality was issued. The decree noted with pain and indignation that "in Russia two million infant lives which had hardly been kindled were annually extinguished because of the ignorance of the oppressed people and the inertness and indifference of the bourgeois state. Every year two 87 million suffering Russian mothers shed bitter tears while filling with their toil-hardened hands the early graves of those made the innocent victims of the gruesome state system.'' These words were no exaggeration.
The underdeveloped economy and the callous attitude of the ruling classes of tsarist Russia to the problems of mother and child welfare were at the root of the terribly inadequate medical organisation catering for mothers and children. Before the October Revolution all of Russia had only 9 outpatient consultation clinics for mothers and children. In 1913 there were not more than 7,500 beds for pregnant and parturient women, while on the territory of the present-day Central Asian Republics there were only 120 obstetric beds. There were extremely few pediatricians, obstetricians and gynecologists. Only 5 per cent of confinements were given any medical aid. No wonder that more than 30,000 women died of puerperal septic diseases every year.
Pre-school institutions were practically nonexistent since all of Russia had nursery accommodation for only 550 children, and less than 4,000 children attended kindergartens.
It is clear that the mother and child welfare service had to be built up from nothing. A mother and child welfare department was organised by the People's Commissariat of State Charity as early as December 1917. In 1920 the People's Commissariat of Health took over the organisation of all this extensive activity.
By 1940 the USSR already had a modern system of skilled medical care for women and children. The system included a large number of polyclinic-type institutions---8,600 mother and child consultation centres and children's polyclinics. The hospitals had close on 90,000 beds for children, and nearly 1,000 children's sanatoriums accommodating 95,000 had been opened. In maternity homes and obstetric departments the number of beds for pregnant and parturient women had reached 147,000 and there were another 33,000 for gynecological patients. Special faculties for training pediatricians began to be organised in medical colleges in 1930. The first of them was opened in the N. I. Pirogov 2nd Moscow Medical Institute. Before the Second World War the country already had 19,500 pediatricians and more than 10,500 obstetricians and gynecologists.
The basic and most typical medical institution for administering skilled aid to children is the children's hospital, 88 usually combined with a children's consultation centre or a children's polyclinic. Medical aid to pregnant and parturient women is given at maternity consultation centres, maternity homes and obstetric departments in hospitals. These institutions provide effective therapeutic and prophylactic aid for women from the very first months of pregnancy and for children from the day of birth until the age of 16.
The health services for women and children, like those for the entire population of the Soviet Union, are built on the divisional principle. For every 800-1,000 children of a territorial division of a town there is a pediatrician in the nearest children's polyclinic. Like the divisional internist, the pediatrician acts as a family doctor, giving medical advice and administering medical aid to children. His immediate assistants are the nurses of the children's polyclinics who visit the children at their homes not only to help the doctor in the administration of treatment, but also to teach the mothers and other members of the family how to take care of a child, give them health instruction, etc.
Pregnant women are served by obstetricians, gynecologists and medical nurses also on the divisional principle; they are supposed to visit their doctor at least once a month. In normal pregnancy every woman visits her doctor 6 to 8 times.
These institutions thus ensure continuous medical observation and control of the health of mothers and children and thereby carry into effect the prophylactic trend of health protection.
This system is supplemented by pre-school institutions--- nurseries and kindergartens. In the nurseries and kindergartens the children are observed both by divisional pediatricians and those specially employed in these institutions.
It should be noted that in addition to the divisional pediatricians schools employ special school doctors who maintain constant observation of the health and physical development of all the pupils and devote particular attention to prophylactic activity, such as health education, control of prophylactic inoculations and other sanitary measures.
It should be observed that, as their principal method of work, children's polyclinics and maternity centres exercise dispensary supervision. This takes the shape of summons of pregnant women to the maternity centres for examination, 89 visits to the homes lor curative and prophylactic purposes, and also the detection of early signs of disease in children and pregnant women and the administration of timely aid. Children with poor health are sent to out-of-town or forest schools. These are unique educational and medical institutions which provide conditions for normal study and medical control by highly-skilled specialists. There arc also sanatorium-type institutions with medical observation for expectant mothers.
The wide scope of such curative and prophylactic measures aimed at improving the health of women and children can be judged by the sharp increase in the in- and outpatient institutions intended for this purpose. In 1968 the number of maternity consultation centres and children's consultation centres and polyclinics, both independent and attached to hospitals, exceeded 20,500; hospital beds for children numbered close to 400,000, while those for pregnant and parturient women exceeded 223,000.
Table 9 shows the increase in women's and children's medical institutions and nurseries, as well as in the number of pediatricians, obstetricians and gynecologists.
T a b 1 e 9 Mother and child care institutions 1913 1940 1950 I960 I9R8 Maternity health centres, children's consul-- tation centres and polyclinics (independent and attached to other insti-- tutions) Beds for pregnant and parturient women Pediatricians 9 7,500 8,600 147,000 19,358 11,300 143,000 32,105 16,400 213,000 58,908 20,500 223,400 74,868 Obstetricians and gynecologists Permanent nurseries Number of children at-- 30 10,620 24,000 16,624 19,600 26,663 43,600 38,500 22,500 tending permanent nurseries 550 781,400 619,400 1,312,900 1,285,200 90From the table it follows that the number of different medical specialists in mother and child care has increased many times over. In 1970 there were about 27.4 doctors per 10,000 population, and of these 3.3 were pediatricians and 1.7 obstetricians and gynecologists. These figures prove that women and children are adequately provided for with highly-skilled medical aid.
The figures showing the state of affairs in the USSR as a whole are also true of every one of the Soviet Republics. For example, in 1970 there were more than 3.000 pediatricians in the Uzbek SSR, about 4,000 in the Kazakh SSR, over 800 in the Kirghiz SSR, and 650 in the Turkmen SSR. Before the Revolution, as we noted above, these outlying areas of Russia had practically no such specialists or medical institutions. This high level of mother and child care has naturally made itself felt in the sharp improvement of the health of mothers and children. Today practically all women (more than 98 per cent) bear their children under the observation of skilled medical personnel, 91 per cent giving birth in lying-in maternity hospitals. As a result, the mortality rate of parturient women has decreased in Soviet times to less than one-fifteenth of its pre-revolutionary figure.
The table also showed the increase in the number of nurseries and of children attending them in Soviet times. But these figures include only the number of permanent nurseries and do not take into account the large number of seasonal nurseries, i.e., those opened for a certain period of the year, mainly in rural areas when there is a particularly great need for labour during the harvest. Moreover, the table does not include the figures of kindergartens and other pre-school and extra-school institutions. Today more than 9 million children attend pre-school institutions as against 4,500 children in 1913. During the summer months, however, the number is swelled by the five million or more children from collective and state farms who go to kindergartens and creches.
About 8 million schoolchildren annually spend their vacations in Young Pioneers' camps. The rest and recreation, as well as all the health-building activities in the camps are carried out under the supervision of doctors.
These are just some of the facts attesting to the untiring care of the Soviet state for the health of women and the rising generation.
91Nor is tins care confined to the administration of medical aid. In the USSR mothers and children are rendered extensive and all-round assistance. There are laws, according- to which working women are granted 112 days of paid maternity leave; in cases of the birth of two or more children or childbirth complications the leave is extended. After this leave women may leave work for a period of a year, during which they retain their jobs and an unbroken work record. Nursing mothers are entitled to additional rest and breaks at work.
In addition to these and other privileges, the state grants allowances to mothers of large families and to unmarried mothers. Thus in 1970 the state paid allowances to 3,217,000 mothers of large families, including 1,185,000 mothers of four children. Moreover, in 1970 some 373,000 mothers of two children were granted an extra allowance on the birth of their third child. Back during the Great Patriotic War a special decree of the Presidium of the USSR Supreme Soviet established the honorary title of Mother Heroine and instituted a Maternal Glory Order and a Maternity medal. By 1966 some 95,000 mothers who had borne and brought up 10 children had been awarded the honorary title of Mother Heroine and more than 9 million women had been decorated with the Maternal Glory Order and the Maternity medal. Care for mothers and children has become a tradition in the Soviet Union. This also found an expression in the decisions of the 24th Congress of the CPSU.
__ALPHA_LVL2__ Sanitary and EpidemiologicalThe prophylactic trend of Soviet public health includes, as has already been pointed out, not only nationwide measures of a social and economic nature aimed at preventing disease, but also a number of specifically medical and medicotechnical undertakings. An important role in the prophylactic work is played by the sanitary and epidemiological service. Before the Revolution there was, in practice, no such service. Some sanitary control functions were performed l>v doctors in the towns. There were very few epidemiological specialists and sanitary inspectors, and then only in certain cities. Immediately after the establishment of Soviet power, 92 during the time oi Civil War and economic dislocation, when epidemics became rampant, particular importance was attached to organising a sanitary and epidemiological service. As early as 1922 the Council of People's Commissars ol the RSFSR issued a decree on the sanitary agencies ol the Republic. This decree determined the range ol duties oi the state control bodies. It also established that sanitary workers in the public health services should have one sanitary inspector per 50,000 urban population, and defined the functions of sanitary inspectors in supervising housing conditions, controlling the sanitary norms of production and storage ol foodstuffs, etc.
The first sanitary centre, which was the prototype of today's sanitary and epidemiological stations, was organised at that time in Byelorussia in the town of Gomel. Similar sanitary and epidemiological stations began to be set up all over the country in 1932.
The regulations concerning the sanitary agencies of the Republic were approved in 1927. These regulations defined the scope and duties of the sanitary and epidemiological organisations. One of the most important duties of the sanitary inspectors and corresponding institutions was deemed to be preventive sanitary supervision. From that time on preventive and current sanitary supervision became the most important line of the activities of the sanitary and epidemiological service.
In order to enhance the responsibility of and impart greater authority to the sanitary and epidemiological service, an All-Union State Sanitary Inspectorate was established under the Council of People's Commissars of the USSR in 1935. Its chief function was to direct all work in combating epidemic diseases. In 1936 the All-Union State Sanitary Inspectorate was put under the jurisdiction of the People's Commissariat of Health. It was at that time that a clearly-defined system of sanitary and antiepidemiological institutions, with particular emphasis on sanitary and epidemiological stations was established. Close on 2,000 sanitary and epidemiological stations were already functioning in towns and in some rural areas in 1940. More than 50 specialised institutes developing problems of hygiene, epidemiology, microbiology, etc., had been set up.
The efficient organisation of antiepidemic work made itself felt during the Great Patriotic War in that there were no 93 serious epidemics in the USSR, despite the fact that a large part of the country was occupied by nazi troops.
The sanitary and epidemiological service continued to be consolidated and expanded after the war. In 1970 the number of doctors in the sanitary and epidemiological service (sanitary inspectors, epidemiologists, etc.) exceeded 40,000 and averaged 1.7 doctors per 10,000 population as against 12,500 doctors in 1940. Today the Soviet Union has close on 5,000 sanitary and epidemiological stations.
Sanitary inspectors and epidemiologists have assistants (junior medical workers). Today the number of these assistants exceeds 31,000, not counting more than 68,000 disinsection and disinfection technical workers, whose job is to prevent the spread of infectious diseases by treating the foci of these diseases.
The basic institution of the sanitary and epidemiological service is now, as formerly, the sanitary and epidemiological station, which organises sanitary and antiepidemic measures in its given area (district, town, etc.) and exercises sanitary supervision, i.e., sees to it that all sanitary rules and standards are strictly observed by all organisations and institutions. Work cannot be started on any construction project in the Soviet Union without the approval by agencies of the sanitary and epidemiological service. This service enjoys broad rights, which extend to the point of fining or even closing down enterprises which violate the state sanitary laws and fail to observe sanitary standards and rules.
The sanitary and epidemiological stations employ doctors of different specialities. Among the sanitary doctors in the USSR there are specialists in labour hygiene, occupational diseases, communal hygiene, educational or school hygiene, nutritional hygiene, etc. The head doctor of a sanitary and epidemiological station is simultaneousy chief sanitary inspector of the corresponding administrative territorial unit--- district, town, etc. The chief sanitary inspector of the Soviet Union responsible for the work of the entire sanitary and epidemiological service is Deputy Minister of Health of the USSR.
The USSR Ministry of Health thus directs all work of the institutions of the sanitary and epidemiological service through the corresponding public health bodies (ministries of health of the republics).
94 __ALPHA_LVL2__ Health Resorts and SanatoriumsWhenever health resorts and even sanatoriums are mentioned, the idea of rest and recreation in pleasant and picturesque surroundings usually comes to mind. It goes without saying that such rest and recreation is not only pleasant, but also extremely healthful. At the same time sanatoriums and health resorts exist not only for rest and recreation, but primarily for the treatment of the after-effects of various diseases, in other words, they are primarily medical institutions. That is why, in the Soviet Union, sanatoriums and health resorts are considered an important branch of the public health service.
All health resort business started with the signing of the Decree On Therapeutic Areas of Nationwide Importance back in 1919. According to this decree, all health resorts along with all their buildings, facilities and equipment became the property of the workers' and peasants' state. In 1921 the Crimea was proclaimed an All-Russia health resort. The first sanatorium for peasants was opened in the former tsarist palace in Livadia (the Crimea) in 1925. Health resorts on the Caucasian coast of the Black Sea began to receive workers, peasants and soldiers in 1921--1922, while the restoration of health resorts in other parts of the country, including Siberia and the Far East, began in 1923.
Holiday-homes, entirely new institutions, began to be organised at the same time. Characteristically, the first holidayhome was opened on V. I. Lenin's initiative as early as June 1920.
The overall supervision of sanatoriums and health resorts was concentrated in the Chief Health Resort Administration of the People's Commissariat of Health of the RSFSR.
A large number of sanatoriums and holiday-homes, for the working people to spend their vacations and recover their health, have been built in Soviet times. In 1970 alone more than 19 million people spent their vacations and took treatment in sanatoriums, health resort polyclinics, holidayhomes, and boarding-houses. A large proportion of them were accommodated either free of charge or at a 70 per cent discount, the social insurance bearing the remainder of the expense.
However, the health resorts now in existence cannot fully satisfy the needs of all the working people, and new 95 sanatoriums and holiday-homes are constantly being built. Thus, for example, holiday-homes with accommodation for 145,000 people and tourist health centres with accommodation lor 213,000 people have been built in the last live years alone. In addition to separate sanatoriums, boarding-houses and holiday-homes, large holiday and sanatorium complexes are now under construction in the Caucasus. These will provide accommodations for 7,000 people in Adler, for 4,000 people in Pitsunda, for 2,000 people in Nalchik, etc.
The Soviet Union possesses virtually unlimited natural resources for furthering public health. Expeditions by various research institutes and laboratories working in the Held of balneology have discovered close on 6,000 mineral water springs and more than 700 deposits of therapeutic muds. Today the Soviet Union has more than 500 health resorts and spas.
The following table gives some idea of the increase in the number of sanatorium accommodation.
Table 10 Sanatorium accommodation 1939 1950 I960 1968 Number of sanatoriums (for adults and children) 1,838 2,070 2,073 2,207 Number of beds in them (in thousands) 240 255 :m 417 Including: Sanatoriums for children 957 1,027 1,100 1,178 Number of beds in them 'in thousands) 95 95 120 140The number of boarding-houses in health resort areas also increases steadily. In 1967 there were 190 boarding-houses with accommodation for 55,000 people.
It is now planned to make wider use of sanatoriums and health resorts for restorative therapy following cardiovascular, nervous and other diseases, traumas and surgical operations. To meet these requirements, besides sanatoriums, an extensive network of polyclinics and other medical institutions in health resort areas is being built.
96The number of people given vouchers for receiving medical treatment in resort polydinics grew, between 1950 and 1967, from 67,000 to 673,000.
As has already been noted the management of health resort treatment was originally effected by public health bodies. Nor has the situation changed essentially when in 1960, by decision of the Council of Ministers of the USSR, a large proportion oi sanatoriums and holiday-homes was given over to the trade unions. This enhanced the role of the trade unions in the organisation of the working people's medical treatment, rest and recreation. Health resorts received additional allocations for their development from the social insurance budget and industrial enterprises' own hinds, which improved the material base of sanatoriums and holiday-homes. A special Central Council for managing the trade union health resorts was organised under the AllUnion Central Council of Trade Unions. The corresponding republican, regional and territory trade union councils also have corresponding bodies for managing trade union health resorts.
Sanatoriums for tuberculosis patients and for children have remained the charge of public health bodies. The sanatoriums for tuberculosis patients arc maintained at state expense, and patients stay in these sanatoriums free of charge until complete recovery. Medical control over the health of the inmates in all sanatoriums and holiday-homes, including those managed by the trade unions, is exercised by the public health bodies through the doctors working in these institutions.
[97] __NUMERIC_LVL1__ Chapter 6 __ALPHA_LVL1__ PEOPLE IN WHITE GOWNS __ALPHA_LVL2__ [introduction.]It would be no exaggeration to say that the training of a vast army of highly-skilled medical specialists and junior medical workers and auxiliary personnel is one of the greatest achievements of the Soviet public health system, which reflects the immense successes scored by Soviet economy, science and culture. It may even be asserted that medical education was built up and doctors and other medical specialists trained at a rate which outstripped the development of the overall material and technical base of public health.
Indeed, as has already been noted, in 1913, before the October Revolution, there were only 28,000 doctors and some 46,000 junior medical workers in all of Russia, whereas today there are more than 20 times as many doctors and more than 40 times as many junior medical workers. During the same period, the number of beds in medical institutions has increased 12-fold.
The following table gives some idea of the number of doctors per 10,000 population in the USSR and in five economically developed capitalist countries. (See p. 99.)
According to these figures, one doctor serves some 400 people in the Soviet Union, i.e., far fewer than in the USA, FRG, France, Britain and Japan.
Development of a new system of medical education began in the very first days of the October Revolution, despite the adverse conditions of economic dislocation and the Civil War. Between 1918--1922, as many as 16 new medical faculties were opened, many of them in formerly outlying national areas of the tsarist empire, in Tashkent, Baku, Yerevan and Minsk, as well as in Omsk, Irkutsk and other distant regions.
__PARAGRAPH_PAUSE__ 98 Table 11 Number of doctors of all specialities in the USSR and five capitalist countries^^*^^ (exclusive of army doctors) Countries Years Number of doctors per 10,000 population USSR 1970 27.6 USA 1969 19.2 FRG 1968 19.8 France 1967 16.8 Britain 1965 15.2 Japan 1968 14.4 __PARAGRAPH_CONT__ Even during this first decade of Soviet power, the medical colleges of the young Soviet Republic turned out several times as many doctors in a year as had all the medical faculties before the Revolution. In 1928, for example, they turned out more than 6,000 doctors, i.e., nearly 7 times as many as graduated in 1913. By 1930 the USSR already had 40 medical colleges, and in 1940, on the eve of the Great Patriotic War, 72. By that time there was not a single Union Republic without its own higher medical school where specialists were trained for the national public health system.Before the Revolution, Russia's ten medical faculties of universities, the so-called higher women's courses in Moscow, Kiev, and Odessa, and the women's medical institutes in Petrograd and Kharkov all trained general medical practitioners without any primary specialisation; in Soviet time the principle of medical education was modified.
In 1930, the medical faculties of universities were reorganised into independent medical colleges, in which therapeutic, sanitary and hygienic, pediatric and stomatological faculties were established. At the same time, institutes and faculties were organised for training pharmaceutists. Thus, in addition to general practitioners the medical institutes began to train specialists in the major branches of medicine. Their subsequent specialisation usually took place in clinics and large hospitals, as well as through a combined system of postgraduate study, internship and advanced training. Already before the Great Patriotic War scientific and _-_-_
^^*^^ USSR in Figures, 1970, Moscow, 1971, p. 01. In Russian.
99 Emacs-File-stamp: "/home/ysverdlov/leninist.biz/en/1972/HPITU125/20070729/125.tx" __EMAIL__ webmaster@leninist.biz __OCR__ ABBYY 6 Professional (2007.07.30) __WHERE_PAGE_NUMBERS__ bottom __FOOTNOTE_MARKER_STYLE__ [*]+ __ENDNOTE_MARKER_STYLE__ [0-9]+ technical progress necessitated an increase in the term of study in medical colleges, which at that time was 5 years. The Government passed a special decision to extend the course of training in therapeutic, pediatric and sanitary and hygiene faculties to six years, in the stomatological faculties to five years, and in the pharmaceutical institutes and faculties to 4 years 6 months.But this length of training, which met the high international standards of medical education, had to be abandoned during the war, because both the front and rear needed a large number of medical specialists for treating the sick and wounded servicemen and civilians. The medical colleges, a large number of which had been evacuated to the country's eastern regions, speeded up the training of doctors, the course having been cut to four years. After the war many of these graduates went back to medical colleges to complete their training.
The Soviet system of medical education has continually striven to find the most rational forms and methods of training. Particular attention has been devoted to specialisation during training, i.e., to a deeper study of the future narrow speciality to be practised professionally. Considerable importance has also been attached to the rational combination of the theoretical or, as they are also called, medico-- biological, clinical and social disciplines. Already in early 1920s the curricula of medical schools gave prominence to subjects and disciplines giving the students a correct understanding of the significance of social conditions in the origin and development of disease, and teaching them to devote special attention to prophylactic measures. In other words, the higher medical school began to adapt itself to the social-- andprophylactic trend, which had by then emerged as the leading one in Soviet health protection. The departments of social hygiene organised in medical colleges in the 1920s, together with the departments of social sciences---philosophy and sociology, helped to instil in students the materialist world outlook and give them an understanding of the paramount importance of the social environment in health protection.
Today students of medical colleges are given general, preclinical, as it were, training during their first three years. They study medico-biological subjects, morphology, physiology, pathology, medical microbiology, and the natural 100 sciences---physics, chemistry and general biology. In the fourth year, and for general surgery and the clinic of internal diseases even in the third year, the students receive primary clinical training, i.e., they are taught the fundamentals of various clinical subjects. About this time, depending on the faculty, students undergo their primary specialisation. Today primary clinical specialisation is given additional emphasis. Senior students of medical colleges are given every chance to acquire additional knowledge in one of the major medical specialities---internal diseases, surgery, obstetrics and gynecology, etc. Specialisation within such a broad speciality as pediatrics is, as has already been noted, effected in special pediatric faculties or pediatric colleges of which the Soviet Union now has over 30.
The vast amount of scientific and technical information to be coped with, and the need to further improve the training of doctors have necessitated the decision to extend the course of training in medical colleges by an extra year. Now the course at Soviet medical colleges lasts for 7 years, which includes 5 years of training in pre-clinical and main clinical subjects, as well as primary specialisation. The first year of specialisation (the sixth year of training) takes place in the medical college, i.e., in its clinics and laboratories where the students work as interns. They actually perform the duties of hospital doctors under the supervision of experienced specialists, usually instructors of medical colleges. However, internship does not cover all, but only a few major medical specialities, namely, internal diseases, surgery, obstetrics and gynecology. During the sixth year at pediatric faculties, training continues in the general branch of medicine chosen, with elements of primary specialisation (child surgery, pediatrics) introduced. In sanitary and hygienic faculties ( colleges) senior students also specialise in the main hygienic subjects (communal hygiene, educational hygiene, occupational hygiene, nutritional hygiene, etc.). In the seventh year students work as interns in large hospitals under the supervision of their more experienced colleagues. After the sixth year students take their state examinations which cover the most important theoretical and clinical subjects. However, those who have successfully passed their examinations are not immediately given their doctor's diplomas, but must, as we already noted, serve as interns in a hospital for a period of one year. Only after successfully completing their probation 101 do they get their diplomas and, with them, the right to independent work.
Of course, this system does not as yet solve all the problems of specialisation because in present-day conditions it takes a much longer time to master the basic medical skills of any one branch of medicine. This is why considerable importance is still being attached to institutes of advanced medical training. In these institutes doctors of various specialities take courses for a period of 2 to 5 months or longer in accordance with special programmes. In some branches of medicine correspondence courses are available, but in any case, those enrolled in them must take examinations in conclusion. More than 35,000 doctors a year attend institutes and faculties of advanced medical training.
Internship in a clinic and post-graduate training are other ways of improving the doctors' professional knowledge in their chosen specialities. Internship takes 2 years and postgraduate course, 3. At the end of post-graduate course the physician must successfully defend a thesis in order to be awarded the degree of Candidate of Medical Science. To improve their professional skill, doctors are also commonly sent for various periods to the largest medical institutions specialising in a particular branch of medicine. Students' scientific groups and societies organised in the chairs and clinics of medical colleges initiate students into medical research. They not only test their abilities in research, but can also acquire additional special knowledge in a particular field.
New faculties have of late begun to function in a number of institutes. Prominent among them are medico-biological faculties, intended for training specialists in associated fields, medical biophysics and biochemistry. Young specialists in these fields are now trained at the medico-biological faculty of the N. I. Pirogov 2nd Moscow Medical Institute and at the Kaunas Medical Institute. Naturally, this form of specialisation requires the knowledge not only of the fundamentals of medical subjects, including clinical ones, but also of biology, mathematics, chemistry, physics and other sciences.
The country's 77 medical colleges, 5 pharmaceutical institutes and 9 medical faculties at universities, enrolling the total of over 250,000 students, turn out annually some 30,000 doctors and pharmaceutists.
102The increase in the total number of doctors, including specialists in different branches of medicine is shown in table 12.
Table 12 Number of doctors in major specialities^^*^^ 1940 1950 I960 1970 Total Per 10,000 population Total including: 155,323 265,031 413,752 668,400 27.4 internists 42,564 55,940 96,208 134,588 5.5 surgeons 12,564 22,501 44,460 67,182 2.8 obstetricians and gy-- necologists 10,620 16,624 28,663 41,400 1.7 pediatricians 19,358 32,105 58,908 80,811 3.3 neuropathologists 3,213 5,118 10,543 18,108 0.7 psychiatrists 2,408 3,119 6,389 14,502 0.6 ophthalmologists 3,625 5,661 10,481 15,952 0.7 otolaryngologists 2,641 4,543 9,632 15,792 0.6 dermato-venereolo-- gists 4,807 9,216 9,355 12,431 0.5 sanitary doctors 12,527 21,926 31,454 40,474 1.7There is no need to cite the number of doctors in the different Soviet Republics; it is enough to mention that in 1970, the RSFSR had 378,400 doctors, the Ukrainian SSR--- 131,000, the Byelorussian SSR---more than 23,000, the Uzbek SSR---more than 24,000, the Kazakh SSR---almost 29,000, and the Georgian SSR---more than 17,000. The republics which formerly were nearly deprived of medical aid, in particular the Central Asian Republics, now have large numbers of highly-skilled specialists. For instance, the Tajik and the Turkmen Republics have 4,700 doctors each, the Kirghiz SSR---more than 6,000, etc. In some of the republics the ratio of doctors to the population is greater than in the Soviet Union as a whole.
The system of training junior medical workers has also changed in Soviet times. Before the October Revolution the _-_-_
^^*^^ Only doctors of the major specialities without the other categories are shown in the table. In 1967 the latter numbered 187,199 or 6.9 per 10,000 population.
103 country had, as has already been noted, only 46,000 nurses and other junior medical personnel, whereas today the number of junior medical personnel has exceeded 2 million. This means that there are 78.6 (in 1967) junior medical workers per 10,000 population. They include surgeons' assistants, midwivcs, assistant sanitary inspectors, trained nurses, various laboratory and X-ray technicians, dental mechanics, disinscctors and disinfectors, etc.The increase in the numbers of junior medical personnel may be judged from the following table.
Table 1 Number of junior medical personnel in the USSR^^*^^ 1067 1940 1950 I'.IGO Per 10,000 Total population Total including: 472,000 719,400 1,388,300 1,860,700 78.6 surgcons'assistants 82,200 160,000 334,700 417,400 17.6 women surgeons'assis-- tants and midwivcs 12 -SOO 42,000 76,200 82,100 3.5 midwivcs 68,100 66,700 139,300 184,800 7.8 trained nurses 227,700 325,000 623,500 892 600 37.7 laboratory technicians 11,700 25,300 52,500 71,700 3.0In 1970 there were 87 junior medical workers per 10,000 population (a total of 2,123,000).
An equally good rate of growth in the number of all categories of junior medical workers can be found in all the Soviet Republics. Thus, for example, in 1940 the RSFSR had 290,400 junior medical workers, and by 1970 this number had increased to 1,212,300. In the Ukraine during the same period there was an increase from just over 100,000 to 411,500, in the Kazakh SSR, from 11,900 to 104,800, in the Kirghiz SSR, from 2,600 to 21,600, in the Tajik SSR, from 2,700 to 15,400, etc.
The rapid increase in the number of the junior medical personnel has been made possible by the organisation of a large number of secondary medical schools, of which there jrkcrs _-_-_
^^*^^ Only the most important categories ol the junior medical wor are given.
104 were 666 in 1970. Today the total enrolment of these schools amounts to more than 410,000, with more than 100,000 graduating every year. The secondary medical schools admit young people with 10 or 8 years of general schooling. In the former case the course of training is 2 years and in the latter case, 4, since in addition to studying special medical subjects, those who have not completed their secondary education must do so while in the secondary medical schools. The curriculum of secondary medical schools includes all the major medical subjects, but not surprisingly, particular attention is given to teaching the students practical skills in the care of the sick.In addition to doctors and junior medical personnel the country's medical institutions also employ a large technical personnel. The total number of people employed in the public health system now exceeds 4.5 million, which equals 2 per cent of the entire population or 4 per cent of the working population of the USSR.
Among this group, one of the largest professional groups in the Soviet population, there are thousands of outstanding physicians, world-famed scientists and well-known public health workers. Many thousands of them have been decorated with orders and medals, more than 10,000 doctors have been awarded the title of Honoured Physician of the Republic for their contributions to public health, and some 100,000 medical workers have been decorated with the honorary Outstanding Public Health Worker badge. For their great contributions to the development of heaith protection and medical science more than 100 scientists and 70 practicing physicians have been awarded the honorary title of Hero of Socialist Labour.
[105] __NUMERIC_LVL1__ Chapter 7 __ALPHA_LVL1__ HEALTH INDUSTRY __NOTE__ No LVL2's in this LVL1.It is a well known fact that in capitalist countries the pharmaceutical and medical industry is considered among the most profitable. According to some sources, the net profits of all the US pharmaceutical firms reach or even exceed those of such a large capitalist corporation as General Motors. Hundreds of books and pamphlets have been written about the truly fabulous profits of the drug merchants. It comes as no surprise that this industry is so highly developed in many industrial capitalist countries. But can it be regarded as a "health industry"? Hardly so, since breakthroughs in the production of drugs, medicines and medical equipment in capitalist countries are brought about by the pursuit of greater and greater profits. Hence the exorbitant prices of drugs often produced at very little cost. Nevertheless, far from decreasing, the demand for drugs and medical equipment continues to grow because, when it comes to health, people usually stop at no expense.
The development of the pharmaceutical and medical industry in the Soviet Union serves the cause of bettering public health. Not maximum profits, but skilled and timely medical aid are the stimuli for the development of the health industry in the USSR. The whole question of profits does not arise, since medical aid in hospitals, polyclinics and other therapeutic and prophylactic institutions is administered free of charge. Moreover, large sections of the population, including children under one year of age; some categories of patients---consumptives, diabetics, schizophrenics, epileptics, cancer patients---and war invalids are able to obtain medicines in pharmacies free. Naturally, patients do not pay for 106 the use of medical instruments and equipment in the curative and prophylactic institutions. Plans are now under consideration to make all medicines dispensed to the population in pharmacies free of charge.
The USSR health industry is comprised of some 130 upto-date factories producing drugs and medical equipment and instruments.
Before the Great October Socialist Revolution Russia had practically no chemopharmaceutical industry of its own. Most of the more complex drugs were imported, and only a few primitive chemists and pharmacies produced infusions, syrups, extracts, salves, etc. On the eve of the First World War the import of drugs to Russia amounted to 75 per cent of the country's requirements which, compared with those of today, were extremely low. Although Russia exported medicinal plants, all the alkaloids, glucosides and other substances derived from these plants had to be imported.
A national chemopharmaceutical industry dates from the very first days of the October Revolution. To begin with, all the existing pharmaceutical enterprises were nationalised and a single body, Pharmcentre, was set up to supervise and develop this industry. A chemopharmaceutical research institute was founded in 1920; subsequently this institute played an important role in developing new drugs. Before the war the country already had its own chemopharmaceutical industry complete with large factories such as, Acrichine, which specialised in producing antimalarial drugs very much needed at the time.
During the Second World War the chemopharmaceutical industry suffered great material losses, the nazi invaders destroying some 40 chemopharmaceutical factories. New large chemopharmaceutical plants were built in the eastern parts of the country under the extremely hard and trying conditions of the war.
The chemopharmaceutical industry succeeded in surpassing the pre-war level of drug production as early as 1945. Subsequently the mass production of efficacious sulfa drugs, antibiotics, synthetic hormones, analgesics, vitamins, etc., was organised. An outstanding contribution was made then by Z. V. Yermolicva, G. F. Gauze, V. A. Severin, N. A. Krasilnikova and other scientists who elaborated antibiotic therapy and produced new and efficacious antibiotics.
Since the end of the war the medical and 107 chemopharmaccutical industry has been developing apace. Here it is neither necessary nor possible to dwell in detail on the drugs and instruments produced in the USSR. We need only say that in the last lew years efficacious modern drugs have been developed lor the treatment of cardiovascular diseases, malignant tumours, neuropsychic disorders and tuberculosis, as well as antibiotics, synthetic vitamins, endocrine substances, etc. Between 1968 and 1970 alone the Ministry of Health recommended close on 60 new drugs for medical use and removed many medicines from production since new and more efficacious drugs had been evolved.
Today the USSR is producing a large variety of medical instruments and apparatus required by modern medicine. Such perfect and complex pieces of apparatus as the artificial blood circulation machine (AIK), the "iron lung" and the "artificial kidney" have won recognition in many countries. Soviet-developed instruments for suturing blood vessels have found broad application. Twenty-five of these different suturing instruments---for gastroesophageal, esophagoenteric, gastroenteric, major blood vessel sutures, etc.---are in use today.
Medical and surgical instruments are developed by special research institutes, the most important of these being the Ail-Union Research Institute of Surgical Instruments and Equipment.
The Soviet medical industry produces various instruments for diagnosing and treating cardiovascular diseases ( electrocardiographs, rheographs, electrostimulators) and ultrasonic diagnostic instruments used in traumatology, oncology, neurosurgery, etc. The industry has also mastered the production of up-to-date instruments for radiological treatment and electronarcosis, as well as modern, high-speed dental drills, etc.
One of the most important achievements of modern medicine is the use of polymeric materials for prostheses of human tissues and organs (blood vessels, heart valves, esophagus, tendons, etc.). The breakthroughs in Soviet surgery, especially thoracic surgery and the transplantation of tissues and organs, are of course directly related to the development of the Soviet medical industry, and in particular to the production of polymers for medical purposes.
A sharp increase in the production of drugs and medical instruments is planned in the near future. The production 108 of antibiotics, vitamins and hormones will in particular be increased. An idea of the rates of increase in the output of the chemopharmaceutical industry in recent years can be obtained from the following: if we take 100 as the index of production in 1960, by 1970 it had increased to 270.
The planned production of drugs is supervised by a special ministry of medical industry; all the enterprises of this important branch of the national economy come under its control.
A vast network of pharmacies dispenses and sells drugs and certain types of medical instruments and equipment. There are now more than 22,000 pharmacies in all the towns and villages of the USSR, and in addition some 4,300 hospital pharmacies which dispense drugs for use in hospitals. Besides, in the countryside and small towns there are close on 93,000 chemists' stalls. There are about 270 laboratories for testing the drugs. Pharmacies and other pharmaceutical services employ more than 250,000 peoples, but every year more are needed. The number of pharmaceutical workers annually increases by nearly 3,000 graduates from higher pharmaceutical schools.
[109] __NUMERIC_LVL1__ Chapter 8 __ALPHA_LVL1__ MEDICAL SCIENCE, A BRANCHThe Programme of the Communist Party of the Soviet Union, an outstanding document of our time, states that we are witnessing the greatest scientific and technical revolution ever and that science is becoming a direct productive force. In the world of socialism science is at the service of the people. Since the Great October Socialist Revolution an essentially new material and technical base for the development of science has been built in the Soviet Union. The isolated laboratories and a handful of university departments of tsarist times have given place to big modern research institutions, where a large number of scientists equipped with up-to-date knowledge and research methods are developing the progressive traditions of the best scientific schools of pre-- revolutionary Russia.
The attention given to the development of science by the Communist Party and the Soviet Government is most clearly evidenced by facts drawn from the most difficult periods of the country's life---the Civil and the Great Patriotic Wars. Even at a time when the whiteguards and the armies of foreign interventionists sought to strangle the young Soviet Republic, when the bread ration amounted to a mere 50 grams a day and the few remaining vital resources were running desperately short, the Government issued decrees establishing research institutes and laboratories. It was during these very first years of Soviet power that institutes of microbiology, chemopharmaceutics, physical culture, roentgenology, radiology, etc., were organised. New medical journals came into existence---Izvestiya Sovietskoi Mcditsiny (Soviet Medical News), Klinicheskaya Meditsina (Clinical 110 Medicine), Meditsinsky Referativny Zhurnal (Medical Reference Journal), etc.---and works by such outstanding Russian scientists, as V. M. Bekhterev, N. P. Kravkov, G. V. Khlopin, and others were published despite all shortages. In the difficult year of 1921 the Government passed a decision, signed by V. I. Lenin, concerned with enabling Academician I. P. Pavlov and his associates to continue their scientific work. The decision provided optimum conditions for the scientific work of Pavlov's laboratories and for the publication of the great physiologist's works which subsequently won world renown. During_ the trying year of 1918 the 1st AllRussia Congress of Bacteriologists, Epidemiologists and Sanitary Inspectors passed a dicision on organising a complex of research institutions, what was known as the State Public Health Institute. Soon afterwards, in 1920, this newtype institution, which became the prototype of the subsequent amalgamations of medical research institutes in the USSR and other countries, started research into the most urgent public health problems of the day.
On the eve of the Second World War the USSR had some 220 different medical research institutes which, together with the medical colleges, employed close on 20,000 medical scientists, i.e., a number almost equal to the number of fully-qualified doctors before the revolution.
Medical science was also promoted during the Great Patriotic War. An Academy of Medical Sciences intended to be a centre of medical research was founded, the existing research institutions continued to function, monographs and collections of articles were published and a decision was taken to bring out a unique work---The Experience of Soviet Medicine in the Great Patriotic War.
Since the end of the war medical science has developed even more rapidly. In 1969 the number of scientific workers and teachers at all higher medical schools reached almost 50,000, including more than 5,000 doctors of science and about 29,000 candidates of science. The total number of medical research institutions in the Soviet Union exceeds 350 today.
The Academy of Medical Sciences of the USSR comprises many big research institutions. In addition there is a large number of research institutes and laboratories subordinated to the ministries of health of the different republics.
The USSR and republican ministries of health have 111 scientifie medical councils which, working jointly with the Academy of Medical Sciences, co-ordinate and control research plans. Large research institutes have special problem committees. Fifty such committees are functioning today, each of them studying an urgent problem in the field of public health and planning long-term fundamental research.
On the recommendation of the Scientific Council of the Academy of Medical Sciences some large new research institutions have recently been established in the Soviet Union; among them are institutes of pulmonology, gastroenterology, influenza, medical genetics, organ and tissue transplantation, the institute of control over medicinal preparations and a number of research laboratories. A Siberian branch of the Academy of Medical Sciences of the USSR has been set up.
The overall planning, co-ordination and control of all scientific medical institutions is effected by one central agency, the USSR Ministry of Health. This is in keeping with the major principles of the public health system in the USSR and above all maintains the unity of Soviet medicine. On these grounds it may quite rightfully be concluded that medical science is in itself a branch of the public health service.
To describe in full the achievements of medical research in the USSR, one would have to examine a vast field, including not only numerous large research institutions complete with scientists and their assistants, but also dozens of fully formed and well-known scientific schools and trends. Within this vast system it is quite difficult to distinguish the main lines of development of medical research in the Soviet Union. We would not be mistaken in saying, however, that the development of Soviet medical science is determined by two main trends.
The first of these has already been defined here as the general line of public health development, the prophylactic trend. The second line of development could well be called the physiological trend.
By the prophylactic trend in the development of medical research we imply primarily the work of the numerous research institutions, schools and also individual scientists who have made an appreciable contribution to the development of such sciences as hygiene and its branches, epidemiology, microbiology, immunology, occupational pathology, social hygiene, etc. The common aim of these and related subjects is to develop scientific grounding for the system of
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We feel it imperative to mention the contribution made by some of the more eminent Soviet medical scientists. One of them is Academician N. F. Gamaleya, an associate of I. I. Mechnikov and a founder of modern virology, responsible for discovering the phenomenon of bacteriophagia and the causative agents of a number of infectious diseases and for working out a method of producing the cholera vaccine. Other eminent microbiologists and epidemiologists were associated with his activities, notably D. K. Zabolotny and L. A. Tarasevich who developed and organised the production of a number of vaccines and sera, led well-known expeditions to study cholera and plague, advanced the theory of transmissible diseases and made valuable contributions to immunology and other branches of medical science.
Y. I. Martsinovsky, Y. N. Pavlovsky and P. G. Sergiyev won world recognition for their research in parasitology and malariology, and in particular their theory of the natural foci of diseases. Academician K. I. Skryabin, the founder of helminthology in the USSR, made a contribution of worldwide importance to helminthology by his theory of vermifuge treatment and extermination of the sources of infection. Important research in virology and immunology was carried out by M. A. Morozov, L. A. Zilber, M. P. Ghumakov, A. A. Smorodintsev, V. M. Zhdanov, V. D. Timakov and P. F. Zdrodovsky. When we mention epidemiology the name that naturally comes to mind is L. V. Gromashevsky.
Hygiene has followed the course of research mapped out by pre-revolutionary scientists, concentrating its attention on social factors of man's health. Chairs of social hygiene were established in the USSR as early as the beginning of the 1920s. The leading scientists in this field were N. A. Semashko, Z. P. Soloviov, Z. G. Frenkel, A. V. Molkov and S. V. Kurashov. Along with others, they made important contributions to the development of the theoretical principles of public health, social aspects of work, nutrition, housing, and methods of organising and running the health services. Early social hygiene covered a very wide range of scientific problems, including occupational pathology, educational or school hygiene, communal hygiene, industrial hygiene, nutrition, etc., but since then all these have emerged as independent and very promising branches of this science.
113As we have already noted, the other major line in the development of medical research in the USSR is the physiological trend. However, this designation does not mean that contributions to this trend are made only by physiologists, but rather serves to emphasise the direction of research conducted by physiologists, as well as biochemists, morphologists, etc. The essence of this trend is the employment of experimental, mainly physiological, methods in studying the regularities of development of pathologic processes and the vital functions of the human organism. The physiological trend is, quite naturally, based on numerous and representative schools of physiology and pathophysiology, in particular that founded by I. P. Pavlov. As is well known, the theory of higher nervous activity completed by the great physiologist in Soviet times helped to establish the physiological regularities in the activities of the substrate of mental processes. Moreover, it provided for a genuine and creative union of physiologists, experimenters and clinicians, already recommended by outstanding medical scientists of the past, in particular by Claude Bernard. The conditioned reflex method suggested by I. P. Pavlov enabled physiologists to investigate the regularities of the physiological processes operating in the central nervous system, particularly in the cerebral hemispheres. Pavlov himself defined the brain as the ``director'' and ``regulator'' of all of the organism's activities, i.e., he demonstrated by strictly objective research and experimentation the regulating role of the central nervous system in all of the organism's vital functions.
Thus the study of higher nervous activity proved one of the most important contributions to the development of the principle of nervism, which had already been elaborated by Pavlov's predecessors, in particular by I. M. Sechenov. The principle of nervism, which, according to Pavlov's own definition, issues from the striving to extend the influence of the nervous system over as many activities of the organism as possible has become one of the main principles in the development of the physiological trend of Soviet medicine.
Many prominent physiological schools, including that of I. P. Pavlov, studied the regularities and interrelations of the basic physiological processes of inhibition and excitation. Thus the theory of transmission of nervous impulses by means of chemical substances called mediators was elaborated by A. F. Samoilov and his pupils, the principle of the 114 dominant was substantiated by Academician A. A. Ukhtomsky and the latest data on the peculiarities and levels of the interrelations between cortical and subcortical processes, on the so-called return afferentation, on the role of the reticular formation, and on plasticity of the nervous system were furnished by Academicians P. K. Anokhin, I. S. Beritashvili, E. A. Asratyan, and others.
Professor I. P. Razyonkov further developed Pavlov's ideas in the physiology of digestion, and was one of the first to apply Pavlov's physiologic theory in the study of problems of industrial hygiene and physiology. Academician V. V. Parin and his associates conducted a series of important investigations into the physiology and pathology of the cardiovascular system. The school headed by Academician L. A. Orbeli, one of Pavlov's closest pupils, evolved the theory of adaptive-trophic influence of the vegetative nervous system and considerably furthered the development of Pavlov's concepts concerning the evolution of the nervous system. Academician K. M. Bykov demonstrated, by using the method of conditioned reflexes, the regulatory role of the cerebral hemispheres in the functions of the internal organs, which manifests itself either directly through reflex mechanisms or through endocrine, humoral systems. He and his pupils also originated the conception of corticovisceral pathology. Academician A. D. Speransky and his pupils carried out extensive research into nervous trophism and demonstrated the leading role of the nervous system in the development of many diseases, including infectious ones.
I. P. Pavlov and his numerous pupils have on many occasions used the theory of higher nervous activity to explain the origin and development of various diseases. For instance, Professor M. K. Petrova, Pavlov's closest pupil, by studying the mechanism of formation of neuroses in animals through so-called collisions of the processes of inhibition and excitation has furnished clinicians with some most valuable material on the pathogenesis of hysteria, neurasthenia and other human neuroses. In the works of Pavlov and his pupils the importance of protective inhibition has been shown. Thus arose the idea of treating various diseases by prolonged sleep and drugs which normalise the two basic nervous processes of excitation and inhibition.
The results of studies of the activity of the nervous system, including higher nervous activity, have found extensive __PRINTERS_P_115_COMMENT__ 8* 115 application in various clinical disciplines. For example, the outstanding internists G. F. Lang and A. L. Myasnikov advanced the conception of the pathogenesis of angina pectoris and the hypertensive vascular disease connected with neuropsychic overstrain and vasomotor neuroses. Neuropathologists and psychiatrists, L. V. Blumenau, M. M. Asatiani and, especially, V. M. Bekhterev, made use of the theory of higher nervous activity in explaining the pathogenesis of neuroses and a number of psychoses. Academician N. D. Strazhesko evolved a theory of the neurogenous origin of diseases of the abdominal cavity. Internists A. I. Yarotsky and N. I. Leporsky used physiologic data in elaborating methods of diagnosing and treating gastrointestinal diseases.
The experimental, physiologic trend has also clearly manifested itself in a number of theoretical medico-biologic studies, particularly such vital present-day problems as those dedicated to interoception (schools of G. M. losifov, B. I. Lavrentiyev, V. N. Chernigovsky, and others), and blood and lympth outflow collaterals (V. N. Tonkov, B. A. Dolgo-Saburov, D. A. Zhdanov, and others).
Prominent schools of histologists have conducted their research in close connection with the development of physiology. Such was the case with the school of A.A. Zavarzin, who has advanced the theory of parallel series of tissue evolution, and the school of N. G. Khlopin, the author of the theory of divergent evolution. The synthesis of physiology and morphology has also found reflection in the studies carried out by the school of V. A. Vorobyov (vegetative nervous system), the school of V. P. Shevkunenko ( individuality of topographic-anatomical correlations), and in the theory of paranecrosis advanced by D. N. Nasonov and V. Y. Alexandrov and others.
The studies carried out by the schools of the eminent pathologists A. I. Abrikosov, I. V. Davydovsky, A. A. Bogomolets, N. N. Anichkov and S. S. Khalatov effected the union of physiology, morphology and evolutionary biology. They not only described formerly unknown changes in the morphological substrate in various diseases, but also obtained decisive facts throwing new light on the pathogenesis of a number of diseases. Soviet pathologists developed the theory about the physiologic system of connective tissue, elucidated the role of allergy, and connected atherosclerosis with disturbances in fat metabolism and the ageing of body tissues.
116The schools of biochemists headed by such eminent researchers as A. V. Palladin, V. D. Engelgardt, A. N. Bakh, B. I. Zbarsky and S. R. Mardashev, etc., have contributed new data about intimate reactions occurring in the nervous system and muscles, and revealed the role of a number oi enzymes in the oxidation-reduction proceses and other phenomena.
Pharmacology, which owes a good deal of its recent advance to Academician N. P. Kravkov and other outstanding scientists, has also developed by way of experimental research. A "pathologic pharmacology" was evolved, based on the study of the action of drugs on animals with experimentally induced pathologic processes.
The physiologic trend also found expression in the establishment of a new science concerned with the resuscitation of separate organs and organisms and in the studies of the problem of clinical death. The experiments started by S. S. Bryukhonenko before the revolution have since resulted in the development of complex apparatus (for artificial blood circulation, etc.) which has made it possible to give the problem of resuscitation a scientific basis.
The synthesis of natural science, technology and the progressive ideas of the physiologic trend has led to the development of a number of new branches of medicine in the USSR, in particular thoracic and cardiovascular surgery. Back before the Second World War the Soviet surgeon, Y. Y. Janelidze, in a special monograph generalised the experience of a few hundred operations performed on the heart in different parts of the world. Academician A. N. Bakulev and his associates were among the first in the USSR to operate on an inborn heart defect. Subsequently S. S. Yudin, B. V. Petrovsky, A. A. Vishnevsky, P. A. Kupriyanov and others have worked out numerous methods of surgical ``correction'' of inborn defects of the heart and major blood vessels and of other thoracic organs.
N. N. Burdenko and other eminent Soviet surgeons have made a very substantial contribution to neurosurgery, N. N. Petrov, P. A. Herzen, N. N. Blokhin and others, to oncology, G. I. Turner and R. R. Vreden to traumatology and orthopedics. V. P. Filatov, by substantiating his method of the migrating tube graft, furthered the development of plastic surgery. His operations involving the transplantation of the cornea from corpses have won world renown.
117The joint activities of the pathophysiologists (A. A. Bogomolcts), internists (M. P. Konchalovsky and A. A. Bogdanov) and surgeons (S. S. Yudin, V. N. Shamov and N. N. Yelansky) have resulted in the elaboration of the scientific principles of hematology and blood transfusion.
Also widely known are the works of the outstanding Soviet internists, A. I. Nesterov, Y. M. Tareyev, P. Y. Lukomsky, and others on cardiology and rheumatology, and V. P. Obraztsov, N. D. Strazhesko, V. Kh. Vasilenko and others on gastroenterology.
The best-known schools in Soviet pediatrics are those of G. N. Speransky, A. A. Kisel, M. S. Maslov and Y. D. Dombrovskaya. The mechanism of childbirth, the prophylaxis of toxemia of pregnancy, the prevention and treatment of inflammatory diseases and other disorders after childbirth, as well as methods of painless childbirth, such as psychoprophylaxis, have become the subject of successful studies by major Soviet schools of obstetrics and gynecology headed by V. S. Gruzdev, K. K. Skrobansky, M. S. Malinovsky, and others.
In clinical work the prophylactic trend has also been prominent in both scientific research and practical activities. It has manifested itself not only in the organisation of the system of medical aid in different diseases, but also in the particular attention devoted to scientific studies of the most urgent problems of prophylaxis. An example of this is the teaching on premorbid states evolved by M. P. Konchalovsky and other eminent Soviet clinicians. It defines the principles of preventing diseases and effecting early diagnosis. The mass prophylactic examinations of the population conducted by clinicians make it possible to detect early stages of diseases, including symptoms of malignant tumours, and thereby to prevent their development to a stage when the disease is irreversible.
The work of Soviet medical scientists have been highly appreciated by the people and the Government. Some 40 medical scientists have become Lenin Prize Laureates and some 260, State Prize Laureates. A number of talented scientists have been awarded the honorary title of Hero of Socialist Labour. Many research workers have been elected members and corresponding members of the USSR Academy of Sciences and the USSR Academy of Medical Sciences. Some outstanding works have won official international 118 recognition. For example, Professor L. M. Shabad was awarded a UNO prize for his studies in cancerogenic agents and cancer prevention; Professor A. L. Myasnikov was awarded a golden stethoscope by the International Society of Cardiologists for his studies in hypertensive vascular disease and atherosclerosis; Professor P. G. Sergiyev received a World Health Organisation prize for his fundamental research in malaria.
In conclusion, it should be emphasised that all these major achievements in medical research are the result of assiduous labour and the struggle of conflicting opinions, schools and scientific trends. The history of Soviet medical science shows many examples of the overcoming of onesided, metaphysical and at times openly idealistic views and convictions which were held by some scientists. There have been animated discussions, for instance, on pedology, Freudism, eugenics, the theory of unchangeable idioplasm and heredity, etc. In evaluating erroneous and at times reactionary conceptions, such as Neo-Freudism, social-Darwinism, etc., which are widespread abroad, Soviet scientists are firmly guided by the method of dialectical materialism.
Continuing the materialist traditions of Russian medicine and enriching itself further with the achievements of modern scientific schools and institutions, Soviet medicine is making a considerable contribution to the world's store of medical knowledge.
[119] __ALPHA_LVL1__ CONCLUSIONIn conclusion we deem it necessary to dwell if only briefly on one more characteristic feature of the Soviet public health system, namely, the international relations of Soviet medical scientists.
Medical co-operation that has been established between the Soviet Union and the other socialist states may be regarded as a typical example of fruitful and friendly relations among the socialist states pursuing the common aim of improving the health of their people. These relations are based on equal rights and mutual respect, and consolidated by their unity of purpose. Agreements exist between the various socialist countries on bilateral and multilateral co-operation in public health; many specialists from the other socialist countries annually participate in national congresses, conferences and symposiums; the socialist countries exchange specialists, drugs and equipment, and practise visits by large groups of working people for consultation and treatment, and also for rest in the health resorts.
The Soviet Union and the fraternal socialist countries co-operate not only in practical problems of health protection, but also in medical research. Several conferences have recently been held in the USSR and other socialist countries for the elaboration of plans and programmes of joint medical research. One of them, for example, elaborated the question of establishing common criteria for evaluating the health of the population not only in a single country, but also on an international scale. The recommendations of this conference were later used by the World Health Organisation in 120 revising the international nomenclature of diseases. At a conference in Moscow public health workers of socialist countries discussed joint plans for and programmes of scientific cooperation in the organisation and economics of health protection, and in the teaching of social hygiene. Many more such examples could be cited. There is practically not a single medical problem that has not been discussed by specialists from socialist countries.
Active participation of doctors and other medical workers from socialist countries in international scientific symposiums and congresses has of late become a tradition. Socialist countries, as a rule, send the most representative delegations to international scientific congresses. This was the case at, for example, the international congresses of oncologists, microbiologists, anthropologists, hematologists, etc., which were held in Moscow.
The ministers of public health of the socialist countries hold regular conferences for the purpose of building up the co-operation of these countries in health protection. Some of the most important problems of public health were discussed at the conferences and symposiums held in the capitals of the socialist countries; they included the economics and planning of medical aid, personnel training, the organisation of medical care of industrial and office workers, and the rural population, the control of cardiovascular diseases, ways of expanding international co-operation in public health and other urgent problems.
Guided by the Leninist principles of peaceful coexistence between states with different social systems, the Soviet Union steadfastly pursues the policy of developing cooperation with capitalist countries in various fields of economy, .science and culture. The contacts between the USSR and the USA established in the field of medicine are a good example of such cooperation.
Soviet-American cooperation in medical science and health protection which has lately been developing on the basis of inter-governmental agreements concluded in 1958 in the field of science, culture and education, has made it possible to ascertain those enormous opportunities offered by the joint efforts of scientists in different countries for the solution of key problems of modern medicine.
In May 1972, an agreement has been concluded in Moscow between the governments of the USSR and the USA on 121 cooperation in the field of medical science and public health, and also an agreement on cooperation in the field of environmental protection. The joint efforts of the scientists of the two countries will be directed in the first place toward combating the most widespread and serious diseases such as cardio-vascular and oncological diseases, and also toward solving other major problems of public health. Cooperation between the two countries in the matter of environmental protection will facilitate the solution of many medical problems.
These agreements open broad opportunities for a general improvement in health. The USSR takes an active part in the work of international medical organisations, in particular the World Health Organisation. The USSR and other socialist member-countries of the WHO advocate the immediate admission to this organisation of the GDR and other states which are refused admittance by the western powers for purely political reasons. With the support of the socialist countries the USSR has sponsored at the WHO assemblies a number of resolutions; for instance, on enhancing the role of WHO in overcoming the consequences of colonialism in the sphere of public health, on the harm done to the health of mankind by thermonuclear arms tests, on the necessity of banning these tests, on condemning the use of chemical and bacteriological weapons, etc. The USSR and the other socialist states gave their unreserved support to the resolutions passed by this organisation stressing the role of doctors in safeguarding and strengthening peace, condemning the policies of apartheid, racial discrimination, and other resolutions contributing to the prestige of WHO and to the development of humanitarian and democratic principles of co-operation in health protection.
The 23rd WHO Assembly held in May 1970 adopted the resolution proposed by the Soviet Union on the basic principles of developing national health protection. This resolution generalises the experience of the socialist countries and others with progressive medical systems and establishes the most rational principles of national protection, such as, free medical aid, planned development, prophylaxis, active participation of the people in health protection, etc.
The USSR makes wide use of the opportunities and experience offered by WHO to strengthen its international 122 relations and render assistance to the states that need it. It was, for example, on the initiative of the Soviet Union that WHO instituted a global campaign for wiping out smallpox. Many countries, in particular the developing nations, are interested in studying the experience of progressive public health systems in order to make use of it in building their own national health services. In view of this, the USSR, aided by WHO, organises seminars, conferences and symposiums for public health workers of foreign countries. Participants in the so-called itinerant seminars have the opportunity to examine medical institutions in various Soviet towns and regions. More than 80 such WHO seminars, drawing representatives from some 100 countries, have been conducted in the Soviet Union. The WHO conference in Tashkent which discussed problems involved in the control of infectious and parasitic diseases was particularly representative.
In the summer of 1971 an International Conference on Tuberculosis was held in Moscow. Prominent specialists from many countries gathered in Moscow to discuss urgent problems of pulmonology. The Conference summed up the results of nearly fifty years of work of the International Antituberculosis Union which includes associations of close on 90 countries. President of the Union is a prominent Soviet phthisiatrist, Corresponding Member of the Academy of Medical Sciences, Professor F. V. Shebanov. Soviet doctors are making a considerable contribution to the study of tuberculosis. As a result of broad social prophylactic measures the incidence of tuberculosis has fallen sharply in the Soviet Union.
The title of this concluding chapter "Health Vaccine'', was suggested by the expressions of gratitude the Soviet Union has received for its disinterested medical aid to the developing countries. "Health Vaccine" is the term used for the potent vaccine against poliomyelitis which was produced at Soviet enterprises and sent free of charge, by hundreds of thousands of doses, to the developing countries. In the period from 1960--1966 alone the Soviet Union gave about 1,000,000 million doses of dry smallpox vaccine to such countries as India, Iraq, Afghanistan, Burma, Zambia and other countries free of charge.
At the 21st Anniversary Session of the World Health Assembly, marking 20 years of WHO activities, the 123 representativc of India expressed his gratitude to the Soviet Union for granting his country 250 million doses of dry smallpox vaccine, a gift of vital importance in eradicating this dread disease. Nor is the fraternal aid extended by the Soviet medical profession to other nations, as a matter of international duty, confined to supplies with vaccines, drugs, etc. The Soviet Union gives disinterested aid to the developing countries in the creation of national public health services, and in the building of pharmaceutical factories, medical schools, hospitals, polyclinics and other very necessary medical institutions. With the aid of the Soviet Union factories for producing antibiotics and other drugs have been built in India, and a factory of antibiotics in the Arab Republic of Egypt. Modern Soviet-built hospitals for 500 beds in Cambodia and Guinea are deservedly popular. The polyclinic and hospital for 200 beds built by the Soviet Union in Burma is attracting more and more patients who not only want to be accommodated in this beautiful, modern medical institution, but also insist on being treated by a Soviet doctor. The hospital of the Soviet Red Cross and Red Crescent in Ethiopia has been operating for more than 20 years, during which time Soviet specialists have administered skilled treatment to more than 35,000 inpatients and some 250,000 outpatients.
Soviet-built hospitals, polyclinics and other medical institutions carry out their humane work not only in the capitals of developing countries, friendly to the USSR, but also in the provinces where medical aid is particularly needed. One such hospital operates in Upper Giuba (Somali). The hospital built in 1947 by the Soviet Union in Teheran (Iran) has become the city's main medical centre, and branches of this hospital are to be found in various out-lying parts of Iran. Hospitals in Yemen, Nepal, Algeria and Congo, a pediatric centre in New Delhi, a maternity home in Brazzaville and a hospital in Kabul---this is far from a complete list of medical institutions built by the Soviet Union in the developing countries.
The work carried out by Soviet doctors is often fraught with danger and risk. The groups of specialists sent to combat cholera, smallpox and other acute contagious diseases long since eradicated in the Soviet Union, work under severe conditions and are constantly exposed to the danger of contracting these dread diseases. The people saved from death in Algeria, Somali, Mali, India, Cambodia, Burma and 124 other countries are profoundly grateful to the Soviet specialists for their selfless efforts in combating infectious diseases.
The Soviet Union also renders the developing countries extensive aid in training national medical personnel, physicians, assistant surgeons, nurses, etc. More than 2,000 foreign students, mainly from the developing countries, are being trained in Soviet medical schools and colleges. The medical faculty of the Patrice Lumumba Friendship University is training doctors entirely at the expense of the Soviet Government. More than 1,100 doctors who will work in the developing countries have completed course in the last few years. Soviet medical institutions offer their facilities for training skilled instructors and scientific workers in various branches of medicine. More than 300 foreigners who received higher medical training in the USSR have become skilled scientists and successfully defended candidate's theses.
Of late the representatives of a number of bourgeois states in international organisations (UNO, JLO, WHO, UNESCO, etc.) have often made references to ``rich'' and ``poor'' countries, maintaining that the ``rich'' countries must administer all-round economic aid, including aid in health protection to ``poor'' countries. The advocates of these ideas usually make no distinction between the different ``rich'' states and divide the responsibility belonging to the colonial powers for the many centuries of exploitation of the population and national resources of the countries at present embarking on the path of independent development equally among the ``rich'' states. However, it requires no special social research to differentiate the ``rich'' countries, since they belong to different social and political systems.
The USSR and a number of other socialist countries are, as is well known, highly economically developed, but the source of their national wealth is to be sought in the selfless work of their workers, peasants and intelligentsia, while the capitalist industrial powers obtained no small part of their wealth through inhuman exploitation of the dependent and colonial countries. It would therefore be quite wrong to disregard the differences in the social and political structures of the state indiscriminately referred to as ``rich''.
Soviet aid radically differs from that administered by capitalist countries, including the colonial powers. The 125 so-called aid of the imperialist powers to the developing countries stems from their desire to enslave and weaken these countries and to subjugate their economy. The governments of the imperialist states for many years put barriers in the way of the formation of national intelligentsia and national specialists, including medical workers, in the dependent countries.
Soviet aid does not involve any conditions or political terms. It is aimed at developing independent economies in the newly-free countries. It is necessary to take into consideration that the hospitals and medical schools which the USSR has made a gift of to the developing countries are products of the labour of the Soviet people, its workers, peasants and intelligentsia, and that Soviet people in making these gifts share the results of their work with their brothers in other lands.
Naturally, the assistance rendered by the Soviet Union to the public health services of other countries cannot fully replace a nation's own efforts, without which not a single country can build its own modern public health services. However, assistance can hardly be unwelcome when it comes in the form of the precious "Health Vaccine'', without which it is so much harder to control disease and overcome the distressing sanitary consequences of the past.
In entitling the last chapter of this book "Health Vaccine" we also would once more emphasise the tremendous care taken by the Soviet state, its Government and by the Communist Party to protect the health of the people. It is precisely this care, aimed as it is at improving the welfare of the Soviet people, raising their cultural standards and developing their public health services, that accounts for the continuous improvement in the nation's health.
In all the noble endeavours the Soviet medical profession draws its inspiration from humane ideas of struggle for -the health and happiness of mankind, and from the lofty ideal of building communism.
[126] __ALPHA_LVL0__ The End. [END]REQUEST TO READERS
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