MEUICAL EDUCATION IN RUSSIA

INDEX.

Gregg, Dr. Alan

Diary of Russian trip, 1927

* Report on medical education in RussiR, 1927.

Map

See Appendix page 32a

* Preliminary raport prepared by Paris office,  1927

See Appendix

Public health administrntion in Russia

Semaschko, Professor N.

Public health system of Soviet Russia

* Has its own table of contents.

285.
1.

201,219,

219.

As a ccndenssd statement of the broader and more

important considerations to be borne in mind in the study of Russian

conditions I would like to present:

A) 8oms general remarks upon Russia;
B) oommonts upon the llnitations and
  validity of this report ;

C) the principal circumstances and
   characteristics of medical education
  in Russia at prasent .

A.

General Remarks on Russia ,

-

1, Russia is a nnme - and like many names it covers more than

it oxplains anu implies a greater diversity than can bs enumerated

or described. On rsflexion you cannot dlsniss the importance of the

sfze of Russia in 1m-d and population, on evan superieicial acquaintance

YOU oamot forget the variety of paoples IsI?:u~@s and customs within

its boundaries.

It cannot be described in terms of Western Europe or

America just as it s languages cannot be convoyed in our alphabet ,

One sixth of tho earth is in Eussia and more languages are spoken

there than in all the rest of Europe. The effect of this immense

variaty is heightened by the grext distanoos and the resulting costly

communications . And yet it is an entity - controlled politically by

(1)

fifteen or twenty men and treated Dy the rest oE the world a8 a

(l).- The policy of tho present government has been to tolerate the

regional differences of language, culture, and local govern-

..........

political unity - as "Russia".

2.

Yet, this huge agglomeration has a certain unity of another

order than the political for It has had 'en bloc' a cultural history

and perhaps even more important it has not experienced 'en bloc'

oartain historical changes ooxnon to Western Europe.

Russia never

passed through a Renaissance and never knew a Refonnation.

For cent-

uries it was governed by a small clan representing the church md the

nobility.

"he tradition was of 8 government passive of (or at least

ineffective before) illiteracy, social oppression, and inequality of

hm rights. There were almost no great social reforms up to 1917.

And so the traditions of the Russian are radioally different from the

West - so different that Russia and 'Jestern Rump have at bottom

extremely little in common - I say at bottom for the veneer of Bestern

ways was forced upon Russians by Peter the Great and his descendants

and if the veneer has cracbed now, that is after all only the nature

of veneer. It is misleading to expect or attempt to comprehend Russia

only in the terminology and thought of Vestern Europe. We must break

little laws if we are to see the big laws in oporation; we must cast

aside sraall categories and terms if we are to encompass what is import-

ant in modern Russia. It is futile to expect to find the type of

democracy, of justice, of efficiency, fair play, vhich are importan6

to US. We must distinguish between the makers and figure heads of the

Russian Revolution and the conditions which made a Revolution inevitable,

It is in these conditions that Russia is peculiarly importantly and

..(from previous page  ment while keeping centralized control of

the essen 2 ial:-.souraea of power.

3.

uniformly different from the rest of the world.

quality of the Hussian's life are peculiar, the problems of contri-

buting to his welfare must be considered in the light of these

peculiarit ies .

If the tern and

  3. A war, disastrously mimarulged, a revolution rsdical in its

inspiration in the cities, and far reaching in its agrarian counter

part, and then a horrible period of chaos, foreign intervention in

favor of counter-revolution, famine and epidemic disease - few

European oountries have known aw of these afflictions ad none has

borne the staggering losses in wealth,men ad social stability that

have fallen uponRussia. 'Phis is the course that has been run. The

after-offeats are apprent everywhera, Prom many Russians one gets

the impression that these after-effects ara not considered merely as

the fruit of Communism but as the result of oonditions in ohich

Communism was a part.

sequence of war', revolut ion, famine and disease entail almost irrepar-

able loss quite apart from the type of Government.

(and weakness) of the Comunist Party lies now not only in their de

facto control of government but in the belief of most Hussians that

no radically different form of government could be good enough to make

up for the incalculable losses of another revolution.

the Soviet Government is a success nor Communism workable, but the

Soviet Government cannot be judged solely by the fruits immediately

viRible - they are the fruits of war intervention and famine as well;

In any case it could be msintained that such a

Indeed the strength

I do not think

4.

The revolutiozi began in the army and in the cities but it took a speaial

form almost contemporaneously in the villages,.where it was an instinct-

ive and unreasoned revolt of the peasants against the landlords.  It

took the form of arson pillage and general destruotion ad stealltig,

but only gradually (and at the instLgation of the Communists) were

ideas of legalized redistribution of land believed and praotised by

the peasants.

the industrial and urban proletariat of Mosoow and Petrograd repres-

enting a small but hard nucleus of extremists who knew what they

wanted and aided by previous ferment in amy and navy, seized the

essential machinery of government and obtained event uallg aomplet e

control. But,moro important, the October revolution was not merely

an unreasoning aversion to the old, but a farat io deolarat ion of

sonisthing new - Xarxiam and Communism.

In October, changes had gone so far that the leader6 of

4. !the great struggle in Russia is between city and country,

between proletarian and peasant, between property sharer and property


owner.  It can best be grasped when you remember that the peasants

took and divided the landlords' domains but had no new ideas about

property qua property, dhereas the industrial workers in taking over

the factories were aflame with a mw and fanatical creed. Peasant

and faatory exrployee made common cause against owners, but every
succeeding year sinc-e they have Uiscovered how fundamentally different

are their points of view, their experience, and their interpretation

of the right government polioy.  The story of Russia for the next

8.

twenty or thirty years will probably center around a struggle,  The

political theorist, or the Communist supported by the industrial

employee, will struggle against the peasant - the mass and inertia

and opposition of the millions of pemants.

In Moscow and Leningrad there is frequent referenoe

to the "periphery".  This means all Russia exoept Moscow and Lenin-

grad - and especially the villages and distant gubernias or depart-

ments *  There is a certain vagueness and vastness implied and the

term seems really significant of an important relationship, namely =

the city governs the oountrg, and yet the country is too vast to

know itself or to be known comprehensively. And furthermore, the

oity tabs upon itself the guidance of the country, and this

relation explains the great conoentration of model  institutes in

Alosccxv and Leningrad.  Possibly they were not built  to show to

foreigners  (who sometimes flatter themselves by advancing this

theory ) but because the Soviet Government knows the periphery is

too vast to be transfomd in this generation by scattered instit-

utes and yet that  it looks to Moscow and Leningrad for guibrroe.

   5. The most important and outstanding faot about the U.S.S.R.

is that nowhere in the world will the next three dsaades witness 80

olearly the vivid effects upon aational life of general eduoation.

The illiteracy of Russian soldiers was 7& in 1914.  The Conmanists

must have oonverta.

Continuity of this form of goveranrsnt dependa

upon the ednoation of the children.  Commrrnisp is a fanatic oreed -

8 Faith which, as in our Reformation, takes Education as its bride

not for oompanionship but to beget children. But the future genera-

tion, so ardently desired by the fathar, will be even more influenced

by the mother. Is it possibly that education widespread in Russia

for the first tlmo will fail to change the political and social

picture? I do not under-estimate tho impomeability of the present

ignorance, nor do I expeat swift miracles, but a very great awakening

is coming to a people of 140,000,000 when genera3 education is

encouraged in every possible wag after hundreds of years of fostered

ignorance.

6.  Russia is changing no longer by revolutions but by processes

analogons to aellular replacement o Experiments may be imposed by

administrative authority but the verdict of erperienae in the long

run is returned and one by one  the theories which don't work can be

disoarded. Tho New Xconomic Policy, the recent limitation o the

size of medical sohools illuatrate how theories that won't work have

to be modified - or even reversed in response to imperative oirouur

stanoes. The inner councils of the Government are small enough to

produce ard powerful enough to apply many more experiments in govern-

ment radical and fantastio perhaps, but in caae of failure more

likely to be withdrawn than defeated by the outbreak of counter

revolution.

to stage a counterrevolution, ad the Communists are willing to make

saorifiaes to eaah other's views to keep power in their own hands.

Non-communist8 are too terrified and weary to be able

I have attempted to call attention to the size end

oomplexfty of what is called Russia, and to its pecular natioml

past which is so different from that of Vestern Europe. I have em-

phasized the effects of th.e recent past which would have exhausted

any country regardless of its form of govement o

indeed the coaflict between city and country, worker and peasant,

Communist and country 'bourgeois' bas been noted as the struale

of the future in Russia. I have explained the extraordinary import-

ance whiah education is liwly to have in modifying the social and

political picture in the U.S.S.E. and  I have tried to indicate the

way that future changes are likely to be effeated. These factors

stand out in qy mind as the primarp oomidorations in any attempt

The contrast and

to translate into our om terns what is taking place in Runs&.

Coinrnents won this Report.

The information upon Russia which is available before an

1

actual visit ta that country is as a gaoral rule vitiated by the writer's
fears and prejudices - racial, religious, economic and political.' Russia

is too large and heterogeneous to be dercrfbed by statements to which

exception cannot be taken,and conditions are changing too rapidly for

even the beat irna@nable description to be valid a year after it is written,

bQr visit vas brief,  and restricted to the two great cities,

Of the Npsripherytt I could learn only indirectly,

There vias the serious

barrier of not understtmding Russian,  iio doubt much information was with-

held throu.gh fear or caution, and it is probable that the best was eagerly

displayed thou@ I know of at least one institution which was

to be shown" - if I

Russia before I had no basis of comparison for *at was to be seen,
it is quite oertain that the occurrences of the past 12 years there,are
both quantitatively and qualitatively beyond the imagination of those vho

       "too good

Nevor having visited

believe the guide I ahose,

And

have not paseed through such experiences,  Like most reporters of condi-

tions in Russia, I can mike snlall claim to accuracy and no claim   at ever

to thorough knowledge.  And if it were possible really to Imon the condi-

tions there it mould be extraordinarily difficult to convey a aorrect

impress ion,

The report is a record of some infomation which is undoubt-

edly correct, of initial impressions and of the general outlines of 8
rapidly changing situation in a country of considerable size and importance,

x,  There harebeen fortunately some notable exceptions (e& reports of

Philip Xiller and W,H, Gantt),

9.

-- C

Principal Circumstanoes and Characteriratice of

Kedical Eduoation in the UISIS.R.

1.

Xedical eduaation in Tsarist Russia vas inadequate to the needs of

the country, thou& there vas produced an elite of practicioners,  teachers

and investigators of unquestionably high quality.
almost overwheImin$ignoremt and superstitious peasants was the despair of

the private practicioner and a goad to the conscience of any one  interested

in public health work or preventive medicine,

ation of the government lent but little support to soaial medicine or

hygiene.

ly supported by the government but were nevertheless well represented in

the scientific world,

The larm number of

But the spirit and organiz-

In reaearah work the Russlians of Tearist times were not brilliant-

2,

The war, revolution and erdgration, famine and epidemics (especially

tyghus) have thinned the

extent, Add to that the effeat of the destruction of the sources of wealth

which contributed to create and maintain clinics and inatitutes and the

obstacles now plaoed jn the path of private praatice and it is clear why

isolation from the outside world of medical science is almost the *'coup de

gr&cetl for teacher or doctor in the U.S.S.R.

of practicioners and ternhers to an appalling

3, That is the background for the present situation in the medical

sohools.

overwhelm a richer and mre brilliant system of medical education,  But in

addition there is isolation espaoially from the outside mrld, and poverty

in comn with most of the $overnment institution6,and the mepaired

depreciation of buildings during the lant 14 years,

The size of Russia and the vastness of its medical problems vould

The interruptions,

deaths, resignations, emigraticms, and reorganizations have broken in many

places the continuity of standards and traditions in medical edmation,

           The control of tile selection of students and election of

professors llas been more rabidly political than it is today, Red professors

and red students was a forrmla &id procucod practicioners so palpably

inferior that they were vomited back into the schools - the theory broke

down and now the Cormissariat of Edccation is restlessly gropinc for a

means to produce capable teachers and village prauticioneru and coldly

limiting the nuinber of students in relation to tho fauilities for their

instruction. >ut the choice rermins favorable to teachers and students

likely to be in sympathy with the Coriist Party.

4. As salient characteristics of medical education in the V,S,S.X, the

following deserve mention:

The Commissariat of Education exerts a strong and centralizd

control over all the schools.

selection of professors determined by authorities in :.:oscow, ThrouC;h model

institutes in Leningrad and ~s:osoow the periphery is supplied with standards

and training centers,

The curriculum is virtually uniform,  the

         Tho teaching of medicine is strongly permeated with the

prevontive rather than curative point of view, the care of the mass rather

than of the individual, Indeed a considerable share of the teaching of

medicine (0.6, post graduate schools)  ls in care of the Cormissariat of

Public !Ioalth,

11 o

The standards and quality of instruction given is maintained

by men traineh before the revolution and it is to their devotion to their

work above any oonsiderations of personal comfort or political sympathy

that we must look for the continuance of standards of Medical education in

Russia, Whether in their isolation and poverty they will be able to

transmit their tradition and tneir tempo of devoted work is still in doubt,

There is the same contrast and conflict between professors and politicians

as in other countries - indeed it is more bitter for being repressed on one

side and suspicious on the other,

From tho student body of Tsarist times that of today is

quite different, for it is reoruited in larhe part froin a class that had

no tradition, no background or no opportunities fifteen years ago,

professors of reactionary sympathies comment on the amzing eagerness of

these students to learn, but are equally anphatic as to their 13Ck of

general culture and informtion,  It is inrpssi'ole to suggest what effect

upon the 3ussian medicine of to-morrow this change will have, but there  is

no doubt of the difference,

Even

The schools of inedicine in the U,S.S&, are poorly maintained.

Like nearly everything in Russia, better t'nan the recent last would encourage

one to expeot, not infinitely worse than in Tsarist times, but in contrast

to America unbearably sad, mthetioally poor and in great need of outside

contacts and encouragerent,

12.

There are 24 Xedical Paoulties in the U.S.S.R. (1927)

with a total student enrollment of 26,000.

15 of these are in the

R,S,F.$.R, and are attended by 18,000 students.

There were 20

medical faculties in the R,S,F.S.R, in 1922, but 5 have been

disoontlnued,

Gosudarstvennyj Medicinskij Institut imeni Lunatcharskogo,
(State LunaaarskiJ Medical Institute) founded in 1918,

800 students in 1926,

Ebt er in0 s lap .

Ekaterinoelavskij Wicinskij Institut. (Ekatarinoslev
Nedical Institut),
achool for women.
ity with four faaultiee;
Medical Institute, 1300 students, half women, in 1926.

Founded in 1916 ae higher medical
In 1918 wa~ re-organized a8 Univers-
   in 1920 became again only

St~tS-UnlVerSitiit. (State Univgrsitp). Has faculties
of medicine, agriculture, social sciences and techniaal
faculty, 1150 students in 1926,

Kazan,

Goaudarstvenny Kazanskij Universitet imni V. I, Ul janova-
Lenina, (Uljanov-Lmin State University) , Founded in
1804.  Ha8 faculties of physical mathematios, medioine
and work. 1928 students in 1926.

13 o

Kharkof f .

Medioal Faoulty title ist 11Kharkow?3ki Heditzlnslqr

Inst i tut" o

Kiev.

Klinycnyj mtitut, (Kiev clinical Institute for
higher mediaal education).

Founded in 1918,

Kyivsky Bakteriologionyj Institut. (Kiev Bacterio-
logical Institute),
in medicine, vaccine, malaria and epidemiology,

Founded in 1896 and does work

ICubanskij YTdieinskij Institut, (nbaner Medical

Institute.).

Voenno-Xedicinskaja Akademija. (Military Medical
Academy). Founded in 1798,
in 1922,
practicioners asd teaahers,

1000 selected students

Not only for military but also for civil

Leningradskij Wdicinskij Institut, (Leningrad Xedicsl
Institute), Founded in 1897, 2170 in attendance at
leotures (ti84 men, 1586 women) in 1926,

GosudaratvennyJ Institut deja usoversenstvovanija vraaej.
(State Institute for higher Mediad Eduoation).
oonneotfon with it is the Grandduoheas Helene Pavlovna
Free Clinical Institute, Founded in 1885, Partioularly
interested In praotiaal medioine and sanitation,
attendance at lecture8 in 1926,

In

501 in

Gosudarstvennyj Institut Mdicinskiah ananlj, It GINSA '1,
(State Kedioal Institute),  Founded In 1908 as B psycho-
neurological institute, Eaoh month holds a saientifio
meting under the Chairmanship of the Rectors, ma
OOnneOted with it the State mstitute of Obstetrios and
Gyneaology, The Institute of Stomatology and the Lenin-
grad Institute of Traatology, 1845 sfulents in 1926,

&eninmad (continued)

Leningradskij Gosudarstvennyj Universitet, (Leningrad
State University). Founded in 1819. Has fauulties of
language and culture, social sciences, physical mathe-
matioa and geography. 4435 students in 1926, No
mdical faculty,

Gosudarstvennyj Lnstitut 6xperimntalnnoj Udiuiny.
(State Institutefbr Experimental midicine),
1890, Supported by Narkowdrav,

Founded in

Minsk.

Belorusskij Gosudarstvennyj Univeraitet. (White Russia
State University), Founded in 1921, Ha8 faculties of
socialism, pedagogy and medicine,

2400 students in 1926,

mscow,

Peruyj ~skovskij Gosudarstvennyj Universitet, (First
Mosuov State University). Founded in 1755, Has faaulties
of physiaal mathermtics, ethnology, Sovietiem, medicine,
9050 students (4456 men, 4594 women) in 1926,

Xoskovakij I1 Gosudarstvennyj Universitet. (Second Moscow
State Univereity).
Courses for Romeu, Has faculties of medicine, chemico-
pharmauy and pedagogy,
women) in 1926,

Founded in 1926 as Xoscow Higher

5108 students (1907 men, 3201

**Girlt
"Institut okhrany rnaternistva i inladentchestra"
de Proteotion de la &ternit6 et de l*;Enfanoe),
Vh6orologique de 1'Etst.

"Gosudarstvenny j Im t itut Zdrabovkhrun6niat1 ,

( Institut

lnstitut

Institut d*Etet de Physiothbrapie.

?doscow bas various rnedical institutes, lnuludlng Institutes
of lilropical rmdicine, of Sanitary Qgiene,  Infeutious
Disaases, Tuberoulosis, etu,

Nizegorodskij Gos, Universitet,
Has facultiea of mechanics and chemistry, but not  of
mediuine, 1664 students (of which 463 are women) in 1926,

(Novgorod State University) ,

.Odessa .

Odeswj Dereavnyj Xedycnyj Institut. (Odessa State :NZedioal
Institute). Founded in 1900,

Odesskij Gosudarstvennjrj Demto-?enerologciueskij Institut.
(Odessa State Skin and Venereal Disease Institute).  Founded
in 1917,

There is also a Department of Xedioine and Biology in the
~auuao-issledovatel'skie atedry v. Odeese, (Research Inst,).

Perm.

Permskij Gosudarstvemyj Universitet. (Perm State University).
Founded in 1916 88 branch of the University of Petrograd,
Has faculties of agriculture, medioine and pedagogy. 1966
students in 1926,

Rostov on Don,

Warsaw Medical Faoulty transferred to ROGtOV.

SarmrskiJ Goaudaretv. Universitet.
Haa faculty of pedagogy, 427 students (148 men, 279 TO-)
in 1926. No medical faculty,

(Samara State University).

Ssratov,

GOSUdar6tV, Saratovskij Univeraitet imeni V.0, Ct3rngSeVSkOg0,
(No& Verngsevslwgo State University).  Ha8 faculties of
pedawgy and medicine, 1200 student6 in 1926 (of uhich
700 are women).

Saratov ale0 has a Distriot Institute of Xicrobiology and
%imiO1OW of Southeastern U,S,S.R,

Smolenskij Gosudarstvennyd Univeraitet imeni Okdjabr'skoj
revoljuuii,
Ea6 faoultiea of madicine and pedagogy, 1925 students in
1926,

(Smolensk State Oatober Revolution Univereity),

16.

--. Tif 1 is

liphlisis ssachelmtzipho Universitet. (State University
of Tiflis), Founded in 1910. IIas faculties of pedamy,
medicine, soaial econocqy, agricultvre and polyteuhnics,
Over 5000 students in 1926,

Voronez.

Voronezskij Gosudarstv. Universitet.
veraity), Founded in 1802 as Dorpat University, Bt3Came
'Sroronez University in 1918,
and medicine. 2155 students in 1926,

(Voronez State Vnir

Has faculties of pedagogy

Tashkent.

Medical Faculty title not known,

Baku.

Azerbeidjansily Josudarstvenny Universitet,

Omsk.

omski3 Bbdicinskij Institut, (Om& 1Led.ical Institute) ,
Founded in 1920,

Tomsk.

Tomskij Gosudarstv. Universitet.
Fomded In 1880,
nmthematics. 1601 students - 901 mwn, 700 mm,

(Tomk State University),

Has faculties of medicine and phyaical

Irkutsk,

Gosudarstv. Irkutskij Universitet, (Irkutsk State University),
Founded in 1916, fIas facizlties of imdicine, law and
administration, pedagogy and work.

180 graduates in 1925.

Vladivos tok,

Dal'ne Bostocnyj Gas. Universitet,
East), Eo Faculty of Nedicinez poasibly after two years.

(University of the Far-

ma faculties of polytechnics, oriental 1-08
POdWDgP*

2. HISNRY 03' THE IEDICAL UNIVERSITIES.-

It is rather remarkable that the medical universitioe

have continued to function as well as they ham when we review the

conditions. These have not been normal since 1914. At the beginning

of the Tlorld War, the ten medical universities in Russia were well

equippod and moderately well supported, although tho number of

students handled was not sufficient for RUSSi8'6 needs. A few of


the Institutes and hospitals were heavily endowed by private bene-

faotors; for example, the Leningrad Obstetrioal Hospital which was

erected by the last ozarina, at a cost of'over a million pounds,

and was one of the finest hospitals of its kind in the world.

From 1914 on the schools received progressively less

in funds and materials, so that by 1917 they were getting about half

of the prewar funds and practically no medioarnents or equipment

except that little whioh was manufactured within Russia. The condi-

tions of the hospitals and of the personnel was, however, not precar-

ious; there was food, fuel and a surplus in some things. Then came

the upheaval of two revolutions, followed by four years of widespread

famine and decimating epidemics, during which tim the theories of

Communism were applied to the schools as well as to  the individual.

During these years there were almost no funds, materials or any kind

of medical supplies; no repairs to the buildings, ad only a pitiful

amount of fuel or food, and earnings were pade impossible because all

trading was abolished by law and punished by imprisonment.

Practioally

all members of the personnel suffered.

from day to day due to general conditions of getting what ws necessary

to hold body and soul together, was the one thoukht uppennost  ia

everyone's mind.

shovelling snow, standing in line for their rations of blaok bread,

potatoes and herring, and hurrying by foot from one pest of duty to

anothcr, an6 in what time was left performillg their special duties.

The bare question of existence

Professors spent part of their time in squads

19.

instruction in Communism and sonte attempt at

Soviet coxtrol has been introduced. During the period from 1918-

1921, when a striat application of Communistic priiic.5.ples was

applied to everythirg, the medical schools were also Sovietized.

At present the residusl changes are:

1) Large increase  in the nimber of students.

2) Large increase in the percentage of women and of

workmen and peasant students.

3) Large reduction of budget .

4) Xore highlg centralized fi'overiiment  oont rol and

emphasis on prevention and hygiene.

5) Although impaired facilit ics and equipment through
       exhaustion of fimnces with rosulting lowering
      of efficiency of teaching in some branches,
      there has been some growth in other lines,
     particularly in pub1 ic health instruct ion.
        'Tho sahools were nearly completely paralyzed
      from 1917 to 1920, but made a remar'kable
     partial reoovory during 1822 and 1923, and
      they are being gradually restorQd to  their
       former condition.

  "After the Iicvolution every effort was made to edwite the pro-
letariat, for whom higher aducation had been previously diffictilt to
obtain. Students from the bourgeois class were discriminated
against .
   "It was quite natural, therefore, that great numbers of all
wes flocked to the institutions of hiyhar education. Although they
were enthusiastic and eager to learn, thex had no educatioral bsck-
ground; many of them had just learned to read and write. Tho uni-
versities were draadfully overorowded. Student comitteos were
allowed to interfere with the (3urricu18, and tho professors were
forced to mko their instruction more and more elementary in order
to be intelligible.
of students, each class was passed almost en masse, whether it had
learned anything or not

3ecause of the pressure of the oncoming droves

20.

   "Last year tho first crop of medical grsduates went
out into practice and, interestingly enough, the residents
of the distruots in which they began to work, themselves
complained to the Government about the inadequate training
of these new dootors.
medical schools for a mpplementary course of two years. The
new goverment, after the Revolution, refused to heed the
advice of the medioal faculties, and it has learned by the
trial and error method that its theory of education was
imp~%CtiC8ble, or at least iaapplioable to the medioal
prof esrion.

medical education was with Professor Lmg of the Leningrad
Medioal fnstltute. After the Revolution his sohool was foroed
to reoeive 600 students a year, but the number is now limited
to 200, The students' interference with the ourrioulum has
decreased to about 2546 of wbat it was just after the Revola-
tion; and he believes. that it will d8OreaSe still more, for
he said that it was apparent to everybody that the system then
in operation failed entirely in its own purpose - to produce
good practitioners". (Notes on my Visit to Soviet Russia,

They are therefore beizg raturned to

"The most interesting conversation on the eubject of

by Dr. C. Philip Miller, 1926).

In the past the contacts of Russian medical faoultiea

were first with Gemany and Austria, ard seoond with France - third

probably difficult to determine. It mag be noted that before the

war Switqerland had large numbers of Russian medical students. Now

(1928) the number of oontacts with Vle6tern Europe a slmost negligible
but the order of preferenoe would probably be Oelmally,'Franoe, and

herioa.

Medical eclucation in the faculties of' medicine is

in the Commissariat of Uuaation. The Commissary is

M. Lunacharsky, but the special member or section chief

for meciical education is Professor Vi. Bronner, a neurologist

with Parisian tniniq, and a man of considerable abilitg.

He has visited every faculty in Russia and is tho best-

informed individual regardiw; tho status of medical education

in the U.S.S.R.

     There are numerous medical institutions, espeoially

in tho field of hygiene and post-graduato medical instruction

which are not under the Cornissariat of 3ducztion but under

the Commissar&t of public IIenlth (Narkomsdrav) , whoeo

Cormnissary is Somashko.

In both cases thore is high1,ycentralized control

of appointments of staff, expenses, and curriculum in the

hands of the authorities in Moscow. Thus the control is

in the Urds of the Communist Party, ad its influence is

felt by the rank and file of rectors, deans a& professors

22.

whose interests are not political and whose sympathies are

often covertly non-Communist .

The chief professors have at

times, but not frequently, been thawed from the positions they

held before the lievolution.

This political control is probably

not as harraful as it would be in other countries, and it has

certain advantages. It tencis to preserve order and prevent

dissensions ami anarchy, in a time when further squabblixg

would be suioidal, and strict iiiscipline is neoessarg for

rejuvenation. Tho schools my owe more than they have realized

to this strict control.

Yhc iiector of a University is appointed by tho

Government and the lioctor in turn appoints his deans. Professors

ar:H chosen from a l4st prescntcd by a special faculty commission

of three

(1:

to the Seotion Chiof (Bronnsr) of the Commissariat

of $ducation. Bromr consults the State Scientific Council

(30 members) and then chooses tho professor from the list

submitted. Bronner oould impose a proi`essor if he wished, but

in practice hr? has not done so, he said.

In 1926 Gantt noted;

     "Although most strictly administrative posit ions are

assigned to Communists,  the scientists thomselves are left

entirely to work out their scientific problems as they desire,

(1) one politioal, one repre'senting the Narlramsdrav, and

one the students.

23.

as they did formerly. As far as I have beon able to

ascertain from two year's work in Soviet Russia, distribution

of Soviet funcis to laboratories and appointment to scientific

positions is made accordiw to merit rather than to Folitics.

I have aeon during tho past gear that some of the scientific

1abomtoIQs phose heads are direutly opposed to Soviet politics

have received the greatest amount of money and equipment.

Politics does not often interfere with a doctor's

having the position to which his ability entitles him, except

for administrative places which are usually given to party

members.

The heads of public health departments are Comunists,

ad gonerally, judging from my experience, efficient organizers,

and in most of the scientific  institutes there is a polit ioal

cmissarjr witlircertain administrative powers ."

me arrangemont of the curriculum (q.v.) is in the

hands of the central authority (Bronner) and is uniform for all

the R.S.P.S.R. The allotment of the budget is determined

similarly but with some looal modifications in distribution.

!&rough surveillance the quality of work and the validity of

the University degree is standardized by the Narkompros..

For its internal managment, each medical faaulty is

administered by the dean an3 the Faoulty oounuil, together

24.

with special comnittees for each discipline.  The Faculty

council of the Xedical Vacultg of thc First University in

bscow, for example, meets ten to fiteen times a year,

discussing teaching problems of faculty 8s a whole, possible

candidates for vacant chsirs, armi the pmmotion of teachera,

assistants, etc. The special cornittees for estch discipline

meet from two to twenty-five times a gear as circumstances

recuire, and for the following purposes: attempts to improve

teaching facilities of a given department, detorminat ion

of programmes of work, discussions of teaohing methods,

discussions of candidates for vacant professorships, reports

on tho work of vsrious institutes, accounts of activities

of the teaching staff, lectures of candidates for docentships.

4 *- UNIV&S I'CY

FINANCE .(I

     No information was available, excqt that

published in the announcement of the First Xoscow University

which follows:

The finanaial oonditlons during the period that

followed the Civil GVar were most depressing.

1924 that a gradual improvement began to take place.

It is only in

The budget of the I Bbascow University for 1913

amounted to 2,638,911 Roubles. It went domn as far a8

2,087,440 Roubles in 1923-1924.

1924-1925 - 2,963,389 noubles .

1925-1926 0 4,894,116 "

It may consequently be observed that the 1925-26

budget is 66 highor than that of 1924-26 and is equal to the

1913 budget (considering the rate of exolsstnge), It may be

added that, in 1913, there was a rewlar income of 300,000

from the aapltal of various philanthropic foul3datioss o

     The school year of 1925-26 brought about 8 radical

mnge in the financial situation. !Rle Soviet of Moscow and

the State Bank joined their efforts and managed to cover

most of the University debts. The allotment of the State

was also considerably increased at that time. The slogan

was: the best thing isgto reduce expenditures, but on

the contrary, to increase the expenditures and consequently

the assets as well.

27 .

Very soant information is available to give the picture

of meciical school finance at the present the, and if plenty of

figures were available, many pitfalls muld still lie in their

correat interpretation. The gold value of the rouble is

particularly important for foreign purchases butA new of no

&#& KWl',

importance for rent, and very little for food.  Depreciation

of buildings apparently would not appear in bud.pt  est imat e6

since the buildings I saw had not had any repairs for ten years

and more.

It will however be a very heavy item in the next

ten years.

There is no base line or comparison of the available

figures since the significance of the money itself has changed.

As a matter of record tho following budgets in gold

roubles may be noted:

1913 1914 1916 1916 1922 1923

- ---

Leningrad

Mecl. Institute 40m7 3-99 33,484 33,484

Leningrad Xilitary 875,000 288,000

Baadsmg

&led. Institute 276,395 222,444 33,592

Leningrad State

In 1927-28 salaries of professors.

The Militav Academy in Leningrad has (1927-1928)

5000 roublos for purohsse of apparatus abroad and 1200 roubles

for books and periodicals.  The rouble vas 2.50 to the dollar

1928.

in December 1927 and 3,OO in Februaqi.

For students' fees, etc,

see under this heading - this source of income 'is negligible, as

is that of gifts and incomes from private sources. No figures

wore given me of actual medical school budgets but the departmental

budgets vary from 100 to 250 roubles a month { $350 to $1000 a

year) (See under Laboratories and Clinical Facilities) ,

         Full-time professors recsive 250 roubles a month,

men in practioe 180. Assistants 95 and "aspirants" 80 roubles 8

month.

roubles a month, an item that shows how illusory is the supsrficial

comparison of budgets and figures of faoulty expenses  in the

R .S .I? .S .I1 , at pressnt .

Living quarters (2 rooms) for a prox'essor oost 5 - 10

         The First University at Moscow runs its own clinics

and indeed oharges special rates for patients and supports some of

the laboratories from the surplus. The othsr schools visited

either use municipal hospitals or hospitals supported partly by

Narkomsdrav and partly by XBrkornpros  o

29.

In general frorh tho schools visited the impression

received is that tho laboratories are fairly well housed, rather

uniform in equipnent and housing,  in a bad. state of repair, but

even so, used more effectively for tho avoraqe student than is the

rule in Vestern Europe. The floor space is usually considerable

and the schools limit the number of students to their laboratory

facilities . Apparatus and reagents are almost uniformly imdequat e

and there is much difficulty in getting apparatus from abroad on


account of the restriction placod upon amounts for foreign purohases.

Tho teaching seen was impressive on account of tho intense serious-

ness of the students, but I gathered that their intellectual

baggage was scant, their poverty a great handicap and tho large

proportion of girls may not be able to accept the extraordinarily

heavy work demanded by the conditions of country practice.

hy sums spent for apparatus wuld be used twice to

ten times as much as in most Buropan countries - in this point

Hussian medicine elosely resembles the American practice.

Tho Government has at first concent rated support

more in the independent institutes allied to medicine, but is now

30.

turning to the faculties and beginning to help them relatively

more 1 iberally .

The following random notes on some of tho laboratories

visited in December 1927 may indicate what were the general condi-

tions of the best faculties in Russia as regards laboratory

eo u ipen t .

It should first be noted that practical work was

honestly emphasized everywhere and that the numbers of students are

adjusted to the laboratory facilities and if necessary strictly
limited. There is a dearth of apparatus and supplies that is in

evidence everywhere.

betmen two OY more plaOe8.  But in sone ways these dQfQOts are

made up by the oarnostness of the students and the fact that hard

intellectual work is an actual solace for an othcrwise unbearable

existence .

!Phe assistants divide their time and energies

FIRST UNIV3RSI!I!Y - LdosCOV/.

&iatomy.-

Professor Piotr Karusin - old man,

strict teacher. Finishes current gear in old building. New building
2/3 done.    rooms costing one XH XXJC million roubles, begun In

1926. At present ICarusin has 600 students, 100 bodies for them.

Other laboratory expenses well taken oare of, Good museum. Not

much invest i@ ion going on.  Histology, ESnbrgology and Topographiaal

62

Anatomy all separated from Anatomy.

Pathological Anatomy.- Professor Abrikosov (away),

Prosector Davidovski. Three oourses, total 1000 students. 300

autopsios a year. Staff: Professor, 1 prosector, 1 Assistant

proseotor, 5 paid assistants, 16 aspirants ( yoq assistants trying

out for academic posts) . Budget 250 roubles a month, but can

only spend 10 r. a month outside Russia.

the clinics. doellent lab, 100 microscopes - one for each student

in a section.

Does all autopsies for

Can't buy the journals they need.

Pharmacology .- Prof . Vasilg Nicolaief f . Came from

Kazan. \!(as pupil of' Schmiedeberg. Pair laboratory. 15 rooms,

Student gets lectures, demonstrations, ami about 40 hours of

laboratory 'work. Also oonsiderable practice in pharmaoics of Moscow

in prescription making. N's salary 250 roubles. Laboratory budget

130 roubles a month. Great improveanent over oonditions 3 years ago.

hT. has 3 assistmts and 3 aspirants.

few, chemical 8 not always good.

Appsratus expensive, journals

Hygiene .- Thero are four chairs of Hygiene:

1, General Hygiene. Professor Syssin, 4 Assistants,

3 aspirants .

large, well-1 ighted, well-equipped.

Given in third year 252 hours in all. Laboratories

2. Occupational Hygiene, Professor Kaplun,  144 hours

in 4th year.

Only 2 small rooms, mostly museum.

3. Sohool Eygiene. Professor Molkov. 144 hours

in 4th year . Largely leoturss . No rooms.

4. Social Hygiene. Professor Sernashko. One room

filled with charts.

        "he laboratory building's of the First University were

built about 1890-1895 and are comparable to others elsewhere of that

era, except that considerable repairs should be mado in the near

future .

SXCOND UNIVBSIIY .-

Xxperimontal Bioloi?y.- Professor SI. Zawadowsky

(absent). Assistant Blacker.. ihcellent little laboratory. Fine

spirit. Good work on genetics in fishes am3 axolotl. 25 roubles

a, month is the laboratory budget .

Students during their first year and a half - 10 sections a week

In existence only three years.

for 2 hours.

Physiology.- Professor Lina Storn, formerly in

Geneva. Speaks Russian, Italian, French, German and English. l;/ell-

equipped, small laboratory, giving good impression. She complained

of division of assistants' time and of the poverty of her students.

Was given 10,000 roubles to equip her laboratory two pars ago, now

has budgot of 40 roubles a month.  Has students 2 semesters - they

get 2 hours a week of lectures, 2 hours of seminar, a weehand 36

hours a semester of laboratory work.

Topographical Anatomy .- Professor K.D. Ssipov.

Talented

draughtslllan, most brilliant teaching collection of charts and drawlxgs

33.

1 have soen in 3ur.ope. Good operstirty room for animal surgery.

Microbiology .- Professors Rritschevsky ani Ismilsky.

k large, rather well-equipped, but inappropriately-housed Imtitut e

which does imnunity serology, ohemotherapy an6 bacteriology as an

indepundent institute, and also does teaching for the I1 University.

Under Commissariat for `Uuoat ion. Both professors an3 Tersonnel

look like good men. Aa important oonter. 40 on the staff, 15

aspimnts, 15 puDlioations in 192%1923, 61 in 19261927. Total

budget for 192-1927 was 27,000 roubles,

MILITALY UdDTC-AL AC;U)%E 0-

Phamaco1ogy.- Professor 3 .`,`:. Anitschkoff. You%

Laboratory small, not well-equipped, but very active.

and active.

Two good assistants.

200 in class.

Pathological Anatomy.- Professor N.N. Anitschkoff.

Oareful worker. Good equipment, good work going on. Relatively

young man,

Physiology .- Professor L. Orbielli .- Good laboratory.

Drcellont laboratory work by students, ifho seemed better type than

elsewhere. No girls. Soldiers and officers have preferenoe at the

Academy, Military students get wffonn and 60 roubles a month and

must serve two years in anny for every year in school paid for by

State, Pavlov held this chair but resigned as protest against ex-

pulsion of children of clergy from Universities.

34.

Hygiene .- Professor G. Chlopin. Only hygiene of

environment.

Large museum ard empty laboratorie 8 .

No relation with

pract ical work.

Good quarters inadequately used.

Epidemiology and Bacteriology .-  Professor Zabalotny .

No demonstration ares.

Laboratories well-equipped and in fair use.

&let him when he was in the midst of conferences with students on

program for next year.

NorEuropean touohl

MEDICAL IIET ITUY?& .-

Anatomy.- Professor absent. One of the best

teaching museums I have ever seen, work of former professor Yeinberg.

Large and well-equipped inst itute o

Phannaool0gy.- Professor Lichatcheff .

Small laboratories

but eroded and well-equipped.

3 assistants but half of the work is

cione by voluntary assistants, whose clinical academic careers are

strengthened by a year or so in "theoretical" branches.

got 100 roubles a nonth before the war, now 70 but this 70 has the

Labomtory

value of 20 or 25 roubles before the mr.

Preprat ion of students before they take pharmacology

is one semester of inor-nic chemistry, two semesters of organic

chemistry, one semester of colloidal ohemistry, and tm semesters

of biological chemistry. In pharmacology each student gets 3 hours

of lectures a week and 6 to 8 practical exercises of 3 hours during

33.

For information regarding recent changes in t eachiw

methods, facilities, ctc. in the First University of &soow, see

Appendix I . This infomation is translated from the offioisl

publicat ion of the University.

7 .-CLINICAL F.4 IL IT IUS .-

         In general the teaching clinics of the Y'aculties

visited in Decomber 1927 were well-staffed and directed by able

and well-informed men, who evidenced in most cases no political

interest or influenco. The nursing was poor aril the housekeepinC;

worse . 'The buildings need a great deal of repairing. Squipment

seemed antiquated and worn at times, but there is a good deal of

renewal, and tho level is better than mi:;ht be expected.

The First University in Eoscow possesses its om

clinics and must rnsintzin them by fees from patients.

?Joscow University an6 the schools in Leningrad us0 city or govern-

ment hospitals, bearins only the teaching charges.

!The Second

I wa,s impressed by the desire of the clinical teachers

to see that the average student shall get a Sood training - rather

a contrast to tho attitude in Italy, Lustria or Frace. The emphasis

is upon practical familiarity by each student with the cases assigned

to him, and the attitude of tho teachers, was kindly serious and

unaffected.

points of view, but the dread of country practice keeps a larger

number of interns and voluntary assistants at work in the faculties

in Bussia than with us.

There are many parallels between American and Russian

37.

         As in tho laboratory branches one gets the impression


that the pre-war generation is the sheet anchor of iiussirsn medicine,

even in the case of the younger men.  Pleir orientation Is much

broador and their standards more comparable to those in `7estern

Europe o

Nost of the clinical chiefs h3ve some private

practice, heavily taxed, but none the less relat ivelg lucrat ive.

The demands from this quarter and the crovded wards of their

service have largely put an end to much of the interesting clinical

investigations that would otherwise be possible o

The ordinatw is the equivalent of our intern,

but he sleeps outside the hospital and stags from tw  to three

years, He is a hclpor for tho assistants, and hopes to be chosen

as an assistant o

The assistants do a small amount of private

practice and may remain not longer than 10 years as assistnnts,

The aspirants

(1)

are young men desirous of an academic career,

selected by the Xinistry of Xiucation, and detailed for a period

of about 3 years or special training in laboratories and clinics.

In Appendix 3 is given in detail accounts of

teaching and other activities of the clinics of the First University

38 .

in Moscow including Social Hygiene  in the form of a translation

from the ofLicial announcement of the Faculty.

d few notes of clinics visited may be of some

interest .

I . UNIV 33s ITY XOSCO',:' .

         Second Surgical Clinic, Professor Mart inov, Building

belongs to University, about 30 years old, wards fairly clean? pat-

ients look rested. 80 beds on this service, of which 24 can be

taken for free cases fop teaching purposes.  Others all pay - on

open mld 40 rouolos a month, private rooms 300 roubles a month.

Thus the clinic earns 2500 to 3000 roubles a month, one-third

of which it can keep for it8 own eqenses, the rest is turned

over to the faculty for the support of tho institutes.

In second semester of last year the students get

one month of clinical clerk's work. Teaching muoh as in Amerioa.

The equivalapt of our interns are called ordimtors; they do not

live in the hospital but stay for tvJo to three years in hopes

of getting assistantships. Assistants cannot stay more than ten

years.
kope~rs ( 1/2 p! ; for "tea".

Students' midday meal 10 kopeks (5 6 ) or bread, 3

Good selection of cases on the ward. An O.P.D.

service of 40 cases a day.  Urtinov an able operator, assistant

39 .

Blumonthal .

First Surgical Clinio .- Professor N.M. Burdenko .

Uuch like the Second Clinic, but cleaner and apparently more favorod

with apparatus and material.
They used to have 3 1/2 -fiars of training aftsr coming up from

gymnasia. Now less preparatory training, but still look the

superior of most nurses in for example, France or Belgium.

No organized course for nurses now.

        Medical Clinic,- Professor Pletniov, who has high

roputst ion in Noscow. 80 beds. Xxtensive laboratories with good

equipment and in use . 3lect ro-cardiagraph and Haldane apparatus

just arrived. Special room for blood chemistry only. Good $enoral

impression .

Meu icsl Clinic of I1 University .-

In City Hospital, 68 beds. Pair X-Ray equipment.

Wards not clean, but pstients look oomfortable. The histories were

the best I have seen in %rope. Three courses given third, fourth

ad sixth year. gbout four cases for each student but carefully

worked up.  Cesw stay an average of one month in hospital but

a good selection is claimed.

University paying for teaching expenses only.

Expenses of hospital paid by City,

10 ordinators, 4 Aspirants, Ordimtors are chosen

by a committee, one-third of which are students.

years as interns but with no division of labor as is found in U.S.

Sped two to three

40.

Surgical Clinic of I1 University .-  Professor

Y.S. Lswit, capable younger man oallod hero from Irkutsk, 8000

kilometers distant. About 80 beds o No subdivision into specialties.

Good appearance of wards, plenty of space, equipment good, repairs

of building in progress, which show good knowledge of what  is needed.

LEMIXGUD MILITARY ACADI3dX.-

Has a complete general hospital, including wards

for gynecology and obstetrics.  About half of the patients in the

hospital are soldiers.

There is some selection of cases for teachirp;

purposes.  Most of the buildings are old and were badly out of

repair in 1926 when 200,000 roubles was spent on painting, plumbing,

etc.

I did not visit any of the wards except the Eye-ear, nose and

throat. Professor Voyatsohek (Director of the School). This was

clean, modest and effectively managed.

Ample assistance, practloal

equipment, building needing repair o

Tho Peter Paul Hospital of the Lenirgrad Medical

Institute.

  (quoted from Dr. C. Philip Miller's notes).  ##The
hospital is old, the oldest building dating from 1835;
ws formerly a olty Institution, but later became a
teaching hospital for the Women's Medical Sohool.  This
institution was formerly exclusively for women,  as the
othor medioal sohool in Leningrad, the lilitary Acadany,

wa8 closed to them. Since tho revolution, it has
become co-eduoat ioml .

sidered to be the best clinician in Leningrad and
one of the best in Russia. He is well read and up
to date. His research work has consisted either of
repetitions of other work, or of small Arbeits. He
is not liked by the students because he is too
"Scientific?' for them, i.e. presents a subjeot by
giving all the theories and evidence pro and contra.

     "When Law booarne Director of the Hospital
in 1924, it was in a deplorable state as to clean-
liness, orderliness and discipline, and also as to
the instruction offered. He considers that in these
two years it has improved to about 50 per cent of &at
it should be. In some respeots it is now better
than before the war, men it was scadalously over-
crowled, e.g. in winter all the corridors were full
of beds. It had almys been neglected because it
was a city hospital.  Xext year the hospital will
be entirely renovated. During the past tm years the
Oboukov hospital which had been the worst in Leniwrad,
has been modernized at the cost of one million roubles
and now the Peter Paul Hospital will have its turn.

oldest building (91 years old) is gloomy, dark and
badly ventilated. Tho newest is fairly good. The
laboratories are very inadequate, both as to size and
equipment; e.g., two small rooms serving; one hundred
students for all oliniosl laboratory examinations.  Lang
is ashamed to show the laboratories whiah aro supposed
to be for research. The wards look about like those
in the poorest Gemn clinics.

eaoh for the third, fourth and fifth year students, At
present one of the chairs is vacant .
paid assistants, with salaires rangirg from 40 to 80
roubles a month. About 45 volunteers serving fmrn one-
Tourth to one-half time.  Money for investigations is
very scarce. It is difficult to get money for pre-
olinioal teaching. The clinical is better off, because
the small grants from the oentral government  are aug-
mented by fullds frun the city for care of patients; eg.
Lang waa able to buy an electro-oardlograph outfit for

"Professor Law, the Direotor, is con-

"The Hospital has a total of 1040 beds. The

"3taff: There are three medical olinios, one

There are ei@t

42.

Roubles 8,000 by gettpg 2,000 from the State and 6,000 from
the City. In the same wag he has managed, in the past two
years to buy X-Ray and lipat therapy appamtus".

IISEDICAL INSTITUTE.

--HI----------

      Dexmatology and Syphilis.- Dr. Saohnovskais. 100

beds and 200 patients a day in the O.P.D. which is open from

10 a.m. to 7 p.m. with three assistants on duty for 3 hour

service. 62 roublas a month for maintainanoe. Students in

fourth 8nd fifth years make prrard visits in groups of ten,

daily for a month.  Building not repaired for the last 13 years

and looks it. Large numbers of lupus oases. 330,000 in

R.S.F.S.R. Also much fungus disease.- 500 cases in tm years.

Surgical Clinic .- Professor Y!. Schasoh. (Pupil of

Lexer and Bier;.


year.

Two days a week this service takes in all surgical entries,

the rest of the week they mako seloction of oases from the

O.P.D. they maintain. No paying patients. Building was

excollent, now badly worn and dirty. Nursing poor. 15 nurses

for 75 beds, only 3 sleep in hospital. Sohaaok says there are

nursing schools but they are not connected with teaching

hospital.

76 beds supported by olty, 1200 ptients a

bO roublas a month from faculty for teaching service.

Staff for Professor S. is

5 paid assistants and 25

43.

voluntary.

(3(& in 1923 an3 1% in l927), ad the death-rate in the

They keep record of clean cases which go septic

clinic 4% now.

Gynecology and Obstetricrs Clinic .-

Professor

Skrobansky. 240 beds, 100 of which are for obstetrios. About

10 deliveries a day in tho hospital.

24 hours duty in hospital.

Students get 8 days of

They deliver only tM) cases by

themselves. No district work. Skrobanse has a first and trio

second assistants from the Paoulty &si three from the hosyital.

In all 40 on staff.

Vie pst eisht years have seen a series of

ck:anges in the library facilities of the medical Yacalties of

;Joscow and Leningrad.

a few nev, collections begun. In the institutos ad clinics of

tho medical facultics, thore is an almost uniform poverty of

books and journals

prisingly wsll-equipped since l92b. For oxample, in thc library

of the second Surgical Clinic of the I University at ICoscow thore

wero 21 jourmls, 12 of which were forei:;n, in 1327. Probably

in the provinces the poverty is the rulc, with ths gifts of the

R.2. as the only exocption.

There have been numerous coalescences and

since 1914 or 1917, thouyh a few are sur-

           The main obstacle in adequately furnishing the

libraries is the restriction on all kincis of purchases abroad,

which is onforceti by the Govemnent as a means of preserving the

value of tho rouble in forei:;r exchan;e. The only organization

vdth special privileges in this matter is the Tzekubu which is a

central organization or Union of Scientific workers, but  it s

library is available only to men in &SCOW and even so is not

very near the Vldical School workers.

45.

As a rule, centralization of library resources is

frequent, funds available are small, and library service not very

well developed, except for the long hours during which the libraries

are open.

The poverty o the studants makes the p'oblm of text-

books part iculsrly troublesome and urgxit . The impression recoived

is that no single material aid from outside Russia ~vould be more

appreciated ad more generally use6 than books and journals.

me

folloving translation from the publicat ion of tk:o First University

of Eoscow for 1926-1927 is of interest.

UNIViSITY L IBRBHY .-

There were 483,170 volum%rts in the University Library

by January 1st. 1925.

The year 1926 resulted in an increase of this

library by 13,3751 volumcs, 17 manuscripts and 24 maps.

Yhe library used to receive 546 subscriptions to

scientific jourwls during 1925, which number $vas raised to 564 in

1926                            This number can be divided

(compared with 402 during 1924).

as follows:

'EJatural sciences and mathematics 244
Lied ic ine 151
Sooial sciences 114
History, philology, literature and

bibliography 53

The largest number of scient if ic periodicals conse-

quently falls on natuzal  soienoes and medioine,

icals in social sciences has been increased lw during 1926 (114

instead of 54), and this is likely to continue. Considering that a

The mbor of period-

46.

number of outstanding libraries in Moscow (such as the Public

Library under the name of Lenine, the Library of the Communist

Academy, Xarl Marx's and F. mels' Institute Library, etc. have

subscribed to a number of foreign periodicals, the University

Library has decided to reduce their number of subscriptions and to

subscribe to merely the most outstanding reviews.

The State allotment to the University Library is

only Sw' of the pre-war figure.

One of the greatest problems of

the Library is the question of back files in whioh there  is 8

oonsiderable e;ap to be filled.

In 1926, 137 institutions of various countries were

in permanent contact with the Library of the I  University of Moscow

in supplying literature.

Among those were: 10 Aoadamies, 84

Universities, 1 Xinistry, 12 State libraries, 12 scientifio

institutes, 8 "learned societies", and 10 various organizations:

Gemaq. 1. Deut sche dcademie der Vissenschaftsn+ Berlin.
     2. Bsyerische Akademie der '!;issenschaft en, Itinchen.
     3. Staatsbibliothek, Berlin.
Austria. 1. illcademie der Wissenschaften, Vien.

     2. Ibtionalbibliothek, mien.
NOI-WZLy . Acadhie des Sciences et des Lettres, Oslo.
Japan. Imperial Academy, Tokio .
Jug0slavia.- Acadhie des Scienaes, Belgrade .
Bulgaria. Acadhie des Sciences, Sofia.
Englaml. British Museum.
France. 1.

h

L.

MinistBre de 1' Instruction Publique
Bibliothbque Stionale .
Public Library of New York
Montofiore Hospital of New York
The Rockefeller Foundation of New York
Smithson Institute of Washillgton
Carnegio Institution of Rishington.

47 .

Received


Sent

Uchange of lit erat ure with foreign countries .

1924 1925 1st Sem. 1926

541 volumes 1335 853

137 218 131

The library is open evctq day from 10 am. to 11 pa.

for the use of both tho teaching staff and the students.

Administration (1926)

Director: Pro:. A.N. Nersessoff,
Assistant Director: N.V. Skorodoumoff .

Seminary Library of the Clledical Faculty .

The seminary library has been able to considerably

increase its number of volumes smd periodicals although they are

still frequently unaole to fill in the requirements of all the

students. On the other hand, these requiremcnts .are constantly

liable to increase and may be explained first of all by the growing

number of scientific publications and partly by the poverty of

students who in many cases are unable to acquire exponsive books.

At tendance:

6361 during 1925 - 4826 during the first half of 1926.

Most of these fall on the 3rd and 4th year.

llhe lecture room is open evory day from 3 to 10 p.m.

Xost of the books consulted 31'9 in &ctoriolo,"g and Pathological

Anatomy; then come Interml medicine, Social medicine, Hygiene.

The average. attendance is 52 students per day with

63 books .

The professors are chosen as noted in section 3 by

the central autkorit lcs of tho Comnissariat of Education in con-

sultation with the State Sciontific Counoil in IJoscow, from lists

submitted by the Univers it y collegium .

to be that the I:rovincial universities have had a much larger

number of changes in personnel than is tho rule in ~IOSCOW and

Leningrad. higrat ion, sickness or death, and retirement , expulsion

and resisnation have accounted for many changos and in approxim-

ately the given order of importance.

their political views to themselves and devote themselves to their

work are neither molested or discriminated against but those

teachers mo are openly in favor of CorzuaiSm  are likely to

receive more favorable treatment. There is a serious dearth of

pro1)crly trained men ad the provision of adequately prepared


teachers  is one of the principal concerns of tho Central Authorities.

The present  sit uat ion swms

(1 1

The professors vho keep

Any discussion 09 salaries is apt tc be nislescjing

if comparisons are made with other countries,  since in Russia food

and lcdgiw are cheap - all else extremely expensive. A professor

is entitled to 8 square meters of room for each member of his

family, plus a room for his wrk. Tho itm of rent comes to

5-10 roublos a month out of his sslary of 150-250 roubles  o

(1) liesibmation often due to refusal  to learn a local dialect

whioh has become the official lan;-uage of the region.

49.

"(Cf, Dr, 0, Philip EillePs notes)  .........

Salaries.- The head of a department in 8 scientific institute
receives abont 36, 200 to 260 8 month,  Three mn told me
that their salaries were 190, 200 and 230 roubles, respeotively,
These men mere working an full-time and had no other sources
of inoome. Belonowski receives R8, 150 as professor in the
Institute for Post-Graduate Instruction, but also hold8
another position, ais first assistant gets Rs, 100 a month,
Lang's (Leningrad) assistants receive Rs, 40 to 80 a month.

      "A good many posts pcy R8, 100 or less, but allow
the occupant to hold two or three positions,
be rather the rule than the exoeption, It seemed to me rather
a pity that som men whom I met were forced to divide their
time between two or three laboratories in different parts of
the city in order to mike a living wage,
Cost of Living,,- The man receiving Rs, 190 a month (unmarried)
told me that he paid 38. 1.50 a month in taxes and an average
of 38, 20 for rent, heat and light,  Rent and semice are very
cheap according to Amerioan etandards, and butter, eggs and
coarse linen cloth are cheaper than in American cities;  but
prautioally everything else is
rmuzythhgs are three times as expensive as in America, All
the Ameriorms I spoke with, in Russia, on this subject said
that they were quite unable to understand how the Russians
manages to live, A great rmny things which ve consider
necessities of life are luxuries too expensive for the mjority
of Russian scfentists, or one might say, for all Russians,
few prominent clinicians have very comfortable incomes from
their practices, but they are really rare exceptionstr,

This seemed to

a8 83Cp8nSiVt3, and a good

A

The past has been unbelievably difficult and precarious,

so that a dreary present seem good by comparison, It is a great

trial that it  is so difficult to get -permission to leave Russia - to

eay nothing of the great expense of travel,

On the other hand, great

ability is relatively better rewarded now than under the gwernment

of the Tzar, if we my believe members of the laboratory branohes,

Surgeons and physicians of note receive less than in pre-revolution-

50 o

In general these are the oiroumstames -  the

lot of teachers is very hard, but the professors in comparison

with other oooupations are well paid and their poaltiona sought

after,

and their work Is a spiritual solam for whioh they do not pity

themeelvee.

They have lived through timse that make 1927 seem good -

A brief review of the past indicates only some

of the diff iuult iea,

        The nreuinum salaries of professors in the medioal
s~hools before 1914 was about $300 a wnth, and living in Rusaia

was oheaper than in most other countrios of Europe.   Then

salaries dropped rapidly in 1915 and 1916, 80 that by 1917

they vere barely equal to living expenses,

1921 there were no aalaries paid in Ruseia, and everyone mho

performed some nuaeful production mrP was issued a ration.

During these years teahers therefore reoeived rations depend-

ing on the number of positions they held,  A m811 mbo wa8 able

to hold EL position in two institutions received two ratiom.

Rations were issued amording to grades, suoh as manual work-

ers, Conarmzlists, ecientifio workers, eto,   During the worst

time, in 1919 and 1920, the resouroes of Russia . . . . . . ;

mom 1917 to

,

m3de possible less than a pound of black bread, and about a half-

pound of potatoes daily for the scientists, a& occasiorsli cigarettes

were issued instead of bread. With the initiation of the New Economio

Policy in 1921 salariss were again paid.  These started at about 86.00

(maximm) monthly, and gradually rose in 1924 to about $ 17.00 as a

maximum, supplemented by a ration of flour, herring and potatoes of

about 1,500 calories daily, and free apartments. Dr. Pavlov, for

example, vbose special worth has been recognized by the Soviets,

received this amount. !The amount received is sufficimt to support

the recipient, but with no surplus for any books, comforts or luxuries,

and if there is a family the others must obtain sone fonn of amploymezlt

which will provide them also with the means to live.

duced standard of living in Russia, the absence of all luxuries, ad

the cheapness of plain food make it even possible for tm, or three to

live on a very small salary.  Altho bare liviw is cheap, all luxur:  q

and most comforts are much more expensive than in Eh$ard or Amrioa.

Unfortunate was the n)an who had not many valuables to sell to tide

him over these years.

The greatly re-

The followiag list of professors was given me by

Professor Bronner :

52.

IPO .

la
2.

3.

4.
3.
6,
7.
a.

9.

10.
11 w
12.
13.
14.
15 o
16.
17 .
18 0
19.
20 .

21.

23 a

24

26 .

2s a

Chair

LIST OF PROFESSORS OF THE MEDICAL SCHOOLS OF

            blOSCO?/ AND LENINGRAD.
(Administered by the Narkompros (People's Comiasariat

of Public Instruction) of the R.S,P.S.R,
Socialist Pederat ive Soviet Republic ) .

(Russian

    I
MOSCOW.

Ned. Faoulty of        kled. Faoultx

(be of Pmfessor) Bora   (he of Professor) Born

the I Moscow Univer. of the I1 Mosmw Univ.

Physics MloaZ ievaw
Gen. Chemistry Prjeboroveky
           St epanoff
Gen. Biology I(ursanoff

            Bogo iavl e ns hy
lponrmpl Anatomy &ruz in
Histology Gurv ich
Phy ai ology Shat ernikoff
Biolog . Chemistry Oulevich
Bharnacology Nikolaef f
Patholog Anatovig Abrikosoff
Patholog. Physiolcgy Sakharoff
Operative Surgery Obrosoff
Miorob iology Barrkin
ihperim. Hygiene Syssin
.Social Hygiene Sernsshko
Labour Wgiene ICaplun
Educational Hygiene Molkoff
Legal Medicine Mfnakoff
Surg 2psoped .Cliaia Gerzen
Therap. Prop . Clinic Fromgold
Therap. C1 inic

(4th year) Vikbert
Surgiaal Clinio
(4th year) Bourdenko
Gynecology and
Obst . (Clinio) Maliaovsky

Ophthalmology

Clinio . Odintzoff
Dermatology & V.D, Mestohersgy
~ediatrioa (GI.) Wlchanoff
NeUIWlOgy (c1 a) ROSSO1hO

188 3
1883
1872
1877
1870

18 74
1870
18 67
1871
1876
1873
1880
18 74
1874
1874
1897
18 70
18 63
18 71
1881

ia 64

1884

18 78

1880

1876
1874
18 68
18 60

Idlodz i evsQ
Refo mat sky
Mildm il e nko
Zavadovsky

Dioshin

Mrs. Stern
Smorodinzef f
Slmorzof f
Xedrovsky
Bogornolet e
Esipoff
Krit chevsky
Ignatoff
Solovief f
Wlun
Molkoff
Minako f f
We i s 8 b ro t
Nieviadomsky

Rarpoff

&banof f

Spasokukot zky

KuM i nov8ky

(Brrtude)

188 3
1865
18 64
1897

la 64

18 70
1879
1881

1866
1881
1874
1885
18 70
1877
1897
1870
18 65
18 74
188 3

ia 79

18 64

1870

18 74

1872
18 66
1864
18 56
1878

53 o

m.

27 o
28.

29 .

30 o

31 o

32 o
33 .
34 o
35 o

36 o

1.
2.

3.

4.
5.
6.
7.
8.
9.
10.

11 .
12.
13.
14 o
16.

16 o
17 o
18 o

Chair

Med. Faculty of Med. Facultg

(Name of Professor)

the I Mosoow University Born of the 11 Wscm Un. Born

(&me of Professor)

Psychiatry (C1 . ) Oanushkin
Hospital Therapy
(Clinic) (5th year) Pletneff
Hospital Surgery
(Clinic, 5th year) artymff
Ot o-RhinD-Laryn$o-
logy (Cllnio) Ivanoff
Infectious ais-
eases {Clinio) Kireeff
Urology Fronat ein
Phys. Therapy hze rnit zky
odontology (C1.) Lukornsky
Tuberauloeir
(docent ship)

He flexology I)

LENINGRAD

1876

1871

18 68

18 67

18 73
188 2
18 78
1893

Physios

General Chemistry Zalkimi

General Biology Rid son

Normal Anatomy Kornilovich

Phy 8 i 01 ogy

Biologioal Chemistry Salazkin
Phannaoology Likhat oheff
Pathol. Anatomy Sohohr
Patholog, Physiology Xhalatoff

Ginsberg

Knipov iah

Histology BBartpoff

Orbell

1876
1870
1867
1862
18 67

188 2
1862
1866
1872
1884

1872

Operative Srwgerg Sussloff 18 67
Microbiology Zabolot ny 18 66
lkperim. Hygiene Khlopin 18 63
Social Eygiene Nikit in 18 68
Labour Hygiene

Eduaational Hygiene Same as above
Legs1 Media ine Tah ist ovioh 1870
Surgioal Proped.

C1 inio .

Vaoancy to be filled
through competition


Vacancy to be filled
through ccmpet it ion

Gilarovsky

Konohalovsky

Levit

Sverj evsky

Marz inovsky
Le5 noff
Bogasfie f f
Kogan

Einiss

-

1876

18 75

1883

1867

1874
1873
1878
1880

18 90

State Institute

of Xedical Sciences .
Orloff 1874

Jukoff 1861
WS*Q 18 68
Ivanof f 1878

Zeldov ich 18 69
Deineka 1876
Tuhr 18 66
Ilyin 18 66
Gramenitzky 188 2
Sysroef f 1085
Vacamy to be

filled through competition.
ms. LiSOVBky 1876

Ivanof f 1871
Frenkel 18 69
KO i ranslrg 1886

Bert 188 2

Griboiedoff 1875
Tohlstoviah 18 70

54 .

No.


19 o

20.

21 .

22 0

23.

24 .
25 o
26 .
27 o
28.

29 .

30.


31 a

32.


33.

34.
35 .


36 o

Chair

Medical Institute

Therap. Propod. Clinic Levin

Therap. C1 init3

Surgical C1 inio

Gyneoologg and Ob-

Ophtbalmolcgy (C1 .) Andogsky

Dermatologg and V.D. ldrs. Salzhnovaky
Pediat r ias ( C1 inia )   Rrasnogorsky
meurology ( C1 inio ) Niki t in
Peychiatry (Cl.)      0 s t anko f f
Hospital Therapy
(Clinio, 5th year)    Chernoru t zkg
Hospital Surgery
(Clinio, 5th year)    Dj enal idze
0 t 0-F-h i no-larpgol ogy
(mini 0) Verkhovaky
Infectious diseases
(Clinio) Ivashenze f f

(4th year)        Wng

(4th year)          Taak

(st etrioa (C1.)      Skrobansky

Urology Mrs. Lisovsky

Phys. Therapy       &S. &iSOVBe
Od0~tOlOgiCal clinic   LVOff

Tuberculosis

Ref lex0 logy

(Docent ship) -

Bekht eref f

Born

18 61


1875


1880

1873

1869
188 2
it883
1879
18 68

1884


1883

18 63


1883

1876

-

1884

1837

State Institute
of Med . Sc ionce 6 o
(mksme of Professor) Born

Rube1 18 67

Glinchiko f f 18 78

Rokitzky 18 70

KriYSky 1870

Zelenkovsky 1872
Stein 18 74
FU~LUI 18 74
Bekht 0re ff 1857
Gerver 1873

KO nd rat ovi ch    1873

Grekof f 1867

Belogolovof f 1874

Ro 88 nb erg 1876

Vacancy, to be filled
through oompet it ion
Uihailovsky 18 77
Lsmberg 1894

-

Bekht ereff 1857.

55 .

STATISTICS

No. of Professors in both the
Moaoow and LeninriTad Instituteg.

33 .............. 1

34 .............. 1
37 .............. 1
41 .............. 1
42 .............. 2
43 .............. 4
44 .............. 9
45 .............. 5
46 .............. 3
47 .............. 4
48 .............. 4
49 .............. 6
59 .............. 3
51 .............. 7

53 .............. 13
54 ..............
55 .............. 5
56 .............. 4

57 .............. 11
58 .............. 3
69 .............. 6
60 .............. 6
61 .............. 7
62 .............. 4
63 .............. 4
64 .............. 2
65 .............. 2
66 .............. 2
67 .............. I
70 .............. 3
72 .............. 1
73 .............. 1

52 .............. 6

In pre-war times, women had aooess only to spacial

schools, the ohief of %ich were the Women's Medical  Institution in

Leningrad and the Second University at MOSCOW. They were always

admitted by elramination.

Men were admitted also by examination unless

they had received a certifiaate of graduation from a recognized gym-

nasium.

Siaae the war, the requirements have been changed;  so that

now, for both sexes, a certificate is necessary from the secondary

schools which have replaced the former gymnasia

sal professional

school 3.

Dr. Lichatchef, Professor of pharmacology in Leningrad,

says:

"During the Revolution, an attempt ms made to acoept

as students even such people who had not passed through a
grarmnar school, after e very superficial examination.  This
resulted in unprepared students.
sad results as one might have expeoted, for the unprepared
students proved unable to pass the examinations required by
the medioal school,  in order to be transferred from class
ts class, and after a year or two, a majority of them left
the sohool. It should be noted, however, that the overfilling
of sahools with students had a bad influenco on the teaohing.
The students are supplied to the medical schools also by the
so-called "Rebfaki" i .e. courses for mrlrmen whose special
aim ia to prepare them for entering the Universities. Al-
though the goneral oulture of people graduating from workmen's
oourses is not high the preparation mostly proves satisfaotory.

   tvI)U~ to the fact that already, in pre-revolution times
and more especially during the last gears, the Petrograd
sohools were unable to accept all those desirous of instruction,
it UELS neaessary, every year, to make a oertain seleotion
among the candidates to be admitted.
this was done by means of 8 comparison of aredentiala, those

It did not lead to just as

In pre-revolution times,

57 o

being admitted who had the best papers.
that there were restrictione with regard to the Jews. At the
present time, speoial conmissions attend to the admittance of
students and in wmpliance with the existing official rules,
foremost preference is given to members of the Connmrnist Party,
persons having attended ',Vorkment8 Courses, and people oommd-
eered by Professional Unions, persons belonging to the Workmen
and Peasant class, etc, These method6 of admittance account
for the -ked change in the class el~ment8 among the students,
for instance those 3f the Uilitary 3ledioSl Aoaderqy, as shorn in
a table below.
between 16 and 26, but most of them are 17 to 18 years old when
they enter",

It ahould be mentioned

The age of' thu students, at entrance, vary

The entrance erdnation now is given in Russian

Uithemetics, Physics and General Culture, and the objeot of such

examinations is to limit classes to the laboratory facilitiee of the

faculties,

The graduate of the Rabfak or working 111811's Wniversity"

(really a secondary school open to workers) automatically gets into

the medioal f aoUrty without examination,

It is interesting to note that half of  the students

who entered the medioal schools in 1918, 1919 and 1920, were dropped

before reaching the fifth gear, This is an example of the fact that

a doctrinaire asswqption that anyone is capable of receiving a uni-

versity education is false enough to become self-evident  over a

period of a few years,

No copies of the entrance examination were secured,

See Seotion 15, Souroe of Students.

58 o

        In the opinion of Mias Alioe Davis, of the Frieda

Society, who has mingled oonsiderably with the students, it takes

300-500 roubles for the necessary coaching to pass the entranoe

examinations to the faculty of medicine.

50.

11 .-FZZS OF STUDEIOTS, Am STUDEXP LIFE .

In 1927, 607% of the medical students received aid Pran

the State for their living expenses, 4@ paid no tuition wbatever, ad

1% paid something for their eduoation.

        The objeot of State aid is, first, to pmvide oareera

for the ohildren of workmen, peasants and state employees (there are

about 50,000 students in all branohes on Government stipends) and,

seoond, to reoruit ranks of rum1 pmotitioners. It is usually the

bourgeois student8 who pay for their tuition, the maximum being 300

roublss a year.

Iche student who reoeives aid from the State gets 25

to 30 roubles a month. 40 roubles might be enough, but as it is the

life of such students is next to that of a pauper. They live from

two to sir in a room, paying 2.50 roubles for rent, and 12 to 14

rouble6 for food . Books cost 5-10 rouble8 (20-40 oents) and are

(1)

thus only occasional luxuries for the poor student.

In Leniwmd

three text-books in the library were for 260 students.

(1) The University of Moscow announces that in 1926-1927 the Univers-

ity Refeotories oan take are of 2,400 students a day.  A dinner of

2,000 oalories oosts 32 Kopeks, the University losing 6 Kopeks as the

real Cost is 38 Kopekd.

60.

lYLuch time is taken by politiaal or semi-political

associations, and this, together with the constant need to make a

little money to supplement the government stipend, makes serious

inroad upon many of the students'  time.

examination conanittee in Mosoow states in 1927 16 were prepared -
86 with medioore preparation and t$ inadequately prepared.

reason for this lack of efficioncy on the part of the students,

The rQport of the State

The

a8 diaoovered by the Faculty Counoil, was the general overcrowling,

the depressing financial conditions and the neaessity to  seaure em-

ployment outside of the UniYsrsity, inadequaoy of teaching equipment

and the relatively small number of teaching foraes as compared with

the large mmbQr of members.

The obligation to the State whiah is incurred by

acceptance of aid ie discharged by three to five years service as a

oountry doctor (see Distribution of Graduates, section 16).

Student living conditions in the recent past might

themselves be easily responsible for the failure attributed to

faculty methods of instruation, etc.  According to a professor in the

Leningrad Medical Institute the conditions in 1923 were iaproving, Dr.

Gantt observes:

  "During the revolution the pecuniary position of the
students became oonsiderably wor88, arxi the assistanoe of
the State oonsisted in the issue of war payok ration to
1200 students which in 1920 were chosen to enjoy the so-
called State supply,

Those mbo did not receive that payok

were expeoted to pull through as best they could, Since
this year conditions have improved, an3 the students have
been allocated Rs. 200 (5 1.0) per month besides payok and
clothing. Moreover, many of the students get lodgings at
student-home8 established by the Govement b
regular students there are also physicians studging at the
Academy.  These are partly physioians comndeered from
military departments, partly better students kept on by
the Academy after their graduation for improvement.  The
latter am kept on by the Academy for a period of tm years
after having writ ten a competition somposit ion (Fonnerlg
there were kept by the Aoadenpr eaoh year ten physicians,
now this number is only five).
students were sent abroad each year on amount of the State,
for a two years' sojourn there. This system proved emellent,
and most of the Petrograd professors, as well as those of
the counhry, were of the number of such students.

' "The following number of students edooyed 8tipendB at
the Petrograd Medical Institute:

Besides

In fonner times three

1nstitute"s Private
Stipend . St iped o

In 1913 57 182 Total 249. Freed from tuition: 123,
                                             127.
In 1914 66 164 330.
In 1923 525

    "The Students' Feeding Division of the Amerism Relief
Admini st rat ion, conducted bg Mr , S .IT . Eeeny, fed Univers ity
students in Odessa, Kiev, &scow and Leningrad from 1921, to
1924. About 12,000 students reoeive one meal eaoh day, repres-
enting about 1,200 calories. Soup, meat, bread, ad potatoes
made up the menx, and the meal cost about 2 to 6 d. in Hussia
without cost of merhead. It was furnished free, of course,
and constituted the only meal of the day to most of the students
who ate in these kitchens. Many of the best students get their
meals in this way and considered themselves extremely lueky.

   "In 1923 many students of the medical sohools get food
from the American Helief Asministrat ion. Thanks to this assist-
ance students who otherwise wuld have boen compelled to quit
studying altogether were enabled to continue their studies",

W *#

A professor of the Lenirgrad Medical  Institute states

as follows:

"In pre-revolutionary times, the students of bdedical

Sohools paid 50 gold roubles for eaoh semester.  An exaqtion
to the rule was the Military tdediaal Aosdssng, where a great
majority of the students wore onjoying subsidies from the
War Department and therefore were free from the payment  of

fees. Other schools too used to exempt the most needy
amongst the students and there existed State and Public
ad  Private Funds, out of which subsidies wer? paid to a
certain number of students.  They were distributed by the
school administrat ion with part icqation of the students.
After the revolution, payment of fees was abolished, but
there was also disoontinued payment of subsidies to the
students ( the bonds in which the subsidy fund -111 invested
having been annulled by the Goveranent ) .  Also there were
closed the students' kitchens, eich were tranafonned into
publio kitchens for the population at large. All that trade
the cond-itions of the students very hard.
of them, owing to these changed oonditiom, were oompelled
to combine with their studiea some work in order to earn
their living.

  "Mow the conditions of studying, as well a8 of life in
general, are notably improved, although beginning with this
year (1923) a fee is again required amounting to about  200
to 250 roubles ( 3s 1. to&2.10,0 ) for a sanestere
have been introduood again in a muoh larger number than there
eristed before the revolution, but the subsidies nodays
are distributed according to special rules, preference beixg
given in this distribution to those mho are rnmbers of the
Carrmnnist Party or belong to the workmen or peasant class.
There are also homes and kitchens beirg restored for use
among the students".

The large majoritjf

Subsidies

The follov!ing is a quotation from the bulletin of the

Xedical Faculty of the I University in Moscow:

"The financial situation of the majority of the students

is still quito preoarioua in spite of the fact  tht  the rate
of govermcnt stipend was increased up to t3/25 Roubles per
month, and that the total amount of government subsidies for
stipends ma raised to 803,505 Roubles.

  "One of the first actions of the new university senate
was to go into the problem of etudent life.
about an improvement in their mode of living, speaial donnit-
orioa and refectories were organized.  B system of loans for
poor students was also established. The number o students
in these domitories was of 1728 in 1925 and of 2 6 6 in 1926''I

In order to brim

12,- DEGREES h QUALLFICATI0NS.-

Stat e examinat ion8 for Govermnent comnissions

formerly were in vogue, before tho applicant was permitted

to praotice.  They were minimized during the war and t3bOlished

in the revolution, the schools being entitled to issue diploma

for the right of practice to all those who completed their

courses. now, State examinations are re-established,

      There are two grades of qualification in Russian

medical education, tho lesser being the aertificate of graduation

from one of the established medical faculties, and the higher a

document at testing to the sat isfactory completion of higher or

specialized study, this also being conferred by the faculty. In

pre-revolut ionary times, physiaians desirous of devoting themselves
                                      required
to scientific career and of getting positions of teachers were first/

to get the grade of doctor of mdioine. The same grade uas necessary

for taking over certain administrative jobs. In order to get that

grade physicians were to pass through spofal eraminations for all

the scionaes for which they had already passed through examinations

when graduating as physicians, sad also to write up some scientific

work as a "dissertation".

scientifio work, and tho writing of it frequently required several

years of diligent work.

This usually was a very considerable

4 o

Since the revolution all scientifia grades and titles,

also that of doctors of medicine, have been officially abolished.
However, even myw schools are enabling those who are desirous of it
to pass through erraminations on a series of sciences clos8ly connected
with the speciality selected by the applimt.  Those passing through

such examinations are then expected to write a scient ific work of the

same kind as the foimer dissertations, after vhich they get from the

school documents cortigying to their scientific qualifications.
qualifiaations aro required from candidates for the posts of senior

teachers.

Suuh

The fomr system, therefore, has kept up in its essential

a

points'..

Thore  art? thus no titles or degrees as we know them

conferred, but it is apparent that the Cornissariat of Education is
aat ivelg supervising the examinat ions through a special ~0m1s~ ion for
that end, which reported in 1927 that l@ of the medical students were
well prepared for the final examinations, 8% had mediocre preparation
ami 5$ were badly prepared.

It oannot be inferred that because all the medical

fauulties are uder the Cornissariat of Education the value of instruo-

tion in different faculties is approximately the same. The training

at the Military Aaademy in Leningrad is still probably the highest  In

Russia, due to selection of students, strict internal discipline, and

to superior teaching personnel.

Tho medical training given outside

65 o

Leningrad and Moscow is probably uneven and of poor quality - Kkarkoff

possibly excu1:ted.

For an Important discussion of the present and prastiaallg

uniform aurriculum from the government's point of view,  see

Appendix 2,    The curriculum itself is the following:-

1st Year = 1st Semea.

'per week,

1. Normal Anatomy 2 5 126 1. Norrml Anatomy 2 4 108

2, Physica 3 4 126

3, General Biology 2 2 72

4. Gen. Chemistry 3 2 90

( inorganio)

5, Sooial saience 2 2 72

cea

6. Military So - 2 - 36

7, Foreign Languages -

7 Subjects . . . 31

2, Hist,& Embryology 2 4 108

4, General Biology 2 2 72

6. Soaial scienae 2 2 72

7, Foreign La-88

7 Subjeats . . .

Total Ho, of hours per year  - 1st jar,

Anatomy 234
Hi 8 to logy 108
Physioa 216
General Biology 144
General Chemletry 234
Soalal Scienae 144
DEilitary Saienaes 36
Foreign hqpage8 72

1,188

67 .

xo, of ILrs,

r week

ow

                     1- 2- 72
1, Mornral Anatomy

2, Hiat. & Enibryology 2 4 108

22

3, Physiology 2 5 126

4, General Chemistry 2- 36

(phys .& collold)

5, Biol, Chemistry 23 90

6, Social Science 21 54

7, Military Saienaeer 2- 36

6. Foreign Langu8ges -2 36

8 Subjects o . , o 31

No. of Ura.
per week

1, Physiology 2 5 126

2, General Biology 2 2 72

3. Biol, Chemistry 2 4 108

4, Uioro-biology 2 2 72

5, Elements in Geo- 2 - 36

logy Cpc Mineral.

6. Social 3ciences 2 154

7, Foreign Languaps - 2 36

7 Subjects . . -E---

Total No. of how durw the a Year,

Nom1 Anatomy
IIis tology
Physiology
General Biology

Elerrants in Geolggy
and Idineralogy
General Chemistry

Miaro-Biology
Ulitery Suiences
Foreign Languages

Biolog, tl

72
108
252

72

36
36
19 8
72
36
72

954

1. Pathologiual Anatoq 2 2 72

2, It Physiology 2 2 72

9. Ub-o-Biology 2 3 90

4, Pharmuology 2 2 72

6, lkperim. Hygiene 2 4 108

6, Sooial Hygiene

(&no statistius, 1 1 36

anthropology and

enthropomtry)

7. Propedeutios of Int, 4 72

di8tmSt36

8. Propedeutius of 4 72

surgical diseases

9, Operative aurgery 1 2 54

with topog, anat.

7

9 Subjeuts , . . 36 648

1. Pathologiual Anatow

2, n Phys i ol o

3. Pharmaoology

6, Midwifery (physisl,

part)

6. Propedeut io8 of ht ,

di89-90

7, Physiual methods of
     trea tmnt

8. Propedeutius of


9. Operative surgery

surgloal diseases

with topog. anat.

9 Subjeuts . . o

2 2 72


2 2 72


2 2 72


2 6 144

1 - 18

4 72

3 54

4 72

1254

7

35 630

Total No. of hours durb the 3rd Year.

Pathologioal Anatmy

Xicro-B iology
phasmaoology
Experimental Hygi me
Social Hygiene
Xidwif ery
Propedeutius of Int.Dis,
Physioal methods of

Propedeutios of Surg,Die.
Operative surgery with

It Phy8fOlOgy

treatment

topogr, anatomy

144
144
90
144
252
36
18
144
54

144

108
1 o 278

-

Po, of Hrs.
per week

No. of Hre,

1, Clin,of Into diseases 5 90

2, It sw3, It 6 90


        laecePaary)

(with apeo,orthopedia
oouroe wherever deemed

3, Clin, of Obstetrios & 5 90

Gyneao logy

4. C1in.of New. Diseases 6 108

5, 11 fl Derm, & V.D. 4 72

6, ff fl Ophthalmology 2 36

7, Industrial Hygiene 2 - 36

8, Sohool Hygiene 2 -36

9, Legal nredicine 2 2 72

10, Military Hygiene      2 - 36

   10 Subjeota . . o o     37 666

-v--

1, Clin.of Int.disease8 5 90

2, 11 Surg. 6 108

(with spec.orthopedio
courtae whrever deemed
      neceaeary)

3. Clin, of Obertetrics & 5 90

Gynecology

4. Pediatrioal olinio 4 72

5, Clin, of Der- & V.D. 5 90

6, fl * Ophthalmol. 1 18

3 54

7, Industrial Iiygiene -

8, Sohool Hygiene I 3 54

9. Clin, of Pediatrics 3 - 54

2 64

10, Legal medioine 1

7

10 Subjeots , , . . 38 684

TotBl No. of hours durinsr: the 4th year.

Clinic of Internal DiseRBe6

  tt t1 Sur#cal tt
Gyneoology % Obstetrios
Neurology
Psychiatry
Dermatology and VoD,

Industrial Hygiene
Sohool Hygiene
Pediatrics
Legal Uedicine
Nilitary Hygiene

ophthalnrology

180
198
180
108
72
162
54
90
90
54
126
36

1.350

L

70 .

Clin,of Int .Di& (with 1, C1i.n. Of Int.Di8, 4 72
a cow88 of Tb, wher-
ever necessary.) 5 90 2, lt (1 Infeot, bis. 4 72

Surg,clinia (with brief 4 72 3, Surgiaal clinia 4 72

64

-

oome of Urology) 3

126 4. Gynecol, & Obstetr. 3 54

Gyneoology SC Obstetr. 2 36 5, Oto-rhino-laqmgol, 2 36

Odontology 3 54 6. Xervoils diseases 4 72

0 t o-rhino*laryng, 2 36 7, Clin. of Pediatr, 4 72

Peychiatry 4 72 infant di seams)

(with course of

Pediatrics (with 4 72 0, Derlnatology & V.D. 2 36

course of infant

disea . ) 9. Ophthalmology 3 54

2 2 72

Ophthalmology 3 54 10, Social Hygiene

Soaial Hygiene 2 2 72 11, Patho1,Anatoq 1 1 36

(dissect .course1

7

10 Subjeats , . . . . 36 648 11 Subjects , . . 36 640

10. Xilitary Hygiene

Tot -of hours duriw the 5th par,

Clinic of Internal Diseases 16 2
    lf Infectious '1 72
Surgiml clinic 198

~lin, af Gynecology & Obstetrics   90
Odontology 54
Clin, of Otho-rhino-laryngology m 72

lt Nervow diseases 72
    If Pediatric8 144
1q Dermtology & V,D, 36
l1 1) Ophthalmology 108
Sooial Hygiene 144
Military Hygiene 36
Patholog, Anatoqy (diesect,uourse) 36
                   1.296

71.

Distribution of Studies acuordiw to Semesters,

Autumn semester,

Beginning Sept. lst, ending Jan, 31st = 153 days.

Of thoset winter vauation = 21 days;

= 27 It

-

holidays rfj n

There remains = 126 days.

i. e. 18 WBBk8.

Snrian aemest~,

Beginning Feb. lst, ending June 15th = 135 days.

Of those: spring vacation - 5 days;

9 I'

-

-

hol idags = 4 tt

There reminsz 126 days.

Le, 18 wee-.

TOW :

36 weeks is equivalent of 216 working days,

-

Non working days: winter vacation = 21 dags

spring It . 5 I1

holidays = 10 1'

flmdass z 36 '1

Sumner vacation - 77 n

Total non-working bys . . . . . z 149

72.

Only in Moscm and Leningrad are there  four chairs

of Hygiene in each faculty.

In the smaller provincial universities

there are only two -

Experimental or General Hygiene, ad Social

Wicine.  A11 course6 given in Hygiene are campulsory and the alinic-

lam complain that Hygiene is robbing too much of the time of the

student o

           !J!he Social Saieme of the first tm years ie of oouree

largely COmnunist doctrine and is aaalogous^to the course in Amerlcan

in Importance to xedicins

Institutions which is required for entrance to the Medical School of

the Univerai ty of California o

!l!he student spends 5 years in a medical school, and

there is some talk of requiring a sixth hospital year. Clinical work

begins in the third year, with the physical examination of patients,

From the third yeax to the fifth, the student is given more a& more

responsibility in the wards and at the same time devotes less and leas

time to lectures. In the fifth year, the student does clinical olerkim,

somewhat similar to the Ehglish mediaal student. Preparation for the

State examinations takes an additional 3 to 6 months.

Very many students take a longer time than this for

making their studies and rermain at the sahools seven gears or more.

This delay b80We especially frequent after the outbreak sf the war,

&en many of the students  left for the front line in the capacity

of nSanitars" or assistants, or instead of studying, worked  in the

Petrograd Hospitals

The first tm years of the regular study period are

occupied with chemistry, physios, anatomy, histology, physiology,

biology and physiologioal chemistry, with laboratorg and praot foal

work in eacrh.

work. Since the number of ordimtors and assistantships in hospitals

is small, the effort is to give a thorough practical experience in

olinical work in the fifth year,

The fourth and fifth years are devoted to alinical

           me work of the students is controlled by notes of

laboratory work, practioal tests, and by examinations.

there is sme latitude in this matter.

itself on the strict rule of examinations at the end of each year

and only two make-up examinations allowed a student  in Ootober.

faoulties refer to examinations at the end of the second year,

Apparently

lpho Military Academy prides

Other

        Up to 1906 the students were aanpelled at the end of

the year to pass through exaninations on all subjects they had studied

during that year. In 1906 this sgstan un(ierwent some ohanges; the

students were given more scope in regard to the time of passing.

through those examinations, but there was also required: 1) that the

students pass through examinations on all subjects atudied durizg

the first tva years before admitting them for work in the upper

!

74 o

cla~ses, and  2) a definite order in passing through the examinations

while in the upper alasses,

arrangement wimilar to the old system prior to 1906,

Now it is plamed to return to an

After having attended a medial sohool in order to

get the right of practising, the students were compelled in pre-

revolution times to pass again through a series of examinations

[mostly theoretfoal EiChnce8, such as anatq, phpiology, physio-

logical chemistry, general pathology, pathological anatomy, pharm-

cology, pharmaog, hygiene, legal medioine, and also on all oliniual

subjeote - in all twenty-three examinations) before speoial examin-

ation-oomni8sions. The examinatore of those comnissions were teachers

to high schoolst to act 8s presidents to those collpnissions the

Govermmt usually nominated either the motor of the respective

mdicraloouraes or well-known professors of mediual saienoes from

other schools.  Af'ter the war the number of examinations before

government-oomnisaions was reduced and during the revolution these

emminations were altogether abolished, the schools being entitled

to issue diplomas for the right of practising to all Student8 who

went through the course of studies without renewed exardnatione,

At the time being, the examination8 before the government-commissions

are re-established,   It is planned beside8 to compel the students

in the near future, before giving them the right of praotising,  to

spend one year at hospitals (not oomeoted with the sohoola),

76 .

The following comment on the most reoent curricula

changes in the First University of Mosom is translated from the

bulletin of the Faculty of Medicine.

During the 8OhOO1-year 1925-26, the Faculty council

continued its previous attempts (ever since 19243

a change in the teaohing methods by canoentrating chiefly upon the

seminery and labolatory methods a of work and $radually giving up

the purely theoretical methods.  The number of theoretioal hours waa

sacrificed and replaced by seminaries.

was also considerably increased.

inorganic chemistry, phannacology, physiology, pathologioal physiolcgg) ,

practiual exercjsss have been made cunpulsory in the eo-aalled

"prophylactio disciplines" (general and social hygiene 1.  Praatical

work in the field was -de compulsory.  A certain amount of ambulatorium

wrk had to be done within the programme of teaohing of social hygiene

and the student was acquainted with dispensary methods. The teaahing

of clinical subject8 w8s reorganized so as to bring about a oloee

contaot between the student and the everyday clinical mrk (in smbula-

toria, labolatories and merd8) .  This reorganization resulted in the

oreation of groups of students each of whioh is oompelled to spend a

certain amount of time in various olinics and taking an active part

in their regular wrk.

to bring about

The number of praotiual hours

?

In certain subjects (organic and

76 o

The details of the main oourse in Hygiene (General

Hygiene) in the I University of Moscow (Prof. Syssin) are of interest.

The class is divided into groups of eighty students and for four

weeks intensive period in each of tm semesters they have five aaminars

of four hours each, In the seaond semester there is 140 hours of

laborstory work (Whicb includes excursions).

As indicative of the scope of work ,he following is t

program of study in the first  semester;

1) Bases of qualitative and quantitative chemical analysis.
2) Carbon dioxide - signifiosnuo and tests for.
3) Measurement of humidity, wind velocity, sunlight, heat and

     atmospherio pressure .
4) Katathenny and effeotive temperatures.  Making and reading
     of arohitectur81 plsm .
5) Observation and inspeation of buildings.  Hygiene of
      dwellings .
6) Baoteriology and biology of water.

8) mination period.
9) Observation and report on assigned hospitals fmm a sanitary

n n '1 earth and air.

7)

standpoint o Report and defense of critiaisms. Same
regarding faot ory worker' s houses.

10) One dag spent with Sanitary inspotor.

         To give this oourse the Xnstitute receives 500

roubles a semester (cf. 455 r. to Institute of Pharmaoology).

77 .

14.-lWMBER OF STUDEM!S.-

I have no reoent figures by Faaulties to show the

distribution of students of medicine in Russia. I was told that in

the 24 faculties of the U.S.S.R. there were approximately 24,000

students ani that in the 15 Faoulties of the R.S.P.S.R. there were

18,000. Bronner also said that there were about 7,000 doctors in

Government rural praotfoe and 28,000 as a total of the number of

doators in the U.S.S.R.

is calculated as 28 years in Russia, so that replacement alone

would require 1,000 graduates a year .

The average professional life of a dootor

Tho percentage of medical students who graduate

in relation to tltal enrollment of the school has been low: during
the years 1916-22 2$ to 6$ at the State Institute of Medical' Scienoe

in Leningrad from 1916-1922, the same range of percentages at the

Military Aoadmy for the yoar 1918-22, ani the me for the Lenin-

grad Medioal Institute. Since 1922 the peroentage gradwting has

inoreased, as is indicated by the report of the I MOSCOW Medical

Faculty . 2,654 students have been regularly attendim the leatures

and praatical work of the mediaal faoulty during 1924-25.

year: 336 - 2nd year: 581 - 3rd year: 625 - 4th year: 538 -

Sth year: 574)  601 students have completed their studies at the

Faculty in 1925 and have obtained their doctor's degree.

(1st

2,449

78 o

students were registered in the faculty by the time of the opening

of the 1926 spring amester.

3rd year: 535 - 4th year: 484 - 6th year: 536). 419 students

have oompleted their studies and obtained their doctor's degree in

the spring of 1926.

(1st year: 304 - 2nd year: 690   -

79

15, SOURCE OF STUDEN!L?S.

Very few phaeee of rnedical educatim under the Soviet

government axe more important and more distinctive than the  source

of the preeent student body.

The future of mediual and public

health work in Iiussia will be influenoed by the backgromd, train-

ing and attitude of these students, by their qualities ae well a8

their defects.

University life in Russia is thus influenced by a

student body different from that of any other country as the

following information from the 1. University of "Xoscow indicates,

Table indati nR the t880~ia3n orirri;

FRO u1 ts 0 fr

             Total

96 196 9.6 712 9.4

--?

Sciences J a pr, EthnoloBy

P

P %

Worhea 104 3.4 316 19.2
Children of workmm 309 10.2 157 9.5 77 4a 20.5 963 12.7
Peasant 8 72 2.3 183 11.1 62 156 7,b 473 6.2
PaasRntsl children 324 10.7 166 10.1 58 343 16.8 891 11.8
Employees 971 38.5 389 23.7 162 349 17.0 1861 24.7
  n ohildren 805 26.7 1% 9.1 137 313 15.2 1405 18.6
lt Intsllec tual" workers
(this inuludecr a oertain
group of enployees) .A.N. 266 8.8 121 73 156 21 1.0 564 7.4
Their ohildren 108 3,s 95 5.7 74 67 3,2 344 4.6

Non-working %lementtI      ..I -


Others           37 1.2 35 2.1 18 1B7 7.6 247 3.2

- - 7-

-

7 .4

Their clhildren 9 0.2 19 1,l 6 26 1.2 a 60 0.7

3,005

1,638

836 2,048

7 527
&

80 o

Members of' the All Russian Coxnunist Party

22.4% (

Members of the 811 Russian Association of 1 550s

Communist Yo a th

33.8 (

Students belonging to no political parties

( ss-oalled llimpartiall') 44 04%

Russians    75.4% White Russians 1.55
Ukrainians    1 Jews 14 2%

Mordva, Choowshes, Zgrians, Bashkirs, Boukharians, Ugbeks, TadJ iks,

Tartars, Udmurts, eyptians, Persians, - each of those nationalities

from 0.1% to 0.s. - Poles, Germans, British, Greeh, LetvIBna,

Esthonians, each of those from 0.1% to 0.s.

Great restrict ions were made, beginning 1926, as regards

the %ocial origin".

Althoagh ent rase ezaminat ions have been rendered

more diffioult, the peroentage of men and girls fro3 the working alsss

has ranained the same/during 1925.  The same applies to the percentage

as

of communist members, About 31% of all University students come from

the iiabfak.

!This then is the pioture at Mosoow,

In Leningrad at the

Institute, Professor Lichatchef told me tbt 1,000 students apply

for admission but that only 200 are taken. Of these 200, 100 oome

from the Rabfak (Worltersl Sohool) and the other hundred are chosen

in the following order of preference:

1st o Factory workers' ahildren and children of professors.
2nd. Children of governnent employees.
3rd e *I *' other workers.
4th. 11 merohant s , shopkeepe rs ani bourgeoi 8.

Professor Lichatchef admitted that the selection is not

entirely by saholastic merit , but Professor bit sohoff oorreated an

otherwise erroneous impression by adding that the zeal of the students

vas as great, if not greater, than in Tsarist days.

the impression of Professor Stern in the Second University in Moscow,

This was also

who said that never had she seen students in Switzerland so eager to

learn nor so implicitly confident of the value of knowledge.

        One further fact regarding the camposition of the stud-

ent bodies in the Medical Faoulties: the proportion of girls is high -

as high as 7&$ in the sahools originally founded for wmen like the

Seaond University in blosoow or the Leningrad Medical Institute, and

usually not below
women (except the Military Medical Academy in Luningrad) .

in the other faaulties which are now open to

I had the

impression that the girl who would take 8 nurse's training in Can8da

would in Russia enter a medical school.

02 .

16 .- DISTRIBUT ION OF GRADUATES.

The distribution of dootors is the great problem for

the Soviet goverment, for the oonntry dootor is badly needed, .ha

there are only 7,000 now for the hwe territory of the U.S.S.R.

has always been so - there were virtually no aountry dmtors in

Tsarist times. The post of Zeunstrovratoh, or distriot doator, was

regarded as a aacrifiae, if not 8 martyrdom. The ignorance and

stupidity of the peasant, his lack of appreciation or intelligent

co-operation of a dootor's servioes, made a doofor's life hard ad

the ineffable isolation of many stations from any oenter of culture

or congenial companionslip was and still is the final argument

against "going into the periphery" .

It

There are 1500 doctors of medioine in bloscow who

refuse to go into the country, though places await then.. . nominally.

Professor Bronner told me that 56 of medioal graduates in Mosoaw

stay on in the city, whereas only 16 of graduates in Irkutsk stay

on in the city.  He is consequently in favor of spending more upon

the prwinoial faculties eioh really help to solve the pressing

problem of getting doators into the districts.

candidates for admission to the medioal sohool are chosen more care-

fully than before, and those willing to go to the provimes are

given the preference o

Even the Rabfak

The government stipends for students are used to

oblige the graduates to go into practice for at least a term of 3

or 5 years,

A talk with a young woman graduate at present

serving her time in the district of Putiloro near Leniagrad cast

some light on this question.  Dr, Natalie Sviazheninoff graduated

in 1923 from the Leningrad ]Medical Institute. She speaks Gemsn,

English a& Prewh.  She has been stationed in Putilovo, a town

of 8,000 and, with a younger girl (M.D.) as an assistant, has a

dietriot oontaining 19,000 people to attead to. She is responsible

for a 30lbed hospital and 200 outpatients a day.  The radius of her

oalls is 30 kilometers. She was on leave with retinal hemorrhagos

and had been much overworked.

roubles a month,  She said the reason for the unwillingness of young

dootors to 'Igo to the periphery" is the aortainty of ovemrk and

underpay.

For this service she is paid 80

The proportion of doctors in Russia is 1: 3,800

population, and roughly one-tenth of these doctors are men.  About

one-third of the medical profession suacumbed durizg the recent

famine and epidemics. The proportion of dootors in the United

States is 1: 800, and in Great Britain about 1: 1400.

It would appear that by means of exorbitant taxation

the governnent attempts to frighten the weaker dootors out of

private praotico.

not tot*.


the same.

Dootors - an do private practice "but they prefer

The professors and well-known oonaultanta make money all

!&e men in the servioe of the IBrkomsdnw are on

full-time "60 far as is known". This includes 8 large number of

dootors in the cities and all the dootors in the distriats.

85.

From xibat I have read and seen and heard,  I should

say that the MilitaFy Medical Academy in Leningrad was the most

important medical school in Russia.

In second plaoe, I would put the

Medical Faculty of the I University in Moaoow.  A dose third is

the Lenizgrad Medical Institute. Fourth, the Faculty of the If

University at Bboscow ad fifth, the State Medioal Institute in

Leningrad o

(1 1

Among the provinofal universities, Rharkoff

is

(2)

important as the principal sohool in the Ukraine.

Seratov and

hean are also important oenters, Kiev and Odessa mnk after

Kharkoff in the Ukraine.

Phe Military Medical Aoadepzy has a great tradition

as the oradle of great professors all over Russia, and  it still

(1) lyhe new medloal mho01 in Eharkoff is formed by the combination
of the Faculty of Medicine and the Mmen's Xediaal College.
old buildings have been renovated and newlg-equipped.

The

(2) The Ukraine is the largest, richest, and most powerful republic
out side Great Russia.

86.

has a etroxg personnel and a higher standard than the other sohools.

The close association between medioine and the public health service

and its institutions for investigation and teaching give a oertain

advantage to the sohools in the capitahand of these the First

University is easily the more important.

a7.

,18.STATUS OF RESEARCH.

Hesearch in the medical sciences if going on more

aatively in the special  institutes outside the faculties than within

the teaching institutions. 'phis is due to the faot that the research

institutes are often new and especially favored by the Comuniate,

whereas the faculties of medicine are looked to for their most needed

product - young doutora, and are crowled with teaching responsibilities

for their immediate production.

The princim  factors in the researoh mrk done in the

medical scienoes in Russia today are;

1) The strain of the immediate past;
2) Heavy teaching duties;
3) Inadequate sums for researoh;
4)  Intellectual isolation from the rest of the

scient if io world.

Some of these faotors have 4 favorable side. Though

the imndiate past has been almost infinitely depressing ad enemat-

ing, the present difficulties aeem by oomparison an enornous improve-

ment. Piork is natural and ialeed a relief from an otherwise

unbearable existence. The mall sums in support of researoh at

least emphasize the importance of ideas rather than technique and

the originality of much of the preaent work is an evidenae that

isolation is not unrelated to a certain freshness in point of view.

aa .

The atorg of the past ten gears and the atruggle

made by soientiets to keep at their work is ertraordimry.  Gantt

has written much on this theme ad deserves to be quoted at length

(See Appendix 5).

From 1918 through 1922, 88 a result of the general

state of the aountry, researoh work was done under appalling condi-

tions and soience kept alive at the cost of enormous energy alld

heroic saorifioea of the illdividual workers. JXlring 1924 and 1925

..

the living oonditions of the soientists, though still preoarious,

greatly improved, and the Soviet Government rendered considerable

financlial aid to science.  Some laboratories have returned to normsl,

many new ones have been formed, and there are a few institutes which

surpass anything of their kind heretofore produced in Russia.

!he clpirit of research is prevalent and is being

fostered. Soience will suffer duriw the next deoade or 80 from

the anisration of former soientists, the lack of preparation in the

pupils of the Bar and revolution periods, the laak of adaptation

between tho professor arad the pmseat type of student alrl fram other

inevitable adjustments to the new sooial oanditiona." The bringing

of soienoe under oentral control and Soviet patronage, though it

mar give a slight politioal colouring, is putting it on a much

more et8ble financial basie than it was in old Russia:'  The present

(1)

(1) C'!,H. Gantt .

3%.

position of soience is, in the opinion of Dr. Gantt,  one of

the most hopeful signs in Soviet Russia.

The best recent work ia medioal research in Russia

includes Pavlov's work on conditioned reflexes in animals;

Krasn~gorslqy~a work on children's coadit ioned roflexos, Orbeli's

work on the effect of the sppathetic nerves on striped muscle

fibres, Speransky's work on cerebro-spinal fluid in relation to

rabies, diphtheria, measlea and meningitis, Bogomoletz's work

on prophylaxis of musoular fatigue, and on omcer, Bylcov's work

on the effeet of vegetable juiaes on gastrio secretion.

         The report of ths First University of Eloecow shows

coxrunendable interest in research, but the enumeration of only the

numbers of scientifio works, 738, published, shows a rather

primitive attitude tomnls the subjeot.

The training of future teaahers is a serious diffioulty

for the Medial Seotion of the NibrRompros -- a difficulty becoming

more and more apparent as death and retirmeat continue to make

more chairs vacant.

There are few ohanges among the olass of assistants

more important than the increasing euonomic pressure to hold more
than one assistantship (for the sake of supplementing an impossibly

low salary).

and ooasequently slow and inadequate progress in any single branch

of medicine. 1; -8 told that the qualifications for docentships

had changed: now it is not the publio defenoe of a thesis but

published work and past record which counts.

-11, but the fact is that the general group of assistants is in a

wretched position.

tion and training of the older professors nor the advantage in most

mses of being young and ardent Communists.

value in any young professor's life were years of war, revolution,
famine and halting reconstruution. It is not remarkable that they

are handicapped o

This results in a dissipation of energy and attention -

In theory, this sounds

'phey are underpaid, they have neither the reputa-

The ten years of greatest

Profeesor Bronner and his oolleagues have devised

a system to reoruit the aclademio personnel .  !This is the so-dled

"aspirant" - omparable to a resident fellow locally or travelling

between different faculties in the U.S,S.R. The aspirants are

chosen by a central committee of which Bronnor is the chief, the

Glavpzofobr, from lists presented by the Rectors, who have in turn

received nominations from local University commissions of 20-30

aomposed of professors, assistants, and (one-third) students o

'Phe aspirant in the mediaal soiences begins just

after graduation and works three years; in the clinical branches he

is chosen from among the oldinators (internes) w%o are graduates

of two or three years standing, and he too will remain an aspirant

for three years.

and duriw the third gear he usually gets practice in teaohing.  Tbe

aspirant from the smaller faoulties usually goes to a larger center,

those from Moscow aml Leningrad stay in these centers. Professors

have no power to refuse or to choose the aspirants working with them,

and there is 60me criticism that the aspirants are not closely enough

cont roll ed o

The aspirant aspires to the post of paid assistant,

        The Glavpzofobr is extremely anxious to improve this

form of training by extending their travelling fellowships to foreign

countries.  Pingoff had favored this and before the war there were a

number of well-adminiatered and well-paid foreign fellowships,

especially at the Military Medical Academy.

fellowships is a vivid memory in the Russian mind though the present

The value of foreign

performance is insdequat e o

In 1925, 80 foreign fellowships were aarded,  in 1926

120.  The maximum amount given for a foreign fellowship is  500

roubles, the usual amount 300 r. !Phe costs are 50 r. for a pascpert

for soientific p~lrposes, 100 roublas return trip tioket to Germany

(?here most fellows go), 100 to 300 roubles for living expenses, and

60 roubles for extras.

statement is required regarding later employment.  There is 110 posaib-

ilitg of sending even the best as far as America.

The men are carefully seleated and a olear

Without muoh doubt these travelling fellows have lllany

lacunae to fill in their period of foreign study, but it is likely


that few travelling fellows work harder in the meagre time at their

disposal.

countries visited.

Germany, France and the Baltio countries are the principal

1 got the definite impression that foreign fellowships

wem so precious that every care is exercised to preserve the standing

of these men in the countrias visited.

Due to the oomplete change in the socfal status of

the students,  it is chiefly from the classes which have reason to be

interested in the Soviet Govgrnment (workmen, peasants and coxnunists)

that the medical students are likely to be gathered.

professors and doctors must come fmm the classes who now have the

The future

93.

opportunity for eduoation.  Althou&fh some of the old professors

apprehenjl expulsion from their chairs when enough new regime professors

will have been prepared to take their plaoes, it does not seem likely,

from the past policy of the Soviet Government in regard to science


that they will expel an efficient professor for any other reason than

counterrevolut iorvrry polit ical aot ivity.

94.

20 .- ASSOC WTlD XNSTITUT%S e-

As mill be seen below, thers are a large number of

teeohing and research institutes in Russia whose work is in the

medical field but vihose Eldministmtion is not under the Cormissariat

of Mucation. The maljority of these institutions are under the

Narkomsdmv or Commissariat of Public Health.

       The most important group of such institutions under
the Narkomsdrav, of whioh Professor Bach (see below) is the chief,

are the following:

State Institute of Public Health, Director Professor Baa.
Biochemical Institute,
Institute for Experimental Biology,

I1 11 II

'I

                                'I Kol t sov .
ab of Microbiolegy, II I' Barikin.
11 *' Nut r i t ion,

I'

Shat e rnikof f .

11

for Control of Sera & Vaccines, M Diat ropoff .

I*

(fomrly Prof. Tarassevitah) .

I1 of Physics and Biophysics, 'I Lazareff.
I1 Troploal Medicine,

Maz in6 ff ski .

I1

" W.B.

*I Sanitary Hygiene, I1

Before giving individual descriptions of some of these

institutions, it may be noted that Profossor Baoh told me they needed

nothing,that literature was adequate and apparatus good.

The contrary

was the ca8e with clinics and institutes of the medical faculties and

some of the institutiom of IVarkomsdrav not in the above group.

Bach Institute, Moscow.- Professor Baoh is an old

revolutionist of 69 yeare do returned to Russia after the Revolution

95 o

from his exile in Switzerlalrjl. Address: Voronzov Polye 8,

Dfreot or: Baoh .  Housed in an excellent building, aplerrlidly equipped.

The building was formerly a private residenae whioh wae nearly demolished

during the Revolution and ~RLS the first building to be reoonetructed

in Moscow.

Staff: About 2s full-time and 20 part workers. First

Assistant, Dr. Sbar8ky. Seoond, W.A. Ehgelhardt (excellent English) .

Problems: Mostly industrial ohemioal; e.g. tar, peat

and phamceut ioal preparations .

metabolism, enzyme act ion, physico-chemical a& immunol@giaal .

Also 8ome purely saisnt if ic research,

Institute for Erpe rimental Biology, Mosaow.-  Adjoins

the Baoh Institute and the Inetitute for Hygiene. These three buildings

were the former residences of three rich merohants who founded and

endowed the Institute for IWperimental Biology. One of them expressed

his desire that his house be used as a saientific institute after he

fled from Russia. Direator: I, Kolsoff. Organized in 1916. Good

equipment, eraellent library, good spirit .

Problems: Genetics, general physiology (physioo-

chemical).

Divided into following sections:

1) Physico-chemioal ;
2) Eydrobiology (station 60 Kilometers distant) .
3) Hematology - blood group8, physial ohmistry of blood.
4) General genet iaa.
5) hgenios, hunan hereditarg traits.

7) Psychol'ogy - hereditary phase8 sad studies.
8) Tissue culture and embryology.
9) Endocrinology.

Domest io Animal Fam, 40 En. away .

6) CrtolO~.

96 o

Professor Kolzoff impresses one as beiw a very active

investigator .

This institution desoribed in detail by L.C. Dunn in

letter to Dr. Hutchison of International Education Board.

Piom-Biological Inst i t ut e, Mo scow .= Addre 8s :

Pogodinskaya 10 .

Is housed in a large, old building which also contains

the Institute for Tropical Diseases and the Institute for the Proteotion

of Labour. astablished in 1921, Director: W. Barikin.

        W0t.k: i33idemiology of typhus. Studies beariw on the

epidemiology of choleia. Studies on the toxins of scarlatina, strep-

toooouuis, diphtheria,  toxin and ant i-toxin.

hstitute for the Control of Sews and Vaccines, Mosoow.

Address: 41, Qivzev, Vraj ek. Director: Professor

Diatropoff (fonnerly Tarassevitch). Sstablished in 1919. Housed in an

old building whiah has been well adapted to its present needs.

'Work: Tests and standanlizes all sera and vaacines

made in Russia or imported, and assists the Public Health  service ita

opportunity arises.

Staff: Eight dOCtOr6, - are expeoted to do research

because routine duties consume only about 1/3 to 1/2 of their time.

Labomtory is good, has enough ordinary materials and smll Bnimals,

but has difficulty in getting new appsratus.

Library is fairly good.

97.

Om room is devoted to a Metchnikoff Museum and

contains all his manuscripts, notes and most of his correspondence.

Institute of Physics and Biophysics, Leningrad.

Uirector: Piotr Lazareff. Staff of 39. Sections are as follows:

1 . Molecular physiaa .
2. Photo-chemistry .
3. Hoent genography o
4. Ionic theory.
5. Pure physics.

Institute large, well-built and well-equipped.

Aside

from work on eleotrioal phenomena of the nerve impulse, most of the

work is in applied physics, Large iron deposit discovered in XouIsk

gubernia by magnetic deflect ion studiss, etc.

Inst it ute for Tropical Diseases, Moscow.- Planned

befora the mr, organized 1919, began work 1920.

Direct or: E .I. Marz inovsky .

Five Sections: Chemotherapy, ptotozoology, entomology, helmin-

thology, clinical.

Problems: Bearing on mlaria. The chemists are studying the effect

of quinine on various ferment actions anu the excretion of ferments

d.lriig malarie. Momologists studying mosqlzito metabolism. An

inteiesting w~rk was dono on the relation of the p.H. of natural

bodies of water to the preaenoe of mosquitoes. They were found

to be mostly absent when the p.H. vas lower than 5.

There are of course a larger number of institutions

carrying on relatively much less investigative mrk and more directly

concerned wit?. maintenance of the public health or the special pre-

paration of mepllbers of tho public health servioe.

Socle of these

institutions accept medical studonts and aspirants, thus playiw a

considerable part in the training of doctors and teacher8 of medicine.

A model xxxxx is the Rronner Inctitute for Combatting

Venereal Disease. It is unbr tho Narkomsdrav and is lodged in a

former large domitory of the I University of Moscow.

It was begun

in December 1921 and now has a burlget of 300,000 rouble8 a year, one

half of which is paid in salaries to a personnel of 180.66 of whom are

staff doctors. The O.P.D. has about 200,000 visits a year, ard the

hospital beds are ocoupied 23,000 siok days a year.

The seotions are:

1. Social venerealogg .
2. Acperlmental
3, -10 gonorrhea 20 beds in hospital.
4. Female 'I 15
5. Dermatology 20 'I
6. SmhiliS 50 "

I1 It

n It

I1 11

14 aspirants work there and already three professors have been supplied
from the staff.

Three of the assiatsnts in the Denmtolcgical Clinic

of the University work there (doubling their employment). Course of

lectures is given each day in waiting rooms by young assietanta.

This institute has 159 branches and 149 mobile

diagnostio units making venereal surveys all over U.S.S.R. (Trans-

90 o

baikal region, 4% of the popdation have syphilis but no tabes or

G.P., Caucasus has 26$, Turkestan 26, etc .) o

for 50-60 dootors to live in the institntion for a 4 months post-graduate


oourse (twice a year), ad during this time their home salaries are

paid for their families and a further stipend of 60 roubles paid).

`There are accomnodations

Thore is an extensive and impressive experimental

seation.  Waseenaams twice a week on patients, twice a week on

certain experimental animals.

On the social side a home it3 maintained for unemployed

infectious women, where  550 u8n work and receive more pay than if

they oontinued on the streets, and reueive oontrolled treatment.

they leave the home they receive a card givizlg them first preferenoe

at the employment bureaus.

When

I have gone into detsil to shorn the spirit of some

of the institutions in the Rtrkomsdrsv.

Spaoe prevents full description of the Institute of

Sooial Hygiene under Molkov, Central Baoteriologioal Laboratory under

J. Lewin, Metchiiff Institute, and the State Scientific Institute

for the Protection of Labor, under Livitsky - all in Uosaow.

Two more Narkomsdrav inst it ut ions ahould be desoribed:

the State Institute for the Improvemefit of Doctors in Lenirgrad,

100 b

and the State Medical Institute in Leningrad.

The State Institute for the Improvement of Doctors

has for an object the '%ompletion of a doator's medical trainiag

rather than detailed gpeoialization",

laboratories and a hospital of 425 beds with olinioal privileges

regarding 800 other hospital beds in the city.

exoellent: Direotor Dr. Kharit. Though there is only one Communist

on the staff, it is one of the best supported institutions in

Leningrad o

It has a large series of

The rmnagerment is

The staff numbers 65, with 145 additional on temporary

assigrment .

Several professors of the medioal faoulties leoture there

The student8 are distriot doators out of medioal

school at least 3 years, who 0-8 up on diatriat (Gubsdrav) fellow

8hipS or on fellow8hip direot from Narkomsdrav.

From 1885 to 1920

the average number of pupils was 333 per oourse, in the year

1926-26 the number -8 1378 and in 192627, 1830, 'Phe aourse is

4 months long and is given twioe a year.

For the year 1925-1926:

101 .

In 1925-1926, 66 of the doctors were men, 46 women, and by

ages they were divided as follows:

21% up to 30 years,
61% 31 to 40 **

   51 to 65 It
3% above 55 years.

21% 41 to 50 "

The labom3torie8 were the b-st and cleanest I 8

w

In Leningrad or bsaow.

Belonowsky. WS about 130 students, mostly bacteriologists from

publio laboratories.

ami serological diagnosis. Bacteriologiaal laboratories are

housed in 8 good building mhich is being renovated, well qUippeda

Two large rooms for class instruction with large desks equipped with

gas and water, aoaonanodating two men each.

for assistants o

The Department of Bacteriology headed by

Instruct ion in new methods of bacteriological

Many individual rooms

Librarg fairly good (Belonowsky considers it very

good).

Not quite enough foreign jouraala.

Tho State Medical Institute - known usually a8 Gimsa,

is really a medical school with a peauliar history and status.  It

was organized before the war as Bechtererew's Institute of Psyaho-

neurology, from private gifts,and never limited the number of Jewish

students.  It has always been liberal and progressive In its teaching


methods.  Gerber is the present direator and Nloolaieff the professor

102 o

of ESrperimsntal Medioine.

the 4th sanester and are given degree after 3

The enrolment is 1780 distributed thus: 1st year 250, 2rr3 year,

250, 3rd year 250, 4th year 480 and 6th year 550.  This reduotion

in the lower classes represents the reaction against the come one

come all theories of 1920-1924.

At present feldsahers are admitted to

1/2 more years.

The clinioal work is done at hospitals supported

by the Narkomsdrav and there is muoh emphasis on the teaching of

hygiene. I did not visit this institution, The laboratories and

olinics are said to be poorly equipped.

Pavlov's Institute is now housed in a special new

laboratory building which is excellently equipped and needs

nothing in point of maintenance. I did not see London but met

Pavlov and his assistants.

the work is of extraordinary interest .

It is a pure researoh institute arrf

103.

        I reoomPnend the following actions on the part of

the Division of Medioal Education of the Rookefeller Foundation:

1)

Imreaee by the sum of five thousand dullars annually

the pesent amount given to Ruasian Bdical Faculties, and divided
approximately as $3,000 to institutions under the Narkompros  and

$2,000 to teaohing institutions of the l?arkomsdrav,

2) The -tension of the teaching institutes of medicine

in the U,S,SJi, of the present progr8m of foreign fellowahips

administered by the Division of Wioal Muastion of the Rookefeller

Foundation, 60 that a few of the most able young medioal soientists

of a large but dangerously isolated country may be enabled to ex-

ohange inforraetion and aequire training,

3) Until time and opportunity be afforded for a thorou@

and p?olorzgeB visit to Russia no extemion of these recomnendationa

need be considered as probable,

Years

-

1897
1900
190 2
1910
1914
1915
191 6
1917
1918
1919
1920
1921
1922

The Leningrad Medical Institute, formerly the Women's

NedicaT Institute, was founded in 1897.

  When inaugurated the institute was oaloulsted for
1,500 students, with a yearly aaoeptanoe of 200 to 250.
Due, however, to tho enomoua mass of those desirous to
enter the Institute for studg, this number inareased
after the revolution ad exaeeded 1,000 pereons per year,
and in 1919 the total number of those aocepted reaohed
3,635.

   "At the present time it has been again decided to
reduoe the aooeptame, for the Government has oonvinued
itself that the Commissions of Professors were rimt in
asserting that the sahool oannot 80 suocesafully handle
so large a number of students. An idea of the number
of students aooepted during the various years sinae  its
foundation, as well as of the number of graduates and
students working at the Institute, may be gathered from
the followiw table:

To tal

-

166
8 21
I597
1618
1149
1594
1720
20 65
3287
3635
1833
23 20
2481

Inst it u

&I& CLASSES.

Men Women

-

166
8 21
1697
1618
1149
1594
1720

139   1926
601   2686
718   2917
255   1580
458   1862
576   1905

- Total - Men Wmen

166
238
333
187
162
599
61 6
519

18 27
1045
1069

841
8 89

186
238
333
187
162
599
61 6

139    380
692   1236
175   1230
145    914
286    56 6
250    579

GWATES

Total Yen Tomen

---

11 1 111
246 24 6
282 282
85 86
176 176
80 80
75 2 73
37 27
25 26
108 8 100
136 16 121

.te of

The number of students ad graduates from the State

Medical Science is shown in the followiuz tables:

-

327JDElWS

1910-1911 1011-12 1912-13 191e14 1914-15 1913-16 1916-17

310 M6 78 3 1014 1136 1297 1370

206 o

1917-18  1.918-19   1910-20   1920-21 1921-22   1922-23
1480       1503     1611    1163 1 cl. 488      66 2

2 503      76 2
3 167      501
4 108      164
5 63      91

Total: 1279 2170

The University of Qaratov, which is one of the smaller

medioal sahools, oared for 400 to SO0 medical students before the
War; in 1922 - 23 it had about 2,000 medias1 students enrolled.  The
ratio in the other schools outside of Leningrad has been practioallg
the same In the University of Qaratov, e&. in the University of
Odessa Xedical Sahool there were in 1914 nearly 1,000 students,  in
1917, 1,600; in 1923, 3,300, and after 1921 there was a slight
dearease again o

The number of students and graduates from the State

Institute of Medioal Saience is shown in the following tablee:

Students .

1916-17

1911-12  ... 456.          1917-18
1912-13  ... 783.         1918-19
1913-14 ... 1014.         1919-20
1914-15  ... 1135.         1920-21
1915-16  ..e 1297.         1921- 2 2

192%23 ... 2170

Graduat e8 .

Mea Women

--

1916 ab. 6 22 1919

1917 0.0  27 54 1921
1918 0. o  40 37 1922
1919 (July)  22 21

Woaen

Men

0..      47      33

0..      22      32
Total    le0     207

-

(Dea .) 26 a

         The followizg table gives an idea of how the number of
students, a8 well as their sooial class elements, have changed at the
Military Medical Baademy of Leningrad, fomerly the Imperial Medial

IJUMBER OF S!RJDE3Q!l!S 1913-17 1918 1928 19;eO 1921 1922
Freahmen 321 486 1886 829 1064 671
TOTAL Hup6BEZi 900 1257 2108 1682 1875 1715
$ from Workmen and
Peasants' Claas lsg6 36 6% 684 a@ 93%
         There graduated at the Aaadeny: in 1913 - 1604 1914 -
130; in 1916, 1916, 1917, there were no graduates; 1918 - 72; 1919 -
108; 1920 - 68; 1921 - 48; 1922   52.

       bTewly admitted students totalled 65-75s. the remaining
35-%$ was mds up by students from the preoediag gear's admittance who
had remained for the aeaond yea*,

Academy.

207 o

         Present Conditions.

        From 1918 through 1922, as a result of the general

state of the oountry, research work mas done under appslling air-

oumstances and soienoe kept alive at the cost of enonnons energy
and saorifiae of the individual workers. During 1924.snd 1925 the

living condition of the scientists, though still preoarious, has

greatly improved, ad the Sovist governnent has rendered oonsiderable

financial aid to science. Same laboratories have returned to nonnal,

many new ones have been formed, and there are a few new institutes

whioh surpasa anythiwp of their type heretofore praduued in Russia.

The spirit of researoh is prevalent and is being

fostered.  There is a cordial and helpful nelstion between teaoher

and pupil.  Although there are some irregulatities in the method of

work, they are uarrpensated for br long hours and inoreased enew

at other thee.

Soienoe will suffer during the next deoade or so

chiefly from the anifgation of former soientists, the laGk of pre-

paration in the pupils of the Wr and Revolution periods and of the

present type of student, and from inevitable adjustments to the

present sooial conditions.  The bringing of Science lander oentral

oontrol ad Soviet patronage, although it may give a slight politioal

oolouring, is putting it on a much more stable financial basis than

it mas in old Russia. The present position of science is, inmy

opinion, one of the brightest spots in Soviet Russia .

(1)

In a subsequent papfir I shall say something of the

conditions of scientific work for foreignsrs in Russia, an3 give a

few details of some of the important work.

Scientific work during and after the Revolution.-

        Scient if ic work almost ceased. "Constant anxiety for

food aad fuel, endless miting in queues, a half-starved beggarly

existence could not but strowly affect the life of scientists. Prom

1918-1920 they, as well as all the other inhabitants of the aitios,

nevar left their houses without a bag on their baoks in which to

brirg home braad, potatoes, etc. reoeived as a ration. An eminent

profeeaor lived the wintsr through in his bath-room, 8s it was the

only place that could be heated.

scienoe to aarry up to their apartments wood and water, and to empty

the ~ev~ge, as the lavatories did not function. Professor Bechtereff

states that the noura-psychical energy of an organism decreases

with the decrease of nutrition.  A gelleral depression of personality

results in passivity and lack of will-power. Besides resulting in

a high mortality among the scientists in Leningrad, the center of

It ms a usual thing for men of

(1) Formerly the laboratory of Professor Pavlov at the Institute of
   Werimantal Medicine had to support itself largely by
    selling the gastric juiae of the experimental dcgs.

mental life of the country, these hard gears deoreased the oapacity

and energy of those I&O survived''.

Leaving aside the difficulty of working in unheated

laboratories, -inations could not be done owing to the lack of

gas, uater and illumination. There was a total lack of both Russisn

and foreign literature .

(1)

"In order to write down one's observations,

one had to use grey paper of a very bad quality which was stealthily

bought from speoulators (trading being prohibited).

ink -8 usually prepared out of some dye hardly suitable for the

The selfavpde

purpose".

Many soientists left Leningrad or were employed in some

other kind of work. But %otwithstandi?g all the termrs, scientifio

life in Leningrad did not cease altogethsr. During tho most diffioult

periods one oould Be0 men of scienoe working in their overooats,

caps anii snow shoes.  Half-starved men continued to carry out  their

experiments on half-starved snimals.  Dead animals were cooked and

fed to the living.  After an operation,  the animal mas often taken

home for the night to be kept near the stove with the investigator".

Scientific assemblies were held although the rnanbers had

to go on foot and to sit in overcoats. Often a lamp or oandle had

to be used instead of eleotriaity.

By the end of 1919 scientifio

(1)"When a foreign journal reached Petrograd, those who desired to

read it, wrote their muneb in order and patiently waited the
happy hour when their turn to read it
1918  there was only one medical journal in the whole of
Huesla .

From Deoember

210.

life began to revive. Sn spite of the bad conditions, several new

scientific societies were fomed during these years and important

work carried on.

There oontinues a chronic need of money and things in

some institutes. Professor X. told me when he went into a publia

library to work during the winter of 1924, the ink was frozen, and

that part or the time when he was lecturing, the temperature was 10

degrees Contigrade below freezing. The students were so chilled that

they had to keep on their wrappings and stand during the lecture,

"But", he remarked, they oontlmed to come in spite of the cold".

The Russian medical profession offered themselves

freely during these years and often without remuneration. They ren-

dered the poptilation no 6-11 assistance in checking the epidemias

and carrying on other relief measures.

supplied much of the material and sometimes the stimulus for organiza-

tion, tha aotual work was dono by the natives, as the number of

foreizners was too small to oount for more than a stimulus.

Although foreign relief

It is interest- to oonsider the moral rectitude and

unselfishness of the Russian physician during these horrible ad

hopeless years.  They were existing at 8 time *en the strain of

living was so great that some of the population wre driven to

211.

eating human flesh and even killing members of their own family.

In

distributing large quantities of relief s~zppliss through the Russian

physicians, I never knew of a single case of theft by a phgsioian,

although they were in dire need.


6UCh as the following Pologda, a town of 50,000 near Arkhangel,

There viere many oases of heroism,

                       On

8n inspection trip there we found the chief surgeon among others  in

great need, He had not had a new suit or overooat for ten years, he

was wearing trousers that were more patahes than pasts, and out of

his salary of less than a pouna sterling montly (in April 1923)/had

he

a wife and nine ohildren to support.

On returning to Leningrsd, we

sent him, and other dootors there, a relief clothing package. A few

days later we received a gracious letter saying that he had givern the

\

paowe to a colleague more needy than himself, enolosing a letter

of thanks from the reoipient. As late as September 1925, I have

seen researah workers paying one half of their monthly salary for

paper to chart their rssults, and many prof:c+ssors give part of their

salary to support the laboratory &ere they work. Scientifio workers

reooive from 7 to 100 rubles (lees than I 1. to 31 IO,)

salaries are without rat ions o

These

Eow, the physician's condition is oonsiderably better

than in 1922-1923, &en his daily inoome was equal to seven times his

tram fare, or one pound of sugar, and hi6 yearly salary equal to the

cost of two overooats, But even at present it is impossible for a

212 b

person with a family to do more than stave off actual starvation on

the official salary.

lXzrirg the past few years the Russian physician has

learned many ways of making the proverbial tm end6 meet o

In the first

place most of the eminent professors have two or three plaoes teachirg,

in spite of the ruling that no one may teach in more than two plaoes.

A fevi write text-booke. !Phose not 80 eminent give language lesson8,

(1)

et c   Prominent olinioiane have regained their praat iees and are making

a comfortable living .

(2)

(Chose physicians *o are old or cannot obtain

outside work are, still in dire circumstances.  And no one kaa~ become

rich in Russia;

I do not know a single doctor who owns a motorcar

(There are automobiles owned by the government at the disposal of

the officials of the public health department).

Communist offioials

(1)  All text-books are censored, rccrepted and printed by the Soviet
  Government.  Seventy-five rubles are paid for 16 ordinarg tart-book
pages, 2@ of which is paid when the oontraot is signed, 60% when
the mas. are ctoapleted, and 2G when the book is published.  A8 the
book is the property of the State, there are no further profits
  for the author.  Professor PaVloV received 25 Roubles for 8,000 Word8
  of his book on condit ioned reflexes.
  the Soviet Covernueat desires written it pays as much as ten times
this amount, I am told.

For special art icles Amich

(2)

mere are no rules prohibitiag professors, the chiefs of hospitals,
etc. receiving patients at their homes. The fee for an office visit
is one to five zubles and for a house-oall 2 to 20 roubles. A former
surgeon to the Tsar's iamily told me he reoeived in 1925 10 to 100
roubles for a major operation. Bills are not sent in Russia, but
the patient (or his family) hands the dootor what he considers
the proper amount a8 he leaves the houm.

213.

receive only 193 roubles monthly, in addition to many free privileges

and some other ways of earning money. A prominent Communist doctor

who occupied several positions told me the maximum he vas able to

earn was 400 roubles a month.

This lack of wealth mitigates, by

camparison, the misfortune of the poorest. Living in Russia is

cheaper than the costs  indicate because the standards of life are

lower and vents are reduced to a minimum.

When I asked a Ukrainian doctor how he managed on

his salary he replied: "By not eatiw much and going hungryet. To

one with an Anglo-Saxon appetite, it does Bern that the Russian

physician gets along remarkably well on little more than weak tea

at frequent ad irregular intervals. The need for dressing is also

reduced to a minimum, although it may be due to trfditional tendency

or personal preference rather than present finmoos that some appear

without socks and shirts in the summr. The doctor also buys few

books or journals ad his amusements limited. If his wife is

lucky or clever she also does 6omo kin& of rmunemtive work, as

teaohing, etc. One young scientist of my acquaintance who receives

10 roubles (36 1.-)monthly gets food from his mother in the country,

anc the chief of the laboratory gives him a few roubles from his

salary of 60 roubles monthly.

of ProfeBsor Pavlov. lives by raising and selling fanog dogs

during off hours at ham.

Another, working in the laboratory

214 .

Vacation & Recreation.- The laok of reoreation ad

vacation has been trgiag on the Russian physician.  It was out of

the question for him to go to the theater, club, etc. for if any

were open he had no money . Ehaept for the past three summers few,

including Comtanists, have had any vacation for six to ten years.

Professor 'pavlov wm twa summers without a vacation. A Russian

scientist whom I met in Dennark in the summer of 1924 told me that

vas the first time he had been out of Leningrad for ten gears.  Be

was then travelling from the prooeeds of a book he had just written.

It is difficult to realize the strain of ten gears without a rest

01' change even when one works under the most  ideal conditions in

the laboratory and lives comfortably at home.

(1)

mere have arisen however many cooperative schema

eich make life simpler and cheaper, such 8s rest homes for the


summer.

to oongresses, eto., ad gives some of the eminent doators and .)

scientists money to go abroad for three to six months.

'Phe Soviet Government bears the expenses of delegates

(1)

In 1913  &en I ha8 the privilege of aconmpanying Professor

F'avlov to the theater, he remrked that he had not been
for five years.  A Russian physician abroad in 1924 told
me he had not eaten in any Russian hotel or restaurant
since 1917. Another said that his favourite recreation
nowadays is working in the laboratory at night.

215 .

        Soviet Government - and Scienoe.- The life of m~ny

scientists and dootors is not' only pemrious, but anxious and un-

certain. He is subject to the fears that have beset the intelli-

sentnria  in gemral (the searet polioe, G.P.U.), oensorship of

letters abrmd, eta. These things may be neceseary to maintain

order, but they do not make for the mental tranquillity of the

suspeot ed 0

Not being a student of politics, I have attqted to

omit references to political principles. As everything in Russia ie

under the striotest political control, it is not possible to do this

entirely. Previously I stated that the Soviets had done what they

oould to foster the growth of science In Russia when this did not

conflict with their political principles.  This was my opinion fmm

my personal obsemt ions in Russia, in 1922 and 1923. The polit icaS

revolution has fallen howwr with a orushing weight on some of the

foremost dootors, and there are some of these who think that the

Soviet regime per ae has had a deleterious effeot on science,  in

addition to the former economioal chaos. A Russian scientist of

international reputation wrote me: '9& feeling is that the Soviet

(1 1

authorities have done what they oould with their unlimited means of

destruotion to kill soiencle and Inhibit its growth because free ad

independent thinking is in direot oonfliat with the Soviet polit icsl

pr inc iple s" .

(1) See B.M.J., Sept. 20, 1924.

216.

An equally pessimistic view is expressed by a yoqer

acientist of Leningrad, who, while admitting the Soviet efforts and

desire to benefit science, sags that the psyohological oonditions are

not oonducive to saientific work - that the scientists themselves

have been thrown into too prominent a social light, and that they

are too dependent upon politics, the will of students, etc., ad too

uncertain as to the future.

The circumstances following on the Wsr and Ftevolution

have caused not a few to feel as an author of a scientific treatise

wrote, that "This Is more the reaonl of a broken and shattered life

than of a profitable completion of ghysiologic8l work''.

There are

others, however, outside the Communist party, who look formad with

more optimiam into the future, and say that they have no politiml

grievances, that the government is doing a11 it can to help than in

their work.  Tnioal of this group, an eminent pathologist told

me, "The corrditioxm in Soviet Russia are much better than they were

in Tsarist Russia for scientific work. As Soviet fiaanaes inareaee,

more momy is being given. The Narkompros (Minister of INucation)

is aotive in making scientifio work more intensive and practiaal

as they say that life can exist only with science.  I think that

scientists will be able to work entirely independently of politios,

and will not be hampered in any way by political considerations.  AB

an example I know of many uortarchiet proferrors who are now receivia@;

217 o

large amounts of money to aarry on their scientific work.  As we

have never had demoorscy in Russia, I oan not say what effect it

would have upon science, but I think science will prosper much

better under the Soviet regime than under the Tsarist government

The opinion of the director of one of the most famous research

institutes in Russia, also not a Communist, told me that Soviet

policy toward science in his institute had been constructive rather

than destructive, and especially so during the past tm years.

                Soviet
Expressive of the officiayattitude toward soience,

is the following extract from the greetings sent to the Academy of

Sciences, on the day of its jubilee, Sept . 5, 1925 - an event whioh

was eagerly oelebrated by the Soviet Government.

It is signed by

L. Kameneff and the president of Soviet Russia, 1. Xalinine:

"The October revolution has removed the social

relations which had impressed their character upon scient-
ific work and hindered its development.
founded on private ownership, ercploitat ion am8 national
oppreseion provokes military collisions and retards the
subdual of the forces of Nature by Man... The radicsl
reorganiz2tion of social relatione.. .. can not be solved
without a development of Science in all its branches. The
Socialist Society is creat ing for scientific thought
condition8 of true liberty.. . Lenin'8 estimation of the
servioes of saience is the basis of the policy of the
Soviet State .

  "Duriw the first hard years which followed the
Revolution, the Soviet Power, forced to defend its exist-
ence.. . could not lend assistance .. . . to the scient ifio
work. Eor could it insure to the soientific worker smh
oonditions of life as are neoeseary for the productiveness
of his work. . . . Scienoo is international . . . .**

The soctial order

3oviet respeut for soience is shown by the celebra-

tion of the 200th anniversary of the Academy of Sciences in Leningrad,

218 .

September 5-10, 1925.  The event was given full, first page accounts

in the government newspapers.  The delegates from all over the world

were guests of the Goverment, and received more cordial and hoepitable

treatment than the political visitors to Russia.

vileges they were given free use of the railroads and hotels all

over Soviet Russia.

Among other pri-

The fact that Lenin eadorsed scienoe has had a great

influence, especially as Leninism has assumed somewhat tho character

of a State religion in Russia.

includes most important buildings) is a room oalled "Lenin's Corner"

(ykol Lenin) oontaining all the writings of Lenin and his pictures

surrounded by his aphorisms.  The rooms are decorated in red and

blaok, and there is an atmosphere of reverence whioh is strongly

suggestive of the former chapels.  It was due to Lenin's influence

that Professor Pavlov was retained in Russia after the Revolution.

In every governeat building (vthich

(1)

(1) One of these says: {Without soience there is no oommunismtl (bez

naouki nyet komrnunisma").
laboratories and publio buildings.

I have seen this several times in

TRB PUBTJIC HBAXTH SYSTEM

OF

SOVI)!T RUSSIA. '9-7

by Professor N. Semaschko,

People's Coni*nissar of Public Health, XoscOw.

1. THE PX0PLE1S COI~IMISSAF,IAT OF PU?3LIC HEAXH

ANL) ITS AXCINISTRATIVE DXPARTF.%NTS.

CENTRA t ORGAN IZAT ION o

      A special. People's CornmissRriat of Pubaio
Pealth was crented by the Government of Soviet R:lssia
in July, 1918, to give the p1'1b1ic henlth system a
position commensurate with its importance for sooietg
and the state. The activities of this CommissPriat
include not only mediool and sanitary duties in a
narrow sense, but also all the activities closely
connec$ed with public henlth are generplly included
under the term social hygiene.

1. Conpetency and dnties of the Commissariat.

      The first decrees as to the creation of a
People's Commissariat of Public Health date fron July
11 and 21; its present statutes were approved by the
~oii~icil of People's Comqissars in 1921.

     The competency and drities of the Commissariat
are expressed in general terms in Artiole 1. of the
Statutes as follows: "1.- The duties of the People's
Commissariat of Pliblic Henlth consist in the administra-
tion of the entire ptiblic health s,ystem and the publish-
ing of all rag:ilations that serve to raise the level of
public health among the people and remove conditions
that are unfavorable of harmful to it!'.
permission to carry on any aotivities that serve to
protect publio health and requires of it, in accordanoe
with modern principles, that it not only engage in

3l.e Gesundheitsverh~nisse in Sowjet-Ruaslnnd. Dentsch'r
  med. Wohnsohr., Leipz. a. Berl., 1921, xlvii.

Article 1.-thus gives the Commissariat

active control of conditions that are notorio:islg
harmful to health, brit assist in raisin? the generel
level of hoplth and increase the real capital to be
fourid in iJho normal physiol.ogicc1 ooridition of a people.
Naturally such activities RS race hygiene, eugenics,
etc., are included in this definition.

      Article 11. of tho Statlites describes the
mOrG detniIed dutios of the Commissariat of Public Henlth,
ns follows:

"The People's Commissariat  of Public IIealth

has the followin,a aims:

a) hkternal and infant welfare; the physical
b) S~nit~ry regulations, the sanitation of cities

e) The control of social and conta~iot~s diseas(33.
d) The orgnnizntion of a medical service.
e) The preservation of hoal-th in tho KedArmy and

tmining of yorith.
arid communities, the organization of sanitary
inspec ti on.

Nkvy.

f) Medicnl certificction in cases of workin:: inability

   arid invalidity, 8s wall as expart advice in
   medico-legal cases.
g) Collatin:? and publishine statistics on the state
   of health in the Rapublic.

h) The study of scientific and pmctical q!iestions in
   the pnblic health field, and the administration
   of institutions created for this pgrpose.

i) Taking part in the organization of medical edumtlofj
   in co-operstion with the corresponding depart-
   ment of the People's Corwnissariat of Public
    Ins$huction.
k) Meas 'ires for spr eadin ,E sani ts ry education.

1) The care of institutions of healing and sanitation,
   together with the instruments, therapeutic
   agencies and other necessary material.

m) The publicntion of new public health regulations,
   app?.ying to a11 institutions nnd citizens in
   tho Repiblio, and bnsed on and further develop-
   ing the regii'l.ations already in force.
n) Supervision of the vork of the sanitary corps1f.

221.

2. Organization of the Commissariat - of Pnblic FTealth.

a) The- People's Commissar, the Couqcil,

At the head of the Commissarint are the Peoplefa

The Council is composed of the People's Cornmiss-

centra?. advisory committees.

Commissar, his imdiate representative, ?nd the council.

ar, his assistant, and three aembers appointed by the
Council of Peoplers Commissars. The directors of depart-
nents or institations of the dommissnriat take part in
the meetings of the Council as advisory members. Pur-
thermore, the heads of other Commissariats or professional
associations are Then required invited to be present as
advising specialists in their own fields.

s Commissariat of Public Eealth is the sciontific Medical
Board, which has to give its expert opinion as to the
scientific basis of the actions of the Commissariat, The
hledical Board has ~1so the right to take ay and study pu-
blhc health qriestions on its own account. The Board,
according to its new roles, which are Rt present being
worked out, is to consist of about thirty members, chosen
by itself and approved by the People's Commissar. The
Commissar himself, his assistant and the members of the
Courlcil are regrilar member6 of the Board. The Board
has the a:~thority to appoint comlttees, and can invite
to its meetings or to those of its committees stich persons
as it considers useftil.

'?he sciantific advisory committee of the People'

Congresses shpl-1 bo cnlled for the disonssion

of stops to be taken in different fields of piibllc health,
and specialists in these fields sk.11 be invited to
attend them.

b) Sei entific and model inatitutions.

A number of sciontific institutions created

within the commissariat 6f Piiblic Health help to work out
the scientific problems that arise in oonnection with
the development and perfecting of the public health
services The work of these institutions is to be chiefly
of a precticR1 nature,  in order to provide the Commiss-
ariat with scientific grounds upon which to base its
activities. At the same tine these institutions serve

222 .

to train speoialists in the different branohea of
the service, such as tuberonlosis control, for inatnnce.
The model institutions, whose chief aim is to serve aa
patterns for the Breotion of local medical, sanitary
and social-hygienio institutions, also' serve to some
extent as training schools.

1.- The Government Soientific Institute of Public Health

MOSCOW. -

composed of the following individual departments:

a) The Microbioloaioal Institute;
b) The Hygienic Institute;
o) The Institrite for Bxperimental Biology;
d) The tropioal Institute;
e) The Serum and Vaccine Institute;
f) The Institute for Physiological Nutrition;
g) The Biochemioal Institute;
h) The Institute for Tnbercalosis Researoh;.
i) The Institute for Organo-therapeotio Preparations.

2.- The Inatitvte of Biologicnl. Physics.
3.- The State Venereologicnl Institute.
4.- The Orthopedic and Physiatric Institute.
5.- The State dental Institute,
6.- The State Institute of Social Hygiene.
7.- The Central State Bacter.iologica1 Institute.
8.- The central state Vaocine Institute.
9.- The Physioal Cultare Institute.

10.-  The
11.-  The
12.-  The

13.-  The
14.-  The
15.-  The
16.-  The
17.-  The
18.-  The
19.-  The
20.-  The

21.-  The
22.-  The
23.-  The

state Institute for Maternal Rnd Infant ii'Jelfare.
Medical-Pedologioal Insti tut e.
Balneological Institute.

Institute of Ex perimentai hled ici ne .
Orthopedic Instittit e.
Physical Culture Institut e.
?bat et rioal and Gynec ol oei cel  Ins t i t ut e.
Glinlcal Institute for Advanced Medical Work.
Roentgen and %dim Institute.
Polenoff Phyaio-snrglcal Ins titiit e.
Physio-therapeu tic  Insti t ut e.

W. I. Lenin Cli nioal Institute in Kasan.
hcteriological Institute in Sebastopol.
Bacteriologiosl Institnte in Tambow.

PIQPROCRAD. -

IN THE PROVINCES.-

24.- Thqhoteriologioal Institate in Rostow on the Don.
25.- The Baoteriological Institute In Krseanodar.
26.- The Microbiologioal Institute in Saratow.

223.

27.- The Mlneologioal Institute in Pjatiqorkk.
28.- The Tuberculosis Institute in Jalta.
29.- The Tnbercnlosis Institrite in Xrassnodar.
30.- The Physio-therapeutio Institute in Tomsk.
31.- The S jetschenoff Physio-therapeutic Institute

in bebast apol.

32.- The model. institntes also have dispensaries for
       mothers, tubercular patients, $ufferers
       from venereal diseases; Purthar nurseries,
       sana t oria , c onval e 3 c o nt . horn 8s.  9 or eat
       schools, etc.

Seotions and de artments of the Peop1e''s

c)rhm -I 88 1 t h .

5.-
6.-

-a

The current activities of the Commissariat

are under five administrntive heads, lsnd these sectlona
(lfUprawletiije") are each divided into departments
(I'Otd jellf) and si7b-departments (lfOtdjelenijell) .

       The present administrctive sections are,
1.- Genarnl administration (internal administration;
   medical personneminnnces; material eq*iipment) .

2.- Sanitary administration (sanitary activities; control
   of c onta 3. o us dis eases , including til bercul osi s
   and vonoreal diseases; maternal and llnfant welfare;
   oar8 of youth).

3.- Medical administrat ion (generRl and 'individual
   medioal service; expert sociologioal service) .
4.- Hypiena and medical service for the departments of

public communication, rail-ways, otc.
Aarninistration of heslth resort 6.
bentral milit 8rv sanitaro administration.

1.- Public Health Bureaus of the Executive Committee.-
?he Public Yenlth uepartments of Governments and K egi 0118
are the only ones that have a separate existence, since
the sanitary work of the districts is oarried on by the
medico1 department of' the general di8trict adqinistra-
tion. Aside from this, both the Public Health Depart-
nents of the Governments and the medical departments
of the districts act a8 locnl oreans of the Peoplere
Commissariat of Public Health.

      These government and region Public Health
uepartments are in their oapaoities as local civil admi-
nistrat ions subordinated to the respective Executive

ComfEittee, but they are at the sRne time, as far as their
medical nrid sanitary activities are conoerned, iinder the
direct orders and oontrol of the Comqlssariat, all the
rtj2:ilRti 011s a:id nrrangemants of the 1Rtter being obliga-
tory in thair case.
       The activities of the government Public Health
i)eyar+ments are divided into a number of different sect-
ions that are more or less modellad on thm e of the central
offices. The smaller the governmarit in qtiestion, the less
dense tho p~p~il-ation, the smaller the indlistrial community,
etc., the simpler also the composition of the Feslth JepRrt-
merit, as they are graded in this respect in three cstegaries.
       The entire work of the henlth departments has to
be clone with the active co-operation of the proletarint arid
the peasants. "Srnitary Advisersr1 are therefore attached
to the local bureags, consistir1.g of members of the unions
and of the association8 for tho aisaeminatiori of c~iltlire
arid inf ormtion.

2.- RailwRy public henlth bure~ios.-

The sanitary Activitias 09 the railroads are

administered by the Railway Public Pealth F:irenus, thst are
directly sobordiriated to the Peopl. e's CommissariRt but
also mnintnin a close relationship with the RRiTxay Admi-
nistrytion end the labor unions of rnilway employees. Proper
co-ordination is mnintsined botFeen these burenus 2nd the
penern1 civil public health departments by havinp ench or-
ganizntion represented on the other's rldvisory and exec~tive
boords.

3.- Eiezioiml public heslth bvreriiis for se8 and river corn-

murjicati ons .-

       These bureaus correspond in number to those of
the cenaral sen and river adqinistration. Repulntioris to
prevent the ndmission of epidemic disenses by way of the
sen boundaries are the work of this bureau.

4.- The Administration of healt,h resorts.-

The health resorts of the Republic are divided

into those that are of importRnce to the whole country nnd
those thztt are only of local intercst. The administretion
of the latter belongs to the local government Public Eealth
Uepnrtmerits, v:hile that of the former comes under the direct

225.

administr~tion of the Commissariat Section for the
parpose. The activities of the different local health
resorts are brought into mntual harmony by representatives
of the Commissariat.

5.- Military public health bureaus.- The military-sanitary
aistrict bureaus form courta of second resort for the

administration of public health in the RedArmy: in the
Bovernment ssnitation lies in the hands of a military-
sanitary snb-department of the civil heolth departaents,
while in the districts it lies in the hands of special
military-sanitary bureaus. These sub-departments have
among. other dnties to decide and supervise the proper
relations between the military Ftnd the civil adminiatra-
tions.

C . RE X'TI O'NS B$?l?A%m THX PROP5R' S

COIWISSARIAT OF PUWtIC ETFIAT,!EI
AND Tm CORRESPON i)ING AUTHORITIEIS
IY THE: AUTONOKOUS RJ4:GIOT?S AND

REPUBLICS .

The autonomous republics that have entered the

Russian Socialist Federative Soviet Republic have their
own Comaissariats of Public Health, sjibordinate to the
respective law-mking bodies of these repriblios. The
laws that have been created by the 811-Raaaian Central
Bxecutive Committes apply to all the republics of the
R.S.F.S.R. * but the regulations of the central People's
Commissariat of Public Health only apply to the antonornous
republics in so far as this is provided for in special
treat ies.

are not the only way in which complete agreement is
achieved between the activities of the different comrnisa-
ariats with those of the commissariat of the R.S.F.S.R.
The Peoplets Commissariats of the ar~tonornoi~s republics
are formed on the pattern of the Central Commissariat,
and most of those who take pRrt in the aotivities of
the former are former norkers of the Central Comaissariat,
and marcly on that account supply a connection with the
latter.

      Fnrthermore, the constant interchnnge of in-
formntion aa to all new events in priblic health and the
manner of meeting them tends to keep up the necessary

In pbactice, however, such formal treaties

226.

uniformity in administration. Of groat valve in this
connection arc3 tho con~ressea tlmt arb ct?i13_ed in I."oacov~
for the 3iscyission of sanitary qoesti one nnd Fittencied by
represeutRtives of all the comainsQriats ?nd sanitnry
organizations.

administrations are organa of' the People's C ommissariat
of the R.S.m.S.R., nnd stand in the same relation to it
as do tho sanitary authorities of the governments.

      The Union of Socinlist Soviet Republics (U.S.
S.R.) has no special Union public hmlth department, but
the right to "decree general measures reauired for the
pgblic health" was eiven the legislative organ of the
Urdon in the U.S.S.R. Constitution of July 6, 1923.

In the Rutonomovis regions the local medim1

TE3 ZPIDEIIICS ANU THFIR CONTROL (191 4-1923)

--- ----

       The years of vrar arid revolution in Russia were
at the sa:ne time years of friehtfnl epidemics that followed
close upon each other's hecls and that reaped 8 rich har-
vest from the worn-out population. Right up to the present
much laoor and large sums have to be spent in the control
of theso plagues. However, the Soviet Government is now In
a position to declare pith the greatost positiveness that
Rnssia hcs pessed through tho  ors st period of epidemics,
the greatest arid most dangeroils of rhich, like cholem,
hnvo completely, or like typhns, mostlg disappeared,
s.nd that we ere iiow in R period in 7r.hich epidemic control
is showing positive reslilts. The only disense at &resent
to be considerad as an active epidemic In Russia is re-
lapsirig fever, ngainst v;hich all o*~r sanitary means nr8
nov: beiq directed.

of uninterrnpt~il pl.:?gnes. As in other departmonts of
yubljc welfore, the povernment of the Czar paid little
attention to tha coristrnt outbursts of infectious dis-
eases, and only when snch infeotions as cholera or the
plaene gained admittnnce to the country did it become
active against them through ita bureaucratic police
orgnns. The so-call4 Somstvo mediorl systems were too
voak to carry on infectioss iisease control in 2 rational
and really large v:ay, and the masses of the people,
v,ith no rinhts P.nd with no trainir-g in metho3s or organ-
ization, ware nnable to oppose such disense8 by any

Even before the wnr Eussin WRS aI.w~ys a country

,227.

concerted action, with the result that the loss of life
in epidemics amounted to a large proportion of the total
number of deaths in RU8SiR. Before the war the annnal
death-rate in Russia was 26.5 per cent. Daring the
pre-war period of 1905-1913, after the first revolution,
a great cholers epidemic swept OverRussia in 1908-1910,
arid others os typhus aria relapsing fever in 1907 and
1908, while smallpox, typhdd fever, dysentery end in-
fectious diseases of children were widely spread.

1918 made the sanitary conditions of tha country much
worse.

arid serlt to the fronts; the srmg had 11,000,000 desd,
wounded and diseased, and of these 1,660,000 were entirely
103t by death or irreparable injury, The so-called
ref!igee movemcnts also took place driring these years,
with whole popriIations simply thrown from the war zones
into the interior of the oountry; up to 1917, 3,200,000
refugees were listed in the official registers nlone.
Geri~rrl sanitnry conditions @row much worse - Ymk of
houses, laok of fuel, the difficalty of obtaining food,
the disorganization of transportation, nll thiar helped to
nourish the soil ont of which the epidemics were to spring.

conditiotis still mOrQ. The 1918-20 blockode, the unbroken
interm1 confrision, the intervention of foreign powera,
and finally the famina of 1.921-22, nll led to tf further
ontbreak of epidemics. It would be very hard to try to
express in figares all the losses incurred during this
period, The general death-rate WEIS 38 per cent during
1920, and the birth rate had fallen very low, amounting
to only 25 per cent. Acoording to the reports of the
central statistical bureau, five million people died on
account of the famine of 1922, which struck a number of
governnents.

Russia at the time give6 Q sufficient idea of the state
of the country; the main cause of the great mortality in
this period was tho widespread epidemics.

fever must be given first place on the list. Even before
the war, 70,000 to 80,000 oases of typhus corild be counted
on in the best years. The war immediately drove up them
figures, and 154,800 cases of typhus were reported in
1915. Typhus waa then spread over the whole country by

Bad as they had been before, the war of 1914-


During the war 14,000,000 men were mobilized

The civil war period complicated penerpl

This general picture of sanitary conditions in

The great pandemics of typhus find relapsing

the ceaseless movernents of troups with no proper sanitRry
control, and by tha masses of refugees and prisoners,
these people all living in narrov, dirty quarters, tinable
to wash eit,her their bodies or their clothes, Typhus
broke out in the same year in the Volga district, in
Siberia, and in the Ural. In 1917 and 1918 the enormous
demobilization and return of prisoners nnd ref-igees
helped to spread the infection again, more intensively
than ever, and the close of the year 1918 may be considered
as the beginning of the gigantic pandemic of typhus that
reached its maximum in 1920. We hRd sudden outborcjts of
typhus in St. Petersburg, on the Roumanian front and in
the Volga in 1918; during 1919 and 1920, the years of
bitter civil wnr, there were general ontb*7rsts of both
typhus and relapsing fever, particularly in the armyla
field of operations. As the Uenikin arid TZoltschak armies
withdrew they left behind them thousands and thousand8
of sick men and thus oreated everywhere centers of infect-
ion for the civil population. On the other hand the lack
of food in the cities started the so-called "IJeschetsch-
niki" movement, these people hurlinE thsmselves into the
food-proiucing districts in their search for bread, over-
uhelming the railways arid other meons of connunicati on.
*his of course rendered ever so much more favournble the
conditione for the spread of infections. Genernl figures
for the two parasitic types of fever during these years
are as follows:

I1

--- - hus exanthematus. Relapsing fever.
Year.

1919. 2,119,549   3% 1:    251.369       42.3
1920. 3,354,65 6       293.9  1,453,421      127.3
1921.   633,250        54.0   763,131       65.1

est extent of the pandemic was in 1920; the following year,
1921, there was a decrease, due to the extraordinary
measures tfiken by the Soviet Government. A new increase
is to be noted in 1922, but this took place almoat entirely
in the regions suffering from the famine, such as the Volga
region, the Ukraine, Crlmea, and part of the Ural. The
successes achieved in the control of typhus were practically
wiped out by tho famine. The total number of oa8es for
the two kinds of fever for *he period 1915-1922 amounts to

Per 10 00

8. 16,661 -e

+ Por 10,Oo 0 Cases

Em164

1922. 1,401,145 109.2 1,446,722 122.7

These figurea need to be exple.ined. The grent-

8,000,000 of typhus and about 4,000,000 of relapsing
fever. The death rate for typhus WRS 9-10 per cent, nnd
for relapsing fever 2-3 per cent,
       The litsrrJtiire on the slibjact states that
the official data for typhgs are extrernsly inexact.
There is undoobtedly Q grmt deal. of truth in this,
for a number of re orts obtained through other channels
from large cities P Moscow) where the statistics were
exhaustive, laad one to believe that the number of oaseta
should be placed much higher. On the other hand those
who insist that aimply untold numbers were attncked are
wrong. This is for instance true of Professor Tarasse-
witch, who states in "RenseiFnements BpidBmiologiqoe~~~,
No, 2, hrj!y, 1922, that there were 30,000,000 people sick
nith typhus alone. If one trikes into consideration the
very lov! sascoptibility of children, who form half of the
Ilopizlation, to typhus, there wonld have had to be accord-
ing to such calcul.ntions an almost total morbixity; at
least one out of every two would hnve had to be sick. But
this is evidently untrue, for the exact figures for bfoscovr,
revised in order to obtain causes of death, show that the
proportion was 1 to 8. This is also proved by the great
increase in the numbor of o&ses in the famine diotricts
in 1922, which aould hgve been impossible if so many
people had previously been imqunized. All these calcula-
tions are of oourse of no practical valne, as nobody denies
thet a greet pnndemic existed. But since the end of 1922
we have had a distinct rind continuons decrease in these
diseases throughout tho vchole country. These figures will
eo to prove it.

                          Iielnpsing fever,
January 52,O
E'e !>r uar y          42 , 658
L-rch 38.057 ?,I , 8 09
Apri 1 28,968- L+ '> 3,156
lli> g 22,925 17,337
June 11,512 9,870
July 5,969 8,462

2 463 5 , 142

E:%

%!P=

1923.

Au gu 6 t 4,284 5,487
September - -- 1,

    Total 208,942 208,435.

The numbers decrersed etill further in October,

1923, with 2304 oases of typhus and 2849 of relapsing fever,
nnd the same thing could bo observed in the following
months. It must further be stated that relepsing fever
reteined an epidemic charaoter in only 8 fen. governments

230.

(those of tho Urol ana the north-western sections of
Russia), in most other PhCQS there were only a few
s ca t t er ed  cas e s .

the center of interest in the organization of the public
health service in Russia. Dnring these years 250,000
bods were provided for infectious diseases, large numbers
of qunrantine and isolation stations were arranged for
along the railroads, 8 fev times movements along certain
stretches were forbidden by Commissariat decrees, mas
clearising of the poor populations, combined with dis-
infection, was carried out under enormoiis difficnltles.
The lack of soap, underclothes, fhel, etc., hindered maoh
of these efforts.
       The People's Commissariat founded nll of its
typhus control on 8 widesprend co-operntion on ?he part
of all the uorking classes. !%in$ "bath weeks!' were or-
genized, d!iring rhich hundreds of thousands were bathed,
cleaned up and shaved free of chnrge, as well as 11c7-enn-
up weokdfl, in which mss cleaning arid repairine were
done on p[lblic bniliiin,rrs and others that sheltored large
crords, such QS railvay stations, asylums, prisons,
barracks, etc. The Iooal. commi+tees of the llStrt~gple for
Cleanlinessf1 served as permanent institutions add were
composed of rapreserltatlvcs from the i-,vOrkerst$nd peasantrj
organiz~iions, the unions, etc. &ornous amounts of
pamphlets, posters nnd notices werc distribnted, while
lecturas and Pne etin:?s were arrcnged. The eovernmont
also opened large credits for the work of epidemic
control .

       Lastly, the scientific work connected Fiith
this qvostion aroiised great gericrnl interest. During
this period sevon All-RgssiarlConpresses of Bacteriology
and EpidemioloEy were held, toeether with a Parge
number of locnl meetings. A Commission fbr the stridy
of typhgs worked with the commissarint and hsd its
findings yllblished by the latter. The general direction
of the prsctical -rork J-ay in the hands 019 the "ComTniss-
ion for the Xxecntion of Epidemic Control", that worked
Rlth tha Comuissnri:it siricd 1915, and that counted
among its members siich noted epidemiologists EIS
Pro -8ssors Tarassewi tach, Sabol otny, Bie troptow, Rarikin,
Blnr zi ri ows ky 8 nd  others .

      Bnt the difficul-t str~~gg1-e did aocomplish
rcssultc;; tho pandemics of typhiis are broken, snd the

Tha control of epidemics natvrmlly occupied

231 o

Commissariat of Public Health is now confronted vith
the problem of peserving the country from any new
eventuality, on the basis of whet it has already gone
through.

physicians, together r>th other members of the sanitary

against typhus. In tha yeara 1918-1920, 3,129 physic-
ians, 41 per cant, fell ill in the Red Army alone, but
these were to be snre zlso the rnosrt dangeroris posts, 8s
far as infection vas concerned.
      Another dise~tse tht has cost great expend-
itures of effort and money is cholera. An outbreak
occurred during the war, as early a8 1915, with over
30,000 cases, partly on the front and partly in the
interior. The number of caees have been as follows
since 1918.

It,miist be pointed orit that thousands of

personnel, suffered greatly in the depressine strugple

Year
1978-
1919
1920
1921
1922

Cases
-9

4; 259
25,923
204 , 228
86, I78

       Cholern was most widespread dvring 1922, the
yePr of the famine. In contrast to the behavior of the
other epidemics of before the war, it did not sprend
along the wsterways, but along the railroads; there were
further certain centers in which c8sm of cholera con-
tinued to occur d:iring the entire winter. Fere too we
have a great dearease in the epidemic dririne 1922, and
in the Pollowing genr an almost complete disappearance,
for only 117 cases were reported in 1923, of 7F!hlch 76
ocourred in Rostow on the Don. Nowhere did ieolated
cases develop into an epidemic. No case v;hatever
ocourred in September 1923.

need only be stated that 10,000,000 in all were vaccinat-
ed in Russia in 1922, and that the whole Red Army wa8
re-vaoainated. The People's Commissariat first of all
created a whole network of bacteriological instituter
arid laboratories, an extensive piece of organization.
There ere nt present 35 inhtitutes scattered throughout
the country, most of them created by the Soviet Govern-
ment (Baoteriologioal Institutes in Taschkent, Tif'lia,

VaccinRtion was the chief oontrol mmsnre. It

232.

Baku, Blraterinodar, sepastopol, Toronesch, Omsk,
Spratow, Irkutsk, E:lraterinbnrg, Archanpol s'x, etc.)
In ICoeco~ werC founded a Centrnl Iristitgf e for the
control of sern Rrid vaccines nnd two Racteriolopical
Institutes, the I,:etschiiikov; Instit3i-e arid the Tiioro-
biological Institute. A total amount of 22,000 liters
of vaccines was produced in 1922.
       As a geri.ra1 rule tho entire Red Army nnd
certain categorius of officials and sanitary personnel
were given m8ss vaccination. At the ti"ne of vaccina-
tion other mas6 measnres were cRrried on for the oleans-
inp of densely poprllnted localities: "water supply weekst1
~ksr~'bources of water supply nera cleansed, nnd new ones
formed; "olean-up weeks1', for the iniprovemant of cl wns-
ing fncilities and of mter intnke nnd outflow. The
economic improvement in 1922-1923 made it possible to
begin increasing the sources of water supply sild canaliz-
ation in a number of provinciR1 towns, such as Archangel,
Tula, Samara bardtow, Odessa, l!T.-Novgorod, arid others.
A decree of September 13, 1923, is6ried by the Council
of People's Commissars, entrusted the gori~rnl direction
of ~tll this kind of work arid the formuktinp of a cencrc\l
plan for the whole Repgblic to the Commissariat of
P!JbIic Eealth. There is therefore 8 gigantic piece of
tcork to be done.

by the Besredka method, were carried out &n 1923; this
kin5 oQ vaccine is at p.-esent propared in Iiiyssian Instit-
utes.
       Typhoid fever Rnd dysentery imrensed in 7920,
but fell afain the gear after. The fiyures prr7 a8 followa:

Experiments nith vaccination by w~:j of mouth,

Year Typhoid fever Dy s en t er y

Casos PGr TO,O 00 Cases P er 10, 000

1918      109 * 264         18.4    59,760        -.
1919      270,168          45.4   184,919      31.5
1920     668,764          59.6    404,010      66.7
1321     463 , 704         35.4    279,482      31.8
1922     307,951         24.0   290,940     25.1

       During the first nine months of 1923 there
were 27,920 0c:ses of dysentery. The same kind of vaccine,
divaccine, played the determining role in the control
of typhoid, althourh 811 knovin rneRst-res against both dis-
eases were taken in so far as their spread by means of

233.

water is concerned. Smallpox was fought with eqgal
vigor by the People's Commissariat. Russia always had
a fairly large number of cases of smallpox, mostly on
account of the lack of compulsory vaccination. The
war increased the number of non-vaccinated, and with
them the number of cases of infection.

Smallpox in Rnasia. 1918-1922.

-

Year Cases Per 10,000
fsf8 29.738 *a

'

1919   108 ;OS1       18.9

1921     96,188        8.8
1922     57,840        4.5

1920 152,094 14.8

Up to October, 1933, there were 37,803 ceses

The Cornmigsariot of Public Fealth a1 ready

of smllpox, therefore here too a decrense.

p!it through a decree for compulsory vaccination in
1918, and further regulations on the subject are being
added. A tt.hibe string of new stations for the manu-
facture of vaccine have boen opened, as well a8 a
centra Vaccine Institute in IrToscow. At present t.he
annual manufacture of vaccine amounts to 20,000,000
doses.

soarlet fever and diphtheria, are very much less wide-
spread. The number of caees has fallen considerably
in comparison with before the war, and not until 1923
did a considernblo increase appenr, in scarlet fever.
       The figures for the different yenrs ore es
f ollowo:
Year Scarlet Fever

1918 3 0-      5.1 4- .


19ZP 112,185        8.7 39,732 3.1

The children's infections, particularly

=%@lo, 000

Cases Per 10, 000 Cases

1919   48,130        8.0 40,129 6. '7
1929   87,951        6.8 46,354 3.6

1922   66,257        5.1 32,398 2.5

       Unfortunately the lack of beds made it dlffl-
cult to combat these diseases, end only now can one look
forward to some measures being taken by the Commissariat.
Sufficient diphtheria antitoxin is at present being
manufactured in Russia.

- ~1 p-7 clph#nrflmqgEs of scurvy increased a good deal

234.

in 1916-1919 and 1922, mostly or1 aocount of the famine.
Duriag 1916-1917 it spread particularly along the Rou-
manian and the south-western fronts. As might be expeetea
the inoresse in 1922 is in the governments affected by
tho famine.
       TKO new contapious diseases, encephalitis
lethsrgioa and infectious ;au~iilioe, spread in 1921-1922,
but did not reach any conaiderable dimensions a8 epidem-
ics. .A special commission has been appointed by the
Commissariat to colleot and study mterial dealing with
encephalitis .
       Another contaeious disease is the plague,
that threatened the Repnbllc a nurnber of tines, and did
braak out in isolnted centers. For instanoe, one import-
ant epidemic center existed in Manchuria in 1920-1921.
In tha following year ramifications of this epidemic
werG to be found in the Far %stern Republic. 498 cases
were reported in nndivostock dnring this outbreak, and
some ten other6 in different prts of the Orient. Tho
localities in which an epizootic plague occurs among
lTTarbagens" are also to be considered as phgue centers.
A new section for the plague has been created at the
Irkutsk Bacteriological Institot e, Rend a plague control
laboratory opened in Chita.

govornments of Astrakhan and Urd, are also ~i. region
ahere the same epizootic occars among weasels, and
shoiild be inclrided in 8 list of plagne oenter8. Two
plagne outbrea'w occurred there, 27 cases in 1921, and
122 cases in 1922. November arid Uecember of 1923 there
were also 120 caseo in the same districts.
        The same control masuros were taken here.
There is in Saratov a State ICicrobiological Institute
with a large plague section under the direotion of the
well-known plague apecialiet, Professor Nihnorow, and
o number of plague stations under this institute are
scattered over the south-western steppes. Control
expeditions, with vaccine 8nd preventive equipment, are
sent out when outbreak occurs. A plague section was
also opened in 1923 in the Rostow Institute.  Two meet-
ings on the subject of plague control hnve been held in
Sarat ow.

      We have purposely left until the last a dis-
cnssion of one infection, malnria, becanse it is the
osnter of the sntire epidemic control work of the
Commiesariat of Public Health. There wera in Russia
before the war large numbers of dietriots that always

r had a high malaria infection, such as Turkestan, the

The steppes of south-western Russia, the

i Cmaasua, the lower Volga region. The total annual

235;

number of cases in Rsssia bosore the war was about

3,000,000, and the war increased these too. The infection
was spread over the entire country by the distrlb1ltion of
troups and other population groups from endemic districts.
Malaria has spread enormously just in the past few years.
There were over 2,000,000 cases reported in 1922, nnd the
first nine months of 1923 gave 4,007,896 cases. The
disease attacked not only the regions already noted for
it, brit also others in the far north, such as Archmgel,
I:?tirrn~n, Siberia, Rveri the most severe tropical forma
were included in this distribntion. Control of this
epidemic was completely paralyaed by the lack of quinine
during the war and the revolution arid by the breakdown
of sanitary and teohnioal iristitutions.
        The Commissariat of Public Health has however
developed an aotive campaign in this field. Tho first
All-Russian blaria Congress met in 1923, and the next
one is to tnke place in January 1924. The general. plan
of attack has been worked ont and approved by the Cornmias-
ariat. One hundred rnplaria st~tions hnve already been
operied in tho Republic, each one with a laboratory, dis-
ysnsaries, a clinic and a hospital; special CourSQs for
physicians are given, and the distribution of qliinine re-
gulated as much as possible, although the demands for it
are ffir from beinc filled. The State Tropical Mediolne
Institiito in bioscow opened in 1920, directs the work, end
sirnilr-lr institutes exist in Taschkent (Tarkestnn) and
Xriwan (Armenia).
      Organizntioris siich as the railroads, that have
an interest in the decrease of malaria, have been drawn
into the control work, and large sums of money are avail-
able for it. Projects of law have been m-orked oat and
placed before the Cornissarist proposing a whole series
of new rights and possibilities. At the s8me time the
disease is 80 widely and intensively distribited that a
long and hard struggle can be expected.

and control. of epidemic diseases in Russia during 1918-
1923. It must be pointed out that the struggle against
them has for the first time during these years of terrible
epidemics, been placed upon B proper basis. The com-
pulsory registration of contagiolis disease was first
required in 1918. A large number of bacteriological Ina-
titiit 8s have been created and treatment with bacterid
&aprations carried out to eome extent. There is for
$he first time oompuleory vaccination on a large soale

The above is a general picture of the advanoe

236.

against amallpox, and mass vaccination agalnat cholera.
Even other extensively introduoed measures of a sanitary
na,tnre, suoh a6 cleaning, baths, improvement of water
aupply, were new to Russia.

Health was based on the extensive inolusion of the popu-
lation for purposes of oo-operation and fwther aanitary
eduoation. The legal norms for the sanitary institutions
of the Republio are deedribed in the decree of the Coanoil
of People*s Commissars of September 15, 1922. "On the
sanitasy lnstitutious of the Republic", which lays the
foundation for an maltera-ble, conti,nuously active
sanitary organization,
      New Russia is fmed with enormoua problerng!
in the sariitation of the conntry. The experiences of
other countries, particularly Germany, the experience
of the past years and their mas8 methods, and a deep faith
in the power8 of the new country give us abaolute ~sz~ur-
anoe that we shall reach our goal by a short and direct
road.

The whole work of the Commisaariat of Publio

111.

SOCIAL

DISEASE

C ON TRO L .

1, The control of tuberculosis.

The Commissariat of Public Health has deter-

mined upon two indispensable requirements for succea8 in
the struegle against the eocial diseases, tuberculosis
and venereal disease, and they are first, State admi-
nistration of the work, and second, actual, direct co-
operation on the part of the people.
       There was before the war no regular oontrol
of tuberculosis. The work of the Tuberculosis League wa8
of an entirely private nature; it had very little money
at its disposal, and this consisted mostly of private
donations, The State took no part in anti-tubercu1oais
work.
       Although only the large oities had any fairly
soourate or complete figures on tuberculosis, and there
were none at all for the oountry as a whole, what ata-
tistlo8 there are prove that the disease was widely dir-
tributed.

237.

Toberculosis blortglity RRte per 10,000 Inhabitants.

x

Year. Tdeningrad.

1912
1913
1914
1915
1916
1917
1918
1?19
1920
1921

34.8
33.6
34.2
36.7
36.2
35.8
37.0
40.3
51.0
36.0

Year. Moscow.

18 93 .
19 98
19 03
19 08
2915
1916
1917
1918
1919

43.5
39.6
32. I
29.9
24 o 2.
24.7
23.3
22.2
29.9

I920     $9.7
1921.     28.1

1909-19X3, yearly
averege of 34.6

x Yot incl!iding soldiers.

It was after the October Revolution of 1917

that the question of t-iberculosis as R social- menace
became a matter of prime importance to the Commissariat
of Public Health. Tuberculosis control was made R per-
manent activity of the Cornmissar.int, and placed in the
hands of a Sp8CiQl section, being recognized as a State
functi on the solution of vihich was Intimately connected
viith the entire social structure of the Republic. Tuber-
culosis control was founded, a3 were nll the other public
health activities, on tho collaboration of the whole people.

this goal, collaborates closely vcith the Commissariat of'
Labor and with the latter's departments for the protection
of workers within the unions, Such co-operstion is par-
ticularly indispenaable in the execution of massures of
social hygiene, especially those against tuberculosis, and
the working methods of new anti-tlibercalosis Institu- .
tions baing created are based tipon it.
      The dispensary is the ~OCUB of the tuberculosi6
control m8ssnres worked oat by tho Tuberculosis Section,
end is charged with both social and medioal functions.
        The medical measures of the dispensary take
the form of physician's oonsultations for patients and
the medical assistance offered in the anbsidiary insti-

The Commissariat, in its attempts to achieve

tritions, such as clinics, night arid dny sanotori8, diet-
etic dinin@. rooms, halls Por sun and light treatments.
%orking in connection witk, the dispensarics art? the hosp-
itals to :vhich tho former can send patients. !?he pDeV0nt-
ire measures to be taken by tha dispenearj eo in t::.o direct-
ions - the home, in v'hich tho work of tho visitiny nurse
is of prime importnnce, arid the shop, factory, indristrial
or governmnt establishment. In the latter case the dis-
pensary activities nre carried on v,ith the assistunce of
the dispensary's ovn social service bonrd, which is com-
posed not only of the physicians arid nurses employod, but
a180 of reyreseritatives of the unions, workers' protective
leagues, and other institations within the radivs served
by the dispensary. The purpose of this bonrd is not merely
to give social aid to individngl patients, but n1.so to
ramove the unhygienic elcmonts in tho manufgcturing or
commercial enterprise, spread n knov;ledge of health laws
among its xorkers, nnd indxe them to tcke an active pnrt
in the prevention of tubercul-osia.

c!ilosis by social mea116 was generally Rccayted, at its
outer edges, so to speak, it was not nt first properly
recognhzed that the dlapensary shonld form the kernel of
the organiwtion. The public health ndrninictrqtions of
the Governmsnts were origimlly bound by the sanatorium
idea. Dnring 1919-1921 252 spmtoria for adnl-to and
childreti were openod in the R.S.P.S.R. and in the Ukraine,
with 19,621 beds, The economic crisis of' 1921 forced the
closing of mny sanntorici in the provinces, vlth the resilt
that the importance of .the dispensary, which rmches -many
times as many people as the sanatorium, wns finn7l.y reco-
gnized, and attention paid to its development. Social
disease control became the most important dlity as soon as
the results of the famine and epidemics had beer) to some
extent obliternted, nnd this brought the q'iestion of dis-
pensary administration into tho foreground. We hnve rt
prbsent 118 dispensaries and 201 sanatoria, ivith 3 total
of 11,221 beds, in the R.S.P.S.R. and in the Ukr~ine. !JOB%
of tho dispensaries are in the large cities, but sanatoria
h-ve recently been opened in small towns, even in villages.
The newly built dispensaries are not only erected with the
lively ?nd active support of the people, but for the most
part, also rith their om money.

capped in tubarcnlosis control by a lack not only of neans
biit also of trairrod personnel. Fruitfril work by the dis-
pensaries 2ni other related institutions depends both on
the thoroughness of the scientific trsining of its workers
in the special field and on the scientific solution of

Although the general idea of controlling tuber-

The rork of the Com-nisssriat is very much handi-

239 .

the problems which the dispensarg act-ially has to handle.
The +ormar must be tpken carc of by the instructors in tu-
berculosis in the universiti3s. In theory, the crep-tion
of university chairs in taberculosis has boon approved,
but in reality they only exist so far in Xoscow and Charkov.
Additional trpining for physicians who wish to speciali 28
in t:iberculosis is also offered at the Tuberculosis Insti-
t!itas that have been founded during the pnst three yenrs
for the purpose of scientific work. Such Covernment
institutes nov. exist in MOSCOW, Leningrad, Charkov, Jalta
and Krasnodar, five in all, and we hove further in MOSCOW
the Tuberculosis Institute that belongs to the Koscow
section of the Commlssnriat of' Public Health. Scientific
tuberculosis institutes hpve 8 department of social
pathology, intended for the stiidy of the disease RS a
special disease. The first thine done vas the mss exsmina-
tion of in,dustrinl groups to determine to That; extent tu-
berculosis is connected with ind!istrinl and soci81 factors.
A grent many such mss examinations have already been
carried out. The card indexes of tho diepensnries nnd
the observations rnade iii these exc.minations offer rich
material for R study of the inciderice of tribercalosis in
indivi dm1 population grol7ps.

ncqnairited with the activities of the central orgsnizntion
by means of congresses at which both theoretical and prnc-
tical subjects are discussed. The first All-RIisslan
Tuberculosis Congress was held in Leningrad in February,
1928; tbe second in hIoscm in I&y, 1923; the third is
planned for Chnrkov in August, 1924. The Tuberculosis
Seation of the Commissariat of Public Health publishes the
mngazine, llWoprossy Tuberkulosa" (Triberculosis Questions"),
devoted to tho scientific and practical aspects of the
si1 b ject.
2. Veneraal &isease control.
     Th~~~~ssnriat; Op .:public :Realth
had two necessary lines of activity to pure*jrj; 1 J +h~ control
of voneraal diseases; first, to improve and extend special
treatmont, making it more available to the masses of the
people, and second, to carry out a aeries of practical
praveutive measDres. A great deal of work has been accom-
plished in both those fields dyring the past five years.

      The first thing that had to be done was to find
out the extent of venereal infeation amone the populations.
The imperial and the civil war hd undoubtedly done a

The more distnnt parts o? the country are iMde

great deal to spread these infections, but it was hnrd to
determirie how much, +'or regi strnti on of voneren7 s*~ffsrers
was imperfsct even before the war, and the statistic81
departmentB after the mr hnd not been able to obtREn fipres
for the whole country.

some lieht on the sabject. The following figfires hnve been
very carefrilly controlled, and give some idop of the extant
of vcncrsel infections.

      The examination of70,000 soldiers of the RedArmy
in the garrisons of fJoscow and Thningrad shows, for Hoscow,
syphilis 0.4 per cent, gonorrhea 0.7 per CQIlt, and for
Leningrad, syphilis 0.9 par cent and gonorrhea 2 per cent.
An anonyinous qnestionnaire sent 96 tho stlidents in the
hi#z institutioris of IvIoscow showea that 19.3 per cent were
or had been iiifected, 1.2 with syphilis. A similsr ques-
tionairc sont on a lartye scale to tho Xoscow worlrers re-
vealed  1 l/2 per cent infected vbith syphilis and 20 per
cent v.ith gonorrhea. The villnges of the tTovernmerit of
Smolensk, which were particnlarly affected, mostly irith
ayphilis, had a rata of 12 per cent for this disease. These
figures undotibtedly provo that tho venereal diseases are
viidely distributed, but they slso Eihov! that the degrae of
infection is much less than 0:ie moald have had renson to
c;iippose on aocount of the war.

increased measures for providing medics1 treatment , but
they are at present far from sufficient, although they have
bean more than do:~bled betweon 1919 arid 1923. Therd PIEIS
one bed par 24,000 people in 1919, while in 1924 thore
is one bed per 9;600. But this is ffir from s!ifficfsnt in
the large ceriters.

atories had their facilities incrensed. ?he moat important
advance in this line is the venereological dispensary,
created since the war. We hRve nov in the R.$.m.$.R. 44
snch dispensarios, 35 in the Ukraine. These dispensnri 8s
are the centers for the eritire public hcnlth work on the
snSJect as well 8s for an enormous amount of medical aid.
All patiants that corne to the dispensaries for advice also
receive completd treatment, nhich is on principle absolu-
tely free of charge. The kind of social hygiene work done
in the dispensaries is of mnny kinds - information, cxamina-
tion, recistration of patients, nrranging social and family
conditions, survsys of tho caljses that oontribute to the
iricrease of venereal diseases, stlidies on the aex require-
ments of vrorkers, taking pnrt in the control of prosti-

)-Iomiever, a~rveys mde iri special sections throw

This extsrisive distribntiou of ir~fection reogires

Not only the hospitals, but the clinics and labor-

241.

tution - all of this is successfully done by the
dispensary, thanks to the olose contact with the people
themselves, who are inducted to cooperate in vonereal
disease oontrol.

special importance in Rvssia as the country of extra-
genital syphilis, is widely spread over the whole
oountry, incltiding the rnral districts. The reswlts
of this work are very great, for the conntry people
affected with syphilis are extremely anxio11s to ob-
tain treatment , they cease to consider venereal in-
feotion as a personal disgrace, and we have 8 number of
cases in whioh meetings of thonsands of peasants have
decided to cell in physicians to make a complete em-
min8tion of their villages nnd mr'x for treatment those
found to be siiffering from infection.

venereal disease control arid the rapidly inoreasing
number of dispensar5es demnd 8 great number of phy-
sicians, not only clinicians but also social. hygiene
specialists. The traininp of such specialists is in
the hands of the Government Venoreological Instit rite,
which was Pounded two years n,qo In Floscopr by the Com-
missariat of Public Henlth. This Institute consists
of three large divisions, the olinical, the experimental,
and the social. The InStitUkQ alsohe ri large hqsp-
itnl with sections for syphilis, for dermatology and
for nale and female gonorrhea.

consists of the followlng sub-departments: mioro- .
biology, serology, cytology, vacoine, pathological
rnatomy, ohemistry, and analysis. Thero is a model
dispensary connected with the social hygiene division.
The most prominent speciallsts help to carry on with
the work of the Institute, and there are now 175
physicians &dying there. During the pest two years
350 physiciana who are noa working in different parts
of the Republio received their special training at
the Inst,ltute. In spite of its brief existence, the
Institute has become an important center for scientifio
venereology, and publishes a jonriial entitled 'rVen9reO-
logy and 3ermatology".

control made it neoessary to manufacture looal
salvarations preparatione in Russia.
are non: beirig manufaotnred, of the rr914" type
"NovarsolW and "NovarsolanW, equal in quality to
any produced abroad. The chemioal department of

the Institute makes a blamiith preparation for the

Education in social hygiene, which is of

!?he accomplishment of ell the requirements of

The experimental divisions of the Institute

The demands of aotive venereal disease

Two of these

treatment of syphilis that is in no WRY inferior to
the b'ranch one as far as action and absence of all
harmfol phenomena aro concerned. Eecently there has
been made preparation for the treatment of syphilis
that is intended for internnl- use, on the French
type. Siolopical experixents with it 2ave such
promiaing ros11Its thnt clinical- use of it will soon
be begun.  The prevention of prostitntion plays an
important role in the control of venereal diseases.
Althongh prostitution had begun to disappear during
the war, when labor was compn7.sory find there were
no unamployed, it has fourJd now ground in which to
develop in tho capitalistic conditions of the new
economic policyb
      Special organs for its prevention were
created in the provinces, their mombers aypointed
by the centrsZ Commisseriat board for venareal dis-
ease control. The prevention of this social evil
is based on a struggle not against the prostitute
but against prostitution. The work is both preventive,
airning to preverit the u:.employmant of women and the ,
vaerancg of women nnd children, 2nd direct, aimed
without nWCy spinst all brothels pnd their keepers,
and r~airist procnr~tion.

IV ITTFANQS AND CPILD `,'!XT,?ARE '17ORY;.

1. Prenatal and Infant W`;cI_"gr$ork.

      The prosent articl6 is intended to give a
genarpl idea of the plsce odeupied by maternnl and
child -?;elfare v;ork in the gerier~l system of the
Soviet governi.r,cnt and more particularly its place in
the orgariizntiori of the Pealth Department.

had beeti mde in Rlis~ia even before the revolution.
There WFIS 8 rell-knom StRtG organizntion, the All-
RUSS~~K~ Kother and Child Protection Society, as well
as D Society for the rted:~ction of Infant Xortality and
a spcinl association in I~Ioscow founded by phi?.an-
thropists and doctors Interested in social mork, and
called The Society for Infant Welfare. But none of
these organizations coald develop properly, for publlo
activities of this sort were always mistrwted in the
Russia of the Czars, while it was a foregone concluer-

It must be emphasized thct certain beginnings

243.

ion ti?c+, in undert?l~iriys of t,t-is sort, of ,- p:irel;r
soci~1 nctiire, fsil!irs T:;oii'-d n1:rn.y~ ei-is.)s b[aFiiise tha
;:.orE- vas orgaliizei-l :,I onr b:>rec::icref:ic lines.

antire country  nu. closolg sl lied lrith the -~.sl.frir~ of
the rspriblic, infalit ael.fare ~.ork w:as first or~aiiized
after tha Oct ober Rovoluti on.

the people's IIeRlth Corn'ni ssariat. The probl. ails are rnnny-
sided, involving every pbse of lifa. 'Jot on'Ly the he2lth
of the mother arid child in t;he nRrro7.v setis8 of tha v;ord
nre involved, b7t the protaction of v:omn's nork as
mother, the problem of educatirig young girls, the re-
organizetion of customs 2nd the bstfibliahnent of the
right of inother and chi1.d to protection ?re rll implionted.
But the chief el-jrntrit remilis the care of the corninf
PJenarPtion. A11 child welfare ii!sti+.~ti ons tilerofore
possess a rc;lihnr' medical depart:ner~t.

l.it,tle in the may of prist axperidrice or inaterial eqgip-
ment. Outside of the four clinics orld the ho:nb for mothers
?rid children in Xoscov* thorc: nas nothing to stgrt ', ith.

      i't& hove bylilt upon the principles evolved by
the experience of the ';l'estarn v!orld, but hsve adslgted tro
fit our o?T;ri concept,i ons t 170 Corms borr used Prom Gerrnnny
rnd America.

      In the first place, ?'6 repnrd nll. inPsnt  el-
fare Txork as a zovernmont problem, nrid motherhood as n
gocia1 duty of women. ?Jot evoii R remote iden of phil-
anthropy is involved. help in^ the norkin? aother is the
duty of the State t-;:ith respect, to tha futvra pt3nsrr7tioils.

      In tha soconil pl-nce, 're ~7.~437~ consider nomen
8s woskers arid the vario1is infnnt ~ol fnre institiitions RE
mwns for lightening the burdens of motherhood.

      That is why we hnve developed nn institution
nl;t very prevslont in the \Vest, the cr5che. Ye do not
consider a creche a temporary rm8siire, and do not 'Look
upon support of' the mother in the home, so thf; she can
stay xith the child, as ideal, but be1.iwe ins:end that
the cr&cha Viil.1 be Tnrthcr teveloped and perfected. The
aim of our instit7itions is to assist women to co!nhi:ie
mot hcrhood with other !iseft11 public work.
      These are the fundnrnental principles in the
light of which we have drawn ny our iri~titutions. The
most fund-xental of these, established a3 part of the
cnmpaign ngairist disease nn6 infant mortality, nre the

As 8 social problern of import-iIce t.0 the

The organizati on of the -: ork WF~E eritr:7stect to

The Divisi 011 for infFnt o~ol f8rrEl ~ork inherited

244 o

creches and the oombined clinics and milk stations, open
to all, and chiefly educational. These are OW model
pliblio institutiona, and following them come homes for
mothers and children, where the mother can pass her legal
rest period of two months before and .two months Rfter the
birth of the ohild, arid sometimes the entire nursing
period. And finally, there are institutions cf a dosed
type, such as homes for infants and homes for children of
one to three years.
      Child exposure, that shameful inherl tance of
the pst, has not been entirely done away with in Soviet
Russia, so that we still have pl-enty of infant homes.
Eomes for children of one to three years are filled almost
exclusively with orphp.na, a frightful number of whom
lost their parents by war, famine, or epidemic.

birth and prenatal work. In large centors such as Lenin-
grad and partly in Ik~oscov~, the various insti$utions have
been considerably developed. In Leningrad, for example,
there is n whole complex of "Xaternal and Child Welfare
Statior8'$ each one consisting of the following divisions:

Entirely sewrate are the institutions for

1. Clinio for infants.
2. Clinics for children from one to three.
3. Clinic for pregnant women.
4. Tubehulosis specialist's office.
5. Venoreal disease spe~ialist~a office.
6. Nutrition station.
7. Milk atation.
8. +legal consultation.
9 . Inf ormti on bureau .

      These stations, about twenty-three In number,
are found in all parts of' Leniugrad. Emphasis shoald be
given to the work of the legnl cons!iltntion brireaus
which constitute a measure against child exposlre, because
they require the fnther of an abandoned child to look to
its maintenanoe. As the first year of these bureaus is
just draring to a close we oannot yet draw any extensive
conolasions from their work.

with which the women obtain the insurance money for the
prenatal arid nursing periods. The support given consiate
of full monthly wages for two month8 before and two month8
after birth in the oase of women doin ph glioal work,

and six weeks before and aix weeks affer $or women doing

These legal burearis also provide the certificate

245 o

int ellectiml mork. Nursine mothers for nine months
receive support amoontine to on*Fonrth of the averpge
Vi;age for that rogion. The fins*irPrice funds also donnte
for the care of the child a sum eaiinl to one nonth's
avercclge wage. These instirance bureaus hnve nothing to
do with the organization of the inntitutions, their duty
is merely to pay ont the money.
      On Janiiary first, 1924, not counting the Ukraine,
White Russia arid the hucasi~s , there were the following
number of instit nti ons:

Creches 548
Eother and chi1 d homes 147
Children's homes 4 01
Children's clinics 185
hlot hers cl i nic s 44
YBternity homes 35

(This does not inclnde the maternity

homes found in hospitals)

-

Other instit uti on s 20
                Total 1350

Tho Public Health Commissariat hns founded in

h:oscow a Scientific Institute for 1:otherhood F!nd Infant
Welfare, which stiidies aiuestions relqted +o the ph,ysiology
and patholocy of infnnts nnd which t?'<88 care of the train-
ing of specialists in this fi92d. Its 'Fork Is purslied in
threa directions. Pirst OP 91.1, there is the thsoreticnl
study of qaestions related to the physiology nnd pntho-
logy of women slnd children, next, the drmdng up of pro-
phyl.aa$:Be rne8611res nnd plnns for the campaipn sga ind
infant mortality, and third, the prnctical trainin? of
obstetricians, ped iatricinns, midwives, an6 nurses1 in-
s t r u c t or s.

demonstratious, nnd gives c7 co:,rse for the preparation and
training of the personnel.. The scientific institnte con-
t;ists of three divisions.

The institute contc7ins cl inics, laboratories,

1. '!?omenls Division (Obstetrics, gynecology,

2. Children's Division.
3. Sciantific 3ivision.
In tho second group there is a division for

nev+*-born infants up to nine or ten days old, for normal
infants, for those requiring artificial feeding, for
children of six months to one year, for older children
of one to three years.

out-petients) .

246 .

       This diviviori ful-lkes care of norm1 children; nnd
there are also others for prematnra cnsas, for syphilitics,
a distribution division whore children taken in by the
institutions stqy three veeks before being nssiened, nnd a
colony situated in the country for physically subnormal
chi1 dr en.
        The third division of scientific aid includes
the gonarnl clinicnl, bacteriological and biochemical
I a bora tori as .  A pa tho1 ogi cal-9 na t omical d epnrtm grit  :vi t h
museum, X-Ray del#irtmont, milk departTent, n good lnboratory
R large library, nnd an exhibit room of tho ~rasden type
dealing with all phases of mater!i:,t infarit care. This
exhibition is used both for instruction and in connection
with MI extensive generpl educntionnl- campien. There
are at wosent 127 doctors and 434 ~io~en studyinp (mid-
wives' and nurses' irietructors) at the Institute.

      At the latest All-R:issian Pediatric Congress
in Lhy, 1923, the auestion of fouridia~ special Uriiweraity
chair8 for the study of infqnt physiology vms tnken up,
bat it was decided to postpone the matter tamporsrily,
as o. chair implies the development of 8n iristitution in
which tho stndents can obtain their practicnl training,
For the present, an extensioii coiirse in infant physio-
logy has been attached to the rer-hr course in child-
ran's diseases at all universities.

xhich we hnvc been working for six years during civil
war rnd econbmic aifficultias. A period of peaceful
prospority rill enable us to extend arid to fortify these

This is the plan and the method according to

PlP 11s o

2. Protecting the he?lth of children arid adolescents.

The ce.re of children arid adolescents is aTso

an ovtgrowth oc the %volution. Before that time,
there existed at best in the oilpita1 cities some school
hygiene at municipal exp8nse. but no attention was paid
to the care of the physically or psychically abnormal
child. This was 1Mt entirely to private intfiiative.
There was to, be sure a school hygiene department in the
Kinistry of &ooction,  but it did nothing bnt pive
sono instraction of no pmotioal vRlue.

and young people became a State function, A department

After tne ?evolution the care of children

247'.

for this purpose was creflted in November, 1917, and
plana for its organization were worked out. This organ-
ization covers the care of tho normal child, school
sanitntion, physioal culture, and the care of the physic-
ally abnorml (tuberculous) and psychically abnormal
(psychopathic, nervously diseased) child.

      The department decided in 1918 to found a
number of institiltions for child welfarein I,!oscow, to
gerve as models for the rest of the country.

      At the same time two higher educational iristi-
tutions were created, the Physical Cn1.t:ire Institute and
the 1nstitut.e for ?;:entally Defective Children, the name
of the latter being changed later on to that of Medical-
Pedologicnl- Institute. In 1921 courses in exercises were
begun again in Leningrad under the name,  Institute of
Physical Culture.
adolescents was transferred in 1.918 from the Commissariat
of Public Instruction to that of Public Renlth, thus
being greatly assisted in the unified execution of its
plans.

of experience as the bnsis of the work.
and abnormal ohildren, vchich are for administrative pur-
poses divided into two parts:
   a) Inspection of sanikry conditions in child

   b) Physical edmqtion. The same for abnormal

   2. Mec)ical pedology in regard to:
a) Physical abnormal children (tuberculosis) .
b) Psychically abnormal children (mentally and

        The x'ork of the divisions falls into two
secti ons, scientific study and special training for
* Dhysiciana and teaohers.

       The creation of great corps of hygienhsts-
pedologists cJnd social eugeni sta by the special training
of physicians was an enormous undertaking, and at first
only a few short or one-year co~rses and later three

%f0&!~r8%ft #?f%t?~' OF Fh e 88BZ%enlh&!!@?!?6 $$8$%h

The department for tha care of children snd

The following points grew out of several yeare

1. Preventive measiires in regard to normal

inatitntions and the care of the health of
school children (pedology) o

children.

morally) .

eec

aa .

forthis instriiction. The improvement OF the rme Rnd
the workiug class as a social eugenic umdertaking ie
the main feature of this training.

         The scientific work of the division is carried
on by the medical-pedologicnl commission; by a number of
scientific conmissions that are appointed by the division
to xork oiit variofis problems of 8 medical-pedological
nature together nith the Comrnissarirt of Public Herlth;
nnd by the scientific professors, laborntories and
comissions of the universities.

enormous field, a plan of objective stitdy WRS as far as
possible ivorked otit to permit the ObservBtion of the
alterations of the orgnnism as a resn1.t of physicnl
exercise. The scientific depnrtment of the central
government Institute of Physical Culture had to blaze a
ne;;' trail. Organic react ions are particularly difficult
to observe, nnd these reactions mnst furthermore be so
numeroits ns to offar the possibility of determining the
relative strength of different factors in producing
them. The first step in this research wee anthropo-
metry, which hor~ever 1 eaves many quest ions unanswered.
The department of anthropometry is assisted by the
physiological la boratorg. At the same time intensive expec
rirnents are carried on in the laboratory to determine
methods for obtaining a desired norm and exact doasge
through certain exerci 88s.
       The state medical-pedological Institfite has
pblished B number of papers. In addition to its scient-
ific work the Institute is also w:orking on ne% ways of
determining the norm and devintions from it in regprd to
leorning ability QS well as in differant child types.
Methods of measuring children's motor ability have been
worked out, the Bannburg method simplified and adppted
for measuring not only childrentsadvancement but also
? heir intellect*ial ability.
       The Bfedical-Petlological Institute considers
defgctive mentality as a psychic and neurologioal mani-
festation and includes it in the field of clinical
pedology.
       All the model experimental Institutes of the
division serve the Institute RS clinics. Among these
are the generrl and dental children's clinics, the forest
school, the dispensary for tuberculous children, the

As the question of physical culture cover8 an

249.

psycho-nenrological and the palalogical clinics.

dental departmont, is the most typical, with office
hours for specialists in all departments of medicine,
These dispensaries are considered foci for the ac-
tivities of a11 the physicians Kho are doing child
welfare aork. They also form the connecting link
with the public by sending children to differant
special institutions, such as diet kitchens, or day
sanatoria, nnd through the medicnl aid depertments,
home vi sits, etc.

forest school as a model resort, the psychically
deficient, the medical Oducati onal colonies.

of %orkine adolesoents, who are the futura qualified
workers of the Republic. A decree of the People's
Commissariat of October 13, 1922, reqnires that the
working adolescent must be examined at resnlar inter-
vals, not less than onoe a yenr. In case he proves
to be doing work too heavy for his physical condition
he must be put on lighter work, Other nenns of pre-
venting physical debili t.y of adolescents are sana-
torium colonies, rest homes, health resorts, etc. The
1923 physioal examination showed that Moscow had 35
per cent and I~~oscow government 30 per cent of i$a
adolescents below normal as far as physical efficiency
vas concerned, It is also against the lav for young
people less than eighteen years old to go to work
without a prsllminnry medical examination.
       Physical cu'ltnre forms a particul-arly im-
portant element in the struggle for health, nnd is
carriad orit in the provinciaZ institutions for the
purpose, These aro copies of the mael institution,
biit on a smaller scnle. The main ngerits for physical
training on a large scale are the clubs of the Corn-
muni st Young People's Unions ('Comssomol) and the
cnltural clubs of the trade unions, There 816 at
present in ~~?oscow 250 workers' physical cultwe clubs,
with 15,000 members,

Institute of the Commissariat of Public HeFilth is the
center of proletsrian physical eduoation, with one of
its purposes to prevent all deviation of physical
training into professional sport or athletios,
       Vie have at pzesent in the 811-Russian Cent-
ral keciitive Committee, ur~der the chairmanship of the

The child ren'8 dispensary, ;.Yith its

Physically deficient children have the


Particular attention is pnid to the henlth

The Central Government Physical Culture

250.

Commissar of Public Health, a Pigh Council for Physical
Bducntion, and in the different provincial commissRriats
local councils, all of them forming a single organ on which
all proletarian assooiations and all authorities are
represented, such as the Commissariats for Vilitary
Lrdning, of Public Faalth, and of Public Instructtion,

by the Council rith the co-operation of the division
for the protectioh of children and adolescente. By a
decree of the People's Commissar of September 15, 3.921,
this Council- is composed of an eqiial number of representa-
tives of tho Comaissariats of Pnblic FeRlth and of Public
Imtr-:ction. Subordinate councils represent it in the
provinces, and to these are added sanitary district
oouncils Find med Lcpll-pedological commissior18.

V. TER PHY3ICIANS.

     TKO perms must be distinpfshed in the con-
dition of physicians as well as in the I.;ihole life of the
country since the October Tovolution: the period of civil
var, nrid the pr?riod of transition to pmce conditions.

      Duirig the civil mar, the blockade, the famine
and the epidemics, the position of the medical service,
particularly the physician, was very gtnd. The fight
against the onemy and against disease reouir ed colossal
sacrif'ices from the entire people atid relentless work on
the part of all physicians. Ths latter were r)ll too few,
and in order to remady this to so38 extent the Cohrniss-
ariat of Pnblic Eealth was forced to license as Ourriedly
as possible persons who were insufficiently prepared
biit tere nevdrtheless indispensable for the ti:ork of
epidemic control.

.Red Army, vchile the rest rere conscripted for forced
labor, in other words, every bysician able to work had
to do so for the state, and could only be appointed or
dismissed by the Co,miesariat of Public Eonlth. All
physicians were registered, and the forced labor make it
possible to use v.hat physicrians there were as rationally
ns possible in vim; of their insufficient numbers, since
they rare if necessary sent to th6 mar or to epidemic

I1

The educational part of the work Is carried on

Most of the physicinns were xobilieed for the

areas .

The great majority of physicians met the

d~mmds of the Republic as Snlly as possible, r.od cievoted
thornsel-vos to the nellical and hen.lth servloe of the coun-
try, in spite of having to Rork under the most difficult
conditioris, starving, sn"fer1ng every kind of primtion;

-251 ,

often dying in great numbers from the tssks that over-
Tihelmed them,  The siicces8 achieved in control-ling the
epidemics cost the country many hundred physicians.   Yhen
the epidemios of typhus end relapsing fever were at their
height, the morbidity of physioisns fighting them reached
100 par cent, arid their morWJity 70 per cent.

C,ongress in '1921, in praisine the work of the physicians:

hand with the pork of unnumbered physicians. If there
had been no medical ~ork done in the Red Army, the Red
Army itself would hwe done no work at all",

      Those physicinns that rempined at their regular
posts hed to carry on the whole work; of epidernic control
among the civil population.

      The victory in the civil war and the decline
of the epidemics made it possible to decrease the force
of the government sariitary depsr+rents. This was also
necessary 011 account of tha trflnsition to 8 repliter
biidget and the lack of fmds of the provinces nnd commun-
ities that were now %de resporisible for the expenses in-
curred by the public health servioe,

becrrna possible to improve the position of the medical
personnel, do away with forced labor, and permit physic-
ians to take up independent prnctico in vacnnttsts,
m'hich later, however, led to their bankruptcy.

      Foreign physicians wishing to practice in
Rnssia are regiilnrly reqriired to pass the Univarsity
examinations, but nccording to an agrecrnent vdth the Comm-
issariat of Public Instruotion, exceptions cnn be made
in the case of men vrho have had years of mcientific or
prnctionl experience,

    Uxfortunately we suffer loss from an actnnl lack
of physicirns than we do from their uriequal distribution.
??e have even a superfluity of them in the large cities,
so that they have a hard time earning n l.iving, Accord-
ing to the lntest figures, there are 33,000 physicians
in the U.S.S.R. Of these 22,000 are in the R.$.m,S.R.,
about 8,000 in the Ukraine, and the rest in the other
rtiyublica of the union, such as Thite Russia, Azerbajan,
Arrrienia, etc,
enormoiis territory with its one hundred and thirty million

Comrade Trotsky said, at the Third Public Heslth
"The building up of the Red Army went hcnd in

The great need for physicinns grew less, and it

This number is of cofirse insufficient for thie

252 .

people. The Comnissariat has ostimted thnt at least 35,000
physicians are reqcrired for the entire medic91 neads of
the R.5,P.S.R. alone. But the plan for P*irnishine them
carmot be put into execution nt present on account of lack
of funds. For the same reason, makeshifts have to be
endured in independerit areas, such 8s barber-s:irgoons, etc.,
their places being filled as soon 86 possible with rogular
physicians,

no physicians, the large oities have ~nany that are unem-
ployed. In B:OSCOW, for instynce, 4190 out of 5440 physic-
ians have government positiony, vihi1Q out of the romining
1250, 956 have registered at the Labor Bxchange as having
no work. In the Government of Leningrad there are 2608
yhysicians in the government employ, while 496 ont of the
rGmqiniog 632 are recistered at the Labor Xxchnnge. A
large number of idle physicinns are elso registered in
crimea, Sarntov, Kiew, 0 desea, Voronesch and other
large centers. Kost of these are young men rho hrve re-
cently obtained R license nnd hnve not yet done their
rdquired yesr of practical vJork.
      This uneven distribntion is due partly to the
low wages pnid in the provinces nnd partly to the fact
tht the physicians thornselves wish to remain in the
oultnrnl arid scientific oenters, as was always to some
extent the case, only growing more pronounced in reoent
years.    The overwhelming mss of physicians are em-
ployed by thc state, 29,500 in all. Those that hnve only
a private prrctice, xith no regular income whntever,
are very few, only 3500, but they have often to register
as needing work, Of the government-employed phgsicisns,
man$ also oarry on private pr-ctice during thair spare
time, as this is not forbidden ond helps to eke out the
low government SA lary.
      The physicians' difficult material position,
which has a bad effect on the Pihole work of the Commiss-
ariat of Public Health, has led to Commissariat and the
medical socisty, "Wsemediko9antrud1', to vork out some
meens of improving it. This subject has been presented
OS one of immediate and pressing importance to the highest
central organization BS well lis to the local soviets,
that support their pblic health institutions out of their
own funds. Numerous congresses and the All-Russian

"Jhile the conrities and remote provinces have

25.7.

Contra1 CQuncil have recognized the necessity for
rnensures of this kind. In spite of the finnrlcinl. dif-
&ic-ilties of the conntry, the minimum wage is regu-
larly being raised, nnd in some districts the resnl-ts
hve already been noticeable. Other ways in which the
lot of physicians is sorneorhat eased is by lowering
their taxes and rent, giving them and their families
pensions , etc.

lutely free. ThQ only thing against which the govern-
msnt is opposed is medical advertising, bnt private
practice can no longer be corisidered the Fource of
income for most physicians. A fern noted special.ists
in lnrge cities have a large prpctice snd large in-
comes. Otherviise private practice exists to my
extent only where there are not enouch state physic-
ians. In comparison with before the vmr private medicat
prF c tice has fpllen very low, and contln~iea to fall.
        The whole intention of the Commissarint is to
do away v,ith the necessity for privnte prnctice bg pro-
viding the vhole coutitry with qtial ified medicnl service
at governlnent expense. Social insvrnnco for the worker,
free hospital and diepensary treatTent, the develop-
ment of qedical service given in the home, free child
welfare consultations, ~ll of these ure intandod to des-
troa private prpctice. And we ses the reD1ilts in the
districts where such service is most fully developed Pnd
private prectice at Q minimum.

the soci ety, ll~~semedikosaritr~d", to xhich all the physic-
ians of the republic belong. It is the organ of all
morkers in the medical field, physicians forming 8 aap8r-
ate section in it. The society also decides, aside from
purely professional mattors, ~ll important qnestions of
on adminiotrative nrture for tha country ?nd its
different sections, in conjunction with the Commissariat
of Public Health. Aihorig these are the appointment and
dismissal of physicians from their posts, the refu'lntion
of salaries arid professional fees, the hours of work,
tho industrial inswnnce of tho peraonnel, etc,
      The Comnissariat, together mith this rtssocia-
tion, has worked out the legal normfi determining; the
rights <~nd dutiss of the medim1 personnel, as reauired
by the particulnr trend of life in Russia. Not all of
the above reguletions, horrever, have yet been put into
practice, due to the poverty of the country.

2rivate pmctioe in Soviet R*issla is abso-

Pr,)fessiorJal interests aro tnken care of by

254.

      One of the most important diitiea of the Commiss-
ariat is providing a better medical educption. During the
war no schooling could be thought of, st~identa were licens-
ed as soon as possible, nnd there was almoat no medical
literature whatever, so that most doctors were left
behind as to scientific information.
        Since then the former institutions have been
permitted by the Commissariat to take up their work again;
neK clinical institutes for Rdvfinced medical stndies
opened, and coiirses organized in the most important depart-
ments of soviet medicine, such as sanitary control, social
diseases, maternal and infant welfare, etc. Advanced
studies for prpctising physicians were made possible in
the provinces by commandeering for the purpose the well-
eauipped provincial aanitary institutes.

      The programs of the medical schools were altered
so as to improve the quality of the medicnl. education of
new gradnates, rnd the so-called practioal year, ahich
we have mda really two years, was introduced.

VI. SANITARY EDUCATIOTTAL TORR.-

The extensive prophylactic me8surQs carried out

by the Soviet can be carried o:it only on the ba& of
considering them the aotivity of the laboring classes.
Arousing the consciousness of the laboring classes to a
pitch where they will become active in health work is,
therefore, tho foundation of the entire system of pre-
ventive madicine.

is not dependent upon the good will of this or that
modioal organizntion or society. It is an oreanic part
of the official Health Department. It has central and
provincial centers, as well as special institutions. The
central direction of the educational work in the Peoplers
Health Commissariat is entrusted to the Realth Eduwtion
Division. In the various provinces, this work ia taken
care of by special msdical inatructors nnd in the sma1.ler
commurlities, it is done by district health officers.
      This unified organization is aotive not only
in the sanitary nnd epidemiol~o~ical~ field, but also In
the work of AI ther and Child lelfare, and Tuberculosis
and Venereal jiaenae prevention
tution oalled the Public Health*%ibit was founded at

sducntional henlth propaganda in Soviet Rtissia

In 1919 a model insti-

`255 .

 GOS SCOW, The exhibition had nine divisions and about
5,000 exhibits. Recently a mo-del library on popular
public health subjects, has been added. It is also
R center where various commissions study problems
connected with public health work. It serves 8s an
educational center for henlth offioers, but is is also
available to the public,

work done can be obtained from the admission sta-
tistics during the last two years, In 1922 there were
465, Find in 1923, there xere 989 groups admitted to
the &hibit. The entire number of visitors in these
two years were respectively 10,950 and 19;758.  If
to these numbers are added the nuhbers of visitors
who were unorganized, the figures amount to 22,875
and 44,492.

      Among the groups in 1923, school gronps
amounted to 99; groups from other higher educational
ins t i t 11 t 1 on s 98 ; va ri o us chi Id r en s ins t i t ut i on s 4 9 ;
other edvcational institutions 79; textile and fnc-
tory centers 55; metal workers 43; health workers
45; communal workers 30; transportation labor 25; and
agricult~iral labor 22, etc,
soientific center. This institute be at its dispos-
al a large supply of exhibit material  siich as lantern
slides nnd negatives. In the provinces we hnve henlth
centers with a prominent exposition, auditorium, libra-
ry and moveable exhibits, as well as collections of
popular litermture, Some of the larger canters have
rooms for the preparation of such material, There is
also a literature and a press bureau, in connection
with these centers. The individual activities differ
widely, There are about forty centers, all founded
within the last five ymrs. In addition to these,
there are 25 places with permanent exhibits, and 80
with moveable exhibits. For the tremendous area of
Soviet Russia this is entirely insufficient but if
the brief period of time, sever6 economic conditions,
and the total lack of preparation, are tnken into
considerRtion, It will be Been that Soviet madicine
has obtained good re8u'Its in this field.

tutiOIAS is provided for partially by the government
budget, The provincial and district Institutions are
on the local budget, The latter, in particular, also

Some small idea of the character of the

The Institute for Social FIygieno is the

Health education in the various model instl-

256 .

share in the various culture nnd labor funds. Xiost of
the work in health education is done by dootors,
chiefly the health oPficidB, school inspectors, and
tubercnlosis and venerea`l disease dispensary doctors.
At the periphery, sane use has been made of hospital
dootors.
eignificant share in this work. By giving PPygiena a
prominent pl-ce in the labor school, both in the
seaond and in the first division, the next task has
come to be that of ediicnting teachers into efficient
health instructors.

aotivities and the preference given to doctors and
heslth officers does not signify that this viork is kept
apart from the generrl eduaational activities. On the
oontrary, health educption is tho bridge that connect* 1
the general health worker with the world of labor and
hence with all labor activities.
        All instruction connected with health educa-
tion is closely tied up with the party organization,
with communistio edlicati onal work among young people,
and Kith general work pmong women and factory workers.
There are standing commit tees composed of representatives
of these various organizations mho make it %heir briaineas
to coordinate and give a special applicstion to the
health work with an eye to the needs of the organiza-
tions they represent.

henlth educntional work is systematically taken oare of
and finanoed. The work itself is done by personnel from
the health department and according to plans prepared
by them. Systsmatic heslth work is Carrie4 on in the Red
Army by hiving regular health lessons.  In the 8ame may,
work is being done among the reserve military forces.
The xork has obtained a firm foothold among transporta-
tion personnel. In all other school8 hygieno has been
included. Other groups have henlth leotures. In two-
thirds of the railway companies, railway car health
exhibits are provided. C1nb work is the form that most
health activities take in Indlistrial work. There are
occasional 1 eotures, discussion evenings on health
topics and provision of a health shelf or health corner
in the librar . All club libraries oontain
health litera f we.
from various new methods including 8 periodical on live
health questions of the day, colleotions every three
days for fighting tuberonlosis, venereal diseases, mala-
ria, etc., health meetings, and espeoially health debates

Teaohers for the present do not take any

The unified organization of all herslth

By means of contrncts with numerous indqstries,

fopular

Good results have been o tained

257.

and the production of health plnys. There is hardly
a place in Soviet Russia where a debnta has not been
held on prostitution, alcohol, and other thought
provoking snbjects. These debntea are extremely po-
pular arid hold the intorost of the audience for
several hours. There have also been some lawsuits
concerning hoiisea of prostitntion, provision of
sanitary facilities, saloons, etc., the proceedinps
of which ar6 ~1130 used RS liternture, In som cases
courts wera octrially held in fect orics whore Zaborors
could attend. Testimony is given by doctors who
explairi poirits espeoinlly with a vim to social hygiene
conditions, Great interest is aroosed by the production
of plays dealing v;ith health problems. The rapcrtoire
includes plays by Tolstoy B~IC~II as IIThe First Alcohol
L)rinkartl, and "Advmit8gesrt, 't?auptmann's %utlrisen, and
qliite a few plays constructed from stories by Chekov,
Gorky, and hiaupassant, 8s well as originnl satires on
haalth sab jects. Presentation of thase plays is always
accomp~nied by a lecture from a health officer.

A liTita3 number 09 hmlth Pilms nre in use.

In 1323 sone new f-tlims were obthined dekling with
mnlaria and social diseases.

Aaong tha ngricultl~ral popnlntion health work


                              Twice

is done throrigh the aprlcnltursl oenter, nnd the agricul-
tural libarary. A model has been provided in ~~OSCOW.
The Agricliltural X:~nseem there also has a l-ibrpry.
a week lectures are given with opportunities for dis-
cussion of which visiting fnrmers cnn tnke advantage.
A library has been organized and much literature is given
out. In provincial centers much the snme plan is followed.
In order to refich tk-0 homes, centers nre provided with
popular liter:itgre, placards, pamphl-ets, etc. The
literrture is so selected that if no health officer is
presmt, a tenchor or librarian cnn use it.

devolve upon the schools and the teachers. This qaes-
ti ory'is novi being considered by the health authorities who
are considering the best means of reaching the great
masses of the population. Pealth v;ork Is reaching the
most remofe parts of the Repnblic which on1.y a short
tine ago groaned beneath the yoke of theczar. The
Jakiits and the Rgrint Kongolinn region in the &st,  as
well as the mountninoos region of Jagesten are beginning

The chief Fork in the future must hecessarily

to prcpare health litera+ure in their own 1.angunges.
Health Fork of this sort nmong national minorities is
sonothine new.

rclntion xith othor labor activities arid the solid
foundation upon bi ologicrrl arid sociological principles
c rive u8 the assiirrnce thnt nll difficulties will be
overcome arid thet the Soviat Republic will attain the
required degree of health culture.

co-operntion from the press. The pnbl-icatiori office of
the People's Commissariat i=;hich was organized in 1919
at the time of civil v:ar and epidemics, has taken se-
riously its tflslr: of providing rnedicnl literature. The
ixnodiate needs occasi oned by epidemics, it met by
issuing a mass of 1itorntIu-e on typhus, eholera, dy-
ssntary aiid other diseases. After tht a specin1
series uf books, text book3, nnd mangal s K'ere pvbtiehed
to aid the 1-srg.e number of peoyl e ?vho were combatting
thesa epidemica.

      In the process of carrying on this 'Nark,
the publication nctivities hclve grsdnal-ly hropdenbd,
taking on r~evt themds arid a more systematic character.
Special otterition has been given to sociQl diseases
and more especielI.y, to ti7 berculosis. On this quest ion,
R numbbr of brochvres nr~d FF largo numh,ar of pamphlets,
as well 8s eicht special collections were published.
Then follows liternture on vsnerml diseases and syphi-
lis. A promineilt p7.~ice is given in the popular liter-
ature %o questions of child welfare on which another
Baries of pamphlets nnd placards treating of chi'l-drents
disensos, the cfre of children, arid advioe to mothers,
are trken up. The braakirig out of an unprecedented
famine was reflected in pub1 ications on nutritional
subjects eayecially on the nntrition of children Fnd on
nutritional standards. An extensive hunger literat lire
has developed.
pqblicatioris arid a total number of 13,000,000 copies of
this popnlqr health literatwe isstled. Along side of
this popular educcc,tion there hs been some development
in more sclentific xork. In addition to the news bull-
etin published by tho Eealth commissariat which checks
up on the development of Soviftt medicine, vario:m scient-
ific periodicnls were gradually published, among them
"Clinical Uedicinerf, llGyneco?ogy and Obstetrios",

hrze tasks still rewin but tha close

Health work cannot be carried o?lt without

buring 1919-1922 there vere 202 separate

259

I1Hygi en8 arid Rpiderniologyn, "Inf8nts1 VQ~fRre Raview",
"Tu berc 111 osi s Qn es ti on 6".  "Van Grog 1 Dis eases nnd

        RS well as; periodic pablications on
t*?berCulOsi8 nnd social hygiene. Tho Peopl elsComm-
issariat, in spite of the high cost of printinp, in
1920 and 1981 brought 0t1t 8 large number of text
books for uriiv er sit $ t ud ent 6.

piiblishing medical scientific 1.it;er-t;ure as well as
mebicnl text books. There has been a special agreement
with the sciantific division of the Government publica-
tion office by vbhich the TseaIth Commissariat is re-
presented as P member on the Pnblicntion Cornnittee.

At present, the Yeal-th Commissariat is

        Before the Revolution health activitias
wer;: divided between severr1 government departments,
Soms hospitals wera run by the control Government,
others by tho district, and murlioipnl governments.
Quite a few heolth instilutions find a sm11 number of
hospitels , especially those of tha nmb13lat'ory type,
~er6 supported by sick or insurance funds of -c:hich,
howQver, there wera norle before 1912. Beuallse the
hosp i t a1 s  vier e di v id ed  between va r iou s a 11 t h ori t i e s ,
there was frequeiltly duplicatioa nrd the most uneco-
nomical use of funds. A majority of the institutions
wer6 inaceessible to the large mss of people. The
district arid city hospitpla which in 1910 included
33.6; of the total and which included 51.5; of all
the beds in oharitable hospitals of religious origin,
all tried to follow the ideal of serving people for
nothing. Natrirally the service thnt could be given
under these conditions left soqethine to be desirad.
Hospitals were overcrowded. Dispensaries had very
low hygienic standards.

       The mmns for keeping tip this net-~ork of
district hospitals serving grRtis, were supplied from
district monies(x). In the cities, hospitals belong-

(x) %@g z3XsTVOS are a form of local self-government
in rhich the better classes participated. Forty-three
out of 83 provinces that existed before the War had
this sort of Iooal overnrnent, In spite of the loyal
attitude of these
r8girne, they never quit6 succeeded in evnding imper-
ial suspicion. For this reason some of their moat de-
mocratic aotivities were systematically suppressed.

............................................................

8 ernstvo8" to the old Czaristi0

ing to tho city nnfhorities pnd supported by the
city, gave aid only to the local popn1ntion. Other
hospitnls belonzin; to various aothorities, as R rule,
reqriired money for their services. Even the Red Cross
activities were no exception in this respect. As far
as participation of tho viorking rnen in medical. service
was concerned, the whole organiz9tion bore 8n anti-
labor and bourgeois aspact.
       Only the better c!.a$ses, and these only
to a certain degree, ha9 nnythine to SR~ nbout fhe
rnFnner in %hick the health service vias organized. The
large rmsses of workiiig people ?;ere not considered.
The proletariat was no+ sur6 of rscoivity the simplest
aid,  As late as the year 1907 only 38$ of the factor-
ies subject to inspaotiori gave any rnedic?l aid. 3venty
per cent, of the institutions provided dispensaries, 7$
had hospitals, and 61$ hd.no medical orgnniaation at
all. This 61,, included 16," ofnths workors. The 7,:
thnt had hospitals included 40;/0 of tha workars, and the
20,; nith dia ansnries comprised 256 of the uorking
poyul~tion. v "Nedical Eelp for Indostrinl Torkers in
1907" by R.A, DEilTIJTJEPF, 1919).

tinually employed xorkiry men in cities, 2nd 285 of +he
periodically employed work.l.rig men received no aid nt
all. (Data presented to +he Third Dum). Every nov
and then a pbCQ wonld be cited as a hospital, which had
only two or three beds.  In institut3ons where mdical
-id 78s officcinlly organized only 44,J of the working
population could reueive hospital service, The others
hed to be content with dispensary service or xith none
at all. This was becnwe tho workine men had no special.
privileges compared viith the rest of the people. The
number of beds was not nearly enough to go around.

or of aid such as that given in sanatoriums for mental
diseases, for examiQle. snch special services ns those
rerc a strict exceytion and were found only in .the
large cities, Medical service had only a very narrow
task, that of supplying medical aid without any inqgiry
into economic or social conditions of the people requir-
ing aid. No effort was made to give prophylactic care
to the inedical service, or to pay any attention to con-
ditions urider whioh the patients did their work. Even
the distriot institutions which dealt especially vdth the

Accordin2 to aata for 1912, 3.9;; of the con-

!!!hers VI&$ no question of lnedicnl aid at home

agricultural population limited thornselves strictly
to medical servicc arid did nothing of D general sarlitary
Gr social hycieriic natura such as irifnnt x'el fnre work,
or camp?igns against social diseases, This inactivity
is pnrtly explained by political conditions nnd portly
by the igno~nce of hyeions on the pnrt of the people
required to give this sarvioe.
      After the Revolution, Russia inhsrited from
tha old regime in addition to nnnnjr riitjeasas, nnd a high
death rete, n poorly organized system of hospitals,
controlled by the more well.-to-do amon? the poputati on
and to B large oxtent destroyad by conditione. In
the district governments this "ormar hospitnl. s,ystem
provided for ono bed for 618 people. For the whoTe
country, the populntiori VBS 813 to one bod, nrid in no
place \vas them more than one bed *or nbotit thrco to fonr
hundred people. In 1910 there ms 0110 physiainn for
every 6,734 peop1.e. grid for every 150 sqriare VerBts,
counting only the inhnbited districts.

very scarce rn6 the inore popiil-nted canters hrd ncceptnble
hospitcils for the bonrgaoisie, bn t poorly organized
hospitrls for the people xithout ?leans. ACter ths October
?evolution the process of uniting this entire system
under tho leadership of the People's F'ealth Com?liasariat
and itD s!ibdivisions in the provinces, tho various health
cornrnittees of pasant arid iriorkinr mmTs associnti ons,
began. A11 hospitals, no mtter to whom they belonged,
ToerF! i$ven to the Health 3epart,msnt.   Fharc: ensued a
period of foverish bail-dine on the principl 5 of free
service and free entrance. This soon came to a11 end
b8Cnuse of intervention by foraip governments and
because of the civil war. A large part of the qedical
personnel and medical mnterial R~S sent to the front;
much property was destroyad or tyken over by the enemy.
Some hotipitals were virec'ced by bnndits, nnd counter-
revolutionaries.

        The continual blocknde also had a bad effect
upon health x-ork, Great dernFnd3 were made on kospitr,ls
and so:ne institations nlso by the epidemics, b:it in spite
of the destroctive inflnerice of the Yar and the unfevor-
able economic conditions of thecountry, constr~ctive
heclth sork made steady procress dgring the Revolution.
It w8s only the famine which prevailad in large areas,
that did give the hospitals 2nd some institutions a severe
setback. There have been Ermt losses which c8n only

111 the provinces tho hospitnls were of course

262.-

be mde good again RS the economic sitimtion slowly
improves.

      The principles upon m-hich rill honIth work
is bassd ?,nd to which it largely owes its snccessful
development nre $3 follows: unity of all health activ-
ities as concerns loadership, control, nnd administra-
tion; the giving of all kinds of help mithout coet;
the encouragement of high standards arid specializa-
tion; close relations with the people; preferred
treatment to insured people and members of their
families; active participation by labor arid agricul-
tural organizations in reconstriicting health insti-
tutions; hnseparable connection of health work and
sanitation and the same olose organic relation between
mediCQ1 work and social preventive work, especially
through dispensaries.

activities were centralized and they have remained a
guiding influence since health work changed to a local
basis in 1921.

Republics have uridergorle in rec2nt years have not weak-
ened these basic principles, espociaiblg that of giving
amiical aid free of charge and in increasing neasnre to
the working masses, especially the proletariat who are
tha people most in need of it. The active participa-
tion of the I.aborin,n population through representatives
from various labor organizations such cis unions, funda,
and committees, in any decision as to the administra-
tion of hospitals in oities and the similar participation
of the agricultnml population through its representa-
tives in regrrd to hospitrrls in rurnl areas, has been
of grest aid in overcomin&rises and has tended to bring
about the healthy uondition of labor control of hospit-
als, bringing them in very close contact with the people
whom they ar8 intended to serve.

societies whose representatives are not only a help in
drawing up plans, but also in carrying them out.

consist of' representntives of all important industries,
of all insurance activities, and of all organizations
for the protection of labor, make it a habit to treat
their basic question, plan, and expenditure, mhich
has no relation to medical holp, extend to insured

All these principles were in force when health

Sven the firiancial crises which the Soviet

A speoial part is played by the instirance


The working mn's insurance conferences which

263.

people.

labor activities. They understand each other. The
entire net of hospitals is used first and foremost, to
aid the insured. On the medical. side, there is also
cooperstion with industries and insgrotice companies in
that doctors hcv6 to detormino incapability, and in-
validity of laborers. This is done by commissions of
doctors and experts. In providing medical aid for in-
sured members, the contribqtions in the way of insursnce
fees are a genuine aid in providing service according
to looal budgets.
       These cotitribtitions are partly paid for by
the employer who tokes car0 of 4.5$ that are placed at
tho dispaal of the health anthorities, and used for im-
yroving the medical service given to the insnred. Al-
together, the funda from this source cover abont half of
the expenditures for rnedical service, both in and out of
hospitals, accordin to data taken from DON. Schabanow's
"16unicipal Kedical anitnry Work in Rrssia. 19151f

1915, one-third of all cities expended 1 to 10 kopeks
for medical aid psr inhabitant. Another third, 20 to
30 kopeks, u.hile 33 cities expended 60 kopeks to
one ruble which in 1923 would be 1 to 5 rubles. At
present, the insiir~nce contribution 8ver~ge6 12 gold
rubleu. &en GO, tho income from this source is merely
a contribution to the looal support taken care of by the
local budgot and the contribution tht ia used for the
special benefit of insured persons.
       Thanks to the possibility of providing this
special service, the henlth a:ithorities in N ovember,
1923 weri able to maintoin one bed to every 130 persons
in the citaes of Russia. These data were obtnined from
tho questionnaire. In the more important medical. centers
conditions werewen more fnvornble; 1 bed per 100 in-
sured persons including the family. Since the medical
service has beon improved there hnve been about 12
visits to the dispensary par insured person. In all
factory and industrial centers except the very amall
onw, first aid organizations were established,

       The number of plaoes that provide first aid
in the home is greatly increased. By the first of
January 1922, we hnd 448 stations for first aid In the

This provides firm contaot betwean hen'lth and

According to 8 q:iestionni-,ire distribnted in

264.

home and 118 regulpr first aid centers. In the entire
Rnasian Soviet Republic v,-e have one doctor to every
3 9 00 i n ha bi ta 11 t 8 .

aid, conditions are not so favorable, but alwys more
fpvornble than before the War. I am referring to
child welfare, obstetrical, gynecological, venereal,
and ophthnlmologicnl institatioris. !?her= hns been a
great improvement in the field of dentistry and physio-
therapy, but the number of beds for psychopathic cases
has gone down. Before the Revolution there were almost
no govarnrnent dental dispansarico or lnborntories, brit
at the beginning of I924 therc were 1902 government
dentel dispe~isaries with 15?0 dental chpirs not counting
those in the army, at resorts, and railway organiza-
tions, or at tha army and nova1 stations. In the
S.S.S.R. not countiup military dispensaries, we have
1843 government dental. lnborntories with 2298 chairs, 2218
dentists, and 134 assistnnts.

government dental- dispensarias with 1080 theirs, 1393
dentists, arid 62 assistsnts. In the S.S.S.R. there
are 78 speciaL educntional dentnl dispensaries with 132
chnirs and 150 dentists. Rtiral dispensaries exist to
the number of 142, with 154 chairs, 118 dentists, and
8 assistants. All these datn were obtniried by questionn-
air e.

      Government dentistry has become the dorninnting
form of dental rork. Anot her indication of the present
trend is the distinct increase in the most expensive
kind of rnedicnl service, --- physiotherapy. Before the
Tar there were in Russia only 8 small institutes, whereas
at present there are 32 government institutions  for
physiotherapy with 1500 beds, mostly organized driring
the Revolution. Fifteen of the 24 nen-ly opened physio-
therapy institutes were founded during the Revolution.
Ahong these are a number of model institutions such as
the Institute for Physiothernpy pnd Orthopedics at
JIosco~, the Tranmatologiml Instil-11.1 e in Geningrad * the
Institute for Phgsiotherapic treatment in Sebnstopol,
and the Radium and X-Ray Institute in Lenir:grad, all
of vfhich are used in the first place for the insured
popolction. For nervous patients we have at present
over 1500 beds while before the YRr we had only 8 few.

achievements in the field of sanatoriums and health

With regard to some special kinds of mediccll

The insored population is served by 822

I cannot desist from mentioning a few of the

resorts. There are a great mny sanatorium beds and
health resorts which, before. the Far, were totally inac-
cessible to the masses and ere now largely given over to
the insured population.
in the Caucasus and at several other places in the Repu-
blic are doing important work in recent yeara.

        Our sariatorin and health resorts to which we
shall later devote a special article, occupy an import-
ant plaoe in the system of health service which alms at
the reatoration of the incapaoitated laborer.

yractioal nativities in hospitals and other institutions,
especially those for physiotherapy, are 0-uestions of
labor, principally the problem of restoring the laborer
to his work as quickly as possible. The whole net-work
of hospitals at the servioe of the insured population,
considers it its prim duty to be a meatis tovard promot-
ing labor condition8 and health among laborers. The
problem of yraventing oaoupational diseases will be
studied oarefully.
     Hospitnls are beginnirig to occnpy 8n important
plaoe in the campaign against industrial diseases in that
they try to ferret out the caiises of the diseases which
they are oalled upon to handle. Activity of this sort
brought resnlts in some of the large centers althouch
it still siiffers from lack of well-prepared doctors 'and
adeqnate meens. One of the tasks of Soviet medicine
is that of trying to popul-arize the methods of treatment
used arid advocated in the dispensaries.

medicine to be a social prophylactic one. The unit which,
as a rule, consists of a dispensary and a hospital, is
the means by which social hygienic knowledge is broiight
to the rural population. It is one of the bearers of
health education. It organizes the. campaigns against
tuberoulosis, vencrwl ciiseases, trachoma, and alcoholism.
It does child welfare work, treats mothers arid children,
and takas oare of rnentpl cases. It forms the clearing-
house for all autonomous activities of the agricalttiral
population in the field of health. In other words, in
our system, it is one of t'he o-itposts of health work
among the peoyle. Its duty is to perceive the presence
of henlth dangers and to give the alarm at the proper time.
It also aims to apply all its means and powers to the
prevention of diseases nad to a systematic protection of
the health of the people. The fundamental principle

The health resorts in the Crimea,

Oooupying the center of both scientific and

In the same way, we conceive the task of rural

266.

assliring tha 8uccess of 'this aork is the urialterable

rule of giving medical aid free to the rurel population.
       30 maintain this free treatment, the Republic
has had to, and still must make the greatest sacrifices;

nfter the difficult blockade years and the continuous
civil war, we still managed at the boginnin$ of 1922 to
hrve one bed for every 381 persons instead of one per
649 as in 1913, the territories covered being identical.
Districts under medicpl supervision hnd increased 41.2,;
at the beginning of 1922, and districts under llfel-dscherw
had increased 46.8$, and the number of beds in hospitnls
47.4$.  The number of people per hospital hnd decreased
E~B& 39.56, and the district served by each hospital
had decreaaed about 24.3$ (16. b 1 sq. versts).  The radius
had been decreased by nboat 13.$ (28.8 versts).  In the
oities there were 79 people to one bed, In rum1 dis-
tricts one bed for 1035 people. D*;lrine the financial
crisis and in connection with tha transfer of all hospit-
als to local budgets, the hospitals, in the rnral
districts, at least, suffered some losses. Eonever,
there was still more servioe than thera had been before
the War,

       Although the municipal hospital sitnation ia
in a comparatively good condition, it must be admitted
that rural hospitals due to the War, famine, and inter-
vention, are in a pretty bad condition. The lack of
repnir, equipment, instrumenta, laundry, mediciiies,
bandages, heat, an3 supplies, vchich frequently prevails
in rwRl hospitals, naturally leads to a'decrease in
attendanoe in comparison with cities, where hospitals
are very well nttended. Under these conditions, it is
encoilraging to note that in 1922, 71.6$ of the attend..
r?rice was at hospitals, gn? ?R.I$ consiilted for medical

$3&iwm registered 8t the fatter.

and rriral medicine, conditions are still far from ideal.
In the cities, there are not yet enough hospftnls to
satisfy req~iremants, especially where specialties are
conserned. Fowever, in the oities a gigantio task ha8
bear] accomplished compared with what has been done in
the villagea. This is explained by the peculiar condi-
tions in tht villages are much more backward, retaining
the ctilture of the former reeirne so far as poverty and
bad roads are concerned.

?id, T'h9rW3S in 1913, @&&,

ttbhd&' hos~ij.~~ 9' knd'jt

As can be seen in the fields of both muriioipal

267 o

      Helping the rural population in every way
and tying up villages with cities, are the problems
of the day. In health work less cooperation is obtained.
from rural areas which, however, consent to have the
State bear the cost.  The Peoplels Bealti$ommissariat
has worked out a series of measures aiming at the es-
tablishment of a net-work of rnral hospitals. These
measures will form the basis for a decree aiming at
the improvement and extension of medical service for
the rural population.

rection, the rate of progress dependingexactly upon
the restoration of economic power. But we have obtained
a firm foot-hobd in this field and will never give
way became proper health work among the agricultural
population In a country chiefly dependent upon agri-
cdtura is the guarantee of economic progress. Putting
the health vork among the proletariat and farmers on
8 social hygienic an3 sooial prophylactic basis, gives
us the data from Lvhich we can lay down the general
principles to be followed in the organization of health
work in general.

Only slow progress is possible in this di-

VIII. Health Resorts.

Soviet Rusaia, extending PS it does from

the Baltic to the Pacific, has aany nnd variotls mineral
springs, salt lakes, rndioactive mrehes, climtio
resorts, warm sea baths, and finally kumys resorts
beyond the Volga steppes. Mnny of these are fnmoue even
ootside Russia, such as the Kinera1 Springs of the
C8ucasvs, the EsgentukP Alkali Springs, the Believeral
Alkali Wells at achelesnowodsk and the Snlines at
Tambuekan. There are also the Salines at 0des88, the
south-coast of Crimea, where is the All-Ruasian Con-
valescent Isope In Crimea; the Black Sea coaat at Kuban,
with its climatic resorts open the year round at
Sotschi, Ga ry, and Suchurn; the Darasum Carbonio Acid

Turkestan,'and so forth. These resorts were nntional-
ised by the Soviet Government by decree of April 4,
1919, regardless of who the former owner waa, and 88 a
result the most valuable and famous among them are
government resorts directly administered by the Commise-,
ariat of Public Health, there being 40 such reaorts
funotloning at the preaent time. The rest of them are

of Only looal importance and are administered by the

.Sprhgs in 5 ransbaikalia; the mountain resorts in

268 .

provinoial or county authorities of the Commissariat.
All the resorts have been placed by the Governmerit at
the disposal of the entire body of workers. Funds ere
furnished by the Government for building, sanitary, arid
administrative requirements. The resorta that mere des-
troyed during the war have thus been rebuilt and put
into oondition, together wlth imperial and private
oastles, the country homes of former dignitaries and
rich cnpitalists, and private sanatoria. All the the-
r~pe!itic equipment in the form of baths, electrig and
meohanioal apparatus, etc,, hFls been renovated. A large
amount of agricul.turnl land has also been g1t.m to the
resorts for their support. The indnstrial and insurance
groups, the. unions, the co-operatives, the trusts assist
the Government in putting these resorts to use by organ-
izing societies that provide free attendance for their
members arid for workers ond employee's in their shops. The
medical department of the arrny hs also co-operated with
the resorts to provide similar facilities for the members
of the Red Army.
      Since the existence of the Soviet Government,
227,860 patients have been treated in the Central Govern-
ment resorts, and this only cioring the summers. The table
below gives deteils for the different gears:

New

Year BZ.

--

1919 1,840 4,990 - - - - -

1920 21,024    48,435    519,542   25'7,600  255,803 1.,2&,370  21.2
1921 29,790    66,515    647.3'79   220,333  514,587 1,392,299  20.1
1922 14,367    28,167    230,313   48,688  273,796 603,287  23.7
1923 22,355    79,735    739,406   308,272  936,530 1,984,208  24.8

These figuros give an indication of the great

extent to which the attendancy'of workers, soldiers, and
others at the resorts has inoreased since 1920. This increaei
ooinoided with the increased territory of the Soviet
Covernrnent, when the minercl springs in the Cn~cast~a,
the Snlin,es at Odeaaa and the Black Sea resorts became
part of the reyablic. After that, when the White Army
was driven out of the Crimea, grert numbers of patients,
most of them workers, were for the first time able to
enjoy the southern climate, sen batha, grppes. Aa the
table shows, the greatest Increase in beds took plaoe in
1921, and the whole period of inorease was exactly daring
the years when oonditions were at their aorst in the whole

269.

couritry, due to the tu.0 years of civil war, the epidemics,
arid the famirie. 66,500 patients were treated and recsived
not only treatment free, but lodging, food, and the trip
both ways. The patients were trken to the resorts in the
sanitary trains. ?he year after, 1922, only half as many
patients could be received, due to the chanp to the New
Economic Policy. Powever, the number increasod again in
1923, in spite of the limited funds the Cornmissaria+ was
able to allow the resorts, so that the 22,355 available
beds served abotit 80,000 persons, although the new beds
for the year were f'a~.in number.
       The degree to which the CentraP Government
resort8 are used by the'people, at the expense either of
the Government itself or of the insurnnce or indw3trinl
eocietios, is iridicnted by the foct that 51$ of all the
patients in 1923 received treatment at fovernment expense,
32.3$$ at society expanse, rind only 17.65 paid their own
wa y .

      The slogan of the health resort administrations
is, "The haalth resorts for the pctive v;orkers", and the
commissariat for Pitblic Health ,?lakes every effort to keep
these iristitutiona at the high level, v.;hich this purpose
requires. Nodel institutions, of which thore were absolu-'
tely none, have been areated to study systematically the
riatnral' therapentic agents of the place and indicate their
[me. There is thus a Bclneological Institute at Piatigorsk
in the Caucasian mineral region, an Irlstitute for Physio-
therape3tics at Sebastopol, under Professor Setchenow, a
Ealneologicnl Institute with n clinical department at
Tomsk, a National Tuberculosis Instittlte st Jalta vith 200
bebs, and another at Kolosvar with 50 beds. These last
two Institutions do clinical work not only in their own
depart merit^, but in children's sanatoria for bone nnd joint
diseases, such ELY the Alupka Sanatorium with its 125 beds,
the one in Geledschik with 100 beds, and also the one for
all forms of tuberculosis at Utsch-Dere, near Sotschi, that
has 75 beds. The work of these scientific model establish-
ments, that are located right on the spot, Ds under the
immediate direotion of the central scientific health
resort commission of the Commissariat of Public Ilealth,
that has attached to itself all worth while souroes in
this field. This commission runs a oentral resort clinic
that studies the CharQCteristiCS of the different localltiea
and trains hy icians for the w rk in a special tw -year

course.

Poyycfinics were openel last year in all !he most

270,

important resorts on account of the great need for
bettor med.ica.1 service at such plnces, and the most
highly qualified professors Rnd specinlista were ob-
tained for the purpose.
       Phys i o t he rap 817 t i c  i ns ti tu t 8s  a rid  i ns t: i t ut e s
for light, electric, X-by, and other treatment, and
dipgnostio laboratories have for the same reason been
added to the most important resorts. I shnll not stop
here to discuss the scientific research beine done
at these model institutioris, except to point out the
siiccess achievod by the use of kumys (horae milk) in
the treatment OD tnberculosis, a method of treatment
tb.t has received too little attention, in spite of
having bean known a long time. Professors Gormitz
and Wlasovo, who are doiri? bacteriological work in the
0renb:irg hboratory in the 'E'hirgiz Republic,, hRve
found a special gas-forming agent of kumys, that they
hnve called Bacil-lus Oranborgi, in tha cream of this
horse milk. Sinoe then it has been possible to mnnu-
facture kumys, this irreplaceable agent tigainst tu-
berculosis, artificinlly in that whole section of the
country, instead of by the old primitive methods, thus
guaranteeing its qnality arid cleanliness. The health .
resort offioials have succeeded in carrying out two
meaawes that were necessary on account of the lack
of places in the resorts and on accouxlt of the poverty
of the country-nnmely, to see to it thnf only those
who are in the greatest need of such assistrnce in the
entireU.S.S,R. are ndmitted to the resorts, and these
only if they belong to t,he real vorkinp populntion.
ETeolth resort committees were nppointed for the pur-
pose in the di+ferent provinces nnd largo cities,
composed of two or three speciaJists, togethar with
l?bor representatives. T,arge numbers of physicinns
whose ciistricts lie sritirely orjtside the resort locnl-
ities have also been drnpin into the work to assist
resort specialists in the task of choosing the most
urgent cases arid send them to +he place that best
me et  th ei r r eq ui r ement s .

        The Soviet Government has no comqerc81
interest in the resorts, but is simply actmted by the
desire to furnish the workirie population with these
advantages that were formerly nvaibble only to the

271 .

rich.
years shows that 83,0 of all. those who were ndmitted to
the resorts have been discharged either entirely cured
or nearly so, feeling perfectly well and able to go
back to their work. It also a pears from the records

ment, was Qchif3Ved in the resorts giving mud bath and
kumys treatments. These statistics must, however, remain
fairly subjectiva and unscientific, dealing as they do
with such objective facts as the determination of cure,
improvement, or the contrary. The lnst congress of
health resort physicians therefore decided that scientific
means should be used to determine the physical end
psychic conditions of the ptients, and their ability to
return to their regular occupations. A special commiss-
ion is at present working on this qvestion find will soon
be nble to publish its findings.

the Soviet Republic, based on the use of the health re-
sorts by all the workers and on the improvement of
methods of treatment, could not heve tnlren place without
the co-operation of all the rorkers, both in scientific
and praotical lines, In the resorts themselves. The
reeultG 09 this co-operation were revealed at the four
congresses of health reaort workers tht hnve been held
in 1921-1924, the hst one on Janmry 8-15, 192A. There
were 240 delegates at this convention, consisting among
others of 26 uriiversity men, 174 health rosort physicians,
end 30 other speaialists. !?he congress listened to 102
raports And voted for 100 resolutions. A nomber of decis-
ions were tnken on queation of orgnnizntion nnd scientifio
methods, and many of the reports dealt Kith methods used
in mud baths, physiotherapy, kumys treatment, etc, I
shall not go into details as to the transactions of the
congress, on acoount of lack of space, but wish to point
out the enormous importnnce of the discns6ion. of improve-
ment in this field for the enormous territory of the
U, S. S .Re

with the slogan of "The heolth resorts for tha workers",
together with the active co-operetion of physicians
arid uriiori representatives, served a8 a bas18 for B wide-
spread cnmpnign of literary propaganda, and much plaoe
was given in the city and provincial press to disousaions

A compilatio; of the figures for the past few

that the best results, with 83,0 3 cure or great improve-

This reorganixntion of medical service in

A11 the work done in organizing this field,

272.

on the advaritages apd disadvantages of the measpires under
consideration. The need was soon felt for a sped81 profe-
ssional periodic31 in this field, and the central office
therefore began the publication of the journal "Health
Resorts", in 2923, This journal contnins sections on
the scientific, administrative, and other aspects of the
snbjact, as well as notes qnd bibliographicnl notices
from Russia and foreign countries. Twelve numbers
appeared in 1923, containing between 80 and 100 original
articles. Five numbers have 90 far appeared in 1924,
mch one with a brief Cermen srimmry of the oripinal
articles, Aside from this regular pub1 ication, there
are irregular onas appearinp from time to time that
describe the sub$ct. Among these is the reference book,
"The Health Resorts of the U.S.S.R.", published in 1923,
with 350 pages, rlnd offering a really scientific dea-
cription of the different locclities. This yar the
Government Printing Offico has published a number of
separate pnmphleta that are well prepared qnd richly
illustratped, such as, "The Henlth Resorts of' the Crirnaa",
r1131ack Sea Resortsr1, "The Resorts of the Ukreinefr, "Guide
to the Resorts Giving the Kumys Treatment". "What Are
FTealth Resorts nnd How Are They Used?1r by Profeasor
Semashko ~ud others. Individunl rasorts had al-rcndy
published previously "The Eeal th Resorts of Siberia!', and
"The Henlth Resorts of the Far Eastrr. The scientific
mork done under the direction of the central burenu re-
siilted in R number of ptiblications of the separate in-
stitutions. Thus, the work of the Balneological Insti-
tute for the Caricasian ILLneral Spring8 wa8 described
last year, while this year there appears the firat vo-
lume of "'?he Xubsno Blnck Sea Tuberculosis Institiite". A
large number of separate pamphlets on the whole subject
have elso appeared during the past few years, such 3s:
"The Climnte Treatment in Suchumrl, by Professor Meser-
niaky; !!The Climate of Red Poljanarl, by the meteorolo-
gist Selenin; !!The Tarm ILIneral Springs of Xu'Ld!irslr",
by Trofimovitch, etc. All these piiblications help to
shov; the great interest of Soviet Rvssia in the immdiate
rshPbilitatlon of the health resorts, BR also the
scientific research done in this line nnd its applica-
tion to the welfare of the workera.

278.

IX. IXIICAL EXJCATION .mn CRATIUATX r*wmc~Ion.

Medicrl education ns zt present carried on is

very different fron what it nas before the revolution.
The most import~rit, points in which it differs are the
large number of medicnl schools, the chrnge in tho com-
position of tho student body, nnd the raforrns in the
teaching program in the way of el-osar 8daptRtion to ~PC-
tic21 life end the present state of medic,cl science. Urijl
1914 there existed in the territory of fhe p~QSOtlt U.S.S.R.
only fiftean medicel schools, eight of them belonging to
the State rnd seven to variorzs private persons or irrsti-
tufions. Nine (?) stnte schools wer,: to bo found ~ithin
the limits of the present R.S.P.S.R., ana four public (?)
and private ones. The relatively large number of privclte
meb0ical schools was due to the f8ct thpt admission to the
goverriment schools(1Ledict-1 %cgltios) was limited, in that
only mnle. persons having obtained the bnchelor's degree
viere admitted; women were not admitted at; all, Jews only
up to three percent of tho total, etc. The removal of
these prohibitions after the Revolution nat,wPIly result-
ed in 8 great rush of young people eaeer for admission.
The valls of the existing instittitions could not contain
them all, Pnd rnedicnl schools grev; up like weads over the
whole country. The lack of physicians ~lso added to the
irrcrease in their number. On January I, 1924, there
vier3 thirty rnedicnl facnlties Pnd institutes in the U.S.SR
23 of them in tho R.S.F.S.n.
      The growth in the number of higher insti-
tntions of lenrning Qnd tho students Pttending them WRS
mostly of an inchoate, nrjorganized nzrtnre, so tht it: had
its dark 8s well 88 its bright side, although it proved
to be positive good in the end. The overfl-ov of students
wa3 so great, pnrticularly in the lowest classes, that
thQ practicrl departments, such as laborotorles and diss-
ecting rooms, could not keep up with it, while the lack
of financial meens, equipment and qualified teachers
hampered the growth of the schools.

to bring about pn orderly development. The number end
nature of the students was the first point of attnkk. The
number of stndents hnd to be carefully limited to the
cnppcity of the laboratories, clinics and institutes,
and this raised the point of how to choose among the

This had of course all to be chsnged in order

271.

hordes of stndents seeking admission. The social clnss
of the student wns chosen as the principle lipon which to
base admission, for in a State of peasnnts nnd workers
the first place must be ceded, in institations of lenrning
as everywhere else, to the pensarits c?nd workera themselves.

thus been greatly altered, for while it consisted mostly
of the bourgeoisie before the Revolution, it is now formed
almost; entirely of the proletariat. The Government is
doing averything in its power t'b mke admission easier for
the workers nnd their children to the institutions of high-
er educetion, that were previously closed to them. Funds
for scholarships are furnished by the State, and during
the ourrent year 8671 medfoal soholarships hwe been dis-
tributed in tho R.S.P.S.R. among 32,136 students. The
professional societies and the unions also furnieh large
amounts for the sama purpose. So-called Torkers' Fkculties
exist in all Inrge cities, to give their workers an oppor-
tunity to acQtiire A hiphar ediicati on, these fnc 111 ties
pr6paring workers who so desire for rdmission to the
unitrersi ties.
       We hope thpt this system of ndmission will
rsoult in the form8tion of the kind of medicnl men a
proletarian State needs, men who are prt of the proletar-
inn nnd pensant populntion, acqoninted vith its mode of
life and it8 needs,
       The whole net of medioal institutions is being
CnrQftll.lJ7 studied. As mentione& above, the number of
schools increased in rer;ponse to the need for physicinns.
But the demobilization of most army physicians and the
decline of the apidenics has decreased this need so much
that we now find mqny unemployed physicians in the large
citiea. On the other hand, we are unable to iricrease the
number of medical institutions in the villages as quickly
as we would like, on account of the latterst material
conditions and manner of life. We are thus foroed to
bring the number of new graduates and the country's requi-
rements into hnrmony, and previous calculations have shown
that it is possible to limit tho number of medical fRCUtti88r
      Tho plan in limiting the number of medioal soh&
will be to distribute them as evenly as possible ever the
whole country, Smcial emphasis will be placed on keeping

The social composition of the strident body has

medicel schools a i ive snd helping them to develop in the

276.

rarnote parts of the couritry irihnbiyed by nntional
minorities , v.here medic91 sarvic o XRS for:na-ly emtirely
la c ki n e;,

cussed in Russin oven bafore the v,ar. 3vt the ckqnge
tht took place in the coilception of tha rint;!ire of medic-
nl. service mlt;h the RGvolution, prevontivo vaiiicine
tc?kirig the first plrce *rid cRlisiiiz the iricrensed deve-
lopment of mternitg nnd infsnt and child v!el.fnre
cent0r.s snd of ooritrol viork of socinl end professional
diseases , this chnnge demnnded nea 1rnonl.edge Pr0.n young
physicians , pnd ~7.~0 n mi methods of teaching.
       The p7.nn of studies approved in 1922 differs
frorn tho one of before the war chiefly by the increnGe
in t,he number of subjects. Few required colirses mere
added for social hy?iane, rirology, ear, nose ,grid throOr7t
diseases, infections dismsss, odontolog, tocethor
vith optionnl. courses in X-Rny thornpy, rsdiology,
physiothorope:itics, etc. Slthosgh thla cilnngo di? brine
with it sone improvements, it did not. solve the problem
of ths reorgariixPtiin of :ii3iiccil. st mlies, brit, rntiier
accentuptad the faults of the old pl.n_n thpt lay in the
too large number of coursos cI1d t.he over7,vorkirig of
s t 11 dent 3.
        A raforin of medicnl educetion is at the
present noment; beiiig workad out in co-operati on rAth the
Stnte Scientific Qoard, the main lines of the nett system
beirig as follma:

irito fiftaeri t,hree-rnonth terms. ?he first two jmrs
are prepnrFtorg, grid will be chiefly devoted to morliho-
logy nnd biology, 1.vhil-a tha rewinifig three yon.rs will-
deal with the specificnlly medical course. ZectlJres will
be 8s fen: ns possj blo, v;ith a ;re?t incrwse in t.he me
of tha seminer method, laboratory sori: t-,nd other pract,ical
exerci8es. The nmourit of morphology required In the
preparatory years v3l.l be deorensed a11d biology pro-
portionata1.y iricrensed. The purpose of instruction in
the ;nedic?l period !vi11 be to see t,o it that, every single
strident does active xork in the lnboratories, clinfcs,
etc., so 2.6 to obtain tho greatest possible direct skill
nnd experience for. independent, work,
       &iring the lrst tvio years the courses piven
at the same honr of the dag hnve been mqde as few a8
possible, and the number of stvderits iri epch course

X reforrr, of medicn'l adncction hod been Cis-

The five ye?r coiir'so rill be rateitled, iiivided

276,

increased, in order to save the tine wasted in going
froin one clinic to another ?rid give the st:~derit~ a chance
to become real1.y fanillrr with the pork dona in any one
place. In this way tho departments that hrvc to be cov-
ered during the last tro years wi1-l not, a6 formerly
hgvc their coursas spaead out simtiltaneously, over the
whole period but will offer them in n regular ntid logical
series.
       GOcturos in clinical departmants Tiiill have
to be intinntely relatad to the studies carried on in
professional sociology nnd economics. The social and
economic stntus of every patient must almngs bo included
nt his clinical prosentation. The study of sociel and
experimental hygiene will be greatly enlareed. A pro-
posal is ot present under considerPtion to arrange
coursas in the medicnl faculty accordine to the group
pri tic ipl e.
       A decree of the Council of Peoplefs Commissars
has made one atimmer term of prnctical rork oblipatory
for University students, including medicnl students, in
order to give them more trpining. In the Ukrzine a. whole
year of prectice is required Por obtaining a medical
license. The question of this required year has been
discussed by the Conncil %or the v,hole R.S.v.S.R., but
the finnncinl aspect has male it necessary to pive this
up for tho present, as at 1enst SO~Q of thc? stndents
siould hpve to be given scholarships to see then through
this additional year.

only chznges in programs and methods, but ?Is0 in the
spirit of the education given, cannot be rapidly accom-
plishod. Rut we are convinced thnt our medic81 schools
will improve from gar to yenr, pgrticulfirly PS `heir
material position becomes more secure.
      ?owever, ths reform of medical schools alone
v;ill not entirely solve the problox of medicfll ediication,
The training of specialists is not the field of the
medical school, but on the other hand science is COLI-
tinually making such enormous strides that it is very
hard for the practitioner in the provinces to keep up
v;ith its latest advances. This brings to the fore the
question of grndnnte instruction, which is of very
special importance in ~USS~A, on account of the short-
coursc physicians that were licensed during the war nnd
the revolution (1915-1920), and for the sake of the
physicians in remote districts vhich even Russian medical
liternture has difficulty in reaching, white foreign

Utjiversity reform, irivolving as it does not

277.

literatura yrrcticelly never eats therr: at all.

      Tho necessity for making physicians acquaintQd
with the Soviet institfitions such RS nurseries, maternity
canters, forest schools, tuberculosis and venereal
dispensaries, the number of which is continually increas-
ing, is what makes it of such importance to get them to
take continuation coursefi.

      The Council of Commissars, recognizing the tre-
mendous importance of such action, took up as soon as poss-
ible the problea of organizing this instruction OII? Q large
scale. Courses were ,niven in 1921 when canons were still
ronring in the civil war and epidemics were sowing down
the population, for all physicians viho had praduated in
1919 and 1920. Theso men were transferred from the pront
and the provinces to Koscow, where they worked for six
months, to retorn after thrt to their former posts. Even
wrlier courses hnd baen provided for trainirig physicinns
in the new fields of Soviat medicine nnd ns specinlists.
But no stable organizaflon vms given this nark until the
Butumn of 1922, at which time reculnr credits were esta-
blished for the support of 600 persons to be trnined 8s
specialists at government expense.
       A more complete training is being given phy-
sicinns at present in the fol1o;'Jing manner. The great
majority of them take tho course nt $he State Clinical'
Institutes for Graduate Iristruotion at Tkmingrad and
Bizan. The former was founded about forty yeart; ago, is
well equipped, has large clinics, a fine big library, and
is able to take c8re of a large number of st!iden+;s, one
thourjland having comploted its course in 1923. There are
twenty-six chairs of instruction and over one hundred
rnd fifty courses fiver] by docents. The Clinical Institute
at Dzan is still young, but although founded in 1920 it
has already a fine reputation among the physicians of the
eastern R.S.P.S.R., and handles a few government shholar-
ships that permit it to send physicians to other places.
Physicinns are required to return to pmctice at their
former posts on completing a continuotion course. They
rismlly obtain a three months' leave of abaenae biit they
c8n get one for a longer period. Aside from these clinio-
a1 institutee, there exist a large number of government
institutions for training physicians in the specialties.
Physicians obtain leaves of absence to attend them either
for special training or scientific work. Such institutes
at Seniryrad are the Institutes of Experimental Pledicine,
of RRdiology, of Physiothewpantics, of Gynecology and

275.

Obstetrics; at Koscow, the Institiites of Bioloeical
Physics, of qiol.ogicP1. Chemistry, of ?hjsiolun.

of Liicrobiology, of Sonitsry Control, of Snnitntion and
Hygiene, of Tubercnlosis and Venereal. aiseases, of
lkternity and Infant VJelf3re, of Physical Cal.tnre, of
ETedicnl Pediatrics, of Physiothernpsutics and Ortho-
pedics, etc. The Bacl eriological Iristitut e at Rostov
is p8rticularlg interested in mrml'yin, and the 7:icro-
biological Institute at Sarstov is the center for xork
on the plague. Most of these institutes dispose of
government scholarships for provincitll physicinns
who receive 1enva of nbbscnce to attend them.
      The Government a130 organized, in addition to
these regulnr courses, periodic ones such RE colirse6 for
sanitary physiciRns, for medico-legal experts, eto. There
is no doubt whetever thrt this kin11 of mork will expand
mora arid more during the next fev. ,years.

Nutrition, of Rxperirnental Biology, of Tropic? ?I! Disenses,

The Soviet GOVer*nmOnt, aw8ro of tho great im-

portance of medical science the bnsis of all public
heqlth reguhtions, hns paid particulnr nttention to
iustitutions of medicnl research. The Commissarin t of
Public Henlth hps been able to support +he Institute of
&perirnental Medicine in T,eningrnd, tht vms already in
existence dnrine the old regime, together Kith 8 whole
group of bacteriolosical nnd clinical institates. It; ha
also founded a large number of new scientific institutes
covering an extensive field, has nlmys kept them in mind
even in the worst periods, and has dovoted more and more
funds to thern as the general Pinnrtcial level improved.
prid the Institute of Si oloFicsl Phy sics at 1,:oscomr are the
most important of tb ,e Soviet Government's creations in
this field. The aim of the Commissarint of Pnblic Yealth
in founding them m-as to create 8 scientific center in
whioh various public heplth problems could be solved and
genarnl lines of action for public health preservation
lsid down, aside from the striatlg scientific research
~ork to be done. The intensive work done alone such linea
in the various institutes of tho Commissariat is evident
in the publicntions that have appeared in Russian and
foreien journals and in separate oollections.

or A.A. vlabimirov, director) is the oldest of th 888 inati-

The State Pasteur Institute of Public Venlth

The Instittite of Experimentnl Medicine (Profess-

279 b

tutions, and at orice aalls to mind tho name of Professor
J.P. Pavlov, probnbly tha most f'arnons of living physio-
logists. This great scieritist is cnrrgitig on his work
alons the same lines os for the past twenty yenrs,
mking an absolataly objective stlidy by experiinental
methods of the higher nerve centars nnd their activity.
This Rnssian 3cIentist hRs formulated a doctrine on the
basis of his own experiments 2nd observations thnt
promises to alter all provious conceptions in this field.
The results of this long period of activity have been
brillinntly recorded in Pavlov*s ?'The Res,llts of hnenty
Yeecs' Objective Study of tho IIigher Werve Aotivities
of llnimals (Qunntlties), Conditioned Reflexes. A Coll-
ection of Articles, Reports rnd Speeches". Intensive
scientific research is n!-so done in other departments
of the Institute, such 8s the departman? of Cenerrrl
EUcrobiology, under the direction of tke well-knom
bacteriologist, Y.L. Omlelrnsky. Ris researchos on the
nitrogen fixation and the ferrnent~tion of call-tissoe
are well-known, and a number of his textbooks and
hnndbooks are widely distri nnted. "The t'ou~~dati ons of
Kicrobiolo@y" hrving been translated into severnl
lnngnages nnd publ-ished in many editions. Another
big scientific Pchievement of the Inatiiute of Exper-
imeritnl IIedicine is the mpthod of vasostomy v:orked\ out
by E.S. London, consisting of the Pormntion of an nrti-
ficial passage into the deep blood vessel.s, pnrticu-
larly those of tha abdominal cavity. Other pieces of
work worthy of riotice are those on nrteriosclerosia by
N.N. Anitohkov, on the epidemiology of the plogiie nnd
other epidemic diseases by D.K. Zabolotny, nrid on nutri-
tion by B.J. Slovtzov.

Moscow, consisting of eight diffarmt individual in-
stitutes, is the place for a great deal of scientific
research, all. done with the ide in mind that it must
be not only of theoretical value but closely related
to the practicnl needs of the times. The object of
this institute is to serve the needs of preventive
rnedioine, and the problems with xhich ita workers are
oocupied are of interest not only to medical men but
also to the general publio,

LA. Tarasievitch) is closely connated with other

. The Scientific Institute of Public Health in

Tho State Publio Health Institute (Professor

280.

s c i en t i f i c  in s t i t u t e6  a rid  e st a bl i s hm ent s  b ot h  in s id e
rnd outEide Russia. The Serwn rind T%ccine Control
Institute, one of ita eight component parts, carries
on not only the work its name implies, but also
goes into a great deal of original research in this
line. Of particular interest is the work done so
far in local and non-specific immunity and on ana-
phylaxis and colloid reactions.

         The Ki c r 0 bi 01 opi cn I  In E t i 1; 11 t e ( ?r of es s or
T.A. Barskin) has to o?fer tho xork done by mrykin

and N.J.-Krich on the nature pnd cultvre 03 the"typhus
bpcillus and on the nature of the antigen nnd the virus
in smllpox. One chnrnctaristic of the kind of work
done in this instit;uto is that immunity rnnnifestations
are studied from the absolute physical-chemicpl
point of view.

I. Wrzinovsky) must necessarily den1 largely xith
malaria in n oountry in m-hich +hart are millions of
mr.laria cases per year. ETethods of treatment and
prevention BrQ particularly dealt with, and the ppmctic-
a1 side emphasized. The Institute is connected with
a whole network of rmZaria stetions, and the problems
arising in yractice are solved both by laboratory work
nnd by expeditions. This institnte also cqrrigs on
studies dealing with other protozoal diseases and with
chemotheraus.

The vcork of the Tropics?. Instit~~te (Professor

-7

In the Sanitnry Eypiene 1nstitut.e (Professor

Djatropnov) the klud of work is determined in advcnce
by its-name.
hygiene, conditions of labor, the snnitnry stntistics
of epidemios; thus, interesting material. hns been
colleoted on the periodicity and seasonal variation
of the epidemics.

Studies are mde dealinc v,ith profassional

-

       Tha Tuberculosis Institute (frofessor V.A.
Vorobjev) founded at EL Intor date. is based 0x1 broFd1lp
socioiogicni grounds.  Ita main pirpose is to investil
gqte the condition of the tuberculous ptient from the
point of view of constitutional idiosynorasies and the
nature of the ground upon which tuberculosis has deve-
loped. The patient is also studied in relation to his
occupation, living conditions, honsirj,g, etc.

Nutriti onnl Phgsi ol ogy (Professor M.D. Shaternikov) is

Of special interest at the Institute of

281 o

the v;ork on the results of orie-sided nutrition, 1R:;hich
pushes nside the so-cnlled endrgetic doctrine of n~.rtri-
tion rnd emphnsires tho importrltice of vitnmines by
proving thnt the addition of vit:irniries to I otia-sided
diet immedintely incronsed the Rscirnilption of the
bnsic food stuffs.

The work of the Biochemical Institute

(Professor A.E. Bach)  is of grest inport~tice, yerticu-
lnrly in tha fi old of enx,ymol ogy.  Professor Wch,

the ireetest suyporter*of the theory of cnzyrnol-ogy,
has recently viorked out an absolute1 y orif7inP7 mathod
of determining the qunntity of ferments, such as catn-
lasos, peroxydases, 1-ipnses nnd proteRscs, in +he
srnpllest possible amourits of blooik. These researches,
together with othors thnt open nelr: paths into tha sub-
jeot of ferments, hPve aror~sed great interest rind led
to the founding of B new sciontific school. Another
activity of the Institute vsorth rnontioriing is Ynch's
discovery that the specificity of the atitibody is
determined not by the ferment, but by the accornpsnying
bodies that are supposed to serve 3s tha btter's
carriers.

Bi ol o

da!

Thc! n8me of' tho Institute of Experimcntnl
Professor N.13. :rolsov) would imp1.y that it waa
y my associated with public he?l.th questions,

but it has nevertheless sricceeded in invading the
field of public health and doing much And importFint
work in it. Some pnrticularly interesting pieces of
research of this kind hrvo dwlt viith inhoritanco in
general, with the inheritance of constitntion in man
in particular,'Pnd with sngenics. Tho problem of' the
rolati on8 between tho int ernnl secret1 ons and the doc-
trine of rejnveiiatlon nlso has R large place in the
work of this institute. Reports of the institute's
activities have 91-ready b een pu hl is hed.
       The ionio theory of activation occupies the
first place in the work of the Institute of Bkological
Ph sics (Professor POPo Lazarev?, and consists prin-
* y in the belief that all. processes of activntion
are besed on Rn alterntion in the ionic content of the
tissues, which then change from a resting to an active
state. The Institcrte has formulated a theory of nerve
and muscle processes, as well ns a genere1 definition of

282.

the laws of activation (tha eber-Fechner l-av penergl-
ized). The subtect of brnin activity fron this strind-
point of chemicnl-physical construction, nnd the aabject
of tha brnin centers, their ,,ark ntid their fatit;ua %re
problems with v.hich the Iristifuta is at p: esent occupied?
One of tha Institute's main findiugs in thiv field is the
unfatigability of the brnin centers.
       The People's Coinrnissariat of Public TIenlth has
under its direotion a large number of scientific-prnct ical
institutions that do mostly practicnl work, with some re-
search, quite apnrt from the Institutes of pure science.
SOmQ of the former existed d~iriri~ the old retiice, but they
are mostly of recant date.

Ps chiatrg and Orthopedics ( ProFese ound ea
Y-
a year ago, thnt hns already tariisd ont a great deal of
research, medioal rnd pedrrgogio work; tha State Institute
of Sooial Hygiene (Professor A.V. i,;olkov) , Inith which
are connected a Museum, a perrnaneiit popular educPtiona1
exhibit, and shops for the rmnqfncturo of objects for
visual instruotion; the State bciantific Institute for
Maternal and lCnf8nt teelfpre (T.C. SpcrPiisPyJ, that seeks
the scientifi c solution of the physiologicnl nnd patho-
logicpl problems of mternity nnd inepticy, and also includes
the related question of maternal nnd infant mortality. Many
specialists receive their training in this Institufo. The
StatflenereologicRl Institute (Professor Efron) combining
purely pedagoclcal with fh empentiu nnd scientific functions,
consists actually of two institutes,  the clinicnl. flnd
the experimental, the latter devoted to pura science in
the form of exporimental. studies in venoroal disease.

does soientific and practice1 viork in dentistry, nnd strive8
to make dental service availr,
neurologicR1 Institute (Profe

&coine Institute (Doctor BIorosov), thpt not only prepRres
stock wccino but carries on studies on smal'lpox immunity
and the nature of the virus, nll are located in or near
111 0 s c ow .

The following Institutes are in %aningrad: The

Among the later are ths State Institu'e of

The State dental Institute (Doctor Jevdomikov)

Pedologioal Itlstitute (Profes -

ble to the masses. The ,Ps cho-
ssor Ketchadjev), tha Ked +r ca
sor Gurevitch). and the State

Roentgen arid Rndium Institute (Professor Nemenov), the work
of which is QlrGady recognized abroAd; the Obstetrio and

283.

necologionl Institute (Professor Ott) ; QIJ~ the
inical Itistitute for Srndunte Yediwl Instruction
IProfessor S.A. 3rusteinJ, thnt not only teaches but

does a large nmount of scientific rork. Another
Institute similer to the last-nomad vias opened in
Xasan not long ago. It is called the llTleniil Institute1', .
and is under the direction of Professor Y.A, Luria.

Russia for Microbiology aiid Ep idemiolopy (3 oc t or
mikanorovl, at saratov, is $he most famous of the proc-
tical-scientific iristitutions in the provinces. One of
its mnin objeots is the study of the plneuo find its
control by megns of expeditions and the training of
specialists. Final.ly, there is a whole series of bacte-
riological Institutes that do all kinds of pr-?ctical
Kork, such QS preparirie vaccines nrid ser-, mking dia-
p~oses, etc., nnd some scientific reseprch rs well, but
it is impossible to go into detpils ns to the activity
of them all. The reports on the st?b;ect %re to be found
in n~merons jonrnPls and special public.?tions thnt h-ve
appeared at home and abroad, and give B cleahicture
of the work done in these different places.
tiwl institutions of Soviet Fussin moonld be incomplete
without mention of the Zciieritific X:edfcnl Council, This
Coanoil, in its cppacity as advisory organ to the Peoplets
Commissariat of Pablic Reslth, is closely connected nith
the scientific m&ical life of the country. Kost of the
above itistitutions, particularly the nev! onas , have been
created with the co-operation of the Couiicil, xhich
worked out their regulation. Tho Scientific Medical
Council adviaes the Comrnissarint in everything relating
to publio health regulatiolis throughout the U.S.C.R. thnt
is referred to itself or to the Council of Commissars, .
The Nedical Council consists of twenty-give members ,
appointed anriurlly by the Council (of Commissars?) from
the ranks of scientific medical men, with th6 rieht to
reelection, The perm?nerit active organ of the ICedicnl
Council la the Praesidium, consisting of the Cheirm9.n
(%.A. Tarasevitch, Professor of Rpcteriology nt the
Second University of Moscow), the viae-cheirman (P.N.
Dintroptov, Profeesor of Hygiene at the same University),
and the scientific secretary (V.V. Ivanov, Professor of
Skin arid Venereal biseases at the First Moscow University),

The Provincial Institute of South-Enstern

This brief account of tho scientific nnd prac-

284.

Uuriri~ the past six years the Scientific I.Todic~1
Council. hes expressed itsol? on 8 brge number of
meeicnl arid sanitary quest.i oris affectinr the vho7.e
country, among others the creation ai13 organization of
the medical Qnd research Institutes, qoes+ions of sani-
tation in connection with +.he epidemics, quostions
dealing with the control 07 foodstuyfs, vc?.cciries,
drugs, thernpoutic',:, sern, etc., as well as ;r:it,h their
domestic rnariufactu~-8 or importafion, qunstions of
iegnl rnedicr?l importance, arid so forth.

scientific medical activity, vjhich ,3id not cmse even
durine the worst years of civil :zir, is at presont
becoming both more intensive arid nor3 extensive, and
there is every reasoil to bel-iova that thi4evelopment
will continue to keep step with the gerisral improvement
in economic cunditi ons o

In conclusion, there is no doubt that

Alan Grcggls Diary during trii) to

     Russia, Deooxbor

          1927.

289.

.a o

230.

27.1.

lG*

.3 o

202 o

186.

295.

296.

.

171.

Pavlov .t

d Oantt

1ru o

o

301.

302.