A MEDICAL REVIEW OF SOVIET RUSSIA: II.--HOSPITALS AND HEALTH CONDITIONS
Authors: W. H. Gantt
Journal: BMJ (1924)

IN a previous paper* it was stated that the present economic conditions in Russia, due more or less to the external and internal wars in that country, were the chief causes of the epidemics of disease there.It is now my purpose to describe in more detail those conditions that gave rise to such widespread disease, and to discuss the role of the hospitals in this perliod.At the expense of repetition we must make some mention of recen-t events in Russia in order to understand the present morbid conditions.Even the extreme optimists cannot deny the effect of war and famine in producing disease.Whatever predictions may be made for the future of Russia, we must admit that the present health of its people is worse than fcrmerly, and that the late conditions there cast a fearful shadow over the future health of Russia, in spite of all that the Soviet Department of Public Health and relief organizations have done.The disor'der of war and revolution in an already dis- ordered country like Russia was sufficient in itself to pro- duce wholesale disease, but when three years of extensive famine were added to these factors it is small wonder that there should have resulted epidemics of a magnitude unrivalled in modern history. GENERAL HEALTH CONDITTONS.Although 80 per cent. of the Russians have probably always been undernourished to the same degree as or even worse than the poor of otlher countr ies, as they existed chiefly on black bread, and tllough the food shortage had become progressively worse since 1916, there was not starva- tion until the drought and famine years.tThe year 1920 was probably the worst; then millions were starvinig and nearly all the population was seriously undernourished.Dogs, cats, horses, camels, and even rats were eaten in 1920, 1921, and the winter of 1922.Int some places cannibalism existed then; quite frequently dogs and men could be seen in the streets of Leningrad fighting over the carcass of a h1orse.On many occasions I have seen people eating roots, wild berries, the bark and leaves of trees, and " bread" made of dirt, grass, and dung.As late as July, 1922, I saw personally two cases of cannibalism, and in September of that year, in a village of South-eastern RAussia, in twenty out of twenty-five huts I inspected at random there was one or more personis actually dying of starvation, too weak to get up.The year 1923 was much better in regard to food.Several other factors accelerated the spread of disease- namely, the lack of clothing,+ dirt, overcrowding, and the refugee movement.Most people in 'Russia have had no new clothing for seven or eight years, and have had to sell part of what they had for food.Owing to the lack of soap and hot water, bathiing as a cleansing process was nearly altogether disconitilnued even by people who were normally neat.Most of the public baths had to be closed for lack of fuel anid repairs, so that in 1919 they operated only one-seventh as nmany days as formerly, and (according to Dr. Sliamoff) "bathing was never popular in Russia."Overcrowding is still a serious problem.The destruction ofhouses bycivilwaror forf uel, anld the lackof plumbing