MEDICAL EDUCATION IN RUSSIA

 

INDE X.
Gregg, Dr. Alan
Diary of Russian trip, 1927

* Report on medical education in Russia, 1927.

Map

See Appendix page 32a

* Preliminary report prepared by Paris office, 1927

See Appendix
Public health administration in Russia

Semaschko, Professor N,

Public health system of Soviet Russia

* Has its own table of contents.

Va RAL amscass Rervort FOR Var

285.
l.

201,219.

219.
INTRODUCTORY RESUME .-

 

As a condensed statement of the broader and more
important considerations to be borne in mini in the study of Russian
conditions I would like to present:

A) some general remarks upon Russia;

B) comments upon the limitations and
validity of this report;

C) the principal circumstances and

characteristics of medical oducation
in Russia at present.

A. General Remarks on Russia.

1. Russia is a name - and like many names it covers more than
it explains and implies a greater diversity than can be enumerated
or described. On reflexion you cannot dismiss the importance of the
size of Russia in land and population, on even superficial acauaintance
you cannot forget the variety of peoples lanvuages and castoms within
its boundaries. It camnot be described in terms of Western Evrope or
America just as its languages cannot be conveyed in our alphabet.
One sixth of the earth is in Russia and more languages ara spoken
there than in all the rest of Europe. The effect of this immense
variaty is heightened by the great distances and the resulting costly
communications and yet it is an entity - controlled politically by
fifteen or twenty men and treated by the rest of the world as a

(1).- The policy of the present government has been to tolerate the
regional differences of language, culture, and local govern=
26

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'
cartain historical changes common to Western Zurope. Russia never
passed through a Renaissance and never knew a Reformation. For cent-
uries it was governed by a small clan representing the church and the
nobility. ‘the tradition was of a government passive of (or at least
ineffective before) illiteracy, social oppression, and inequality of
human rights. There were almost no great social reforms up to 1917.
And so the traditions of the Russian are radically different from the
West - so different that Russia and Yestern Europe have at bottom
extremely little in common ~ I say at bottom for the veneer of Western
ways was forced upon Russians by Peter the Great and his descendants
and if the veneer has cracked 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 Western Europea. We must break
little laws if we are to see the big laws in operation; we must cast
aside small 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, which are important
to us. We must distinguish between the makers and figure hsads 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 essential:sources of power,
Se

uniformly different from the rest of the world. If the terms and
quality of the Russian's life are peculiar, the problems of contri-~
buting to his welfare must be considered in the light of these
peculiarities.

3, A war, disastrously mismanaged, a revolution radical 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 countries have known any of these afflictions ami none has
borne the staggering losses in wealth,men and social stability that
have fallen upon Russia. This is the course that has been run. The
after-effects are apparent everywhere, From many Russians one gets
the impression that these after-effects are not considered merely as
the fruit of Communism but as the result of conditions in chich
Communism was a part. In any case it could be maintained that such a
sequence of war, revolution, famine and disease entail almost irrepar-
able loss quite apart from the type of Government. Indeed the strength
(and wealmess) of the Conmunist Party lies now not only in their de
facto control of goverment but in the belief of most Russians that
no radically different form of government could be good enough to make
up for the incalculable losses of another revolution. I do not think
the Soviet Government is a success nor Communism workable, but the
Soviet Government cannot be judged solely by the fruits immediately

visible - they are ths fruits of war intervention and famine as well;
4.

The revolution began in the army and in the cities but it took a special
form almost contemporancously 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 destruction aml stealing,

but only gradually (and at the instigation of the Communists) were
ideas of legalized redistribution of land believed and practised by

the peasants. In October, changes had gone so far that the leaders of
the industrial and urbdan proletariat of Moscow and Petrograd repres=
enting a small but hard aucleus of extremists who knew what they

Wanted and aided by previous ferment in army and navy, seized the
essential machinery of government and obtained eventually complete
control. But,more important, the October revolut ion was not merely

. 4n unreasoning aversion to the old, but a fanatic declaration of
something new - Marxism and Communism.

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, whereas the industrial workers in taking over
the factories were aflame with a new and famtical creed, Peasant
and factory employee made common cause against owners, but every
succesding year since they have discovered how fundamentally different
are their points of view, their experience, and their interpretation

of the right government policy. The story of Russia for the next
5.

twenty or thirty years will probably center around a struggle. The
political theorist, or the Communist supported by the industrial
employee, will strugele against the peasant - the mass and inertia
and opposition of the millions of peasants.

In Moscow and Leningrad there is frequent reference
to the "periphery". This means all Russia except Moscow and Lenin=
grad - and especially the villages and distant gubernias or depart-

memes. There is a certain vagueness and vastness implied and the

term seems really significant of an important relationship, namely
the city governs the country, and yet the country is too vast to
know itself or to be known comprehensively. And furthermore, the
city takes upon itself the guidance of the country, and this
relation explains the great concentration of model institutes in
Moscow and leningrad. Possibly they were not built to show to
foreigners (who somtimes flatter thenselves by advancing this
theory ) but because the Soviet Government Imows the periphery is
too vast to be transformed in this generation by scattered instit-
utes and yet that it looks to Moscow and Leningrad for guidance.
5. The most important and outstanding fact about the U.S.S.R.
is that nowhere in the world will the next three decades witness so
clearly the vivid effects upon national life of general education.
The illiteracy of Russian soldiers was 74% in 1914. ‘The Communists
must have converts. Continuity of this form of government depends

upon the education of the children. Communism is a fanatic creed —
66

@ Faith which, as in our Reformation, takes Education as its bride
not for companionship» but to beget children. But the future genera-
tion, so ardently desired by the father, will be even more influenced
by the mother. Is it possibly that education widespread in Russia
for the first time will fail to change the political and social
picture? Ido not under~estimate the impermeability of the present
ignorance, nor do I expect swift miracles, but a very great awakening
is coming to a people of 140,000,000 when general education is
encouraged in every possible way after hundreds of years of fostered
ignorance.

6. Russia is changing no longer by revolutions but by processes
analogons to cellular replacement. Experiments may be imposed by
administrative authority but the verdict of experience in the long
ran is returned and one by one the $heories which don't work can be
disoarded. The New Economic Policy, the recent limitation of the
size of medical schools illuatrate how theories that won't work have
to be modified - or even reversed in response to imperative circam=
stances. The inner councils of the Government are small enough to
produce and powerful enough to apply many more experiments in govern~
ment radical and fantastico perhaps, but in case of failure more
likely to be withdrawn than defeated by the outbreak of counter-
revolution. Non=communists are too terrified and weary to be able
to stage a counter-revolution, and the Communists ara willing to make

sacrifices to each other's views to keep power in their own hands,
SQ, Rn oe Oe Aen nes Se he te oe ee ere

0 ee Oe On Oe Oe

I have attempted to call attention to the size and
Somplexity of what is called Russia, and to its pecular national
past which is so different from that of Western Europe. I have em
phasized the effects of the recent past which would have exhausted
any country regardless of its form of government. ‘The contrast and
indeed the conflict between city and country, worker and peasant,
Communist and country ‘bourgeois' has been noted as the struggle
of the future in Russia. I have explained the extraordinary import-
ance which education is lixoly to have in modifying the social and
political picture in the U.S.S.R. and I have tried to indicate the
way that future changes are likely to be effected. These factors
stand out in my mind as the primary corsiderations in any attompt

to translate into our own terms what is taking place in Russia.
3B. Comments upon this Report, **

The information upon Russia which is available before an
actual visit to that country is as a general rule vitiated by the writer's
fears and prejudices - racial, religious, economic and political .~ Russia
is too large and heterogeneous to be described by statements to which
exception cannot be taken,and conditions are changing too rapidly for

even the best imaginable description to be valid a year after it is written,

My visit was brief, and restricted to the tw great cities,
Of the “periphery I could learn only indirectly, There was the serious
barrier of not widerstanding Russian, iio doubt much information was with-
held through fear or caution, and it is probable that the best was eagerly
displayed though I know of at least one institution which was "too cood
to be shown" ~ if I may believe the guide I chose, Never having visited
Russia before I had no basis of comparison for what was to be seen, And
it is quite certain that the occurrences of the past 12 years there, are
both quantitatively and qualitatively beyond the imagination of those who
have not passed through such experiences, Like most reporters of condi-
tions in Russia, I can make small claim to accuracy and no claim whatever
to thorough knowledge, And if it were possible really to lmow the condi-
tions there it would be extraordinarily difficult to convey a correct

impression,

The report is a record of some information which is undoubt-
edly correct, of initial impressions and of the general outlines of a

rapidly changing situation in a country of considerable size and importance,

 

x, There haw been fortunately some notable exceptions (e.g, reports of

Philip Miller and W,H, Gantt),
5.

9.

¢G. Principal Circumstances and Characteristics of
Medical Education in the U,S,5.R.

Medical education in Tsarist Russia was inadequate to the needs of
the country, though there was produced an elite of practicioners, teachers
and investigators of unquestionably high quality, The larpe number of
almost overwhelmingVignorent 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, But the spirit and organiz-
ation of the government lent but little support to social medicine or
hygiene, In research work the Russians of Tsarist times were not brilliant-
ly supported by the government but were nevertheless well represented in
the scientific world,

The war, revolution and ewigration, famine end epidemics (especially
typhus) have thinned the ranks of practicioners and teachers to an appalling
extent, Add to that the effeot of the destruction of the sources of wealth
which contributed to create and maintain clinics and institutes and the
obstacles now placed in the path of private practice and it is clear why
isolation from the outside world of medical science is almost the "coup de
er&ce" for teacher or doctor in the U.S.5.R,

That is the background for the present situation in the medical
schools, The size of Russia and the vastness of its medical problems would
overwhelm a richer and more brilliant system of medical education, But in
addition there is isolation especially from the outside wrld, and poverty
in common with most of the government institutions, and the unrepaired

depreciation of buildings during the last 14 years, The interruptions,
10,

deaths, resignations, emigrations, and reorganizations have broken in mmy
places the continuity of standards and traditions in medical education,

The control of the selection of students and election of
professors has been more rabidly political than it is today, Red professors
and red students was a formula which produced practicioners so palpably
inferior that they were vomited back into the schools - the theory broke
dow. and now the Commissariat of Education is restlessly groping for a
means to produce capable teachers and village practicioners and coldly
limiting the number of students in relation to the facilities for their
instruction, But the choice remains favorable to teachers and students

likely to be in sympathy with the Commmist Party.

4, As salient characteristics of medical education in the U,S.S.R, the
following deserve mentions

The Commissariat of Education exerts a strong and centralized
control over all the schools, The curriculum is virtually wmiform, the
selection of professors determined by authorities in Moscow, Through model
institutes in Leningrad and ioscow the periphery is supplied with standards
and training centers,

The teaching of medicine is strongly permeated with the
preventive 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 (e.g, post sraduate schools) is in care of the Commissariat of

Public lealth,
il.

The standards and quality of instruction given is maintained
by men trained before the revolution and it is to their devotion to their
work above any considerations 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 their 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 the student body of Tsarist times that of today is
quite different, for it is recruited in large part from a class that had
no tradition, no background or no opportunities fifteen years ago, Even
professors of reactionary sympathies comment on the amazing earerness of
these students to learn, but are equally anphatic as to their lack of
general culture and information, It is impossible to suggest what effect
upon the Russian medicine of to-morrow this change will have, but there is

no doubt of the difference,

The schools of medicine in the U.S.SsR, are poorly maintained,
Like nearly everything in Russia, bétter than the recent past would encourage
one to expect, not infinitely worse than in Tsarist times, but in contrast
to America unbearably sad, pathetically poor and in great need of outside

contacts and encouragement,
12.

MEDI

EDUCATION,

8a
i>
tk

There are 24 Medical Faculties in the U.S.S.R, (1927)
with a total student enrollment of 24,000, 15 of these are in the
R,S.F,.5.R, and are attended by 16,000 students, There were 20
medical faculties in the R.S,F.S.R. in 1922, but 5 have been

discontinued,

Astraiken.

Gosudarstvennyj Medicinskij Institut imeni Lunatcharskogo,
(State Lunacarskij Medical Institute) foumded in 1918,
800 students in 1926,

Exaterinoslav,

Ekaterinoslavsk1j Medicinskij Institut, (Ekaterinoslev
Medical Institut), Founded in 1916 as higher medical
school for women, In 1918 was re-organized as Univers~-
ity with four faculties; in 19% became again only
Medical Institute, 1300 students, half women, in 1926,

Erivan,

Staats-Universitat, (State Univgrsity), Has faculties
of medicine, agriculture, social sciences and technical
faculty. 1150 students in 1926,

Kazan,

Gosudarstvenny Kazanskij Universitet imeni V.I, Uljanova-
Lenina, (Uljanov~Lenin State University). Founded in
1804, Has faculties of physical mathematics, medicine
and work, 1928 students in 1926,
13.

Kharkof?,

Medical Faculty title is: "Kharkowski Meditzinsky
Institut",

Kiev,

Klinyenyj Institut, (Kiev Clinical Institute for
higher medical education), Founded in 1918,

Kyivsky Bekteriologicnyj Institut, (Kiev Bacterio-
logical Institute), Founded in 1896 and does work
in medicine, vaccine, malaria and epidemlology,

Krasnodar,

Kubanskij Medicinskij Institut, (Kubaner Medical
Institute,).

ningrad,

Voenno-Medicinskaja Akademija, (Military Medical
Academy), Founded in 1798, 1000 selected students
in 1922, Not only for military but also for civil
practicioners and teachers,

Leningradskij Medicinskij Institut, (Leningrad Medical
Institute). Founded in 1897, 2170 in attendance at
lectures (584 men, 1586 women) in 1926,

Gosudarstvemyj Institut deja usoversenstvovanija vracej,
(State Institute for higher Medical Education), In
connection with it is the Grandduchess Helene Pavlovna
Free Clinical Institute, Founded in 1885, Particularly
interested in practical medicine and sanitation, 501 in
attendance at lectures in 1926,

Gosudarstvennyj Institut Medicinskich znanij, " GIMSA ",
(State Medical Institute), Fownded in 1908 as a psycho~-
neurological institute, Each month holds a scientific
meeting under the Chairmanship of the Rectors, Has
connected with it the State Institute of Obstetrics and
Gynecology, The Institute of Stomatology and the Lenin-~
grad Institute of Traumatology, 1845 students in 1926,
Leningrad (continued)

Lleningradskij Gosudarstvennyj Universitet, (Leningrad
State University), Founded in 1819, Has faculties of
language and culture, social sciences, physical mathe-
matics and geography, 4435 students in 1926, No
medical faculty,

Gosudarstvennyj Institut experimentalnnoj Mediciny,
(State Institute for Experimental Medicine), Founded in
1890, Supported by Narkomsdrav,

Minsk.

Belorusskij Gosudarstvemyj Universitet, (White Russia
State University), Founded in 1921, Has faculties of
socialism, pedagogy and medicine, 2400 students in 1926,

MOBCOWs

Peruyj Moskovskij Gosudarstvennyj Umiversitet, (First
Moscow State University), Founded in 1755, Has faculties
of physical mathematics, ethnology, Sovietism, medicine,
9050 students (4456 men, 4594 women) in 1926,

Moskovskij II Gosudarstvemyj Universitet, (Second Moscow
State University), Founded in 1926 as Moscow Higher
Courses for Women, Has faculties of medicine, chemico-
pharmacy and pedagogy, 5108 studente (1907 men, 3201
women) in 1926,

"Giz" "“Gosudarstvennyj Institut Zdrabovkhrwménia",
"Institut okhrany maternistva i inladentchestra" (Institut
de Protection de la Maternité et de l'Enfance}), Institut
Vénéorologique de l'Etat, Institut d'Etat de Physiothérapie.

Moscow has various medical institutes, including Institutes
of Tropical medicine, of Sanitary Hygiene, Infectious
Diseases, Tuberculosis, etc,

Niznij Novgorod,

Nizegorodskij Gos, Universitet, (Novgorod State University),
Bas faculties of mechanics and chemistry, but not of
medicine, 1664 students (of which 463 are women) in 1926,
15.

Odessa,

Odeskyj Derzavnyj Medycnyj Institut, (Odessa State Medical
Institute), Founded in 1900,

Odesskij Gosudarstvennyj Dermato-Venerologciceskij Institut,
(Odessa State Skin and Venereal Disease Institute), Founded
in 1917,

There is also a Department of Medicine and Biology in the
Naucno~issledovatel'skie Katedry v, Odesse, (Research Inst,).

Perm.

Permskij Gosudarstvennyj Universitet, (Perm State University).
Founded in 1916 ag branch of the University of Petrograd,

Has faculties of agriculture, medicine and pedagogy, 1966
students in 1926,

Rostov_on Don,

Warsaw Medical Faculty transferred to Rostov,

Samara e

Samarskij Gosudarstv, Universitet, (Samara State University).
Has faculty of pedagogy, 427 students (148 men, 279 women)
in 1926, No medical faculty,

atov

Gosudarstv, Saratovskij Universitet imeni N.G, Cernysevskogo,
{N.G, Vernysevskogo State University}, Has faculties of
pedagogy and medicine, 1200 students in 1926 (of which

700 are women),

Saratov also has a District Institute of Microbiology and
Epidemiology of Southeastern U.S.S.R.

Smolensk,

Smolenskij Gosudarstvennyj Universitet imeni Okdjabr'skoj
revoljucii, (Smolensk State October Revolution University),
Has faculties of medicine and pedagogy, 1925 students in
1926,
Tiflis,
Tiphlisis ssachelutzipho Universitet, (State University
of Tiflis), Founded in 1918, Has faculties of pedagogy,
medicine, social economy, agriculture and polytechnics,
Over 5000 students in 1926,

Voronez,
Voronezskij Gosudarstv, Universitet, (Voronez State Unir
versity). Founded in 1802 as Dorpat University. Became
VYoronez University in 1918, Has faculties of pedagogy
and medicine, 2155 students in 1926,

Tashkent,

Medical faculty title not known,

Baku.

Azerbeidjansily Josudarstvenny Universitet,

Omsk,

 

Omskij Medicinskij Institut, (Omsk Medical Institute),
Founded in 1920,

Toms k,

Tomskij Gosudarstv, Universitet, (Tomsk State University),
Founded in 1880, Has faculties of medicine and physical
mathematics, 1601 students - 901 women, 700 men,

Irkutsk,

Gosudarstv, Irkutskij Universitet, (Irkutsk State University),
Founded in 1918, Has faculties of medicine, law and
administration, pedagogy and work, 180 graduates in 1926,

Viadivostok,

Dal'ne Fostocnyj Gos, Universitet, (University of the Far-
East), No Faculty of Medicine; possibly after two years,

Has faculties of polytechnics oriental ]
pedagogy, ® anguaees and
17,

2e HISTORY OF THE MEDICAL UNIVERSITIGS.-

It is rather remarkable that the medical universities
have continued to function as well as they have when we review the
conditions. These have not been normal since 1914. At the beginning
of the World War, the ten medical universities in Russia were well
equipped and moderately well supported, although tho number of
students handled was not sufficient for Russia's needs. A few of
the Institutes and hospitals were heavily endowed by private bene-
factors; for example, the Leningrad Obstetrical Hospital which was
erected by the last ozarina, at a cost of over a million pounds,
and was one of the finast 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 pre-war funds and practically no medicaments or equipment
except that little which 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 time 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, and only a pitiful

amount of fuel or food, and earnings were made impossible because all
18,

trading was abolished by law and punished by imprisonment, Practically
all members of the personnel suffered. The bare question of existence
from day to day due to general conditions of getting what was necessary
to hold body and soul together, was the one thought uppermost in
everyone's mind, Professors spent part of their time in squads
shovelling snow, stanling in line for their rations of black bread,
potatoes and herring, and hurrying by foot from one post of duty to

another, and in what time was left performing their special duties.
19.

instruction in Communism and some attempt at
Soviet control has been introduced. During the period from 1918-
1921, when a strict application of Communistic principles was
applied to everything, the medical schools were also Sovietized.

At present the residual changes are;

1) Large increase in the number of students.

2) Large increase in the percentage of women and of
Workmen and peasant students.

5} Large reduction of budget.

4) More highly centralized government control and
emphasis on prevention and hygiene.

5) Although impaired facilities and equipment through
exhaustion of finances with resulting lowering
of efficiency of teaching in some branches,
there has been some growth in other lines,
particularly in public health instruction,
fhe schools were nearly completely paralyzed
from 1917 to 1920, but made a remarkable
partial recovery during 1922 and 1923, and
they are being gradually restored to their
former condition.

"After the Revolution every effort was made to educite the pro-
letariat, for whom higher education had been previously difficult to
obtain. Students from the bourgeois class were discriminated
against.

"It was quite natural, therefore, that great numbers of all
ages flocked to the institutions of higher education. Although they
were enthusiastic and eager to learn, they had no educational dack-
ground; many of thom had just learned to read and write. The uni-
versities were dreadfully overcrowded. Student committees were
allowed to interfere with the curricula, ami the professors were
forced ta make their instruction more and more elementary in order
to be intelligible. Because of the pressure of the oncoming droves
of students, each class was passed almost en masse, whether it had
learned anything or not.
"Last year the first crop of medical graduates went
out into practice and, interestingly enough, the residents
of the distructs in which they began to work, themselves
complained to the Government about the inadequate training
of these new doctors. They are therefore being returned to
medical schools for a supplementary course of two years. The
new goverment, after the Revolution, refused to heed the
advice of the medical faculties, and it has learned by the
trial and error method that its theory of education was
impracticable, or at least inapplicable to the medical
profession.

“The most interesting conversation on the subject of
medical education was with Professor Lang of the Leningrad
Medical Institute. After the Revolution his school was forced
to receive 600 students a year, but the number is now Limited
to 200. The students’ interference with the curriculum hae
decreased to about 25% of what it was just after the Revolu-
tion; and he believes that it will dgorease 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,

by Dr. C. Philip Miller, 1926).

In the past the contacts of Russian medical faculties
were first with Gormany and Austria, ani second with France - third
probably difficult to determine. It may be noted that before the
War Switzerland had large numbers of Russian medical students. Now
(1928) the number of contacts with Western Europe is almost negligible

but the order of preference would probably be Germany, France, and

America.
al.

3.~ ORGANIZATION OF THE MEDICAL FACULTY.

 

Medical education in the faculties of medicine is
in the Commissariat of Sducation. The Commissary is
M. Lunacharsky, but the special member or section chief
for medical education is Professor W. Bronner, a neurologist
with Parisian training, and a man of considerable ability.
He has visited every faculty in Russia and is the best=
informed individual regarding the status of medical education

in the U.5.S.R.

There are numerous medical institutions, especially
in the field of hygiene and post~graduate medical instruction
which are not under the Commissarist of Sducation but under
the Commissariat of Public Health (Narkomsdrav), whose

Commissary is Semashko.

In both cases there is highly-centralized control
of appointments of staff, expenses, and curriculum in the
nands ot the authorities in Moscow. Thus the control is
in the hanis of the Communist Party, and its influence is

telt by the rank and file of rectors, deans ami professors
226

whose interests are not political and whose sympathies are
often covertly non~Communist. ‘The chief professors have at
times, but not frequently, been changed from the positions they
held before the Kevolution. This political control is probably
not as harmful as it would be in other countries, and it has
certain advantages. It tends to preserve order and prevent
dissenSions ani anarchy, in & time when further squabbling
would be suicidal, and strict discipline is necessary for
rejuvenation. The schools may owe more than they have realized

to this strict control.

The kKector of a University is appointed by the
Government and the lector in turn appoints his deans. Professors
ars chosen from a list nresented by a special faculty commission

\
of ros the Section Chief (Bronner) of the Commissariat
of sducation. Bronner consults the State Scientific Council
(30 members) and then chooses the professor from the list

submitted. Bronner could impose a proxessor if he wished, but

in practice he has not done so, he said, In 1926 Gantt noted:

"Although most strictly administrative positions are
assigned to Communists, the scientists thomselves are left

entirely to work out their scientific problems as they desire,

(1) one political, one representing the Narkomsdrav, and
one the students.
25-6

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

ascertain from two year's work in Soviet Russia, distribution
of Soviet funds to laboratories and appointment to scientific
positions is made according to merit rather than to polities.

I have seen during the past year that some of the scientific
laboratorps whose heads are directly 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 Communists,
ami generally, judging from my experionce, efficient organizers,
and in most of the scientific institutes there is a political

commissary with'certain administrative powers.”

The arrangement of the curriculum (q.v.) is in the
hands of the central authority (Bronner) and is uniform for all
the R.S.F.S.R. The allotment of the budget is determined
similarly but with some local modifications in distribution.
Through surveillance the aquality of work and the validity of

the University degree is stamardized by the Narkompros..

For its internal management, each medical faculty is

administered by the dean and the Faculty council, together
24.

with special committees for each discipline. ‘The Faculty
council of the Medical Faculty of the First University in
Moscow, for axample, meets ten to fifteen times a year,
discussing teaching problems of faculty as a whole, possible
candidates for vacant chairs, am the promotion of teachers,
assistants, etc. The special committees for each discipline
mect from two to twenty-five times a year as circumstances
recuire, and for the following purposes: attempts to improve
teaching facilities of a given department, determination

of programmes of work, discussions of teaching methods,
discussions of camidates for vacant professorships, reports
on tho work of various institutes, accounts of activities

of the teaching staff, lectures of candidates for docentships.
256

4.~ UNIVaRSITY FINANCE .-
No information was available, except that

published in the announcement of the First Moscow University

which follows:

The financial conditions during the period that
followed the Civil War were most depressing. It is only in

1924 that a gradual improvement began to take place.

fhe budget of the I Moscow University for 1913
amounted to 2,638,911 Rowbles. It went down as far as
2,087,440 Roubles in 1923-1924.

19241925 - 2,963,339 Roubles,

1925-1926 - 4,894,116 "

It may consequently be observed that the 1925-26
budget is 65% higher than that of 1924-25 and is equal to the
1913 budget (considering the rate of exchange). It may be

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

from the capital of various philanthropic foundations.

The school year of 1925-26 brought about a radical

change in the financial situation. The Soviet of Moscow and
266

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 is not to reduce expenditures, but on
the contrary, to increase the expenditures and consequently

the assets as well.
27.

5,~ MEDICAL SCHOOL FINANCE,

 

Very scant information is available to give the picture
of medical school finance at the present time, and if plenty of
figures were available, many pitfalls would still lie in their
correct interpretation. The gold value of the rouble is

, vib taney Kaas
particularly important for foreign purchases but, new of no
importance for rent, and very little for food. Depreciation
of buildings apparently would not appear in budget estimates
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 lina for comparison of the available

figures since the significance of the money itself has changed.

as @ matter of record the following budgets in gold

roubles may be noted;

 

Leningrad 1913 1914 1915 1916 1922 1923
Med. Institute 400,257 377,599 33,484 33,484
Leningrad Military 875,000 288 ,000
Academy

Leningrad State

Med. Institute 276,595 222,444 33,592

In 1927-28 salaries of professors.
The Military Academy in Leningrad has (1927-1928)
5000 roubles for purchase of apparatus abroad and 1200 roubles

for books and periodicals. The rouble was 2,50 to the dollar
28.

1°28.
in December 1927 and 3.00 in February’, 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 ander Laboratories and Clinical Facilities).

Full-time professors receive 2650 roubles a month,
men in practice 180. Assistants 95 and "aspirants" 80 roubles a
month. Living auarters (2 rooms) for a professor cost 5 - 10
roubles a month, an item that shows how illusory is the suparficial
comparison of budgets and figures of faculty expenses in the

R.S.F.S.R. at present.

The First University at Moscow rans its own clinics
and indeed charges special rates for patients and supports some of
the laboratories from the surplus. The other schools visited
sither use municipal hospitals or hospitals supported partly by

Narkomsdrav and partly by Narkompros ,
29

6.~ LABORATORY FACILITIES.

 

In general from the schools visited the impression
received is that tho laboratories are fairly well housed, rather
uniform in equipment and housing, in a bad state of repair, but
even SO, used more affectively for the average student than is the
rule in Western Europe. The floor space is usually considerable
ami the schools limit the number of students to their laboratory
facilities. Apparatus and reagents are almost uniformly inadequate
amd there is much difficulty in getting apparatus from abroad on
account of the restriction placed upon amounts for foreign purchases.
The teaching seen was impressive on account of the intense serious
ness of the students, but I gathered that their intellectual
baggage was scant, their poverty a great handicap and the large
proportion of girls may not be able to accept the extraordinarily

heavy work demanded by the conditions of country practice.

Any sums spent for apparatus would be used twice to
ten times as much as in most European countries - in this point

Russian medicine closely resembles the American practice.

The Government has at first concentrated support

more in the independent institutes allied to medicine, but is now
50.

turning to the faculties and beginning to help them relatively

more liberally.

The following ramiom notes on some of the laboratories
visited in December 1927 may indicate what were the general condi-
tions of the best faculties in Russia as regards laboratory

eauipment.

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. The assistants divide their time and energies
batween two or more places. But in some ways these defects are
made up by the earnestness of the students and the fact that hard
intellectual work is an actual solace for an otherwise unbearable

axistence.

FIRS? UNIVERSITY =~ MOSCOW.

Anatomy.> Professor Piotr Karusin - old man,
strict teacher. Finishes current year in old building. New building
2/3 done, 62 rooms costing one xz xxx million roubles, begun in
1926. At present Karusin has 600 students. 100 bodies for them.
Other laboratory expenses well taken care of. Good museum. Not

mach investigation going on. Histology, Bmbryology and Topographical
ol.

Anatomy all separated from Anatomy.

Pathological Anatomy .- Professor Abrikosov (away),
Prosector Davidovski. Three courses, total 1000 students. 300
autopsies a year. Staff: Professor, 1 prosector, 1 Assistant
prosector, 5 paid assistants, 15 aspirants ( young assistants trying
out for academic posts). Budget 250 roubles a month, but can
only spend 10 r. a month outside Russia. Does all autopsies for
the clinics. ixcellent lab. 100 microscopes - one for each student
in a section. Can't buy the journals they need.

Pharmacology.- Prof. Vasily Nicolaieff. Came from
Kazan. Was pupil of Schmiedeoerg. Tair laboratory. 15 rooms.
Student gets lectures, demonstrations, ani about 40 hours of
laboratory work. Also consideraole practice in pharmacics of Moscow
in prescription making. N's salary 250 roubles. Laboratory budget
150 roubles a month. Great improvement over conditions 3 years aco.
N. has 5 assistants and 5 aspirants. Apparatus expensive, journals
‘few, chemicals not always zood.

Hygiene.- There are four chairs of Hygiene:

1. General Hygiene. Professor Syssin, 4 Assistants,
5 aspirants. Given in third year 252 hours in all. Laboratories
large, well-lighted, well-equipped.

2. Occupational Hygiene, Professor Kaplun, 144 hours
in 4th year. Only 2 small rooms, mostly museum.

3. School Eygiene. Professor Molkov. 144 hours

in 4th year. Largely lectures. No rooms.
S20

4. Social Hygiene. Professor Semashko. One room
filled with charts.

Phe laboratory buildings of the First University were
built about 1890-1895 and are comparable to others elsewhere of that
era, except that considerable repairs should be made in the near

future.

SECOND UNIVSRSITY .-

 

Experimental Biology.- Professor M. Zawadowsky
(absent). Assistant Blacker. ixcellent little laboratory. Fine
spirit. Good work on genctics in fishes and axolotl. 25 roubles
a month is the laboratory budget. In existence only three years.
Students during their first year and a half - 10 sections a week
for 2 hours.

Physiology.-_ Professor Lina Stern, formerly in
Geneva. Speaks Russian, Italian, French, German and fnglish. Well-
equipped, small laboratory, giving good impression. She complained
of division of assistants' time amd of the poverty of her students.
Was given 10,000 roubles to equip her laboratory two years ago, now
has budget of 40 roubles a month. Has students 2 semesters - they
get 2 hours a week of lectures, 2 hours of seminar, a week, and 36
hours a semester of laboratory work.

Topographical Anatomy.- Professor K.D. Esipov. Talented

draughtsman, most brilliant teaching collection of charts and drawings
Ode

I have seen in Surope. Good operating room for animal surgery.
Microbiology —_ Professors Kritschevsky ani Ismailsky.
4& large, rather well-equipped, but inappropriately-housed Institute
which does immunity serology, chemotherapy and bacteriology as an
independent institute, and also does teaching for the II University.
Under Commissariat for Education. Both professors and personnel
look like good men. An important center. 40 on the staff, 15
aspirants, 15 puvlications in 1922-1923, 61 in 1926-1927. ‘Total

budget for 1926=1927 was 27,000 roubles,

MILITARY MabICAL ACADEMY .=

Phamacology.~ Professor $.\). Anitschkoff. Young
and active. Laboratory small, not well-eculpped, but very active.
Two good assistants. 200 in class.

Pathological Anatomy.~ Professor N.N. Anitschkoff.
Careful worker. Good equipment, good work voing on. Relatively
young man.

Physiology .- Professor L. Orbielli.- Good laboratory.
&xcellent laboratory work by students, who seemed better type than
elsewhere. No girls. Soldiers and officers have preference at the
Academy. Military students get unfform and 60 roubles a month and
must serve two years in army 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.
54.

Hygiene. Professor G. Chlopin. Only hygiene of
enviroument. Large museum ami empty laboratories. No relation with
practical work. Good quarters inadequately used.

Spidemiology and Bacteriology.- Protessor Zabalotny.
No demonstration area. Laboratories well-equipped and in fair use.
Met him when he was in the midst of conferences with students on

program for next year. Non Suropean touch!

MEDICAL INSTIIUTS .~

Anatomy.-_ Professor absent. One of the best
teaching museums I have ever seen, work of former professor Weinberg.
Large and well-equipped institute.

Pharmacology .~ Professor Lichatcheff. $mall laboratories
but crowled ami well-equipped. 3 assistants but half of the work is
done by voluntary assistants, whose clinical academic careers are
strengthened by a year or so in "theoretical" branches, Laboratory
got 100 roubles a month before the wer, now 70 but this 70 has the
value of 20 or 25 roubles before the war.

Preparation of students before they take pharmacology
is one semestor of inorganic chemistry, two semesters of organic
chemistry, one semester of colloidal chemistry, and two semesters
of biological chemistry. In pharmacology each student gets 5 hours

of lectures a week and 6 to 8 practical exercises of 5 hours during
356

the course, and a small amount of seminar work.

For information regarding recent changes in teaching
methods, facilities, etc. in the First University of Moscow, see

Appendix I . This information is translated from the official

publication of the University.
7 “CLINICAL FaCILI@Ius .-

In general the teaching clinics of the Faculties
visited in December 1927 were well-staffed and directed by able
and well-informed men, who evidenced in most cases no political
interest or influence. The nursing was poor am the housekeeping
worse. The buildings need a great deal of repairing. ‘Souipment
seemed antiquated and worn at times, but there is a good deal of

renewal, and the level is better than might be expected.

The First University in Moscow possesses its own
clinics and must maintain them by fees from patients. The Second
Moscow University and the schools in Leningrad use city or govern=-

ment hospitals, bearing only the tsaching charges.

I was impressed by the desire of the clinical teachers
to see that the average student shall get a sood training —- rather
a contrast to the attitude in Italy, Austria or France. The emphasis
is upon practical familiarity by each student with the cases assigned
to him, and the attitude of the teachers, was kindly serious and
unaffected. There are many parallels between american and Russian
points of view, but the dread of country practice keeps a larger
number of interns and voluntary assistants at work in the faculties

in Kussia than with us.
As in the laboratory branches one gets the impression
that the pre-war generation is the sheet anchor of Russian medicine,
even in the case of the younger men. Their orientation is much
broader and their standards more comparable to those in Western

kurope.

Most of the clinical chiefs have some private
practice, heavily taxed, but none the less relatively lucrative.
The demands from this quarter and the crowed wards of their
service have largely put an end to much of the interesting clinical
investigations that would otherwise bs possible.

The ordinator is the equivalent of our intern,
but he sleeps outside the hospital and stays from two to three
years. He is a helper for tho assistants, and hopes to be chosen
as an assistant. The assistants do a small amount of private
practice and may remain not longer than 10 years as assistants.
The aspirants are young men desirous of an academic career,

selected by the Ministry of Mucation, and detailed for a period

of about 3 years for 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

(1} See page 91.
38.

in Moscow including Social Hygiene in the form of a translation

from the ofiicial announcement of the Faculty.

aA few notes of clinics visited may be of some

interest.

I. UNIV°RSITY MOSCOL.

 

Second Surgical Clinic, Professor Martinov, Building
belongs to University, about 50 years old, wards fairly clean, pat-
jents look rested. 80 beds on this service, of which 24 can be
taken for free cases for teaching purposes. Others all pay - on
open ward 40 roubles 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 its own expenses, the rest is turned

over to the faculty for the support of the institutes.

In second semester of last year the students get
one month of clinical clerk's work. ‘Yeaching much as in America.
The equivalert of our interns are called ordinators; they do not
live in the hospital but stay for two to three years in hopes
of getting assistantships. Assistants cannot stay more than ten
years. Students’ midday meal 10 kopeks (5 4 ) for bread, 3

Kopeks ( 1/2 ¢ } for "tea".

Good selection of cases on the ward. An 0.P.D.

service of 40 cases a day. Martinov an able operator, assistant
39.

Blumenthal.

First Surgical Clinic.- Professor N.N. Burdenko.
Much like the Second Clinic, but cleaner and apparently more favored
with apparatus and material. No organized course for nurses now,
They used to have 3 V2 years of training after coming up from
gymnasia. Now less preparatory training, but still look the

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

Medical Clinic.- Professor Pletniov, who has high
reputation in Moscow. 80 beds. déxtensive laboratories with good
equipment and in use, Slectro=cardiagraph and Haldane apparatus
just arrived. Special room for blood chemistry only. Good general

impression.

Mecical Clinic of II University.-

In City Hospital, 68 beds. Fair X-Ray equipment.
Wards not clean, but patients look comfortable. The histories were
the best I have seen in furope. Three courses given third, fourth
and sixth year. About four cases for each student but carefully
worked up. Cases stay an average of one month in hospital but
a good selection is claimed. Expenses of hospital paid by City,
University paying for teaching expenses only.

10 ordinators. 4 Aspirants. OQOrdinsators are chosen
by a committee, one-third of which are students. Spemi two to three

years as interns but with no division of labor as is found in U.S.
40.

Surgical Clinic of II Univoersity.- Professor
wa. Lewit, capable younger man called here from Irkutsk, 8000
Kilometers distant. About 80 deds. No subdivision into specialties.
Good appearance of wards, plenty of space, squipment good, repairs

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

LENINGRAD MILITARY ACADEMY .-

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 teaching
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 Voyatschek (Director of the School). This was
clean, modest and effectively managed. Ample assistance, practical

eauipment, building needing repair.

The Peter Paul Hospital of the Leningrad Medical
Institute.

(Guoted from Dr. C, Philip Miller's notes). "The
hospital is old, the oldest building dating from 1835;
was formerly a city institution, but later became a
teaching hospital for the Women's Medical School. This
institution was formerly exclusively for women, as the
other medical school in Leningrad, the Military Academy,
41,

was closed to them. Since the revolution, it has
become coeducational.

"Professor Lang, the Director, is con=
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 subject by
giving all the theories and evidence pro and contra.

"When Lang became 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 what
it should be. In some respects it is now better
than before the war, when it was scandalously over-
crowed, ©.2. in winter all the corridors were full
of beds. It had always been neglected because it
was a city hospital. Next year the hospital will
be entirely renovated. During the past two years the
Oboukov hospital which had been the worst in Leningrad,
has been modernized at the cost of one million roubles
and now the Peter Paul Hospital will have its turn.

“The Hospital has a total of 1040 beds. The
oldest building (91 years old) is gloomy, dark and
badly ventilated. The 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 clinical laboratory examinations. Lang
is ashamed to show the laboratories which are supposed
to be for research, The wards look about like those
in the poorest German clinics.

“Staff; There are three medical olinics, one
each for the third, fourth and fifth year students. At
present one of the chairs is vacant. There are eight
paid assistants, with salaires ranging from 40 to 80
roubles a month. About 45 volunteers serving from one~
fourth to one~half time. Money for investigations is
very scarce, It is difficult to get money for pre-
Clinical teaching. The clinical is better off, because
the small grants from the central government are aug~
mented by funds from the city for care of patients; e.g.
Lang was able to buy an electro~cardiograph outfit for
42.

Roubles 8,000 by getting 2,000 from the State and 6,000 from
the City. In the same way he has mansged, in:the past two
years to buy X-Ray and light therapy apparatus".

MEDICAL INSTITUTE,

ae arte ON ED ERD SEED Oe Oe FOr me Ee ENT OEE

Dermatology and Syphilis.~ Dr. Sachnovskaia. 100
beds and 200 patients a day in the O.P.D. which is open from
10 a.m. to 7 pom. with three assistants on duty for 3 hour
service. 62 roubles a month for maintainance. Students in
fourth and fifth years make ward visits in groups of ten,
daily for a month. Building not repaired for the last 15 years
and looks it. Large numbers of lupus cases. 350,000 in

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

Surgical Clinic.- Professor W. Schaach. (Pupil of
Lexer ami Bier). 75 beds supported by city, 1200 patients a
year. 20 roubles a month from faculty for teaching service.
Two days a week this service takes in all surgical entries,
the rest of the week they make selection of cases from the
O.P.D. they maintain. No paying patients. Building was
axcollent, now badly worn and dirty. Nursing poor. 15 murses
for 75 beds, only 3 sleep in hospital. Schaack says there are
nursing schools but they are not connected with teaching

hospital. Staff for Professor S. is 5 paid assistants and 26
43.

voluntary. They keep record of clean cases which go septic
(30% in 1923 and 16% in 1927), and the death-rate in the

clinic 4% now.

_Gynecology and Obstetrics Clinic.- Professor
Skrobansky. 240 beds, 100 of which are for obstetrics. About
10 deliveries a day in the hospital. Students gat 8 days of
24 hours duty in hospital. They deliver only tw cases by
themselves. No district work. Skrobansky has a first and two
second assistants from the Faculty and three from the hospital,

In all 40 on staff.
44.

8 head LIBRARY fACILiItt 9 e

a mr ate ee So Re Oe oe ee

The past sight years have seen @ series of
changes in the library facilities of the medical faculties of
Moscow and Leningrad. Thera have been numerous coalescences and
a few new collections begun. In the institutes and clinics of
the medical faculties, there is an almost uniform poverty of
books and journals since 1914 or 1917, though a few are sur~
prisingly well-equipped since 1925. For example, in the library
of the second Surgical Clinic of the I University at Moscow there
were 21 journals, 12 of which were foreizn, in 1927. Probably
in the provinces the poverty is the rule, with the gifts of the

R.¢. as the only exception.

The main obstacle in adequately furnishing the
libraries is the restriction on all kinds of purchases abroad,
which is enforced by the Government as @ means of preserving the
value of the rouble in foreign exchanze. ‘The only organization
with special privileges in this matter is the Tzekubu which is a
central organization or Union of Scientific workers, but its
library is available only to men in Moscow and even so is not

very near the Medical 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 of the students makes the problem of text-
books particularly troublesome and urgent. The impression reccived
is that no single material aid from outside Russia would be more
appreciated and more generally used than books and journals. ‘The
following translation from the publication of the First University
of hioscow for 1926-1927 is of interest.

UNIVERSITY LIBRARY .-

There were 485,170 volumes in the University Library
by January ist, 1925. The year 1926 resulted in an increase of this

library by 13,578 volumes, 17 manuscripts and 24 maps.

The library used to receive 546 subscriptions to
scientific jourmls during 1925, which number was raised to 564 in
1926 (compared with 402 during 1924). This number can be divided

as follows:

Natural sciences and mathematics 244
Medicine 151
Social scionces 114
History, philology, literature and
bibliography O35

The largest number of scientific periodicals conse-
quently falls on natural sciences and medicine. The number of period-
icals in social sciences has been increased 100% during 1926 (114

instead of 54}, and this is likely to continue. Considering that a
46.

number of outstanding libraries in Moscow (such as the Public
Library under the name of lenine, the Library of the Communist
Academy, Karl Marx's and F. Engels’ Institute Library, otc. 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 60% of the pre-war figure. One of the greatest problems of
the Library is the question of back files in which there is a

considerable gap 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 Academies, 84
Universities, 1 Uinistry, 12 State libraries, 12 scientific
institutes, 8 "learned societies", and 10 various organizations:

Germany. 1. Deutsche Akademie der Wissenschaften, Berlin.
2. Bayerische Akademie der issenschaften, Mlinchen.
3. Staatsbibliothek, Berlin.
Austria. 1. Akademie der Wissenschaften, Wien.
2. Nationalbibliothek, Wien.
Norway. Académie des Sciences et des Lettres, Oslo.
Japan. Imperial Academy, Tokio.
Jugoslavia.- Académie des Sciences, Belgrade.
Bulgaria. Académie des Sciences, Sofia,
England. British Museum.
France. 1. Ministdre de l' Instruction Publique
2. Bibliothéque Natiomle,.
U.S.A. 1. Public Library of New York
2. Montefiore Hospital of New York
The Rockefeller Foundation of New York
Smithson Institute of Washington
Carnegie Institution of Washington.
47.

Exchange of literature with foreign countries.

 

1924 1929 lst Sem. 1926
Received 041 volumes 1335 853
Sent 137 218 131

fhe library is open every day from 10 a.m. to 1l pam.

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

Administration (1926)

Director: Proz. A.N. Nersessoff,

Assistant Director: N.V. Skorodoumoff.

Seminary Library of the Mecical Faculty.

The seminary library has been able to considerably
increase its number of volumes and periodicals although they are
still frequently unaole to fill in the requirements of all the
students. On the other hand, these requirements.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.

Attendance;

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

Most of these fall on the srd ami 4th year,

The lecture room is open every day from 35 to 10 p.m.
Most of the books consulted are in Bacteriology and Pathological
Anatomy; then come Internal medicine, Social medicine, Hygiene.

The average attendance is 52 students per day with
63 books,
48.

Q.- PROFPUSSORIATS,

See BED Oe mee eee ne ED eI Ra Ee Om bine ee RY

The professors are chosen as noted in section 3 by
the central authorities of tho Commissariat of Education in con=
sultation with the State Scientific Council in Moscow, from lists
submitted by the University collegium. The present situation seems
to be that the wrovincial universities have had a much larger
number of changes in personnel than is the rule in Moscow and
Leningrad. migration, sickness or death, and retirement, expulsion
and ren accounted for many changes and in approxim-
ately the given order of importance. The professors vho keep
their political views to themselves and devote themselves to their
work are neither molested or discriminated against but those
teachers who are openly in favor of Com:anism are likely to
receive more favorable treatment. There is a serious dearth of

properly trained men ami the provision of adequately prepared

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

Any discussion of salaries is apt to be misleading
if comparisons are made with other countries, since in Russia food
and lodging are cheap ~ all else extremely expensive. A professor
is entitled to 8 square maters of room for each member of his
family, plus a room for his work. The item of rent comes to
§-10 roubles a month out of his salary of 150-250 roubles .

(1) Resignation often due to refusal to learn a local dialect
which has become the official language of the region.
49.

"(Cf, Dr, C, Philip Miller's Notes) ........6
Salaries,~ The head of a department in a scientific institute
receives about Rs, 200 to 250 a month, Three men told me
that their salaries were 190, 200 and 230 roubles, respectively,
These men were working on full-time and had no other sources
of income, Belonowski receives Rs, 150 as professor in the
Institute for Post-Graduate Instruction, but also holds
another position, His first assistant gets Rs, 100 a month,
Lang's (Leningrad) assistants receive Rs, 40 to 60 a month,

"A good many posts pay Rs, 100 or less, but allow
the occupant to hold two or three positions, This seemed to
be rather the rule than the exception, 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 make a living wage,

Cost of Living,~ The man receiving Rs, 190 a month (umarried)
told me that he paid Rs, 1,50 a month in taxes and an average
of Rs, 20 for rent, heat and light, Rent and service are very
cheap according to American standards, and butter, eggs and
coarse linen cloth are cheaper than in American cities; but
practically everything else is twice as expensive, and a good
many things are three times as expensive as in America, All
the Americans I spoke with, in Russia, on this subject said
that they were quite unable to understand how the Russians
manages to live, A great many things which we consider
necessities of life are luxuries too expensive for the majority
of Russian scientists, or one might say, for all Russians, A
few prominent clinicians have very comfortable incomes from
their practices, but they are really rare exceptions",

The past has been unbelievably difficult and precarious,
so that a dreary present seems good by comparison, It is a great
trial that it is so difficult to get permission to leave Russia - to
Say nothing of the great expense of travel, On the other hand, great
ability is relatively better rewarded now than under the government

of the Tzar, if we may believe members of the laboratory branches,

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

ary days,
50.

In general these are the circumstances - the
lot of teachers is very hard, but the professors in comparison
with other ocoupations are well paid and their positions sought
after, They have lived through times that make 1927 seem good ~
and their work is a spiritual solace for which they do not pity

themselves,

A brief review of the past indicates only some

of the difficulties,

The maximmm salaries of professors in the medical
schools before 1914 was about $300 a month, and living in Russia
was cheaper than in most other countries of Europe, Then
salaries dropped rapidly in 1915 and 1916, so that by 1917
they were barely equal to living expenses, From 1917 to
1921 there were no salaries paid in Russia, and everyone who
performed some “useful production work" was issued a ration,
During these years teachers therefore received rations depend-
ing on the number of positions they held, A man who was able
to hold a position in two institutions received two rations,
Rations were issued according to grades, such as manual work
ers, Commmists, scientific workers, etc, During the worst

time, in 1919 and 1920, the resources of Russia . ....es:
made possible less than & pound of black bread, and about 2 half-
pound of potatoes daily for the scientists, anil occasior@li:cigarettes
were issued instead of bread. With the initiation of the New Economic
Policy in 1921 salariss were again paid. These started at about $5.00
(maximum) 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, whose special worth has been recognized by the Soviets,
received this amount. The amount received is sufficiant to support
the recipient, but with no surplus for any books, comforts or luxuries,
and if there is a family the others must obtain some form of employment
which will provide them also with the means to live. The greatly re-
duced standard of living in Russia, the absence of all luxuries, ani
the cheapness of plain food make it even possible for tw or three to
live on a very small salary. Altho bare living is cheap, all luxur!~s
and most comforts are much more expensive than in Enzlani or Amrica;
Unfortunate was the man who had not many valuables to sell to tide

him over these years.

The following list of professors was given me by

Professor Bronner:
52.

LIS? OF PROFESSORS OF THE MBSDICAL SCHOOLS OF
MOSCOY AND LENINGRAD.
(Administered by the Narkompros (People's Commissariat
of Public Instruction) of the R.S.F.S.R. (Russian
Socialist Federative Soviet Republic).

 

 

I
MOSCOW,
Med. Faculty of Med. Faculty
the I Moscow Univer. of the II Moscow Univ.
No. Chair (Neme of Professor) Born (Name of Professor) Born
1. Physics Mlodzievsky 1883 Ulodzievsky 1883
2. Gen. Chemistry Prjeborovsky 1883 Refomatsky 1865
Stepanoff 1872 Mikhailenko 1864
3. Gen. Biology Kursanoff 1877 Zavadovaky 1897
Bogolavlensky 1870
4. Normal Anatomy Karuzin 1864 Dioshin 1864
Se Histology Gurvich 1874 Karpoff 1870
6. Physiology Shaternikoff 1870 Mrs, Stern 1879
7. Biolog. Chemistry Gulevich 1867 Smorodinzeff 1881
8. Pharmacology Nikolaeff 1871 Skvorzoff 1879
9 Patholog. Anatomy Abrikosoff 1875 Kedrovsky 1865
10. Patholog. Physiology Sakharoff 1873 Bogomoletz 1881
ll. Operative Surgery Obrosoff 1880 Esipoff 1874
12. Miscroblology Barykin 1874 Krit chevsaky 1885
13. Experim. Hygiene Syssin 1874 Ignatoff 1879
14. .8o0cial Hygiene Semashko 1874 Solovieff 1877
15. labour Hygiene Kaplun 1897 Kaplun 1897
16. Educational Hygiene Molkoff 1870 Molkoff 1870
17. Legal Medicine Minakoff 1865 Minakoff 1865
18. Surg.Proped Clinic Gerzen 1871 Weissbrot 1874
19, Therap. Prop. Clinic Fromgold 1881 Nieviadomsky 1883
20. Therap. Clinic
(4th year) Vikhert 1884 Kabanoff 1864
21. Surgical Clinic
(4th year) Bourdenko 1878 Spasokukotzky 1870
22. Gynecology and
Obst. (Clinic) Malinovsky 1880 Kurd inoveky
(Braude) — 1874
23. Ophthalmology
Clinic. Odintzoff 1876 Averbakh 1872
24. Dermatology & V.D. Mestchersky 1874 Yordan 1866
25. Pediatrics (Cl.)} Molchanoff 1868 Kissel 1854
26. Neurology (Cl.) Rossel imo 1860 Mynor 1855

Sepp 1878
53,

 

 

Med. Faculty of Med, Faculty
No. Chair the I Mescow University Bom of the II Moscow Un. Born
(Name of Professor) (Name of Professer)
27. Psychiatry (C1l.) Ganushkin 1876 Gilarovsky 1876
28. Hospital Therapy
(Clinic) (Sth year) Pletneff 1871 Konchalovsky 1875
29. Hospital Surgery
(Clinic, 5th year) Martynoff 1868 Levit 1883
30. Oto~RKhino~Laryngo-
logy (Clinic) Ivanoff 1867 Sverjevsky 1867
31. Infectious dis-
eases (Clinic) Kireeff 1873 Marzinovsky 1874
32. Urology Fronst ein 1882 Lejneff 1875
35. Phys. Therapy Moezernitzky 1878 Bogasheff 1878
34. Odontology (C1.) Lukomsicy 1893 Kogan 1880
35. Tuberculosis
(docent ship) Biniss 1890
36. Keflexology ~ -
LENINGRAD State Institute
Med. Institute of Leningrad. of Medical Sciences.
1. Physics OS EeChey 1868 Orloff 1874
2. General Chemistry Zalkind 1876 Jukoff 1861
Ginsberg 1870 Spassky 1868
3. Genoral Biology Nadson 1867 Ivanoff 1878
Knipovich 1862
4. Normal Anatomy Kornilovich 1867 Zeldovich 1869
5. Histology Mart ynoff 1872 Delneka 1876
6. Physiology Orbeli 1882 Tuhr 1866
7. Biological Chemistry Salazkin 1862 Tlyin 1866
8. Pharmacology Likhatcheff 1866 Gramenitzky 1882
9. Pathol. Anatomy Schohr 1872 Syssoeff 1885
10. Patholog. Physiology Khalatoff 1884 Vacancy to be
filled through competition.
11. Operative Surgery Sussloff 1867 Mre. Lisovsky 1876
12. Microbiology Zabolotny 1866 Ebert 1882
13. Experim. Hygiene Khl opin 1863 Ivanoff 1871
14. Social Hygiene Nikitin 1868 Frenkel 1869
15. Labour Hygione Vacancy to be filled Koiransky 1886
through competition
16. Educational Hygiene Same as above Griboiedoff 1875
‘17. Legal Medicine Tohistovioh 1870 Tchistovich 1870

18. Surgical Proped. Vacancy to be filled
Clinics. through compet ition Guesse 1883
54,

Medical Institute State Institute
of Leningrad. of Med, Sciences,
No. Chair (Name of Professor) Born (Name of Professor) Born
19. Therap. Proped. Clinic Levin 1861 Rubel 1867
20. Therap. Clinic
(4th year) Lang 1875  Glinchikeff 1878
21. Surgical Clinic
(4th year) Taak 1880 Rokitzky 1870
22. Gynecology and Ob-~
(stetrica(Cl.) Skrobansky 1873 Krivsky 1870
23. Ophthalmology (C1.) Anlogsky 1869 Zelenkovseky 1872
24. Dermatology and V.D. Mrs. Sakhnovsky 1882 Stein 1874
25. Pediatrics (Clinic) Krasnogorsky k883 Furman 1874
26. Neurology (Clinic) Nikitin 1879 Bekht eroff 1857
27. Psychiatry (C1l.) Ostankoff 1868 Gerver 1873
28. Hospital Therapy
(Clinic, 5th year) Chernorut zky 1884 Kondratovich 1873
29. Hospital Surgery
(Clinic, 5th year) Djenalidze 1883 Grekoff 1867
30. Oto~Rhino-Laryngology
(Slinic) Verkhevsky 1863 Belogolovoff 1874
31. Infectious diseases
(Clinic) Ivashenzeff 1883 Rosenberg 1876
32. Urology Mrs. Lisovsky 1876 Vacancy, to be filled
through compet ition
35. Phys. Therapy Mrs. Lisovsky - Mihailovsky 1877
34. Odontological Clinic Ivoff 1884 lamberg 1894
35. Tuberculosis
(Docent ship ) - -

36. Reflexology Bekhtereff 1857 Bekhtereff 1857.
AGE

30
33
34
37
41
42

45
47

49
59
51
52
53

55

57
58
59
60
61
62
63
64
65
66
67
70
72
73

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No, of Professors in both the
Moscow and Leningrad Institutes.

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AVERAGE 53 1/2 years,
566

10.— ADMISSION REQUIREMENTS .~

In pre-war times, women had access only to special
schools, the chief of Which were the Women's Medical Institution in
Leningrad and the Second University at Moscow. They were always
admitted by examination. Men were admitted also by examination unless
they had received a certificate of graduation from a recognized gym-
nasium. Since 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 and professional

schools.

Dr. Lichatchef, Professor of pharmacelogy in Leningrad,

says:

“During the Revolution, an attempt was made to accept
as students even such people who had not passed through a
grammar school, after a very superficial examination. This
resulted in unprepared students. It did not lead to just as
sad results as one might have expected, for the unprepared
students proved unable to pass the examinations required by
the medical school, in order to be transferred from class
to class, and after a year or two, a majority of them left
the school. It should be noted, however, that the overfilling
of schools with students had a bad influenco on the teaching.
The students are supplied to the medical schools also by the
so-called "Rebfaki" 1.e. courses for workmen whose special
aim is to prepare them for entering the Universities. Al-
though the general culture of people graduating from workmen's
courses is not high the preparation mostly proves satisfactory.
"Due to the fact that already, in pre-revolution times
and more especially during the last years, the Petrograd
schools were unable to accept ail those desirous of instruction,
it was necessary, every year, to make a certain selection
among the candidates to be admitted. In pre~revolution times,
this was done by means of a comparison of credentials, those
57.

being admitted who had the best papers, It should be mentioned
that there were restrictions with regard to the Jews, At the
present time, special commissions attend to the admittance of
students and in compliance with the existing official rules,
foremost preference is given to members of the Commmist Party,
persons having attended Workmen's Courses, and people command-
eered by Professional Unions, persons belonging to the Workmnen
and Peasant class, etc, These methods of admittance account
for the marked change in the class elements among the students,
for instance those »%f the lMiilitary Medical Academy, as showm in
a table below, The age of the students, at entrance, vary
between 16 and 25, but most of them are 17 to 18 years old when
they enter",
The entrance examination now is given in Russian
Mathematics, Physics and General Culture, and the object of such
examinations is to limit classes to the laboratory facilities of the
faculties, The graduate of the Rabfak or working man's "University"
{really a secondary school open to workers) automatically gets into

the medical faculty without examination,

It is interesting to note that half of the students
who entered the medical schools in 1918, 1919 and 1920, were dropped
before reaching the fifth year, This is an example of the fact that
& doctrinaire assumption that anyone is capable of receiving a mi~
versity education is false enough to become self-evident over a

period of a fow years,

No copies of the entrance examination were secured,

See Section 15, Seource of Students,
58.

In the opinion of Miss Alice Davis, of the Friends
Society, who has mingled considerably with the students, it takes
300-500 roubles for the necessary coaching to pass the entrance

examinations to the faculty of medicina.
596

11.-FSES OF STUDENTS, AND STUDENT LIFE.
In 1927, 50% of the medical students received aid from
the State for their living expenses, 40% paid no tuition whatever, ani

10% paid something for their education.

The object of State aid is, first, to provide careers
for the children of workmen, peasants and state employees (there are
about 50,000 students in all branches on Government stipends) and,
second, to recruit ranks of rural practitioners. It is usually the
bourgeois students who pay for their tuition, the maximum being 300

roubles @ year.

The student who receives aid from the State gets 256
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 six in a room, paying 2.50 roubles for rent, and 12 to 14
roubles for food Books cost 5=10 roubles (20-40 cents) and are
thus only occasional luxuries for the poor student. In Leningrad

three text-books in the library were for 250 students.

(1) The University of Moscow announces that in 1926-1927 the Univers~
ity Refectories oan take oare of 2,400 students a day. A dinner of
2,000 calories costs 352 Kopeks, the University losing 6 Kopeks as the

real cost is 38 Kopeks.
Much time is taken by political or semi-political
associations, ani 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. The report of the State
examination committee in Moscow states in 1927 10% were prepared =
85% with mediocre preparation and 5% inadequately prepared. The
reason for this lack of efficiency on the part of the students,
as discovered by the Faculty Council, was the general over-crowling,
the depressing financial conditions and the necassity to secure em-
ployment outside of the University, inadequacy of teaching equipment
and the relatively small number of teaching forces as compared with

the large number of manbers.

The obligation to the State which is incurred by
acceptance of aid is discharged by three to five years service as a
country 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 instruction, etc. According to a professor in the
Leningrad Medical Institute the conditions in 1923 were improving. Dr.
Gantt observes:

“During the revolution the pecuniary position of the
students became considerably worse, ami the assistance of
the State consisted in the issue of war payok ration to

1200 students which in 1920 were chosen to enjoy the so-
called State supply. Those who did not receive that payok
61.

were expected to pull through as best they could. Since
this year conditions have improved, ami the students have
been allocated Rs. 200 (b 1.-) per month besides payok and
clothing. Moreover, many of the students get lodgings at
student~homes established by the Government. Besides
regular students there are also physicians studying at the
Academy. These are partly physicians commandeered from
military departments, partly better students kept on by
the Academy after thoir graduation for improvement. The
latter are kept on by the Academy for a period of two years
after having written a competition composition (Formerly
there were kept by the Academy each year ten physicians,
now this number is only five). In former times three
students were sent abroad each year on account of the State,
for a two years’ sojourn there. This system proved excellent,
and most of the Petrograd professors, ag well as those of
the country, were of the number of such students,

“"The following number of students enjoyed stipends at
the Petrograd Medical Institute:

Institute*’s Private
Stipend. Stipend,

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

"The Students’ Feeding Division of the American Reliaf
Administration, conducted by Mr. S.iM. Keeny, fed University
students in Odessa, Kiev, Moscow and Leningrad from 1921, to
1924, About 12,000 students receive one meal each day, repres-
enting about 1,200 calories. Soup, meat, bread, ani potatoes
made up the menu, and the meal cost about 2 to 6d. in Russia
without cost of overhead. 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 lucky.

“In 1923 many students of the medical sohools get food
from the American Kelief Asministration. Thanks to this assist-
ance students who otherwise vould have been compelled to quit
studying altogether were enabled to continue their studies",

A professor of the Leningrad Medical Institute states

as follows:

"In pre-revolutionary times, the students of Medical
Schools paid 50 gold roubles for each semester. An except ion
to the rule was the Military Medical Academy, where a great
majority of the students were enjoying subsidies from the
War Department and therefore were free from the payment of
62.

fees. Other schools too used to exempt the most needy
amongst the students and there existed State and Public

and Private Funds, out of which subsidies were paid to a
certain number of students. They were distributed by the
school administration with participation of the students.
After the revolution, payment of fees was abolished, but
there was also discontinued payment of subsidies to thea
students ( the bonds in which the subsidy fund was invested
having been annulled by the Goverment). Also there were
closed the students’ kitchens, which were transfomed into
public kitchens for the population at large. All that made
the conditions of the students very hard. The large majority
of them, owing to these changed comiitions, were compelled
to combine with their studies some work in order to eam
their living.

"Now the conditions of studying, as well as 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 (5 1. tob2.10.0 ) for a semester. Subsidies
have been introduced again in a much larger number than there
existed before the revolution, but the subsidies nowadays
are distributed according to special rules, preference being
given in this distribution to those who are member's of the
Communist Party or belong to the workmen or peasant class.
There are also homes and kitchens being restored for use
among the students".

The following is a quotation from the bulletin of the
Medical Faculty of the I University in Moscow:

"The financial situation of the majority of the students
is still quite precarious in spite of the fact thet the rate
of goverrment stipend was increased up to 23/25 Roubles per
month, and that the total amount of government subsidies for
stipends was raised to 803,505 Roubles.

"One of the first actions of the new university semte
was to go into the problem of student life. Im order to brins
about an improvement in their mode of living, special dormit-
orics and refectories were organized. A system of loans for
poor students was also established. The number of students
in these dormitories was of 1728 in 1925 and of 2206 in 1926"!
65.

12,- DEGREES & QUALIFICATIONS .-

State examinations for Goverment commissions
formerly were in vogue, before the applicant was permitt ed
to practice. They were minimized during the war and abolished
in the revolution, the schools being entitled to issue diploms
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, the lesser being the certificate of graduation
from one of the established medical faculties, and the higher a
document attesting to the satisfactory completion of higher or
specialized study, this also being conferred by the faculty. In
pre-revolutionary times, physicians desirous of devoting themselves
required
to scientific career and of getting positions of teachers were first/
to get the grade of doctor of medicine. The same grade was necessary
for taking over certain administrative jobs. In order to got that
grade physicians were to pass through special examinations for all
the sciences for which they had already passed through examinations
when graduating as physicians, and also to write up some scientific
work as a “dissertation. This usually was a very considerable
scientific work, and the writing of it frequently required several

years of diligent work.
64.

Since the revolution all scientific grades and titles,
also that of doctors of medicine, have been officially abolished.
However, even now schools are enabling those who are desirous of it
to pass through examinations on a series of sciences closely connected
with the speciality selected by the applicant. Those passing through
such examinations are then expected to write a scientific work of the
same kind as the former dissertations, after which they get from the
school documents certifying to their scientific qualifications, Such
qualifications are required from candidates for the posts of senior
teachers. The former system, therefore, has kept up in its essential

points’.

There are thus no titles or degrees as we know them
conferred, but it is apparent that the Commissariat of Education is
actively supervising the examinations through a special cormission for
that end, which reported in 1927 that 10% of the medical students were
well prepared for the fina] examinations, 85% had mediocre preparation
ami 5% were badly prapared.

It cannot be inferred that because all the medical
faculties are under the Commissariat of Bducat ton the values of instruce
tion in different faculties is approximately the same. The training
at the Military Academy in Leningrad is still probably the highest in
Russia, due to selection of students, strict internal discipline, and

to superior teaching persomel. The medical training given outside
60 «

Leningrad and Moscow is probably uneven and of poor quality ~ Kharkoff

possibly excepted.
66.

. 13,- CURRICULUM

For an important discussion of the present and practically
uniform curriculum from the government's point of view, see

Appendix 2, The curriculum itself is the following:~

 

 

 

 

 

 

No,of Hrs, No,of Hrs,
per week, ,__. —per_week
s/s 1 kB 3/3015
ha
Hi Sa] Rg #} S21 Rs
> e’olreda rey PO let ®
2) oF] ag o1oB la 3
Als 6 © mie jog
ist Year - 1st Semes, By £402 ist Year ~ 2nd Semes, Ay a
1, Normal Anatomy 2 5 126 1. Normal Anatomy 2 4 108
2, Physics 3 4 12 2. Hist.& Embryology 2 4 108
3, General Biology 2 2 72 3, Physics 2 3 90
4, Gen, Chemistry 3 2 90 4, General Biology 2 2 72
( inor ganic)
5. Gen, Chemistry 3 5 144
5. Social science 2 2 72 (orgen,.& anal,)
ces
6, Military So - 2 - 36 6, Social science 2 2 72
7. Foreign Languages - 2 36 7, Foreign Languages - 2 36

7 Subjects ... ol 7 Subjects ... Y,

 

Total No, of hours per yoar = 1st year,

Anatomy 234
Histology 108
' Physics 216

General Biology 144
General Chemistry 234
Social Science 144
Military Sciences 36
Foreign Languages 72

1,188
No, of lira,

 

 

 

67.

 

 

 

per week ber week
8 | ‘3 ° cm 38
2 3 y dhe a
oO o 2 [RO eB
o ~oOR
ai g ad loo
2nd Year - 3rd Semester By 2nd Year - 4th semes." |hi Ja?
Normal Anatomy 13 25 72 1, Physiology 2 5 126
Hist, & Embryology 2 4 108 2, General Biology 2 2 72
Physiology 2 5 126 3. Biol, Chemistry 2 4 108
General Chemistry 2 - 36 4, Micro-biology 2 2 72
(phys.& colloid)
5, Elements in Geo- 2 - 36
Biol, Chemistry 2 3 90 logy & Mineral,
Social Science 2 1 54 6. Social Sciences 2 1 54
Military Sciences 2 - 36 7, Foreign Languages - 2 36
Foreign Languages 7 2 36
8 Subjects . ... 31 7? Subjects ... ¥,
Total No, of pours during the gnd Year,
Normal Anatomy 72
Histology 108
Physiology 252
General Biology 72
Elements in Geology
and Mineralogy 36
General Chemistry 36
Biolog, " 198
Micro=Biology 72
Military Sciences 36
Foreign Languages 72

 

954

 
 

 

 

68.

 

 

 

 

No, of Hrs,
pr, wk,
en
glo, [ae
HSE [ae
+
giBF lee
Srd Year - 5th Semester Sr@ Year ~ 6th Semester Ale jan
1, Pathological Anatomy 2 2 72 1. Pathological Anatomy 2 2 72
2. " Physiology 2 2 72 Re " Physiol, 2 2 7
3, Mioro=Biology 2 3 90 3, Pharmacology 2 2 72
4, Pharnacology 2 2 72 4, Experim, Hygiene 2 6 44
5, Experim, Hygiene 2 4 108 5, Midwifery (physiol, 1 = 18
part)
6. Social Hygiene
(San, statistics, 11 &% 6, Propedeutics of Int, 4 72
anthropology and diseases
anthropometry)
7, Propedeutics of Int, 4 72 7. Physical methods of 3 54
diseases treatment
8, Propedeutics of 4 72 8, Propedeutics of 4 72
surgical diseases surgical diseases
9, Operative surgery l1 2 54 9, Operative surgery 1 2 54
with topog, anat, with topog, anat,
9 Subjects .., 36 648 9 Subjects . . . 35 630

 

Total No, of hours during the Srd Year,

Pathological Anat any
7 Physiology
Micro~Biology
Pharmacology
Experimental Hygiene
Social Hygiene
Midwifery
Propedeutics of Int,Dis,
Physical methods of
treatment
Propedeutics of Surg,Dis,
Operative surgery with
topogr, anatomy

144
144
90
144
252
36
18
144
54

144

108
Teens
1.278
1.

Be

10,

 

 

 

69.

 

 

 

No, of Hrs, No. of Hrs,
per week
el fe ee
a8 x] 88 alg /28
u& > ort Sd oa
BIS Of rt a Be de
Plo BI a a Ploola
ae 139 g/BFlS a
4th Yoar - 7th Semester Ala Hw 4th Year - 8th Semester fan Te
Clin,of Int, diseases 5 90 1, Clin,of Int.,diseases 5 90
no Surg, “ 5 90 2 j" " Surge *" 6 108
(with spec,orthopedic (with spec,orthopedic
course wherever deemed course whrever deemed
mecessary) necessary)
Clin, of Obstetrics & 5 90 3, Clin, of Obstetrics & 5 90
Gynecology Gynecology
Clin,of Nerv, Diseases 6 108 4, Pediatrical clinic 4 72
" Derm & V.D. 4 72 5, Clin, of Derm & V.D,. 5 90
"  * Ophthalmology 2 36 6, " * Ophthalmol, 1 18
Industrial Hygiene 2 - 36 7. Industrial Hygiene - 3 54
School Hygiene 2 - 36 8, School Hygiene - 3 54
Legal medicine 2 2 772 9, Clin, of Pediatrics 3 - 54
Military Hygiene 2 - 36 10, Legal medicine 1 2 54
Ww ~~
10 Subjects .... 37 666 10 Subjects . ... 38 684

 

Total No, of hours during the 4th year,

Clinic of Internal Diseases
Surgical "
Gynecology & Obstetrics

t "

Neurology
Psychiatry

Dermatology and V,D,

Ophthalmology

Industrial Hygiene

School Hygiene
Pediatrics

Legal Medicine
Military Hygiene

i

180
198
180
108

72
162

90
90
54
126

 

1,350
Bth Year - 9th Semester

No, of Hours

 

D:.

96

10, Military Hygiene

Clin,of Int Dis, (with
a course of Tb, wher-
ever necesgary, )
Surg,clinic (with brief
course of Urology)
Gynecology & Obstetr,
Odontology
Oto~-rhinotlaryng,
Paychiatry
Pediatrics (with
course of infant
disea,)

Ophthalmology

Social Hygiene

10 Subjects . . 2...

70.

No, of Hours

       

 

per week, er_week
ei f& "a Be,
al 188 e185 | =8
q 3 aa 8 » 42
PLo SR 5 SE eos
3 3 $6 8 & oo
até lea 5th Year - 10th Semes, pe
1, Clin, of Int,Dis, 4 72
5 90 Ze “"  ' Infect, Dis, 4 72
4 72 3, Surgical clinic 4 72
3 54
126 4, Gynecol, & Obstetr, 3 54
2 36 5, Oto-rhino~laryngol, 2 36
3 54 6, Nervous diseases 4 72
2 36 7. Clin, of Pediatr, 4 72
(with course of
4 72 infant diseases)
4 72 8, Dermatology & V.D, 2 36
9, Ophthalmology 3 54
3 54 10, Social Hygiene 2 2 72
Zz 2 72 ll, Pathol, Anatomy 1 1 36
(dissect, course)
2 - 36
36 648 11 Subjects ,.... 36 648

 

Total Now of hours during the 5th year,

Clinic of Internal Diseases 162
" Infectious " 72
Surgical clinic 198
Clin, af Gynecology & Obstetrics 90
Odontology 54
Clin, of Otko-rhino~laryngology m 72
“" = Nervous diseases 72
"Pediatrics 144
" " Dermatology & VD, 36
" Ophthalmology 108
Social Hygiene 144
Military Hygiene : 36
Patholog, Anatomy (dissect,course) 36
71,

Distribution of Studies according to Semesters,

Autum semester,
Beginning Sept. lst, ending
Of those: winter vacation =

holidays =

van, Slst <=

el days:

6 1

There remains =

i, @, 18 weeks,

ri se ter,

Beginning Feb, lst, ending June 15th

Of those: spring vacation =

holidays =

5 days;

4 -

There remains=

1,6, 18 weeks,

153 days,

27 "

126 days,

135 days.

126 days.

TOTAL : 56 weeks is equivalent of 216 working days.

Non working days:

Total non-working days . ....e

winter vacation = 21 days

spring
holidays

Sundays

= 5 af

"

ul
_
Oo

Summer vacation = 77 '"

149

 
72e

Only in Moscow and Leningrad are there four chairs
of Hygiene in each faculty. In the smaller provincial universities
there are only two —- Experimental or General Hygiene, ani Social
Medicine. All courses given in Hygiene are compulsory and the clinic-
ians complain that Hygiene is robbing too much ef the time of the
student.

fe Social Science of the first two years is of course

in importance to medicine

largely Communist doctrine and is amlogous to the course in American
Institutions which is required for entrance to the Medical School of

the University of California.

The 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,
Frem the third year to the fifth, the student is given more am more
responsibility in the wards and at the same time devotes less and less
time to lectures. In the fifth year, the student does clinical clerking,
somewhat similar to the English medical student. Preparation for the

State examinations takes an additional 3 to 6 months.

Very many students take 4 longer time than this for
making their studies and remain at the schools seven years or more.
This delay became especially frequent after the outbreak of the war,

when many of the students left for the front line in the capacity
73.

of “Sanitars" or assistants, or instead of studying, worked in the

Petrograd Hospitals.

The first two years of the regular study period are
occupied with chemistry, physics, anatomy, histology, physiology,
biology and physiological chemistry, with laboratory and pract ical
work in each. The fourth and fifth years are devoted to clinical
work. Since the number of ordinators and assistantships in hospitals
is small, the effort is to sive a thorough practical experience in

clinical work in the fifth year.

The work of the students is controlled by notes of
laboratory work, practical tests, and by examinations. Apparently
there is soma latitude in this matter. The Military Academy prides
itself on the strict rule of examinations at the end of each year
and only two make-up examinations allowed a student in October. Other

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

Up to 1906 the students were compelled at the end of
the year to pass through examinations on all subjects they had studied
during that year, In 1906 this system underwent some changes; 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 studied during

the first two years before admitting them for work in the upper
74,

classes, and 2) a definite order in passing through the examinations
While in the upper classes, Now it is planned to return to an

arrangement wimilar to the old system prior to 1906,

After having attended a medical school 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 theoretical sciences, such as anatomy, physiology, physio-
logical chemistry, general pathology, pathological anatomy, pharme~
cology, pharmacy, hygiene, legal medicine, and also on all clinical
subjects - in all twenty-three examinations) before special examin-
ation~conmmissions, The examinators of those commissions were teachers
to high schools: to act as presidents to those commissions the
Government usually nominated either the rector of the respective
medical courses or well-known professors of médical sciences from
other achools, After the war the number of examinations before
government commissions was reduced and during the revolution these
examinations were altogether abolished, the schools being entitled
to issue diplomas for the right of practising to all students who
went through the course of studies without renewed examinations,

At the time being, the examinations before the government-conmissions
are re-established, It is planned besides to compel the students
in the near future, before giving them the right of practising, to

spend one year at hospitals (not connected with the schools),
75.

The following comment on the most recent curricula
changes in the First University of Moscow is translated from the

bulletin of the Faculty of Medicine.

During the school-year 1925-26, the Faculty council
continued its previous attempts (ever since 1924) to bring about
a change in the teaching methods by concentrating chiefly upon the
seminary and laboratory methods xx of work and gradually giving up
the purely theoretical methods. The number of theoretical hours was
sacrificed and replaced by seminaries. The number of practical hours
was also considerably increased. In certain subjects (organic and
inorganic chemistry, pharmacology, physiology, pathological physiology) »
practical exercises have been made compulsory in the so-called
"prophylactic disciplines" (general and social hygiene). Practical
work in the field was made compulsory. A certain amount of ambulatorium
work had to be done within the programme of teaching of social hygiene
and tho student was acquainted with dispensary methods. The teaching
of clinical subjects was reorganized so as to bring about a close
contact between the student and the everyday clinical wrk (in ambula-
toria, laboratories and wards). This reorganization resulted in the
creation of groups of students each of which is compelled to spend a
certain amount of time in various clinics and taking an active part

in their regular work.
76.

The details of the main course in Hygiene (General

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

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

weeks intensive period in each of two semesters they have five seminars

of four hours each. In the second semester there is 140 hours of

laboratory work (which includes excursions).

roubles

As indicative of the scope of work the following is the

of study in the first semester;

Bases of qualitative and quantitative chemical analysis.

Carbon dioxide ~ significance and tests for.

Measurement of humidity, wind velocity, sunlight, heat and
atmospheric pressure.

Katathermy and effective temperatures. Making and reading
of architectural plens.

Observation and inspection of buildings, Hygiene of
dwellings.

Bacteriology and biology of wator.

" " " * earth and air.

Examination period.

Observation and report on assigned hospitals from a sanitary
standpoint. Report and defense of criticisms. Same
regarding factory worker's houses.

One day spent with Sanitary inspector.

fo give this course the Institute receives 500

a semester (cf. 455 r. to Institute of Pharmacology).
77 4

14.-NOMBER OF STUDENTS .~

I have no recent figures by Faculties 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 and that in the 15 Faculties of the R.S.¥.S.R. there were
18,000. Bronner also said that there were about 7,000 doctors in
Goverment rural practice and 28,000 as a total of the number of
doctors in the U.S.S.R. The average professional life of a doctor
is calculated as 28 years in Russia, so that replacement alone

would require 1,000 graduates & year.

The 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 Science
in Leningrad from 1916-1922, the same range of percentages at the
Military Academy for the year 1918-22, ami the same for the Lenin-
grad Medical Institute. Since 1922 the percentage graduating has
increased, as is indicated by the report of the I Moscow Medical
Faculty . 2,654 students have been regularly attending the lectures
and practical work of the medical faculty during 1924-25. (1st
year; 336 - 2m) year: 581 ~ Srd 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. 2,449
78.

students were registered in the faculty by the time of the opening
of the 1926 spring semester. (lst year: 304 - 2nd year: 590 =

ord year; $355 ~ 4th year: 484 = 5th year: 536). 419 students
have completed their studies and obtained their doctor's degree in

the spring of 1926.
79

15, _ $5 OF STUDENTS

Very few phases of medical education under the Soviet
government are more important and more distinctive than the source
of the present student body, The future of medical and public
health work in Russia will be influenced by the background, train~
ing and attitude of these students, by their qualities as well as

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 I, University of Moscow indicates,

Table ne the "gocial" origin

of the students { September 1, 1926),

Fia@ ¢ uid t y o f :

 

sotenced Lar Ethnology Medec in Total

Workmen 104 «3,4 «606316 «(19,2 a os
Children of workmen 509 10,2 157 9,5 ” 20,5 953 ee
Peasants 72 2.3 183 11,1 62 158 7.6 473 6,2
Peasints' children 324 10.7 #166 10,1 58 343 16,8 891 11,8
Employees 971 38.5 389 23,7 152 349 #$417,0 1861 24,7

" * children 805 26,7 150 9,1 137 313 15.2 1405 16,6
"Intellectual" workers
(this includes a certain
group of employees).A.M, 266 8,8 121 7,3 156 21 1.0 564 7,4
Their children 108 §=3,5 95 5,7 74 67 3.2 344 4,5
Non-working "element" ” - 7 4 - - ~ 7 -
Their children 9 O,2 19 #%41,l 6 26 1,2 4 60 0,7
Others 370 1,2 35 «241 18 157 7,6 «247 «03,2

 

3,005 1,638 836 2,048 74527
80.

DIVISION ACCORD ING 70 POLITICAL VIEaws.

Members of the All Russian Communist Party 22.4% (
Members of the All Russian Association of ) 55.6%
Communist Youth 33.2% (

Students belonging to no political parties
(so-called "“impartial") 44.4%

DIVISION ACCORDING TO NATIONALITIES.

—

Russians 75.4% White Russians 1.5%
Ukrainians 1.2% Jews 14.3%

Mordva, Choovashes, Zyrians, Bashkirs, Boukharians, Uzbeks, Tadjiks,
Tartars, Udmurts, Egyptians, Persians, - each of those natiomlities
from 0.1% to 0.54. ~ Poles, Germans, British, Greeks, Latvians,

Esthonians, each of those from 0.1% to 0.7%.

Great restrictions were made, beginning 1926, as regards
the "social origin". Although entrance examinations have been reniered
more difficult, the percentage of men and girls from the working class
has remained the same/during 1925. The same applies to the percentage

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

the kabfak.

This then is the picture at Moscow. In Leningrad at the
Institute, Professor Lichatchef told me that 1,000 students apply
for admission but that only 200 are taken. Of these 200, 100 come
from the Rabfak (Workers' School) and the other hundred are chosen

in the following order of preference:
81.

lst. Factory workers’ children and children of professors.

end. Children of goverment employees.

ord. " " other workers.

4th. " “" merchants, shopkeepers and bourgeois.

Professor Lichatchef admitted that the selection is not

entirely by scholastic merit, but Professor Anitschoff corrected an
otherwise erroneous impression by adding that the zeal of the students
was as great, if not greater, than in Tsarist days. This was also
the impression of Professor Stern in the Second University in Moscow,

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 composition of the stud-
ent bodies in the Medical Faculties; the proportion of girls is high -
as high as 75% in the schools originally founded for women like the
Second University in Moscow or the Leningrad Medical Institute, and
usually not below 40% in the other faculties which are now open to
women (except the Military Medical Academy in Leningrad). I had the
impression that the girl who would take a nurse's training in Canada

would in Russia enter a medical school.
82,

_i6,- DISTRIBUTION OF GRADUATES,

The distribution of doctors is the great problem for
the Soviet govermment, for the country doctor is badly needed. as
there are only 7,000 now for the huge territory of the U.S.5.R. It
has always been so — there were virtually no country doctors in
Tsarist times. The post of Zemstrovratch, or district doctor, was
regarded as a sacrifice, if not a martyrdom. The ignorance and
stupidity of the peasant, his lack of appreciation or intelligent
co-operation of &@ doctor's services, made a doctor's life hard ani
the ineffable isolation of many stations from any center of culture
or congenial companionship was and still is the final argument

against “going into the periphery".

There are 1500 doctors of medicine in Moscow who
refuse to go into the country, though places await then... nominally.
Professor Brenner told me that 50% of medical graduates in Moscow
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 provincial faculties which really help to solve the pressing
problem of getting doctors into the districts. Hven the Rabfak
caniidates for admission to the medical school are chosen more care-
fully than before, and those willing to go to the provinces are

given the preference.
83.

The government stipends for students are used to
oblige the graduates to go into practice for at least @ term of 3

or 5 years.

A talk with a young woman graduate at present
serving her time in the district of Putiloro near Leningrad cast
some light on this question. Dr. Natalie Sviazheninoff graduated
in 1923 from the Leningrad Medical Institute. She speaks Gemmn,
English and French. She has been stationed in Putilovo, & town
of 8,000 and, with a younger girl (M.D.) as an assistant, has a
district containing 19,000 people to attend to. She is responsible
for a 50-bed hospital ami 200 outpatients a day. The radius of her
c&lls is 30 kilometers. She was on leave with retinal hemorrhagos
and had been much overworked. For this service she is paid 90
roubles a month. She said the reason for the unwillingness of young
doctors to "go to the periphery" is the certainty of overwork and

underpay.

The proportion of doctors in Russia is 1: 5,800
population, and roughly one-tenth of these doctors are wmen. About
one-third of the medical profession succumbed during the recent
famine and epidemics, The proportion of doctors in the United

States is 1: 800, and in Great Britain about 1: 1400,
84.

It would appear that by means of exorbitant taxation
the goverment attempts to frighten the weaker doctors out of
private practice. Doctors can do private practice “but they prefer
not to". The professors and well-ikmown consultants make money a1]

the same.

The men in the service of the Narkomsdrav are on
full-time “so far as is known". This includes a large number of

doctors in the cities and all the doctors in the districts.
85.

17.~ IMPORTANCE AS MEDICAL CENTERS.

From what I have read and seen and heard, I should
say that the Military Medical Academy in Leningrad was the most
important medical school in Russia. In second place, I would put the
Medical Faculty of the I University in Moscow. A close third ia
the Leningrad Medical Institute. Fourth, the Faculty of the II
University at Moscow and fifth, the State Medical Institute in
Leningrad.

(1)

Among the provincial universit seas Sarmett is

important as the principal school in the eee. Saratov and

Kazan are also important centers. Kiev and Odessa rank after

Kharkoff in the Ukraine.

The Military Medical Academy has a great tradition

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

(1) The new medical school in Kharkoff is formed by the combination
of the Faculty of Medicine and the Women's Medical College. The
old buildings have been renovated andi newly-equipped.

(2) The Ukraine is the largest, richest, and most powerful republic
outside Great Russia.
86.

has a strong personnel and a higher atandard than the other schools.
The close association between medicine and the public health service
and its institutions for investigation and teaching give a oertain
advantage to the schools in the capital, and of these the First

University is easily the more important.
87,

18 STATUS OF RESEARCH .

Research in the medical sciences if going on more
actively in the special institutes outside the faculties than within
the teaching institutions. This is due to the fact that the research
institutes are often new and especially favored by the Communists,
whereas the faculties of medicine are looked to for their most needed
product - young doctors, and are crowled with teaching responsibilities

for their immediate production.

The principal factors in the research work done in the
medical sciences in Russia today are;
1) The strain of the immediate past;
2) Heavy teaching duties;
3) Inadequate sums for research;
4) Intellectual isolation from the rest of the
scientific world.

Some of these factors have a favorable side. Though
the immediate past has been almost infinitely depressing and enervat-
ing, the present difficulties seem by comparison an enormous improve~
ment. Work is natural and imeed a relief from an otherwise
unbearable existence. The small sums in support of research at
least emphasize the importance of ideas rather than technique and

the originality of much of the present work is an evidence that

isolation is not unrelated to a certain freshness in point of view.
88.

The story of the past ten years and the struggle
made by scientists to keep at their work is extraordinary. Gantt
has written much on this theme and deserves to be quoted at length

(See Appendix 5).

From 1918 through 1922, as a result of the general
state of the country, research work was done under appalling condi~
tions and science kept alive at the cost of enormous energy and

heroic sacrifices of the imlividual workers. During 1924 and 1925
the living condit ions of the scientists, though still preoarious,
greatly improved, and the Soviet Government rendered considerable
financial ald to science. Some laboratories have returned to nomal,
many new ones have been formed, and there are a few inetitates which

surpass anything of their kind heretofore produced in Russia,

Te spirit of research is prevalent and is being
fostered. Science will suffer during the next decade or so from
the emigration of former scientists, the lack of preparation in the
pupils of the war and revolution periods, the lack of adaptation
between the professor and the present type of student and from other
inevitable adjustments to the new social conditions.” The bringing
of science under central control and Soviet patronage, though it
may give @ slight political colouring, is putting it on & much

(1)

more stable financial basis than it was in old Russia.’ The present

(1) W.H. Gantt.
89.

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

the most hopeful signs in Soviet Russia.

The best recent work in medical research in Russia
includes Pavlov's work on conditioned reflexes in animals;
Krasnogorsky's work on children's conditioned reflexes, Orbeli's
work on the effect of the sympathetic nerves on striped muscle
fibres, Speransky's work on cerebro~spinal fluid in relation to
rabies, diphtheria, measles and meningitis, Bogomoletz's work
on prophylaxis of muscular fatigue, and on cancer, Bykov's work

on the effect of vegetable juices on gastric secretion.

The report of the First University of Moscow shows
commendable interest in research, but the enumeration of only the
numbers of scientific works, 738, published, shows a rather

primitive attitude towards the subject.
90.

19.-TRAINING AND DEVELOPMENT OF TSACHERS.

The training of future teachers is a serious difficulty
for the Medical Section of the Narkompros ~~ a difficulty becoming
more and more apparent as death and retirement continue to make

more chairs vacant.

There are few changes among the class of assistants
more important than the increasing economic pressure to hold more
than one assistantship (for the sake of supplementing an impossibly
low salary). This results in a dissipation of energy and attention -
and Consequently slow and inadequate progress in any single branch
of medicine. I was told that the qualifications for docentships
had changed: now it is not the public defence of a thesis but
published work and past record which counts. In theory, this sounds
well, but the fact is that the gencral group of assistants is in a
wretched position. They are underpaid, they have neither the reputa-
tion and training of the older professors nor the advantage in most
cases of being young and ardent Communists. The ten years of greatest
value in any young professor's life were years of war, revolution,
famine ani halting reconstruction. It is not remarkable that they

are handicapped.

Professor Bronner and his colleagues have devised

& system to recruit the academic personnel. This is the so-called
91.

“aspirant™ - cemparable to a resident fellow locally or travelling
between different faculties in the U.5.5.R. The aspirants are
chosen by a central committee of which Bromer is the chief, the
Glavpzofobr, from lists presented by the Rectors, who have in turn
received nominations from local University commissions of 20-30

composed of professors, assistants, and (one~thim) students.

The aspirant in the medical sciences begins just
after graduation and works three years; in the clinical branches he
is chosen from among the ordinators (internes) who are graduates
of two or three years standing, and he too will remain an aspirant
for three years. The aspirant aspires to the post of paid assistant,
and during the third year he usually gets practice in teaching. The
aspirant from the smaller faculties usually goes to a larger center,
those from Moscow and Leningrad stay in these centers. Professors
have no power to refuse or to choose the aspirants working with them,
and there is some criticiam that the aspirants are not Closely enough

controlled.

The Glavpzofobr is extremely anxious to improve this
form of training by extending their travelling fellowships to foreign
countries. Pirogoff had favored this and before the war there were a
number of well-administered and well-paid foreign fellowships,
especially at the Military Medical Academy. The value of foreign

fellowships is a vivid memory in the Russian mind though the present
92.

perfomance is inadequate.

In 1925, 80 foreign fellowships were awarded, in 1926
120. The maximum amount given for a foreign fellowship is 500
roubles, the usual amount 300 r. The costs are 50 r. for a passpert
for scientific purposes, 100 roubles return trip ticket to Germany
(zhore most fellows go), 100 to 300 roubles for living expenses, and
50 roubles for extras. Tho men are carefully selected and a clear
statement is required regarding later employment. There is no possib-

jlity of sanding even the best as far as America.

Without much doubt these travelling fellows have many
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, Germany, France and the Baltic countries are the principal

countries visited.

I got the definite impression that foreign fellowships
were so precious that every care is exercised to preserve the standing

of these men in the countries visited.

Due to the complete change in the social status of
the students, it is chiefly from the classes which have reason to be
interested in the Soviet Government (workmen, peasants and communists)
that the medical stadents are likely to be gathered. The future

professors and doctors must come from the classes who now have the
95.

opportunity for education. Although some of the old professors
apprehend expulsion from their chairs when enough new régime professors
will have been prepared to take their places, it does not seem likely,
from the past policy of the Soviet Goverment in regard to science

that they will expel an efficient professor for any other reason than

counter-revolutionary political activity.
94,

20.~- ASSOCIATED INSTITUTES —

As will be seen below, thera are a large number of
teaching and research institutes in Russia whose work is in the
medical field but whose administration is not under the Commissariat
of Education. The majority of these institutions are under the

Narkomsdray or Commissariat of Public Health.

The most important group of such institutions under
the Narkomsdrav, of which Professor Bach (see below) is the chief,

are the following:

State Institute of Public Health, Director Professor Bach.

Biochemical Institute, " "
Institute for Experimental Biology, " " Koltsov.
of Microbiology, " " Barikin.
" " Nutrition, " " Shaternikoff.
" for Control of Sera & Vaccines, " 7 Diatropoff.
(formrly Prof. Tarassevitch).
" of Physics and Biophysics, " " Lazareff.
" "  fropical Medicine, " " Mazinoffski.
" “ Sanitary Hygiene, " " NN.

Before giving individual descriptions of some of these
institutions, it may be noted that Professor Bach told me they needed
nothing, that literature was adequate and apparatus good. The contrary
was the case with clinics and institutes of the medical faculties and

some of the institutions of Narkomsdrav not in the above group.

Bach Institute, Moscow.- Professor Bach is an old

revolutionist of 69 years who returned to Russia after the Revolution
95.

from his exile in Switzerlami. Address: Voronzov Polye 8.
Director: Bach. Housed in an excellent building, splemiidly equipped.
The building was formerly a private residence which wis nearly demolished
during the Revolution and was the first building to be reconstructed
in Moscow.
Staff; About 25 full~time and 20 part workers. First
Assistant, Dr. Sbarsky. Second, W.A. Engelhardt (excellent English).
Problems: Mostly industrial chemical; o.g. tar, peat
and pharmaceutical preparations. Also some purely scientific research,
metabolism, enzyme action, physico-chemical ani immunological.
Institute for Experimental Biology, Moscow.- Adjoins
the Bach Institute and the Institute for Hygiene. These three buildings
were the former residences of three rich merchants who founded and
endowed the Institute for Experimental Biology. One of them expressed
his desire that his house be used as a scientific institute after he
fled from Russia. Director: N. Kolsoff. Organized in 1916. Good
equipment, excellent library, good spirit.
Problems; Genetics, general physiology (physico-
chemical).
Divided into following sections:
1) Physico-chemical ;
2) Hydrobiology (station 60 Kilometers distant).
3) Hematology - blood groups, physical chemistry of blood.
4) General genetics. Domestic Animal Fam, 40 Km. away.
5) sugenics, human hereditary traits.
6) Cytology.
7) Psychology - hereditary phases and studies.

8) Tissue culture and embryology.
9) Endocrinology.
96.

Professor Kolzoff impresses one as being a very act ive
investigator.

This institution described in detail by L.C. Dunn in
letter to Dr. Hutchison of International Education Board.

Micro=Biological Institute, Moscow.- Address;
Pogodinskaya 10.

Is housed in a large, old building which also contains
the Institute for Tropical Diseases and the Institute for the Protect ion
of Labour. Sstablished in 1921, Director: W. Barikin.

Work: 5Spidemiology of typhus. Studies bearing on the
epidemiology of cholera, Studies on the toxins of scarlatina, strep-
tococcus, diphtheria, toxin and anti-toxin.

Institute for the Control of Serums and Vaccines, Moscow.

Address: 41, Sivzev, Vrajek. Director; Professor
Diatropoff (formerly Tarassevitch). Sstablished in 1919. Housed in an
old building which has been well adapted to its present needs.

Work; Tests and standardizes al] sera and vaccines
made in Russia or imported, and assists the Public Health service as
opportunity arises.

Staff: Hight doctors, - are expected to do research
because routine duties consume only about Y3 to 1/2 of their time,
Laboratory is good, has enough ordinary materials and smjll animals,

but has difficulty in getting new apparatus. Library is fairly good.
97.

One room is devoted to a Metchnikoff Museum and
contains all his manuscripts, notes and most of his correspondence.

Institute of Physics and Biophysics, Leningrad,
Director: Piotr Lazareff. Staff of 39. Sections are as follows:

1. Molecular physics.
2. Photo-chemistry.
5. RKoentgenography.
4. Tonic thoory.

5. Pure physics.

Institute large, well-built and well-equipped. Aside
from work on electrical phenomena of the nerve impulse, most of the
work is in applied physics. Large iron deposit discovered in Koursk
gubernia by magnetic deflection studiss, etc.

Institute for Tropical Diseases, Moscow.- Planned
before the war, organized 1919, began work 1920.

Director: &.1. Marzinovsky.

Five Sections: Chemotherapy, protozoology, entomology, helmin-~
thology, clinical.

Problems; Bearing on malaria. The chemists are studying the effect
of quinine on various ferment actions and the excretion of ferments
Aaring malaria. Sntomolozists studying mosguito metabolism. An
interesting work was done on the relation of the p.H. of natural

bodies of water to the presence of mosquitoes. They were found

to be mostly absent when the p.H. wes lower than 5.
98.

There are of course a larger number of institutions
carrying on relatively much less investigative work and more directly
concerned with maintenance of the public health or the special pre~
paration of mambers of the public health service. Some of these
institutions accept medical students and aspirants, thus playing a

considerable part in the training of doctors and teachers of medicine.

& model xxxxx is the Bronner Institute for Combatting
Vene real Disease. It is under 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 budget of 300,000 roubles a year, one
half of which is paid in salaries to @ personnel of 180,66 of whom are
staff doctors. The 0O.P.D. has about 200,000 visits a year, am the
hospital beds are occupied 23,000 sick days a year. The sections are:

1. Social venerealogy.
2. xperimental "

3. Male gonorrhea 20 beds in hospital.
4, Female " 1 “ 7 "
5. Dermatology 2." " "
6. Syphilis 50 " " "

14 aspirants work there and already three professors have been supplied
from the staff. Three of the assistants in the Dermatolcgical Clinic
of the University work there (doubling their employment ). Course of
lectures ia given each day in waiting rooms by young assistants.

This institute has 159 branches and 149 mobile

diagnostic units making venereal surveys all over U.S.5.R. (Trans=
99.

baikal region, 42% of the population have syphilis but no tabes or

G.P., Caucasus has 26%, Turkestan 20%, etc.). ‘There are accommodations
for 50-60 doctors to live in the institation for a 4 months post-graduate
course (twice a year), am during this time their home salaries are

paid for their families and a further stipend of 60 roubles paid).

There is an extensive and impressive experimental
section. Wassermanns twice a week on patients, twice a week on

certain experimental animals.

On the social side a home is maintained for unemployed
infectious women, where 550 can work and receive more pay than if
they continued on the streets, ani receive controlled treatment. When
they leava the home they receive a card giving them first preference

at the employment bureaus,

I have gone into detail to show the spirit of some

of the institutions in the Markomsdrav.

Space prevents full description of the Institute of
Social Hygiene under Molkev, Central Bacteriological Laboratory under
J. Lewin, Metchnixoff Institute, and the State Scientific Institute

for the Protection of Labor, under Livitsky - 411 in Moscow.

Two more Narkomsdrav institutions should be described:

the State Institute for the Improvement of Doctors in Leningrad,
100.

and the State Medical Institute in Leningrad.

fhe State Institute for the Improvement of Doctors
has for an object the “completion of a doctor's medical training
rather than detailed specialization". It has a large series of
laboratories and & hospital of 425 beds with clinical privileges
regarding 800 other hospital beds in the city. The management is
excellent: Director Dr. Kharit. Though there is only one Communist
on the staff, it is one of the best supported institutions in

Leningrad.

The staff numbers 65, with 145 additional on temporary

assigmment. Several professors of the medical faculties lecture there.

The students are district doctors out of medical
school at least 3 years, who come up on district (Gubsdrav) fellow
ships or on fellowship direct from Narkomsdrav. From 1885 to 1920
the average number of pupils was 3535 per course, in the year
1925-26 the number was 1378 and in 1926-27, 1830. The course is
4 months long am is given twice a year. For the year 1925-1926;

25% of the doctors have been in practice 3-5 years

26% " 7 ee we o6)llUt ee eo tr i] 6-10 CU
40% Ce | en | 1 tt He 20 «
9% wom te tee eet tt gr more 7]
101,

In 1925-1926, 60% of the doctors were men, 40% women, and by
ages they were divided as follows:

21% up to 30 years.

51% 31to 40 "

21% 41 to 50 ="

@ Slte 565 "
3% above 55 years.

The laboratories were the best and cleanest I saw
in Leningrad or Moscow. The Department of Bacteriology headed by
Belonowsky. Has about 1350 students, mostly bacteriologists from
public laboratories. Instruction in new methods of bacteriological
and serological diagnosis. Bacteriological laboratories are
housed in @ good building which is being renovated, well equipped.
Iwo large rooms for class instruction with large desks equipped with

gas and water, accommodating two men each. Many individual rooms

for assistants.

Library fairly good (Belonowsky considers it very

good). Not quite enough foreign journals.

The State Medical Institute ~- kmown usually as Gimsa,
is really a medical school with a peculiar history and status. It
was organized before the war as Bechtererew's Institute of Psyoho-
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 director and Nicolaieff the professor
102,

of Experimental Medicine. At present feldschers are admitted to
the 4th semester and are given degree after 3 V2 more years.
The enrolment is 1780 distributed thus: lst year 250, 2nd year,
250, 3rd year 250, 4th year 480 and &th year 550. This reduction
in the lower classes represents the reaction against the come one

cone all theories of 1920-1924,

The clinical work is done at hospitals supported
by the Narkomsdrav and there is much emphasis on the teaching of
hygiene. I did not visit this institution. The laboratories and

clinics are said to be poorly equipped,

Pavlev'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. It is a pure research institute ani

the work is of extraordinary interest.
103.

RECOMMENDATIONS.

I recommend the following actions on the part of

the Division of Medical Education of the Rockefeller Foundation:

1) Increase by the sum of five thousand dollars annually
the present amomt given to Russian Medical Faculties, and divided
approximately as $3,000 to institutions wider the Narkomspros and

$2,000 to teaching institutions of the Narkomsdrav,

2} The extension of the teaching institutes of medicine
in the U,S,S,R. of the present program of foreign fellowships
administered by the Division of Medical Education of the Rockefeller
Foundation, so that a few of the most able young medical scientists
of a large but dangerously isolated country may be enabled to ex-

change information and acquire training,

3) Until time and opportunity be afforded for a thorough

and prolonged visit to Russia no extension of these reconmendations

Mowhnge

Alan Gregg,

need be considered as probable,
eahnibe D
APPEAL =

NUMBER OF STUDENTS .~

 

205.

The Leningrad Medical Institute, formerly the Women's

Medical Institute, was founded in 1897.

“When inaugurated the institute was calculated for
1,500 students, with a yearly acceptance of 200 to 250.
Due, however, to the enormous mass of those desirous to
enter the Institute for study, this number increased
after the revolution aml exceeded 1,000 persons per year,
and in 1919 the total number of those accepted reached
5,635.

"At the present time it has been again decided to
reduce the acceptance, for the Government has convinced
itself that the Commissions of Professors were right in
asserting that the school cannot so successfully handle
so large 3 number of students. An idea of the number
of students accepted during the various years since its
foundation, as well as of the number of graduates and
students working at the Institute, may be gathered from
the following table;

 

 

Institute of Medical Science is shown in the following tables:

STUDENTS

1910-1911 1921-12 1912-13 1913-14 1914-15 1915-16 1916-1
310

456 783 1014 1135 1297 1378

7

ALL CLASSES YEARLY ADMISSIONS GRADUATES
Years Total Men Women Total Men Women Total Men Women
1897 166 166 166 166
1900 821 821 238 238
1902 1597 1597 333 333 111 111
1910 1618 1618 187 187 246 246
1914 1149 1149 162 162 282 282
19015 1594 1594 599 599 85 85
1916 1720 1720 616 616 176 176
1917 2065 139 §=6.1926 619 139 380 80 80
1918 3287 601 2686 1827 592 1236 7§ 2 73
1919 3635 718 2917 1045 176 1230 37 27
1920 1833 255 1580 1059 145 914 25 25
1921 2320 458 1862 841 285 556 108 8 100
1922 2481 576 1905 829 250 579 1536 8615 121
STATS INSTITUTE
OF MEDICAL
SCIENCE. The number of students ani graduates from the State
206.

1917-18 1918-19 1919-20 1920-21 1921-22 1922-23

 

1480 1505 1611 1163 1 cl. 428 662
2 503 762
3 167 501
4 108 164
5 65 91
Total; 1279 2170

The University of Saratov, which is one of the smaller
medical schools, cared for 400 to 500 medical students before the
War; in 1922 - 23 it had about 2,000 medical students enrolled. ‘The
ratio in the other schools outside of Leningrad has been practically
the same in the University of Saratov, 6.@. in the University of
Odessa Medical School there were in 1914 nearly 1,000 students, in
1917, 1,600; in 1921, 3,500, and after 1921 there was a slight
decrease again.

The number of students and graduates from the State
Institute of Medical Science is shown in the following tables:

Students,
1910-11 ... 310, 1916-17 4... 1378
191112 ... 456. 1917-18 ... 1480
1912-13 ... = 783. 1918-19 ... 1503
1915-14 ... 1014. 1919-20 ... 1611
1914-15 ... 1136. 1920-21 4... 1163
1915-16 ... 1297. 1921-22 «.. = 1279
1922-235... 2170
Graduates.
Men Women Men Women
1916 ... 6 22 1919 (Dec.) 26 8
1917 4... 27 54 1921 eee 47 53
1918 ... 40 57 1922 soe 22 32
1919(July) 22 21 Total 190 207

The following table «ives an idea of how the mumber of
students, as well as their social class elements, have changed at the
Military Medical Academy of Leningrad, formerly the Imperial Medical
Academy.

NUMBER OF STUDENTS 1913-17 1918 1¢2%6@ 1920 1921 1922

Freshmen 321 486 1886 829 1054 671
TOTAL NUMBER 900 1287 2108 1682 1875 1715
% from Workmen and

Peasants’ Class 19% 30% 52% 62% 84% 93%

There graduated at the Academy; in 1913 - 160; 1914 -
150; in 1915, 1916, 1917, there wore no graduates; 1918 ~ 72; 1919 =
108; 1920 = 68; 1921 = 48; 1922 = 52.

Newly admitted students totalled 65-75%, the remaining
35-26% was mde up by students from the preceding year's admittance who
had remained for the second year,
207 e

Or OD Oe ee ete ees er Oe te Mw ee

RUSHARCH WORK.~ (Quoted from WH. Gantt).

Present Conditions.

From 1918 through 1922, as a rasult of the general
state of the country, research work wes done under appalling cir-
cumstances and soience kept alive at the cost of enormous energy
and sacrifice of the individual workers, During 1924 and 1925 the
living condition of the scientists, though still precarious, has
greatly improved, ani the Soviet goverment has rendered considerable
financial aid to science. Some laboratories have returned to nomal,
many now ones have been formed, and there are a few new institutes

which surpass anything of their type heretofore produced in Russia.

The spirit of research is prevalent and is being
fostered. There is a coniial and helpful relation between teacher
and pupil. Although there are some irregularities in the method of
work, they are compensated for by long hours and increased ene rey

at other times.

Science will suffer during the next deoade or so
chiefly from the emigration of former scientists, the lack of pre~
paration in the pupils of the War and Revolution periods and of the
present type of student, and from inevitable adjustments to the
present sooial conditions. The bringing of Science ander central

control and Soviet patronage, although it may give a slight political
208.

colouring, is putting it on @ much more stable financial basis than
it was in old Russia. The present position of science is, in my
(1)
opinion, one of the brightest spots in Soviet Russia .
In a subsequent paper I shall say something of the

conditions of scientific work for foreignars in Russia, ani give a

few details of some of the important work.

Scientific work during and after the Revolution.-

Scientific work almost ceased, “Constant anxiety for
food and fuel, endless waiting in queues, a half-starved beggarly
existence could not but strongly affect the life of scientists. From
1918-1920 they, as well as all the other inhabitants of the oities,
never left their houses without a bag on their baoks in which to
bring home bread, potatoes, etc. received as a ration. An eminent
professor lived the winter through in his bath-room, as it was the
only place that could be heated. It was a usual thing for men of
science to carry up to their apartments wood and water, and to empty
the sewage, as the lavatories did not function. Professor Bechtereff
states that the neuro~psychical energy of an organism decreases
with the decrease of nutrition. A general depression of personality
results in passivity and lack of will-power. Besides resulting in
& high mortality among the scientists in Leningrad, the center of
(1) Formerly the laboratory of Professor Pavlov at the Institute of

Experimental Medicine had to support itself largely by
selling the gastric juice of the experimental dogs.
209.

mental life of the country, these hard years decreased the capacity

and energy of those who survived".

Leaving aside the difficulty of working in unheated
laboratories, examinations could not be done owing to the lack of
gas, water and illumination. There was a total lack of both Russian
and foreign literature 2 "In order to write down one's observations,
one had to use grey paper of a very bad quality which was stealthily
bought from speculators (trading being prohibited). The self-made
ink was usually prepared out of some dye hardly suitable for the
purpose". Many scientists left Leningrad or were employed in some
other kind of work. But "notwithstanding all the terrors, scientific
life in Leningrad did not cease altogether. During the most difficalt
periods one could seo men of science working in their overcoats,
caps and snow shoes. Half-starved mon continued to carry out their
experiments on half-starved animals. Dead animals were cooked and
fed to the living. After an operation, the animal was often taken

home for the night to be kept near the stove with the investisator".

Scientific assemblies were held although the manbers had
to go on foot and to sit in overcoats. Often a lamp or candle had

to be used instead of electricity. By the end of 1919 scientific

(1)"When a foreign journal reached Petrograd, those who desired to
read it, wrote their names in order and patiently waited the
happy hour when their turn to read it came." From December
1918 there was only one medical journal in the whole of
Russia.
210.

life began to revive. In spite of the bad conditions, several new
scientific societies were formed during these years and important

work carried on.

There continues a chronic nesd of money and things in
some institutes. Professor X. told me when he went into a public
library to work during the winter of 1924, the ink was frozen, and
that part of 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 continued 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 population no small assistance in checking the epidemics
andi carrying on other relief measures. Although foreign relief
supplied mach of the material and sometimes the stimulus for organiza~
tion, the actual work was done by the natives, as the number of

foreigners was too small to count for more than a stimulus.

It is interesting to consider the moral rectitude and
unselfishness of the Russian physician during these horrible and
hopeless years. They were existing at a time when the strain of

living was so great that some of the population were driven to
211.

eating human flesh and even killing members of their own family. In
distributing large quantities of relief supplies through the Russian
physicians, I never kmew of a single case of theft by a physician,
although they were in dire need. There were many cases of heroism,
such as the following Fologda, a town of 50,000 near Arkhangel. On
an inspection trip there we found the chief surgeon among others in
great need. He had not had a new suit or overcoat for ten years, he
was wearing trousers that were more patches than pants, and out of
his salary of less than a pound sterling montly (in April 1928)/had
a wife and nine children to support. On returning to Leningrad, we
sent him, and other dootors there, a ralief clothing package. A few
days later we received a gracious letter saying that he had given the
package to a colleague more needy than himself, onclosing a latter
of thanks from the recipient. As late as September 1925, I have
seen research workers paying one half of their monthly salary for
paper to chart their results, and many professors give part of their
salary to support the laboratory where they work. Scientifio workers
receive from 7 to 100 rubles (less than b 1. to b 10.) ‘These

salaries are without rations.

Now, the physician's condition is considerably better
than in 1922-1923, when his daily income was equal to seven times his
tram fare, or one pound of sugar, and his yearly salary equal to the

cost of two overcoats. But even at present it is impossible for a
2i2,

person with a family to do more than stave off actual starvation on

the official salary.

During the past few years the Russian physician has
learned many ways of making the proverbial two ends meet. In the first
place most of the eminent professors have two or three places teaching,

in spite of the ruling that no one may teach in more than two places.
(1)

A few write text-books. Those not so eminent give language lessons,

etc. Prominent clinicians have regained their practises and are making
(2)
a comfortable living . Those physicians who are old or cannot obtain

outside work are,still in dire circumstances. And no one has become
rich in Russia; I1 do not know a single doctor who owns a motorcar
(There are automobiles owned by the goverment at the disposal of

the officials of the public health department). Communist officials

(1) All text-books are censored, accepted and printed by the Soviet
Gevermment. Seventy-five rubles are paid for 16 ordinary text-book
pages, 20% of which is paid when the contract is signed, 60% when
the mss. are completed, and 20% when the book is. published. As the
book is the property of the State, there are no further profits
for the author. Professor Pavlov recaived 25 Roubles for 8,000 words
of his book on conditioned reflexes. For special articles which
the Soviet Goverment desires written it pays as much as ten times
this amount, I am told.

(2) There are no rules prohibiting professors, the chiefs of hospitals,
etc. receiving patients at their homes. The fee for an office visit
is one to five rubles ami for a house~call 2 to 20 roubles. A former
surgeon to the Tsar's family told me he received in 1925 10 to 100
roubles for & major operation. Bills are not sent in Russia, buat
the patient (or his family) hands the dootor what he considers
the proper amount as he leaves the house.
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 was able to
earn was 400 roubles a month. This lack of wealth mitigates, by
comparison, the misfortune of the poorest. Living in Russia is
cheaper than the costs indicate because the standards of life are

lower and wants are reduced to a minimun,

When I asked a Ukrainian doctor how he managed on
his salary he replied: “By not eating much and going hungry". To
one with an Anglo-Saxon appetite, it does seam 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 traditional teniency
or personal preference rather than present finanoes that some appear
without socks and shirts in the summer. The doctor also buys few
books or journals and his amusements are limited. If his wife is
lucky or clever she also does somo kind of remunerative work, as
teaching, etc. One young scientist of my acquaintance who receives
10 rowbles (b 1.-)monthly gets food from his mother in the country,
and the chief of the laboratory gives him a few roubles from his
salary of 60 roubles monthly. Another, working in the laboratory
of Professor Pavlov, lives by raising and selling fanoy dogs

during off hours at home.
214,

Vacation & Recreation.~ The lack of recreation am
vacation has been trying on the Rugsian 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’. Except for the past three summers few,
including Communists, have had any vacation for six to ten years.
Professor Pavlov was two summers without a vacation. A Russian
scientist whom T met in Denmirk in the summer of 1924 told me that
was the first time he had been out of Leningrad for ten years. He
was then travelling from the proceeds of a book he had just written.
It is difficult to realize the strain of ten years without a rest

or change even when one works under the most ideal conditions in

the laboratory and lives comfortably at home.

There have arisen however many cooperative schemes
which make life simpler and cheaper, such as rest homes for the
summer, The Soviet Government bears the expenses of delegates
to congresses, etc., ami gives some of the eminent doctors and .

scientists money to go abroad for three to six months.

(1) In 1983 when I had the privilege of accompanying Professor
Pavlov to the theater, he remarked 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 Science. The life of many
scientists and dootors is not only pemurious, but anxious and un-
certain. He is subject to the fears that have beset the intelli-
gentzia in general (the secret police, G.P.U.), censorship of
letters abroad, etc. These things may be necessary to maintain
order, but they do not make for the mental tranquillity of the
suspected.

Not being a student of politics, I have attempted to
omit references to political principles. As everything in Russia is
under the strictest political control, it is not possible to do this
entirely. previously: stated that the Soviets had done what they
could to foster the growth of science in Russia when this did not
conflict with their political principles. This was my opinion from
my personal observations in Russia, in 1922 and 1923, The political
revolution has fallen however with a crushing weight on some of the
foremost doctors, and there ara some of these who think that the
Soviet regime per se has had a deleterious effect on science, in
addition to the former economical chaos. A Russian scientist of
international reputation wrote me: "My feeling is that the Soviet
authorities have done vhat they could with their unlimited means of
destruction to kill science and inhibit its growth because free ani
independent thinking is in direct conflict with the Soviet political
principles".

(1) See BM.J., Sept. 20, 1924.
216.

An equally pessimistic view is expressed by a younger
acientist of Leningrad, who, while admitting the Soviet efforts and
desire to benefit science, says that the psychological conditions are
not confucive to scientific 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., ani too

uncertain as to the future.

The circumstances following on the War and Revolution
have caused not a few to feel as an author of a scientific treatise
wrote, that "This is more the record of a broken and shattered life
than of a profitable completion of physiological work". ‘There are
others, however, outside the Communist party, who look forward with
more optimiam into the future, and say that they have no political
grievances, that the government is doing all it can to help them in
their work. Typical of this group, an eminent pathologist told
me, “The comitions in Soviet Russia are much better than they were
in Tsarist Russia for scientific work. As Soviet finances increase,
more money is being given. The Narkompros (Minister of Education)
is active in making scientific work more intensive and practical
as they say that life can exist only with science. I think that
acientists will be able to work entirely independent ly of politics,
and will not be hampered in any way by political considerations. As

an example I know of many monarchist professors who are now receiving
217.

large amounts of money to carry on their scientific work. Ag we
have never had democracy in Russia, I can not say what effect it
would have upon science, but I think science will prosper much
better under the Soviet regime than unier 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 two years.

Soviet
Expressive of the official/attitude toward science,

is the following extract from the greetings sent to the Academy of
Sciences, on the day of its jubilee, Sept. 5, 1925 - an event which
was eagerly celebrated by the Soviet Government. It is signed by
L. Kameneff and the president of Soviet Russia, M, Kalinine:

"The October revolution has removed the social
relations which had impressed their character upon scient-
ific work and hindered its development. The social order
founded on private ownership, exploitation and national
oppression provokes military collisions and retards the
subdual of the forces of Nature by Man... The radical
reorganizetion of social relations.... can not be solved
without a development of Science in all its branches. The
Socialist Society is creating for scientific thought
comitions of true liberty... Lenin's estimation of the
services of science is the basis of the policy of the
Soviet State.

‘During the first hard years which followed the
Revolution, the Soviet Power, forced to defend its axist=-
ence... could not lend assistance.... to the scientific
work. Nor could it insure to the scientific worker such
conditions of life as are necessary for the product iveness
of his work.... Science is international...."

Soviet respect for science is show 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 Government, and reccived more cordial and hospitable
treatment than the political visitors to Russia. Among other pri-
vileges they were given free use of tho railroads and hotels all

over Soviet Russia.

The fact that Lenin endorsed science has had a great
influence, especially as Leninism has assumed somewhat the character
of a State religion in Russia. In every government building (which
includes most important buildings) is a room called "Lenin's Corner"
(ykol Lenin) containing all the writings of Lenin and his pictures
surrounded by his aphorisms The rooms are decorated in red and
black, and there is an atmosphere of reverence which is strongly

suggestive of the former chapels. It was due to Lenin's influence

that Professor Pavlov was retained in Russia after the Revolution.

(1) One of these says; {Without science there is no communism" (bez
naouki nyet kommunisma"). I have seen this several times in
laboratories and public buildings,
219,

—"

Suvwilet F

 

THE PUBLIC HEALTH SYSTEM
OF
Gad”
SOVIET RUSSIA.

by Professor N. Semaschko,
People's Comnissar of Public Health, Moscow.

1, THE PEOPLE'S COMMISSARIAT OF PUBLIC HEATH
AND ITS ADMINISTRATIVE DEPARTMENTS.

CENTRAL ORGANIZATION.

A special People's Commissariat of Pubdic
Health was crented by the Government of Soviet Russia
in July, 1918, to give the pnblic health system a
position commensurate with its importance for society
and the state. The activities of this Commisseriat
inelude not only medical and sanitary dnties ina
narrow sense, but also all the activities closely
connected with public health are generrlly inelnded
under the term social hygiene.

1. Competency and dnties of the Vommissariat.

The first decrees as to the creation of a
People's Commissariat of Public Health date from July
ll and 21; its present statutes were approved by the
Vonucil of People's Commissars in 1921. ;

The competency and dnties of the Commissariat
are expressed in general terms in Article 1. of the
Statutes as follows: "l.- The duties of the People's
Commissariat of Public Health consist in the administra-
tion of the entire pnblic health system and the publish-
ing of all ragulations that serve to raise the level of
public health among the people and remove conditions
that are unfavorable of harmful to it".

Article 1.-thus gives the Commissariat
permission to carry on any activities that serve to
protect public health and requires of it, in accordance
with modern principles, that it not only engage in

Die Gesundheitsverhatnisse in Sowjet-Russland. Deutsch
med. Wohnschr., Leipz. u. Berl., 1921, xlvii.
eo

active control of conditions that are notoriously
harmful to health, but assist in raising the general
level of herlth and increase the real capital to be
found in the normal physiologicel eondition of a people.
Naturally such activities as race hygiene, eugenics,
etc., are included in this definition.

Article II. of the Statutes describes the

more detailed dnties of the Commissariat of Public Health,
as follows:

"The People's Commissariat of Public Health
has the following aims:

a) Maternal and infant welfare; the physical
training of youth.

b) Senitary regulations, the sanitation of cities
and communities, the organization of sanitary
inspection.

ec) The control of social and contarions diseases,

d) The organization of a medical service,

e) The preservation of health in the RedArmy and
Navy.

f) Medical certification in cases of workins inability
and invalidity, as well as expert advice in
medico-legal cases.

g) Collating and publishing statistics on the state
of health in the Republic.

h) The study of scientific and practical questions in
the pnblic health field, and the administration
of institntions ergated for this purpose.

i) Taking part in the organization of medical education
in co-operation with the corresponding depart-
ment of the People's Comnissariat of Public
Instruction.

k) Measures for spreading sanitary education.

1) The care of institutions of healing and sanitation,
together with the instruments, therapevtic
agencies and other necessary material.

m) The publiention of new public health regulations,
applying to all institutions and citizens in
the Repyblio, and based on and further develop-
ing the reenlations already in force,

n) Supervision of the work of the sanitary corps",
22l.

2. Organization of the Commissariat of Public Health.

a) The People's Commissar, the Council,
central advisory committesés,.

 

At the head of the Commissariat are the People's
Commissar, his immpdiate representative, and the council.

The Council is composed of the People's Commiss-
ar, his assistant, and three members appointed by the
Council of People's Commissars. The directors of depart-
ments or institutions of the Vommissariat takxe part in
the meetings of the Council as advisory members, fFur-
thermore, the heads of other Commissariats or professional
associations are when required invited to be present as
pdvising specialists in their own fields.

The scientific advisory committee of the People’
3 “Commissariat of Public Health is the Sciontific Medical
Board, which has to give its expert opinion as to the
scientific basis of the actions of the Commissariat. The
Medical Board has also the right to take up and study pu-
olic health questions on its own account. The Board,
according to its new rvles, which are at 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
Council are regular members of the Board. The Board
has the anthority to appoint committees, and can invite
to its meetings or to those of its committees snch persons
as it considers useful.

Congresses shell be called for the discnssion
of stops to be taken in different fields of pnblic health,
and specialists in these fields shall be invited to
attend them.

b) Scientifie and model institutions,

 

A number of scientific institutions created
within the Vommissariat of Public Health help to work out
the scientific problems that arise in connection with
the development and perfecting of the public health
services The work of these institutions is to be chiefly
of a practical nature, in order to provide the Commiss-
ariat with scientific grounds upon which to base its
activities. At the same time these institutions serve
eek.

to train specialists in the different branches of

the service, such as tubercnlosis control, for instance.
The model institutions, whose chief aim is to serve as
patterns for the é@érection of local medical, sanitary
and soclal-hygienic institutions, also serve to some
extent as training schools.

MOSCOW. bead

1.- The Government Scientific Institute of Public Health
composed of the following individual departments:
The Microbiological Institute;

The Hygienic Institute;

The Institute for Experimental Biology;

The tropical Institute;

The Serum and Vaccine Institute;

The Institute for Physiological Nutrition;

The Blochemical Institute;

The Institute for Tubercplosis Research;

The Institute for Organo-therspentic Preparations.
2.- The Institute of Biologicnl Physics,
3.- The State Venereologicsl Institute.

4.- The Orthopedic and Physiatric Institute.

5.- The State Dental Institute.

6.- The State Institute of Social Hygiene.

7,.- The Central State Bacteriological Institute.
8.- The Ventral State Vaccine Institute.

9.- The Physical Culture Institute.

10.- The “tate Institute for Maternal and Infant Welfare.
ll.- The Medical-Pedological Institute.

12.- The Balneological Institute.

PERTROGRAD. -

13.- The Institute of Experimental Medicine,
14.- The Orthopedic Institute.

15.- The Physical Culture Institute.

16.- The Obstetrical and Gynecologicel Institute.

17.- The Clinical Institute for Advanced Medical Work.
18.- The Roentgen and Radium Institute.

19.- The Polenoff Physio-snrgical Institute.
20.- The Physio-therapentic Institute.
IN THE PROVINCES.-

21.- The W. I. Lenin Clinical Institute in Kasan.
22.- The Bacteriological Institute in Sebastopol.
23.- The Bacteriological Institute in Tambow.
24.- TheGacteriological Institnte in Rostow on the Don.
25.- The Bacteriological Institute in Krassnodar.
26.~ The Microbiological Institute in Saratow.

Miro Hho Poon
27.- The Balneological Institute in Pjatigorak.

28.- The Tuberculosis Institute in Jalta.

29.- The Tnberenlosis Institnte in Krassnodar.

30.- The Physio-therapentic Institute in Tomsk.

31.- The Sjetschenoff Physio-therapeutic Institute
in “ebast opol.

32.- The model institntes also have dispensaries for
mothers, tubercular patients, sufferers
from venereal diseases; further nurseries,
sanatoria, convalescent homes, forest
schools, etc.

c) Sections and departments of the People's
Commissariat of Public Health.

 

 

The current activities of the Commissariat
are under five administrative heads, and these sections
("Uprawlenije") are each divided into departments
("Otdjel") and sub-departments ("Otdjelenije").

The present administrative sections are,

l.- General administration (internal administration;
medical personnel; finances; material equipment).

2.- Sanitary administration (sanitary activities; control
of contagious diseasés, including tuberculosis
and venereal diseases; maternal and infant welfare;
care of youth). a

3.- Medical administration (general and individval
médical service; expert sociological service).

4.- Hygiene and medical service for the departments of
public communication, railways, ete.

5.- Administration of health resorts.

6.- Central military sanitary administration.

 

 

 

B. LOCAL ORGANS OF THE PUBLIC HEALTH SERVICE, -

oe em ee we em me wm & Om em me om em we om em ee Fm om 08 em & & @ 88 a em an oa om oe

1.- Public Health Bureaus of the Executive Committees, -
The Public Wealth Yeparfments of Governments and Regions
are the only ones that have a separate existence, since
the sanitary work of the districts is carried on by the
medicel department of the general district administra-
tion. Aside from this, both the Public Health Depart-
ments of the Governments and the medical departments

of the districts act as local organs of the People's

Commissariat of Public Health.
These government and region Public Health

Vepartments are in their capacities as local civil admi-
nistrations subordinated to the respective Executive
Comnittee, but they are at the same time, as far as their
medical and sanitary activities are concerned, under the
direct ordérs and control of the Comnissariat, all the
regulations and arrangements of the latter being obliga-
tory in their case.

The activities of the government Public Health
Departments are divided into a number of different sect-
ions that are more or less modelled on thee of the central
offices. The smaller the government in aneéstion, the Less
dense the population, the smaller the ind ystrial community,
etc., the simpler also the composition of the Health vepart-
ment, as they are graded in this respect in three categories.

The entire work of the health departments has to
be done with the active co-operation of the proletarist and
the peasants. "Senitary Advisers" are therefore attached
to the local bureans, consisting of members of the unions
and of the associations for the dissemination of exlture
and information.

2.- Railway public health bureans.-

 

The sanitary activities of the railroads are
administered by the Railway Public Health Burenus, that are
directly subordinated to the People's Commissariat but
also maintain a close relationship with the Railway Admi-
nistration and the labor unions of railway employees. Proper
co-ordination is maintained between these buréaus and the
general civil public health departments by having each or-
ganization represented on the other's advisory and execntive
boards.

S.- Recioval public heslth bureans for sea and river com-
munications.-

 

These buréaus correspond in number to those of
the genéral sea and river administration. Rerulations to
prevent the admission of epidemic diseases by way of the
sen boundaries are the work of this burean.

4.- The Administration of health resorts.-

 

The health resorts of the Republic are divided
into those that are of importance to the whole country and
those that are only of local intercst. The administration
of the latter belongs to the local government Public Fealth
Departments, while that of the former comes under the direct
225.

administration of the Commissariat Section for the
purpose. The activities of the different local health
resorts are brought into mutual harmony by representetives
of the Commissariat.

5.- Militar ublic health bureans.- The military-sanitary
district buréaus form courts of second resort for the
administration of public health in the RedArmy: in the
government sanitation lies in the hands of a military-
sanitary snb-department of the civil heolth departments,
while in the districts it lies in the hands of special
military-sanitary bureaus. These sub-departments have
among other duties to decide and supervise the proper
relations between the military and the civil administra-
tions.

 

C. RESATIONS BETWEEN THN PROPLE'S
COMMISSARIAT OF PUB.IC HFALTH
AND TRE CORRESPONDING AUTHORITINS
IN THE AUTONOMOUS REGIONS AND

REPUBLICS.

The autonomous republics that have entered the
Russian Socialist Federative Soviet Republic have their
own Commissariats of Public Health, subordinate to the
respective law-making bodies of these republics. The
laws that have been created by the All-Rasaian Central
Executive Committes apply to all the republics of the
R.S.F.S5S.R., out the regulations of the central People's
Commissariat of Public Health only apply to the antonomous
republics in so far as this is provided for in special
treaties.

In p#actice, however, such formal treaties
are not the only way in which complete agresment is
achieved between the activities of the different commiss-
ariats with those of the Vommissariat of the R.S.F.S.R.
The People's Commissariats of the antonomons republics
are formed on the pattern of the Central Commissariat,
and most of those who take part in the activities of
the former sre former workers of the Central Commissariat,
and merely on that account supply a connection with the
latter.

Firthermore, the constant interchange of in-
formation as to all new events in public health and the
manner of meeting them tends to keep up the necessary
226.

uniformity in administration. Of great value in this
connection are the congresses that are called in Moscow
for the diseyssion of sanitary questions and attenied by
representetives of all the commissariats °nd sanitary
organizations.

In the autonomors regions the local medical
administrations are organs of the People's C ommissariat
of the R.S.™.5.R., and stand in the same relation to it
as do the sanitary authorities of the governments.

“he Union of Socialist Sovist Republics (U.S.
S.R.) has no special Union public health department, but
the right to "decree general measures reavired for the
public health" was given the legislative organ of the
Union in the U.S.S.R. Constitution of July 6, 1923.

THE BPIDFMICS AND THEIR CONTROL (1914-1923)

 

The years of war and revolution in Russia were
at the sane time yeare of frirhtful epidemics that followed
close upon each other's hecls and that reaped a rich har-
vest from the worn-out population. Right up to the present
much laocor and large sums have to be spent in the control
of these plagues. However, the Soviet Government is now in
a position to declare vith the greatest positiveness that
Rnssia hes passed through the worst period of epidemics,
the greatest and most dangerous of which, like cholera,
have completely, or like typhus, mostly disappeared,
and that we are now in a period in vhich epidemic control
is showing positive resylts. The only disease at pw esent
to be considered as an active epidemic in Russia is re-
lapsing fever, ngainst which all onr sanitary means are
nov being directed.

Even before the war Russia was always a country
of uninterrupted plagues. As in other departments of
public welfare, the government of the Czar paid little
attention to the constrnt outbursts of infectious dis-
eases, and only when snch infections as choléra or the
plagne gained admittence to the country did it become
active against them through its bureaucratic police
organs. The so-called Semstvo medicrl systems were too
weak to carry on infectious disease control in a rational
and really large way, and the masses of the people,
with no rights and with no training in methods or organ-
ization, were unable to oppose such disenses by any
2276

concerted action, with the result that the loss of Life
in epidemics amounted to a large proportion of the total
number of deaths in Russia. Before the war the annual
death-rate in Russia was 26.5 per cent. During the
pré-war period of 1905-1913, after the first revolution,
a great cholera epidemic swept overRussia in 1908-1910,
and others os typhus and relapsing fever in 1907 and
1908, while smallpox, typhd fever, dysentery and in-
fectious diseases of children were widely spread.

Bad as they had been before, the war of 1914-
1918 made the sanitary conditions of the country much
worse.

During the war 14,000,000 men were mobilized
and sent to the fronts; the army had 11,000,000 dead,
wounded and diseased, and of these 1,660,000 were ontirely
lost by death or irreparable injury. The so-called
refugee movements also took place during these years,
with whole popylations simply thrown from the war zones
into the interior of the country; up to 1917, 3,200,000
refugees were listed in the official registers alone.
Generel sanitary conditions grew much worse - lack of
houses, lack of fuel, the difficulty of obtaining food,
the disorganization of transportation, all this helped to
nourish the soil ont of which the epidemics were to spring.

The civil war period complicated penerel
conditions still mors. The 1918-20 blockade, the unbroken
internal confnsion, the intervention of foreign powers,
and finally the famine of 1921-22, all led to € further
outbreak of epidemics. It would be very hard to try to
express in figures all the losses incurred during this
period. The general death-rate was 38 per cent during
1920, and the birth rate had fallen very low, amounting
to only 25 per cent. According to the reports of the
central statistical bureau, five million people died on
account of the famine of 1922, which struck a number of
governments.

This general picture of sanitary conditions in
Russia at the time gives a sufficient idea of the state
of the country; the main cause of the great mortality in
this périod was the widespread epidemics.

The great pandemics of typhus and relapsing
fever must be given first place on the list. Even before
the war, 70,000 to 80,000 cases of typhus conld be counted
on in the best years. The war immediately drove up these
figures, and 154,800 cases of typhus were reported in
1915. Typhus was then spread over the whole country by
the ceaseless movements of troups with no proper sanitary
control, and by the masses of refugees and prisoners,
these people all living in narrow, dirty quarters, unable
to wash either 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 29nd refugees
helped to spread the infection again, more intensively
than ever, and the closes of the year 1918 may be considered
as the beginning of the gigantic pandenic of typhus that
reached its maximum in 1920. We had sudden ovtborsts of
typhus in St. Petersburg, on the Roumanian front and in
the Volga in 1918; during 1919 and 1920, the years of
bitter civil war, there were gensral ontborsts of both
typhus and relapsing fever, particularly in the army's
field of operations. As the Denikin and Yoltschak armiés
withdrew they left behind them thousands and thousands

of sick men and thus created everywhere centers of infect-
jon for the civil population. On the other hand the lack
of food in the cities started the so-called "Meschetsch-
niki" movement, these people hurling themselves into the
food-proiucing districts in their search for bread, over-
whelming the railways and other means of communication.
this of course rendered ever so much more favourable the
conditions for the spread of infections. Genernl figures
for the two parasitic types of fever during these years
are as follows:

 

 

 

Year.  Typhus exanthematua. Relapsing fever.
= haaes Per 10,000 Cases Per 10,000.
L318. 130,164 el.9 16.661 Ze 8
1919. 2,119,549 365.3 251.369 42.3
1920. 3,354,656 293.9 1,453,421 127.3
1921. 633,250 54.0 763,131 65.1
1922. 1,401,145 109.2 1,446,722 122.7

 

hase figures need to be explainéd. The great-
est extent of the pandemic was in 1920; the following year,
1921, there was a decrease, dua to the extraordinary
measures taken by the Soviet Government. <A new increase
is to be noted in 1922, but this took place almost sntirely
in the regions suffering from the famine, such as the Volga
region, the Ukraine, Crimea, and part of the Ural. ‘The
sucessses achieved in the control of typhus were practically
wiped ont by the famine. The total number of cases for
the two kinds of fever for the period 1918-1922 amounts to
8,000,000 of typhus and about 4,000,000 of relapsing
fever. The death rate for typhus was 9-10 per cent, and
for relapsing fever 2-5 per cent.

The litereture on the subject states that
the official data for typhys are extremely inexact.
There is undoubtedly a great deal of truth in this,
for a number of reports obtained through other channels
from large cities (Moscow) where ths statistica were
exhaustive, lead one to balieve that the number of cases
should be placed much higher. On the other hand those
who insist that simply untold numbers were attocked are
wrong. This is for instance trve of Professor Tarasse-
witch, who states in "Renseignements épidémiologiques",
No. & Nny, 1922, that there were 30,000,000 people sick
with typhns alone. If one takes into consideration the
very low susceptibility of children, who form half of the
wopulation, to typhus, there wonld have had to be accord-
ing to such calculations an almost total morbidity; at
least one out of every two would have had to be sick. But
this is evidently untrue, for the exact figures for Moscow,
revised in order to obtain causes of death, show that the
proportion was 1 to 8. This is also proved by the great
increasé in the number of cases in the famine districts
in 1922, which would have been impossible if so many
people had previously been immunized. All these calenla-
tions are of course of no practical valne, as nobody denies
that a great pandemic existed. But since the end of 1922
we have had a distinct and continuons decrease in these
diseases throughout the whole country. These figures will
go to prove it.

1923. Tvphus. Relepsing fever.
Janvary 52,008 Z5-336

February 42,658 41,883
hiereh 38,057 31,809
April 28 968° 33,156
Mr y 22,925 17,337
June 11,512 9,870
July 5,969 8,462
August 4,284 8,487
September 2 463 5,142

Total 208 ,942 208 ,435.

The numbers decrersed still further in October,
1923, with 2304 cases of typhus and 2849 of relapsing fever,
and the same thing covld be observed in the following
months. It must further be stated that relapsing fever

retéined an epidemic character in only a few governments
230.

(those of the Urel and the north-western sections of
Russia), in most other places there were only a few
scattered cases,

The control of epidemics naturally occupied
the center of interest in the organization of the public
health service in Russia. During these years 250,000
beds were provided for infectious diseases, large numbers
of quorantine and isolation stations were arranged for
along the railroads, a few times movements along certain
stretches were forbidden by Commissariat decrees, mass
cleansing of the poor populations, combined with dis-
infection, was carried out under enormons difficnlties,
The lack of soap, underclothes, fnel, ete., hindered mach
of these efforts.

The People's Commissariat founded all of its
typhus control on a widespread co-operstion on the part
of all the working classes. Wany "bath weeks" were or-~
genized, during which hundreds of thousands were bathed,
cleaned up and shaved free of chargé, as well as "clean-
up weeka#, in which mass cleaning and repairing were
done on gablic buildings and others that sheltered large
crowds, such as railway stations, asylums, prisons,
barracks, etc. The local committees of the "Strnggle for
Cleanliness" served as permanent institutions and were
composed of rapresentatives from the iyoryergrand peasant?
Organizations, the unions, ete. Hmormous amounts of
pamphlets, posters and notices were distributed, while
lectures end mestings were arrenged. The government
also opened large credits for the work of epidemic
control.

Lastly, the scientific work connected with
this question aronsed great genernl interest. During
this period seven All-RussianCongresses of Bacteriology
and Epidemiology were held, together with a karge
number of local meetings. A Commission for the stndy
of typhus worked with the YVommissariat and had its
findings published by the latter. The general direction
of the practical work lay in the hands of the "Commiss-
ion for the Bxecntion of Bpidemic Control", that wortred
with the Comnissariat sines 1918, and that counted
among its members snch noted epidemiologists as
Pro°essors Tarassewitsch, Sabolotny, Diatroptow, Barikin,
Marzinowsky and others,

But the difficult stroggle did accomplish
results; the pandemics of typhus are broken, and the
231.

Commissariat of Public Health is now confronted with
the problem of preserving the country from any new
eventuality, on the basis of what it has already gone
through.

It must be pointed ont that thousands of
physicians, together with other members of the sanitary

personnel, suffered greatly in the depressing strugele
against typhus. In ths years 1918-1920, 3,129 physic-
ians, 41 per cent, fell ill in the Red Army alone, but
these were to be snré also the most dangerons posts, as
far as infection was concerned.

Another disease that has cost great expend-
itures of effort and money is cholora. An outbreak
occurred during the war, as early as 1915, with over
30,000 cases, partly on the front and partly in the
interior. The number of cases have been as follows
since 1918.

Yoar Casas
1918 41,209
1919 4,259
1920 25,923
1921 204,228
1922 86,178

Cholera was most widespread during 1922, the
yeer of the famine. In contrast to the behavior of the
other epidemics of before the war, it did not spread
along the waterways, but along the railroads; there were
further certain centers in which case6s of cholera con-
tinued to occur during the entire winter. Fere too we
have a great decrease in the epidemic during 1922, and
in the following yesr an almost complete disappearance,
for only 117 cases were reported in 1923, of which 76
occurred in Rostow on the Don. Nowhere did isolated
cases develop into an epidemic. No case whatever
occurred in September 1923.

Vaccination was the chief control msasure. It
need only be stated that 10,000,000 in all were vaccinat-
ed in Russia in 1922, and that the whole Red Army was
re-vaccinated. The People's Commissariat first of all
created a whole network of bacteriological institutes
and laboratories, an extensive piece of organization.
There are at present 35 institutes scattered throughout
the country, most of them created by the Soviet Govern-
ment (Bacteriological Institutes in Taschkent, Tiflis,
202.

Baku, Keaterinodar, Sepastopol, Woronesch, Omsk,
Seratow, Irkutsk, Featerinborg, Archangelsx, etc.)

In Moscow were founded a Centrsl Institute for the
control of sern and vaccines and two Bacteriological
Institutes, the Metschnikow Institute and the lMicro-
biological Institute. <A total amount of 22,000 litera
of vaccines was produced in 19z2,

As & genlral rule the entire Red Army and
certain categoriss of officials and sanitary personnel
were given mass vaccination. At the time of vaccina-
tion other mass measnres were carried on for the cleans-
ing of densely popniated localities: "water supply weeks"
When) gources of water supply were cleansed, and new onés
formed; "clean-up weeks", for the improvement of cl ¢ans-
ing facilities and of water intake and outflow. The
economic improvement in 1922-1923 made it possible to
begin increasing the sources of water supply and canaliaz-
ation in a number of provincial towns, such as Archangel,
Tula, Samara, “~aratow, Odessa, N.-Novgorod, and others.

A decrees of September 13, 1923, issned by the Council

of People's Commissars, entrusted the genernl direction
of all this kind of work and the formuating of a epencral
plan for the whole Republic to the Commissariat of
Public Health. There is therefore a gigantic piece of
work to be done.

Experiments with vaccination by way of mouth,
by the Besredka method, were carried out bn 1923; this
kind of vaccine is at pesent prepared in Russian Instit-
utes.

Typhoid fever and dysentery increased in 1920,
but fell again the year after. The firures ara as follows:

Year Typhoid fever Dysenter
Cases Pér 10,000 Cases Pér 10,000

 

1918 TOS, 264 Th.4 55, 760 TT.8
1819 270,168 45.4 184,919 31.5
1920 668,764 BOLE 404,010 66.7
1921 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 oxses of dysentery. The same kind of vaccine,
divaccine, played the determining role in the control
of typhoid, although all known meascres against both dis-
gases were taken in so far as their spread by means of
233,

water is concerned. Smallpox was fought with equal
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 Russia, 1918-1922.

Year. Cases Per 10,000
T1518 25,758 5.
1919 108, 081 18.9
1920 152,094 14.8
1921 96,188 8.8
1922 57,840 4.5

Up to October, 1923, there were 37,803 cases
of smallpox, therefore here too a decrease,

The Commissariat of Public Health already
put through a decree for compulsory vaccination in

1918, and further regulations on the subject are being
added. A whbe string of new stations for the manu-
facture of vaccine have been opened, as well as a
eentrat® Vaccine Institute in Moscow. At present the
annual manufacture of vaccine amounts to 20,000,000
dosés.

The children's infections, particularly
scarlet fever and diphtheria, are very much less wide-
spread. The number of cases has fallen considerably
in comparison with before the war, and not until 1923
did a considerable increase appesr, in scarlet fever.

The figures for the different years are ss
follows:

Yoar Scarlet Fever Diphtheria
Cases Per 16,000 Cases Pér 10,000

 

 

1918 30,%45— <1 44,464 7.5
1919 48,130 8.0 40,129 6.7
1920 87,951 6.8 46,354 3.6
192 112,185 8.7 39,732 3.1
1922 66,257 5.1 32,398 2.5

Unfortunately the lack of beds made it diffi-
cult to combat these diseases, and only now can one look
forward to some measures being taken by the Commissariat.
Sufficient diphtheria antitoxin is at present being
manufactured in Russia.

_, tor e.7¢ _P#hanampgps of scurvy increased a good deal
234,

in 1916-1919 and 1922, mostly on account of the famine.
During 1916-1917 it spread particularly along the Rou-
manian and the south-western fronts. As might be expected,
the increase in 1922 is in the governments affected by

the famine.

Tvo new contarious diseasés, encephalitis
lethargica and infectious jaundice, spread in 1921-1922,
but did not reach any considerable dimensions as epidem-
ics. A special commission has been appointed by the
Commissariat to collect and study material dealing with
encephalitis.

Another contagious disease is the plague,
that threatened the Repudlic a number of times, and did
break out in isolated centers. For instances, one import-
ant epidemic center existed in Manchuria in 1920-1921.
In the following year ramifications of this epidemic
wers to be found in the Far Fastern Republic. 498 cases
were reported in Vladivostock during this outbreak, and
some ten others in different perts of the Orient. The
localities in which an epizootic plague occurs among
"Tarbagens" are also to be considered as plague centers.
A new section for the plague has been created at the
Irkutsk Bacteriological Institute, and a plagus control
laboratory opened in Chita.

The steppes of south-western Ruaesia, the
governments of Astrakhan and Ural, are also a region
where the same epizootic occurs among weasels, and
shovld be included in a list of plagne centers. Two
plague outbreays occurred there, 27 cases in 1921, and
122 cases in 1922. November and Yecember of 1923 there
were also 120 cases in the same districts.

The same control m@sureées were taken here,
There is in Saratov a State Microbiological Institute
with a large plague section under the direction of the
well-known plague specialist, Professor Nixanorow, and
a numbér of plague stations under this institute are
scattered over the south-western steppes. Control
expeditions, with vaccine and preventive equipment, are
sent ont when outbreak occurs. A plague section was
also opened in 1923 in the Rostow Institute. Two meet-
ings on the subject of plague control have been held in
Saratow. ,
We have purposély left until the last a dis-
cussion of one infection, malaria, becanse it is the

césnter of the entire epidemic control work of the
Commissariat of Public Health. There were in Russia

before the war large numbers of districts that always
had a high malaria infection, such as Turkestan, the

Cavcasns, the Lower Volga region. ‘The total annual
235.

number of cases in Russia before the war was about
3,000,000, and the war increased these too. The infection
was spread over the entire country by the distribntion 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, and the
first nine months of 1923 gave 4,007,896 cases. The
disease attacked not only the regions already noted for
it, bn¢t also others in the far north, such as Archangel,
Murman, Siberia, Bven the most severe tropical forms |
were included in this distribntion. Control of this
epidemic was completely paralysed by the lack of quinine
during the war and the revolution and by the breakdown

of sanitary and technical institutions.

The Commissariat of Puolic Health has however
developed an active campaign in this field. The first
All-Russian Malaria Congress met in 1923, and the next
one is to take place in January 1924. The general plan
of attack has been worked ont and approved by the Commi as-
ariat. One hundred melaria stations have already been
opened in the Republic, each one with a laboratory, dis-
pensaries, a clinic and a hospital; special courses for
physicians are given, and the distribution of quinine re-
gulated as much as possible, althovgh the demands for it
are far from being filled. The State Tropical Medicine
Institute in Moscow opened in 1920, directs the work, and
similar institutes exist in Taachkent (Turkestan) and
Friwan (Armenia).

Organizntions such as the railroads, that have
an interest in the decrease of malaria, have been drawn
into the control work, and large svums of money are avail-
able for it. Projects of law have been worked ont and
placed before the Commissariat proposing a whole seriés
of new rights and possibilities. At the same time the
disease ia go widely and intensively distributed that a
Long and hard struggle can be expected.

The above is a general picture of the advance
and control of epidemic diseases in Russia during 1918-
1923. It must be pointed ont that the struggle against
them has for the first time during these years of terrible
apidemies, been placed upon a proper basis. The com-
pulsory registration of contagious disease was first
required in 1918. A large number of bacteriological ins-
titntes have been created and treatment with bacteriagz

Feparations carried out to some extent. Theres is for
ene first time compulsory. vaccination on a large scale
236, -

against smallpox, and mass vaccination against cholera.
Even other extensively introduced measures of a sanitary
nature, such as cleaning, baths, improvement of water
supply, were new to Russia.

' The whole work of the Commissariat of Public
Health was based on the extensive inclusion of the popu-
lation for purposes of co-operation and further sanitary
6éducation. The legal norms for the sanitary institutions
of the Republic are deadribed in the decree of the Council
of People's Commissars of September 15, 1922. "on the.
sanitary institutions of the Republic", which lays the
foundation for an unalterable, continuously active
sanitary organization.

New Russia is faced with enormous problems

in the sanitation of the country. The experiences of
other countries, particularly Germany, the experience
of the past years and their mass methods, and a deep faith
in the powers of the new country give us absolute assur-
ance that we shall reach our goal by a short and direct
road. -

III. SOCIAL DISEASE CONTROL.
1, The control of tuberculosis.

The Commissariat of Public Health has deter-
mined upon two indispensable requirements for sucesss in
the struggle against the social diseases, tuberculosis
and venereal disease, and they are first, State admi-
nistration of the work, and second, actual, direct co-
opération on the part of the people.

There was before the war no regular control
of tuberculosis. The work of the Tuberculosis League was
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-tuberculosis .
work.

Although only the large cities had any fairly
accurate or complete figures on tuberculosis, and there
were none at all for the country as a whole, what. sta-
tistics there are prove that the disease was widely dis-
tributed.
237.

Tuberculosis Mortality Rate per 10,000 Inhabitants.

 

Year. Leningrad. Year. Moscow.
1912 34.8 1893. ° 43.5
1913 33.6 1898 3°.6
1914 34.2 1903 32.1k
1915 36.7 1908 29.9
1916 36.2 1915 24.1
1917 35.8 1916 24,7
1918 37.0 1917 23.0
1°19 40.3 1918 22.2
1820 51.0 1919 29.9
1921 36.0 1920 39.7

1921 28.1

1909-1913, yearly
averege of 34.6

x Not inclnding soldiers.

It was after the October Revolution of 1917
that the question of tuberculosis as a social menace
became a matter of prime importance to the Commissariat
of Public Health. Tuberculosis control was made a per-
manent activity of the Commissariat, and placed in the
hands of a special section, being recognized as a State
function the solntion of which was intimately connected
with the entire social structure of the Republic. MTuber-
eculosis control was founded, as were all the other public
health activities, on the collaboration of the whole people,

The Commissariat, in its attempts to achieve
this goal, collaborates closely with the Commissariat of
Labor and with the latter's departments for the protection
of workers within the unions. Such co-operation is par-
ticularly indispensable in the execution of measures of
social hygiene, especially those against tuberculosis, and
the working methods of new anti-tuberculosis institu- —
tions being created are based upon it.

The dispensary is the focus of the tuberculosis
control mé&snres worked ont by the Tuberculosis Section,
and is charged with both social and medical functions.

The me@ical measures of the dispensary take

the form of physician's consultations for patients, and
the medical assistance offered in the subsidiary insti-
tutions, such as clinics, night and day sanstoria, diet-
etic dining rooms, halls for sun and light treatments.
Working in connection with the dispensarics are the hosp-
itals to which the former can send patients. The psevent-
ive measures to be taken by the dispensary go in two direct-
ions - the home, in which the work of the visiting nurse

is of prime importance, and the shop, factory, indnstrial
or governuent establishment. In the latter case the dis-
pensary activities are carried on with the assistance of
the dispensary's own social service board, whieh is com-
posed not only of the physicians and nurses employed, but
also of representatives of the unions, workers' protective
leagues, and other institutions within the radins served

by the dispensary. The purpose of this board is not merely
to give social aid to individnrl patients, bnt also to
ramove the unhygieniec elements in the manufacturing or
commercial enterprise, spread a knovledge of health laws
among its workers, and induces them to take an active part
in the prevention of tuberculosis.

Although the general idea of controlling tuber-
cnulosis by social means was generally accepted, at its
onter edgss, so to speak, it was not at first properly
recognbzed that the dispensary shonld form the kernel of
the organizetion. The public health administrstions of
the Governments were originally bound by the sanatorium
idea. During 1919-1921 252 senatoria for adnlts and
children were opened in the R.5.7.5.R. and in the Ukraine,
with 19,621 beés. The economic crisis of 1921 forced the
elosing of msny sanatoria in the provinces, with the result
that the importance of the dispensary, which reachés many
times as many people as the sanatorium, was finally reco-
gnized, and attention paid to its development. Social
disease control became the most important duty as soon as
the results of the famine and epidemics had been to some
extent obliterated, and this bronght the question of dis-
pensary administration into the foreground. We have at
présent 118 dispensaries and 201 sanatoria, with a total
of 11,221 beds, in the R.5.%7.5.R. and in the Ukreine. Most
of the dispensaries are in the large cities, but sanatoria
heve recently been opened in small towns, even in villages,
fhe newly built dispensaries are not only erected with the
lively end active support of the people, but for the most
part also with their own money. —

The work of the Commissariat is very much handi-
capped in tuberculosis control by a lack not only of neans
but also of trained personnel. Fruitful work by the dis-
pensaries andi other related institutions depends both on
the thoroughness of the scisntifie training of its workers

in the special field and on the scientific solution of
239,

the problems which the dispensary actvally has to handle.
The former must be teken care of by the instructors in tu-
berculosis in the universities. In theory, the creation
of university chairs in tuberculosis has been approved,

but in reality they only exist so far in Moscow and Charkov.
Additional training for physicians who wish to specialize
in tuberculosis is also offered at the Tuberculosis Insti-
tutes that have been founded during the past three years
for the purpose of scientific work. Such Covernment
institutes now exist in Moscow, Leningrad, Charkov, Jalta
and Krasnodar, five in all, and we have further in Moscow
the Tuberculosis Institute that belongs to the Moscow
gection of the Commissariat of Public Health. Scientific
tuberculosis institutes herve a department of social
pathology, intended for the stndy of the disease as a
gpecial disease. The first thing done was the mass examina-
tion of industrial groups to determine to what extent tu-
bercnlosis is connected with indystrinal and social factors.
A grent many such mass examinations have already been
carried out. Tne card indexes of the dispensaries and

the observations made in these examinations offer rich
material for a study of the incidence of tuberculosis in
individual population grovps.

The more distant parts of the country sare made
acanainted with the activities of the central organization
by means of congresses at which both theoretical and prac-
tical subjects are discussed. The first All-Russian
Tnoberculosis Congress was held in Leningrad in February,
1922; the second in Moscow in Kay, 1923; the third is
planned for Charkov in August, 1924. The Tuberculosis
Seotion of the Commissariat of Public Health publishes the
magazine, "Woprossy Tuberkulosa" (Tuberculosis Questions"),
devoted to the scientific and practical aspects of the
subject.

2. Venersal “isease Vontrol.

The People's Commissariat of ‘public -Health
had two necessary lines of activity to purgsg is fhe control
of venereal diseases; first, to improve and extend special
treatment, making it more available to the masses of the
people, and second, to carry out a series of practical
preventive measures. A great deal of work has been accom-
plished in both these fields during the past five years.

The first thing that had to be done was to find
out the extent of venereal infection among the populations.
The imperial and the civil war had undoubtedly done a

 
240,

great deal to spread these infections, but it was hard to
determine how much, for registration of venereal sufferers
was imperfect even before the war, and the statistical
departments after the war had not been able to obtain fignres
for the whole country.

Eowever, surveys made in special sections throw
some light on the subject. The following figures have been
very carefully controlled, and give some iden of the extent
of vencroal infections.

The examination of70,000 soldiers of the RedArmy
in the garrisons of Moscow and Teningrad shows, for Moscow,
syphilis 0.4 per cent, gonorrhea 0.7 per cent, and for
Leningrad, syphilis 0.9 per cent and gonorrkea 2 per cent.
An anonyhous questionnaire sent gg the students in the
highr institutions of Moscow showea that 19.3 per cent were
or had been infected, 1.2 with syphilis. <A similar aqueg-
tionaire sent on a larve scale to the Moscow workers re6-
vealed 11/2 per cent infected with syphilis and 20 per
cent with gonorrhea. The villages of the governmant of
Smolensk, which were particnlarly affected, mostly with
syphilis, had a rate of 12 per cent for this disease. These
figures unaonbtedly prove that the venereal diseases are
widely distributed, but they also show that the degrae of
infection is much less than one would have had reason to
suppose on account of the war.

This extensive distribution of infection reavires
increased measures for providing medical treatment, but
they are at present far from sufficient, although they have
been more than doubled between 1919 and 1923. Thera was
one bed par £24,000 people in 1919, while in 1924 thore
is one bed per 9;600. But this is far from sufficient in
the large centers,

Not only the hospitals, but the clinies and labor-
atories had their facilities increased, The most important
advance in this line is the venereological dispensary,
created since the war. We have now in the R.S."™.5.R. 44
snch dispensaries, 35 in the Ukraine. These dispensari es
are the centers for the entire public health work on the
snogect as well as for an @normous amount of medical aid.
All patients that come to the dispensaries for advice also
receive complete treatment, which is on principle absolu-.
tely free of charge. The kind of social hygiene work done
in the dispensaries is of many kinds - information, examina-
tion, registration of patients, arranging social and family
conditions, surveys of the canses that contribute to the
increase of venereal diseases, studies on the sex reqvire-
ments of workers, taking part in the control of prosti-
241.

tution - all of this is successfully done by the
dispensary, thanks to the close contact with the people
themselves, who are induced to coopsrate in venereal
disease control.

Education in social hygiene, which is of
special importance in Russia-as the country of extra-
genital syphilis, is widely spread over the whole
country, including the rural districts. The resalts
of this work are very great, for the country people
affected with syphilis are extremely anxions to ob-
tain treatment, they cease to consider vencreal in-
fection as a personal disgrace, and we have a number of
eases in which meetings of thousands of peasants heve
decided to call in physicians to make a complete ¢xa-
mination of their villages and mark for treatment those
found to be suffering from infection.

™he accomplishment of all the requirements of
venereal digease control and the rapidly increasing
number of dispensaries demand a great number of phy-
gicians, not only clinicians but also social hygiene
specialists. The training of such specialists is in
the hands of the Government Venereological Institute,
which was founded two years ngo in Moscow by the Com-
missariat of Public Health. This Institute consists
of three large divisions, the clinical, the exper imental,
and the social. The Institute alsoms a large hosp-
itel with sections for syphilis, for dermatology and
for male and female gonorrhea.

The experimental divisions of the Institute
consists of the following sub-departments: micro-.
biology, serology, cytology, vaccine, pathological
enatomy, chemistry, and analysis. There is a model
dispensary connected with the social hygiene division.
The most prominent specialists help to carry on with
the work of the Institute, and there are now 175
physicians dudying there. During the past two years
350 physicians who are now working in different parts
of the Republic received their special training at
the Inatitute. In spite of its brief existence, the
Institute has become an important center for scientific
venereology, and publishes a journal entitled "Venereo-
logy and Yermatology".

The demands of active venereal disease
control made it necessary to manufacture local
salvarations preparations in Russia. Iwo of these
are now being manufactured, of the "914" type
"Novarsol" and "Novarsolan", equal in quality to
any produced abroad. The chemical department of

the Institute makes a bismnth preparation for the
242.

treatment of syphilis that is in no way inferior to
the Franch one as far as action and absence of all
harmful phenomena are concerned, Recently there has
been made preparation for the treatment of syphilis
that is intended for internal use, on the French
type. Biological experiments with it eave such
promising resnlts that clinical use of it will soon
be begun.

The prevention of prostitution plays an
important role in the control of venereal diseases,
Although prostitution had begun to disappear during
the war, when labor was compulsory and there were
no unemployed, it has found new ground in which to
develop in the capitalistic conditions of the new
economic policy.

Special organs for its prevention were
created in the proviness, their members appointed
by the central Commissariat board for vensreal dis-
sas@ control. The prevention of this social evil
is based on a struggle not against the prostitute
but against prostitution. The work is both preventive,
aiming to prevent the uremployment of women and the ,
vagrancy of women and children, end direct, aimed
without mercy against all brothels and their keepers,
and egainst procnration.

IV INPANGS AND CFILD WELPARE WORY,

1.  Pronatal and Infant Welfsrefork.

ne present articlé is intended to give a
general idea of the place of@upied by maternal and
child welfare work in the gonersl system of the
Soviet government and more particularly its place in
the organization of the Fealth Department.

It must be emphasized thet certain beginnings
had been made in Russia even before the revolution.
There was a well-known State organizetion, the All-
Russian Mother and Child Protection Society, as well
as @ Society for the Reduction of Infant Mortality and
a special association in Moscow founded by philan-
thropists and doctors interested in social work, and
called The Society for Infant Welfare. But none of
these organizations conld develop properly, for public
activities of this sort were always mistrusted in the
Russia of the Czars, while it was a foregone conclus-

 
243,

jon thet in undertr’ines of this sort, of » purely
cocial netnre, failnrs vonld alvays ens72¢ bsecanse tne
vork was organized »lone byrenucratice lines.

As a social problen of importcnce to the
entire country and closely allied vith the velfars of
the rapnublic, infant welfare work was first organized
after the October Revolution.

The organization of the vork was entrnsted to
the people's Health Comnissariat. The problens are many-
sided, involving every phsse of life. “Not only the health
of the mother and child in the narrow sense of the word
mre involved, bot the protection of woman's wore as
mother, tne problem of educating young girls, the re-
organization of customs and the establishment of the
right of mother and child to protection sre ell implicated,
But the chief? element remains the care of the coming
eenerstion. All child welfare institutions therefore
possess a reyilor médical department.

™he Division for infant welfare work inherited
Little in the wey of past experience or material eavip-
ment. Outside of the four clinics ond the homé@é for mothers
end children in Moscow, therc was nothing to start vith.

We have built vpon the principles evolved by
the experience of the Western world, bot have adapted to
fit our own conceptions the forms borrowed from Germany
ond America.

In the first place, ve repard all infant wel-
faré work as a government problem, and mothernood as a
social duty of women. Not even a remote idea of phil-
anthropy is involved. Helping the working mother is the
duty of the State with recpect to the future gansrations.

In the second place, we always consider women
as wopkers and the varions infant welfare inestitntions as
means for Lightening the burdens of motherhood.

That is why we have developed -n institution
not very prevalent in the West, the créche. ‘We do not
consider a créche a temporary masnre, and do not look
gpon support of the mother in the home, so that she can
stay vith the child, as ideal, bunt believe instead that
the crtche will be further teveloped and perfected. The
aim of our institutions is to assist women to combine
motherhood with other usefol public vork,

These are the fundamental principles in the

light of which we have drawn up our institutions. The
most fundcmental of these, established as part of the
campeign against disease and infant mortality, are the
| 244,

créches and the combined clinics and milk stations, open
to all, and chiefly educational. These are our model
public institutions, 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 after the
birth of the child, and sometimes the entire nursing
period. And finally, there are institutions @& a closed
type, such as homes for infants and homes for children of
one to three years.

Child exposure, that shameful inheritance of
the past, has not been entirely done away with in Soviet
Russia, so that we still have plenty of infant homes.
Eomes for children of one to three years are filled almost
exclusively with orphans, a frightful number of whom
lost their parents by war, famine, or epidemic.

Entirely separate are the institutions for
birth and prenatal work. In large centers such as Lenin-
grad and partly in Moscow, the various institutions have
been considerably developed. In Leningrad, for example,
there is a whole complex of "Maternal and Child Welfare
Statiom's each one consisting of the following divisions:

' 1. Clinic for infants.

2. Clinics for children from one to three.

3. Clinic for pregnant women.

4. Tubetculosis specialist's office.

5. Venereal disease specialist's office,
6. Nutrition station.

7. Milk station.

8. “egal. consultation.

9. Information bureau.

These stations, about twenty-three in number,
are found in all parts of Leningrad. Emphasis should be
given to the work of the legal consultation bnreaus
which constitute a méasureé against child exposkre, because
they require the father of an abandoned child to look to
its maintenance. As the first year of these bureaus is
just drawing to a close we cannot yet draw any extensive
conelusions from their work.

These Legal bureans also provide the certificate
with which the women obtain the insurance money for the
prenatal and nursing périods. The support given consista
of fnll monthly wages for two months before and two montha

after birth in.the case of women doing physical work,
and six weeks before and six weeks after Por women doing
intellectual work. Nursing mothers for nine months
receive support amounting to one-fourth of the aversgs
wage for that region. The ansurence funds also donate
for the care of the child a sum eanal to one month's
averege wage. These insnrancé bureaus have nothing to
do with the organization of the institutions, their duty
is merely to pay ont the money.

On January first, 1924, not counting the Ukraine,
White Russia and the Vauncasnus, there were the following
number of institntions:

Créches 548
Mother and child homes 147
Children's homes 401
Children's clinics 185
Mothers! clinics 44
Maternity homss 35

(This do@s not inclnde the maternity
homes found in hospitals)

Other institutions 20
Total 1350

The Public Health Commissariat hes founded in
Moscow a Scientific Institute for Motherhood end Infant
Welfare, which stndies avestions related to the physiology
and pathology of infants and which taxes care of the trainee
ing of specialists in this field. Its work is pursed in
threes directions. First of sll, there is the theoretical
study of questions related to the physiology and patho-
logy of women and children, next, the drawing up of pro-
phylagtéce meesures and plans for the campaign against
infant mortality, and third, the practical training of
obstetricians, pediatricians, midwives, and nurses’ in-
struetors.

The institute contains clinics, laboratories,
demonstrations, and gives a covrse for the preparation and
training of the personnel. The scientific institute con-
sists of three divisions.

1. Women's Division (Obstetrics, gynecology,

out-petients).

2. Children's Division.

3. Scientific Division.

In the second group there is a division for
new-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.
246,

This division takes gare of normal children; and
there are also others for premature cases, for syphilitics,
a distribution division where children taken in by the
iustitutions stay three weeks before being assigned, snd a
colony situated in the country for physically subnormal
children.

The third division of scientific aid includes
the general clinical, bacteriological and biochemical
laboratoriss. A pathological-snatomical department with
museum, X-Ray department, milk department, a food laboratory
a large library, and an exhibit room of the Dresden type
dealing with all phases of maternal infant care. This
exhibition is used both for instruction and in connection
with an extensive generel educational campaign, There
are at pasent 127 doctors and 434 women studying (mid-
wives! and nurses! instructors) at the Institute.

At the latest All-Russian Pediatric Congress
in May, 1923, the auestion of founding special Uniwersity
chairs for the study of infant physiology was taken up,
but it was decided to postpone the matter temporsrily,
as a chair implies the development of an institution in
which the students can obtain their practical training.

For the present, an extension course in infant physio-
logy has been attached to the regular course in child-
rents diseases at all universities.

This is the plan and the method according to
which we have been working for six years during civil
war end economic aifficultiss. A period of peaceful
prosperity will enable us to extend and to fortify these
plens.

2. Protecting the health of children and adolescents,
The care of children and adolescents 18 also
an ontgrowth of the Revolution. Before that time,
there existed at best in the capital cities some school
hygiene at municipal expsnse, bout no attention was paid
to the care of the physically or psychically abnormal
child. This was left entirely to private initiative.
There was to be sure a school hygiene department in the
Ministry of Sdvertion, but it did nothing bnt give
some instrnetion of no practical value.
After the Ravolution the care of children
and young people became a State function. <A department
247.

for this purpose was created in November, 1917, and

plans for its organization were worked out. This organ-
igation covers the care of the normal child, school-
sanitetion, physical culture, and the care of the physic-
ally abnormal (tuberculous) and psychically abnormal
(psychopathic, nervously diseased) chilé.

The department decided in 1918 to found a
number of institutions for child welfarein Moscow, to
serve as modéls for the rest of the country.

At the same time two higher educational inusti-
tutions were created, the Physical Culture Institute and
the Institute for Mentally Defective Children, the name
of the latter being changed later on to that of Medical-
Pedological Institute. In 1921 courses in exercises were
begun again in Leningrad under the name, Institute of
Physical Culture.

The department for the care of children and
adolescents was transferred in 1918 from the Commissariat
of Public Instruetion to that of Public Health, thus
being greatly assisted in the unified execution of its
plans.

. The following points grew out of several years
of experience as the basis of the work.

1. Preventive measures in regard to normal
and abnormal children, which are for administrative pur-
poses divided into two parts:

a) Inspection of sanitary conditions in child
inatitutions and the care of the health of
school children (pedology).

b) Physical eduecstion. The same for abnormal
children.

2. Me@ical pedology in regard to:

a) Physical abnormal children (tuberculosis).

b) Psychically abnormal children (mentally and

morally). .

The work of the divisions falls into two
sections, scientific study and special training for
physicians and teachers.

The creation of great corps of hygienbsts-
pedologists end social eugenists by the special training
of physicians wes an enormous undertaking, and at first
only a few short or one-year conrses and later three

£0 OPT INSAT+ GOPERS® oF ERK SEE meng RatboERE SdHt8re
248.

forthis instruction. The improvement of the race and
the working class as a social eugenic undertaking is
the main feature of this training.

The scientific work of the division is carried
on by the médical-pedological commission; by a number of
scientific conmissions that are appointed by the division
to vork ont variovs problems of a medical-pedological
nature together with the Commissarirt of Public Henlth;
and by the scientific professors, laborntories and
commissions of the universities.

As the qnestion of physical culture covers an
enormons field, a plan of objective stndy was as far as
possible worked ont to permit the observation of the
alterations of the organism as a result of physical
exercise. The scientific department of the central
governmént Institute of Physical Culture had to blaze a
new trail. Organic reactions are particularly difficult
to observe, and these reactions must furthermore be so
numerous as to offer the possibility of determining the
relative strength of different factors in producing
them. The first step in this research wes anthropo-
metry, which however leaves many questions unanswered,
The department of anthropometry is assisted by the
physiological laboratory. At the same time intensive expet
riments are carried on in the laboratory to determine
methods for obtaining a desired norm and exact dosage
throvgh certain exercises.

The state med ical-pedological Institnte has
polished a number of papers. In addition to its scient-
ific work the Institute is also working on new ways of
determining the norm and deviations from it in regerd to
learning ability os well as in different child types.
Methods of measuring children's motor ability have been
worked out, the Bannourg method simplified and adepted
for méasuring not only children'sadvancement but also
their intelLlectnal ability.

The Medical-Ped@ological Institute considers
defective mentality as a psychic and néevrological mani-
festation and includes it in the field of clinical
pedology.
All the model expérimental Institutes of the
division serve the Institute as clinics, Among these
are the generel and dental children's clinics, the forest
school, the dispensary for tuberculous children, the
249,

psycho-nenrological and the pe@elogical clinics.

The children's dispensary, with its
dental department, is the most typical, with office
hours for specialists in 911 departments of madicine,
These dispensaries are considered foci for the ac-
tivities of all the physicians who are doing child
welfare work. They also form the connecting link
with the public by sending children to different
special institutions, such as diet kitchens, or day
sanatoria, and through the medicnl aid departments,
home visits, 6tc.

Physically deficient children have the
forest school as a model resort, the psychically
deficient, the medical educational colonies,

Particular attention is paid to the health
of working adolescents, who are the future qualified
workers of the Republic. A decree of the People's
Commissariat of October 13, 1922, reanires that the
working adolescent must be examined at regular inter-
vals, not less than once a yesr. In case he proves
to be doing work too heavy for his physical condition
he must be put on lighter work. Other means of prée-
venting physical debility of adolescents are sana-
torium colonies, rest homes, health resorts, etc. The
1923 physical examination showed that Moscow had 35
per cent and Moscow government 30 per cent of ifs
adolescents below normal as far as physical efficiency
was concerned. It is also against the law for young
people Less than eighteen years old to go to work
without a preliminary médical examination.

Physical culture forms a particularly in-
portant element in the struggle for health, and is
carried ont in the provincial institutions for the
purpos@. These are copies of the matiel institution,
but on a smaller scale. The main agents for physical
training on a large scale are the clubs of the Com-
munist Young People's Unions (“omssomol) and the
cultural clubs of the trade unions. There are at
present in Moscow 250 workers' physical cultare clubs,
with 15,000 members.

The Central Government Physical Culture.
Institute of the Commissariat of Public Health is the
center of proleterian physical education, with one of
its purposes to prevent all deviation of physical
training into professional sport or athletics,

- We have at present in the All-Russian Cent-
ral #xecutive Committee, under the chairmanship of the
ie

nw

Commissar of Public Health, a High Council for Physical
Bduveation, and in the different provincial commissariats
local councils, all of them forming a single organ on which
all proletarian associations and all authorities are
represented, such as the Commissariats for Military
training, of Public Eealth, and of Public Instruction.

The educational part of the work is carried on
by the Council with the co-operation of the division
for the protection of children and adolescents. By a
decree of the People's Commissar of September 15, 1921,
this Council is composed of an eqnal number of repréesenta-
tives of the Comnissariats of Public Fealth and of Public
Instrretion. Subordinate councils represent it in the
provinces, and to these are adied sanitary district
councils and medical-pedological commissions.

Vv. TER PHYSICIANS.

Two periods must be distinguished in the con-
dition of physicians as well as in the whole life of the
country since the October Revolution: the period of civil
war, and the period of transition to pmce conditions.

During the civil war, the blockade, the famine
and the epidemics, the position of the médical service,
particularly the physician, was very glad. The fight
against the enemy and against disease reauir ed colossal
sacrifices from the entire people and relentless work on
the part of all physicians. The latter were -11 too few,
and in order to remedy this to some extent the Cofmiss-
ariat of Public Health was foreed to license as Yurriedly
as possible persons who were insufficiently prepared
but vere nevertheless indispensable for the work of
epidemic control.

Most of the physicians were mobilized for the
-Red Army, while the rest were conscripted for forced
labor, in other words, every bysician able to work had
to do so for the stats, and could only be appointed or
dismissed by the Commissariat of Public Health, All
physicians were registered, and the forced labor make it
possible to use what physicians there were as rationally
as possible in view of their insufficient numbers, since
they wore if necessary sent to the war or to epidemic
areas.

The great majority of physicians met the
demends of the Republic as fully as possible, and devoted
themselves to the medical and health service of the coun-
try, in spite of having to work under the most difficult
conditions, starving, su*fering every kind of privation;
251,

often dying in great numbers from the tasks that over-
whelmed them. The success achieved in controlling the
epidemics cost the country many hundred physicians. When
the epidemics of typhus and relapsing fever were at their
hight, the morbidity of physicians fighting them reached
100 per cent, and their morb&lity 70 per cent.

Comrade Trotsky said, at the Third Public Health
Congress in 1921, in praising the work of the physicians:

"The building up of the Red Army went hsnd in
hand with the work of unnumbered physicians. If there
had been no medical work done in the Red Army, the Red
Army itself would hsevs done no work at all".

Those physicians that remeined at their regnlar
posts hed to carry on the whole work of epidemic control
among the civil population.

The victory in the civil war and the decline
of the epidemics made it possible to decrense the force
of the government sanitary departments. This was also
necessary on account of the transition to a repylar
budget and the lack of funds of the provinees and commun-
ities that were now nade responsible for the expenses in-
curred by the public health service.

The great need for physicians grew less, and it
becrms possible to improve the position of the medical
personnel, do away with forced labor, and permit physic-
jans to take up independent practice in vacant psts,
which later, however, lei to their bankruptcy.

Foreign physicians wishing to practices in
Russia are regularly reanired to pass the University
examinations, but aecording to an agrecment with the Comm-
issariat of Public Instruction, exceptions can be made
in the case of men who have had years of weiesntific or
practical experience,

Unfortunately we suffer loss from an actnal Lack
of physicicns than we do from their unequal distribution.
We have even a superfluity of them in the large cities,
so that they have a hard time earning a living. Accord-
ing to the latest figures, there are 33,000 physicians
in the U.5.S.R. Of these 22,000 are in the R.S.7.S.R.,
about 8,000 in the Ukraine, and the rest in the other
républics of the union, such as White Russia, Azerba jan,
Armenia, etc.

This number is of course insufficient for this
enormous territory with its one hundred and thirty million
people. The Commissariat has estimated that at least 35,000
physicians are required for the entire medicsl needs of

the R.S.F.S.R. alone. But the plan for furnishing them
cannot be put into execution at present on account of lack
of funds. For the same reason, makeshifts have to be
endured in independent areas, such as harbeér-surgeons, etec.,
their places being filled as soon as possible with regular
physicians.
While the counties and remote provinces have

no physicians, the large cities have many that are unem-
ployed. In Moscow, for instrnce, 4190 ont of 5440 physic~
ians have government positions, while out of the remaining
1250, 956 have registered at the Tabor Exchange as having
no work. In the Government of Leningrad there are 2608
physicians in the government employ, while 496 ont of the
remnining 632 are registered at the Labor Exchange. A
large number of idle physicians are also registered in
Crimea, Saratov, Kiew, 0 dessa, Voronesch and other

large centers. Most of these are young men who heve re-
cently obtained a license and have not yet done their
réquired year of practical work.

This uneven distribution is due partly to the
low wages pnid in the provinces and partly to the fact
that the physicians themselves wish to remain in the
cultural and scientific centers, as was always to some
extent the case, only growing more pronounced in recent

ears.
7 The overwhelming mass of physicians are em-
ployed by the state, 29,500 in all. Those that have only
a private prectice, with no regular incoane whatever,
aré very few, only 3500, but they have often to register
as needing work. Of the government-employed physicians,
many also carry on private prectice during their spare
time, as this is not forbidden and helps to eke out the
low government salary.

The physicians! difficult material position, ©
which has a bad effect on the whole work of the Commiss-
ariat of Public Health, has led to Commissariat and the
medical sociaty, "Wsemedikosantrud", to work out some
means of improving it. This subject has been presented
as one of immediate and pressing importance to the highest
céntral organization as well as to the local sovicets,

that support their pblic health institutions out of their
own funds. Numerous congresses and the All-Russian
253,

Central Council have recognized the necessity for
measures of this kind. In spite of the financial dif-
ficnities of the country, the minimum wage is regu-
larly being raised, and in some districts the results
have already been noticeable. Other ways in which the
lot of physicians is somewhat eased is by lowering
their taxes and rent, giving them and their families
pensions, ote.

Private practice in Soviet Russia is abso-
lutely free, The only thing against which the govern-
ment is opposed is medical advertising, bnt private
practice can no longer be considered the source of
income for most physicians. A few noted specialists
in large cities have a large prectice and large in-
comes. Otherwise private practice exists to any
extent only where there are not enongh state physic-
ians. In comparison with before the war private medical
preetice has fallen very low, and continues to fall.

The whole intention of the Commissariat Is to
do away with the necessity for private practice by pro-
viding the whole country with qualified medics! service
at povernment expense. Social insurance for the worker,
free hospital and dispensary treatment, the develop-
ment of nedical service given in the home, frees child
welfare consnuitationsa, all of these are intended to dées-
troy private prectice. And we see the results in the
districts where such service is most fully developed end
private prectice at a minimum.

Professional interests are taken care of by
the society, "Wsemedikosantryd", to which all the physic-
ians of the republic belong. It is the organ of all
workers in the medical field, physicians forming a sa@per-
ate section in it. The society also decides, aside from
purely professional matters, all important qnestions of
on administrative neture for the country end its
different sections, in conjunction with the Commissariat
of Public Health. Athong these are the appointment and
dismissal of physicians from their posts, the regulation
of salaries and professional fees, the hours of work,
the industrial insurance of the personnel, etc.

The Comnissariat, together with this associa-
tion, has worked out the legal norms determining the
rights end duties of the medical personnel, as reauired
by the particular trend of life in Russia. Not all of
the above reguintions, however, have yet been put into
practice, dye to the poverty of the country.
254.6

One of the most important duties of the Commiss-
ariat is providing a better medical educstion. During the
war no schooling could be thonght of, students were licena-
ed as soon as possible, and there was almost no medical
literatures 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;
new clinical institutes for advanced medical studies
opened, and conrsés organized in the most important depart-
ments of soviet medicine, such as sanitary control, social
diseases, maternal and infant welfare, etc. Advanced
studies for prectising physicians were made possible in
the provinees by commandsering for the purpose the well-
eauipped provincial wanitary institutes.

The programs of the medical schools were altered
so as to improve the quality of the médical education of
new gradnates, end the so-called practical year, which
we have madé really two years, was introduced,

VI. SANITARY EDUCATIONAL TORK. -

The extensive prophylactic measures carried out
by the Soviet can be carried ont only on the bads of
consid6ring them the activity of the laboring classes,
Arousing the consciousness of the laboring classes to a
pitch where they will become active in health work is,
therefore, the foundation of the entire system of pre-
ventive madicine.

Bdneational health propaganda in Soviet Russia
is not dependent upon the good will of this or that
médical organizetion or society. It is an organic 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 People's
Health Commissariat is entrusted to the Health Educetion
Division. In the various provinces, this work is taken
care of by special mdical instructors and in the smaller
communities, it is done by district health officers.

This unified organization is active not only
in the sanitary and epidemiological field, bat also in
the work of Mother and Child Welfare, and Tuberculosis
and Venereal “igenase prevention. In 1919 a model insti-
tution called the Public Health Szhibit was founded at
3
oO
on
°

Moscow. The exhibition had nine divisions and about
5,000 exhibits. Recently a model library on popnlar
public health subjects, has been added. It is also

& center where various commissions study problems
connected with public health work. It serves as an
educational center for henlth officers, but is is also
available to the public.

Some small idea of the character of the
work done can be obtained from the admission sta-
tistics during the last two years. In 1922 there were
465, and in 1923, there wers 989 groups admitted to
the Bxhibit. The entire number of visitors in these
two years were respectively 10,950 and 19;758. If
to these numbers are added the numbers of visitors
who were unorganized, the figures amount to 22,875
and 44,492.

Among the groups in 1923, school groups
amounted to 99; groups from other higher educational
institutions 98; various children's institutions 49;
other educational institutions 79; textile and fac-
tory centers 55; metal workers 43; health workers
45; communal workers 30; transportation labor 25; and
agricultyral labor 22, etc.

The Institute for Social Hygiene is the
scientific center. This institute has at its dispos-
al a large supply of exhibit material such as lantern
slides and negatives. In the provinces we have health
centers with a prominent exposition, auditorium, libra-
ry and moveable exhibits, as well as coilections of
popvlar litersture. Some of the larger centers 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 years. 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, severs sconomic conditions,
and the totel lack of preparation, are taken into
consideration, it will be seen that Soviet medicine
has obtained good results in this field.

Health education in the various model insti-
tutions is provided for partially by the government
budget. The provincial and district institutions are
on the local budget. The latter, in particular, also.
256.

share in the various culture and labor funds. Most of
the work in health education is done by doctors,
chiefly the health officials, school inspectors, and
tuberculosis and venereal disease dispensary doctors.
At the periphery, sane use has been made of hospital
doctors. ‘teachers for the present do not take any
significant share in this work. By giving Hygiene a
prominent pleceé in the labor school, both in the
second and in the first division, the next task has
come to be that of ednerting teachers into efficient
health instructors.

The unified organization of all health
activities and the preference given to doctors and
health officers does not signify that this work is kept
apart from the geneérrl eé@ucational activities. On the
contrary, health education is the bridge that connects:
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 communistic educational work among young people,

and with general work smong women and factory workers.
There are standing committees composed of representatives
of these various organizations who make it their business
to coordinate ané give a special application to the
health work with an eye to the needs of the organiza-
tions they represent.

By means of contracts with numerous industries,
health educational work is systematically taken care of
and financed. The work itself is done by personnel from
the health department and according to plans prepared
by them. Systomatic heelth work is carried on in the Red
Army by having regular health lessons. In the same way,
work ia being done among the reserve military forces,

The work has obtained a firm foothold among transporta-
tion personnel. In all other schools hygiene has been
included. Other groups have health lectures, In twoe
thirds of the railway companies, railway car health
exhibits are provided. Club work is the form that most
health activities take in indnstrial work. There are
occasional lectures, discussion evenings on health
topics and provision of a health shelf gr health corner

in the librar All elub libraries contain popular
health literatore. Good resnlts have been o tained

from various new methods including a periodical on live
health questions of the day, collections every three

days for fighting tuberculosis, venereal diseases, mala-
ria, etc., health meetings, and especially health debates
and the production of health plays. There is hardly

a place in Soviet Russia where a debate has not been
held on prostitution, alcohol, and other thought
provoking snbjects. These debates are extremely po-
pular and hold the interost of the andience for

several hours. There have also been some lawsuits
concerning houses of prostitution, provision of
sanitary facilities, saloons, etc., the proceedings

of which arsé also used as literature, In som cases
courts were actually held in factories where laborers
could attend. Testimony is given by doctors who
explain points especially with a view to social hygiene
conditions. Great interest is aronsed by the production
of plays dealing with health problems. The repertoire
includes plays by Tolstoy such as "The First Alcohol
Drinker", and "Advantages", "Tauptmann's "Sunrise", and
/ quite a few plays constructed from stories by Chekov,
Gorky, and Maupassant, as well as original satires on
health snbjects. Presentation of these plays is always
accompanied by a lecture from a health officer.

A limited number of health films are in use,
In 1925 some new films were obtained dealing with
milaria and social diseasés.

Among tha agricnltural popniation health work
is done throngh the agricultural center, and the agricul-
tural libgary. A model has been provided in Moscow,

The Agricultural Musenm there also has a librery. Twice

a week Lectures are given with opportunities for dis-
cussion of which visiting farmers can take advantage.

A library has been organized and much literature is given
out. In provincial centers much the same plan is followed,
In order to reach the homes, centers arse provided with
popular litersture, placards, pamphlets, etc. The
litereture is so selected that if no health officer is
present, a teacher or librarian can use it.

The chief work in the future must hecéssarily
devolve upon the schools and the teachers. This ques-
tionvis now being considered by the health authorities who
are considering the best means of reaching the great
masses of the population. Health work is reaching the
most remote parts of the Republic which only a short
time ago groaned beneath the yoke of theCzar. The
Jakuts and the Buriat Mongolian region in the Bast, as
well as the mountainous region of Yagssten are beginning
to prepare health literature in their own languages.
Health work of this sort among national minorities is
something new,

large tasks still remain but the close
relation with other labor activities and the solid
foundation upon biological and sociological principles
give us the assurrnce that nll difficulties will be
overcome and that the Sovist Repuvblie will attein the
required depree of health culture.

Health work cannot be carried ont without
co-operation from the press. The pnblication office of
the Peomls's Commissariat which was organized in 1919
at the time of civil war and epidemics, has taken se-
riovsly its task of providing medicrl literature. The
immediate needs occasioned by epidemics, it met by
issuing a mass of literature on typhus, eholera, dy-
sentery and other dissases. After that a special
séries of booke, text books, and manvals were published
to aid the large number of people who were combatting
thess epidemics.

In the process of carrying on this work,
the publication activities have gradually broadened,
taking on new themes and a more systematic character,
special attention has been given to social diseases
and more especially, to tnbercnlosis. On this auestion,
a number of brochures and a Large number of pamphi ets,
as well as eiecht special collections were published,
Then follows literature on venereal diseases and syphi-
lis. A prominent place is piven in the popular liter-
ature to questions of child welfare on which another
series of pamphlets and placards treating of childrents
diseases, the erre of children, and advice to mothers,
are trken up. The breaking out of an unprecetented
famine was reflected in publications on nutritional
subjects especially on the nntrition of children and on
nutritional standards. An extensive hunger literature
has developed.

During 1919-1922 there were 202 separate
publications and a total number of 13,000,000 copies of
this popuicr health literature issued. Along side of:
this popvlar education there has been some development
in more scientific work. In addition to the news bull-
etin published by the Fealth Commissariat which checks
up on the development of Sovist medicine, varions scient-
ific periodicals were gradually published, among them
"Clinical Medicine", "Gynecology and Obstetrics",
259,

"Hygiene and Epidemiology", "Infants! Welfare Review",
"Tuberculosis Questions", "Vencresl Diseases and
Dermatology", as well as periodic publications on
tnyberculosis and social hygiene. ‘The Peopl e'sComm-
issariat, in spite of the high cost of printing, in
1920 and 1921 brought ont a large number of text

books for universitystudents.

At present, the Fealth Commissariat is
poblishing medical scientific literrture as well as
medicel text books. There has been a special agreement
with the seisntific division of the Government publica-
tion office by which the Health Commissariat is ree
presented as 2 member on the Publieation Comnittee,.

VII. HEAUTH ACTIVITIES.-

Before the Revolution health activitias
were divided between severel government departments,
Some hospitals wero run by the cantral Government,
others by the district, and municipal governments.
Quite a few health institutions and a small number of
hospitals, especially those of the ambulatory type,
wers supported by sick or insurance funds of which,
however, there were none before 1912, Becanse the
hospitals were divided between various authorities,
there was frequertly duplication and the most uneco-
nomical use of funds. A majority of the institutions
were inaceessible to the large inss of people. The
district and city hospitsls which in 1910 included
33.67 of the total and which included 51.5% of all
the beds in charitable hospitals of religious origin,
all tried to follow the ideal of serving people for
nothing. Naturelly the services that could be given
under these conditions left something to be desired,
Hospitals were overcrowded. Dispensaries had very
low hygienic standards. —

The means for keeping up this net-work of
district hospitals serving gratis, were supplied from
district monies(x). In the cities, hospitals belong-
(x) ing ZEMSTVOS are a form of local self-government
in which the better classes participated. Forty-three
out of 83 provinces that existed before the War had
this sort of local government. In spite of the loyal
attitude of these "Zemstvos" to the old Czaristic
régime, they never quits succeeded in evading imper-
jal suspicion. For this reason some of their most de-
mocratic activities were systematically suppressed.
ing to the city anthorities snd supported by the

city, gave aid only to the local popnlation. Other
hospitals belonging to various authorities, as a rule,
required money for their services. Even the Red Cross
activitics were no exception in this respect. As far
as participation of the working men in medical service
was concerned, the whole organization bore an anti-
labor and bourgeois aspect.

Only the better classes, and these only
to a certain degree, had anything to say about the
menner in which the health service was organized. The
large masses of working people were not considered,

The proletariat was not sure of receiving the simplest
aid. As late as the year 1907 only 38% of the factor-
ies subject to inspection gave any medical aid. Twenty
per cent, of the institutions provided dispensaries, 7%
had hospitals, and 61% had no medical organization at
all. This 61,; included 16, of the workers, The 7
that had hospitals included 40% of ,vha workers, and the
20. with dispensaries comprised 259% of the working
population. “tnyedical Felp for Industrial Yorkers in
1907" by B.A. DEMONTJEPF, 1919).

According to dJata for 1912, 19; of the con-
tinually employed working men in cities, and 28% of the
pericdically employed working men received no aid at
all. (Data presented to the Third Duma), Every now
and then a placé wonld be cited as a hospital, which had
only two or three beds. In institutions where meéical
eia@ was officially organized only 44% of the working
population could receive hospital service. The others
hed to be content with dispensary service or with none
at all. This was because the working men had no special
privileges compared with the rest of the people. The
number of bsds was not nearly enough to go around.

There was no question of medical aid at home
or of aid such as that given in sanatoriums for mental
diseases, for example. Snch special services as thase
were a strict exception and were found only in the
large cities. Medical service had only a very narrow
task, that of supplying medical aid without any inquiry
into economic or social conditions of the peoplé requir-
ing aid. No effort was made to give prophylactic care
‘to the medical service, or to pay any attention to con-
ditions uuder which the patients did their work. IKkven
the district institutions which dealt especially with the
agricultural population Limited themselves strictly

to medical serviec and did nothing of a general sanitary
or social hygienic nature such as infant welfare work,
or campaigns against social diseases. This inactivity
is partly oxplained by political conditions and partly
by the ignorence of hygiene on the part of the people
required to give this service.

After the Revolution, Russia inherited from
the old régime in addition to many diseases, and a high
death rate, a poorly organized system of hospitals,
controlled by the more well-to-do among the population
and to a large extent destroyed by “ar conditions. In
the district governments this former hospital system
provided for one bed for 618 people. For the whole
country, the populntion was 813 to one bed, and in no
place was there more than one bed for abont three to fonr
hundred people. In 1910 there was one physician for
every 6,734 people, and for every 150 square versts,
counting only the inhabited districts.

In the provinces the hospitals were of course
very searce rnd the moré popniated canters hed acceptable
hospitrls for the bourgeoisie, but poorly organized
hospitels for the people without neans. After the October
Pevoiution the process of uniting this entire system
under the leadership of the People's Health Commissariat
and its subdivisions in the provinces, the various health
committees of peasant and working men's associations,
began. All hospitals, no matter to whom they belonged,
ners given to the Health Department. There ensued a
period of feverish bnilding on the principls of free
service and fres entrance. This soon came to an end
because of intervention by foreign governments and
because of the civil war. A large part of the medical
personnel and médical material was sent totkhe front;
much property was destroyad or teken over by the enemy.
Some hospitals were wrecxed by bandits, ond counter-
revolutionaries,

The continual blockade also had a bad effect
upon health work. Great demands were made on hospitnls
and some institntions also by the epidemics, buat in spite
of the destrnetive influence of the War and the unfavor-
able economic conditions of thecountry, constructive
health vork made steady progress during the Revolution.
It was only the famine which prevailed in large areas,
that did give the hospitals and some institutions a severe
seatback. There have been great Losses which can only
262.-

be made good again as the economic situation slowly
improves.

The principlés upon which all health work
is based and to which it largely owes its successful
development are as follows: unity of all health activ-
ities as concerns leadership, control, and administra-
tion; the giving of all kinds of help without cost;
the encouragement of high standards and specializa-
tion; close relations with the people; preferred
treatment to insured people and members of their
families; active participation by labor and agricnl-
tural organizations in reconstructing health insti-
tutions; bnséparable connection of health work and
sanitation and the same close organic relation between
medical work and social preventive work, especially
through dispensariés.

All these principles wers in force when health
activities were centralized and they have remained a
guiding influence since health work changed to a local
basis in 1921.

byen the financial crises which the Soviet
Republics have undergone in rec=unt years have not weak-
ened these basic principles, espaciably that of giving
m@dical aid free of charge and in increasing measure to
the working masses, especially the proletariat who are
the people most in need of it. The active participa-
tion of the laboring population through representatives
from various labor organizations such as unions, funds,
and committees, in any decision as to the administra-
tion of hospitals in cities and the similar participation
of the agricnitnral population through its representa-
tives in regard to hospitals in rural areas, has been
of great aid in overcomingérises and has tended to bring
about the healthy condition of labor control of hospit-
als, bringing them in very close contact with the people
whom they are intended to serve,

A special part is played by the insurance
societies whose representatives are not only a help in
drawing up plans, but also in carrying them out.

The working man's insurance conferences which
consist of representatives of all important indnstries,
of all insurances activities, and of all organizations
for the protection of labor, make it a habit to treat
their basic question, plan, and expenditure, which
has no relation to médical help, extend to insured
263,

people.

This provides firm contact between health and
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
cooperation with industries and insursnee companies in
that doctors heve to detormine incapability, and in-
validity of laborers. This is done by commissions of
doctors and experts. In providing medical aid for in-
sured members, the contributions in the way of insurance
fees are a génuine aid in providing service according
to local budgets.

These contributions are partly paid for by
the employer who takes care of 4.5% that are placed at
the disponl of the health anthorities, and used for im-
proving the medical service given to the insnred, Al-
together, the funds from this source cover abont half of
the expenditures for medical service, both in and out of
hospitals, according to data taken from D.N. Schabanow's
"Municipal Medical Sanitary Work in Russia, 1915"

According to a questionnaire distribnted in
1915, one-third of all cities expended 1 to 10 kopeks
for medical aid por inhabitant. Another third, 20 to
30 kopeks, while 33 cities expended 60 kopeks to
one ruble which in 1923 would be 1 to 5 rubles, At
present, the insurencse contribution averrges 12 gold
rubles. Even so, the income from this source is merely
a contribution to the local support taken care of by the
local budget and the contribution that is used for the
special benefit of insured persons,

Thanks to the possibility of providing this
special service, the health authorities in N ovember,
1923 were able to maintein one bed to every 130 persons
in the cityes of Russia. These data were obtained from
the questionnaire, In the more important medical centers
conditions were even more favorable; 1 bed per 100 in-
suréd persons including the family. Since the médical
service has been improved there hove been about 12
visits to the dispensary per insured person. In all
factory and indnstrial centers except the very small
ones, first aid organizations were established,

The number of places that provide first aid
in the home is greatly increased, By the first of

January 1922, we had 448 stations for first aid in the
264.

home and 118 regnlar first aid centers. In the entire
Rnasian Soviet Republic we have one doctor to every
3900 inhabitants.

With regard to some special kinds of medical
aid, conditions are not so favorable, but alweys more
fevoreable than before the War. I am referring to
child welfare, obstetrical, gynecological, venereal,
and ophthalmological institutions. Thers has 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 government dental dispensaries or laboratories, bunt
at the beginning of 1924 there were 1902 government
dental dispensaries with 1570 dental cheirs not counting
those in the army, at resorts, and railway organiza-
tions, or at the army and naval stations. In the
S$.5.5.R. not counting military dispensaries, we have
1843 government dental laboratories with 2298 chairs, 2218
dentists, and 134 assistants.

The insured population is served by 822
government dental dispensaries with L080 chairs, 1393
deutists, and 62 assistants. In the S.S.S.R. there
aré 78 special educational dental dispensaries with 132
cheirs and 150 dentists. Rural dispensaries exist to
the number of 142, with 154 chairs, 118 dentists, and
8 assistants. All these data were obtained by questionn-
aira,

Government dentistry has become the dominating
form of dental work. Another indication of the present
trend is the distinct increase in the most expensive
kind of médical service, --- physiotherapy. Before the
War there were in Russia only 8 small institutes, whereas
at present there are 32 government institutions for
physiotherapy with 1500 beds, mostly organized dnring
the Revolution. Fifteen of the 24 newly opened physio-
therapy institutes were founded during the Revolution.
Ahong these are a number of model institutions such as
the Institute for Physiotherapy end Orthopedics at
Moscow, the Traumatological Institute in Leningrad, the
Institute for Physiotherapic treatment in Sebastopol,
and ths Radium and X-Ray Institute in Leningrad, all
of which are used in the first place for the insvred
populetion. For nervous patients we have at present
over 1500 beds while before the War we had only a few,

I cannot desist from mentioning a few of the
achievements in the field of sanatoriums and health
265.

resorts. There are a great many sanatorium beds and
health resorts which, before the War, were totally inac-
cessible to the masses and are now largely given over to
the insured population. The health resorts in the Crimea,
in the Caucasus and at several other places in the Repu-
blic are doing important work in recent years.

Our sanatorin and health resorts to which we
shail later devote a special article, occupy an import-
ant place in the system of health service which aims at
the restoration of the incapacitated laborer,

Occupying the center of both scientific and
practical activities in hospitals and other institutions,
especially those for physiotherapy, are questions of
labor, principally the problem of restoring the laborer
to his work ag quickly as possible. The whole net-work
of hospitals at the service of the insured population,
considers it its prime duty to be a means toward promot-
ing labor conditions and health among laborers. The
problem of praventing occupational diseases will be
studied carefnily.

Hospitols are beginning to occupy an important
place in the campaign against industrial diseases in that
they try to ferret out the canses of the diseases which
they are called upon to handle. Activity of this sort
brought resnlts in some of the large centers although
it still snffers from lack of well-prepared doctors and
adeqnate means. One of the tasks of Soviet medicine
is that of trying to popvlarize the methods of treatment
used and advocated in the dispensaries.

In the same way, we conceive the task of rvral
medicine to be a social prophylactic one. The unit which,
as a rulé, consists of a dispensary and a hospital, is
the means by which social hygienic knowledge is bronght
to the rural population. It is one of the bearers of
health education. It organizes the. campaigns against
tuberculosis, vencreal diseases, trachoma, and alcoholism.
It does child welfare work, treats mothers and children,
and takes care of mentel cases. It forms the clearing-
house for all avtonomovs activities of the apricultural
population in the field of health. In other words, in
our system, it is one of the ontposts of health work
among the people. Its duty is to perceive the presence |
of health dangers and to give the alarm at the proper time,
It also aims to apply 211 its means and powers to the
prevention of diseases and to a systematic protection of
the health of the people. The fundamental principle
266.

assuring the success of this work is the unalterable
role of giving medical aid free to the rurel population.

To maintain this free treatment, the Republic
has had to, and still must make the greatest sacrifices;
after the difficult blockade years and the continuous
civil war, we still managed at the beginning of 1922 to
heve one bed for every 381 persons instead of one per
649 as in 1913, the territories covered baing identical.
Districts under medicel supervision had increased 41.2%
at the beginning of 1922, and districts under "feldscher"
had increased 46.8%, and the number of beds in hospitals
47.4%. The number of people per hospital had decreased
nepet 39.5%, and the districtsserved by each hospital
had decreased about 24.3% (1621 sq. versts). The radius
had been decreased by abont 13.2% (28.8 versts). In the
eities there were 79 people to one bed. In rural dis-
tricts one bed for 1035 people. During the financial
crisis and in connection with the transfer of all hospit-.
als to local budgets, the hospitals, in the rural
districts, at least, suffered some losses. However,
there was still more service than there had been before
the War.

Although the municipal hospital sitnation is
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
repair, equipment, instruments, laundry, médicines,
bandages, heat, and supplies, which frequently prevails
in rural hospitals, namrally leads to 4 decrease in
attendance in comparison with cities, where hospitals
are very well attended. Under these conditions, it is
encouraging to note that in 1922, 71.6% of the attend-
ance was at hospitals, oe 28.4% consulted for medical
eid, heress in 1913, 6.632 attend ea hosbitare ana’?
B3;a0'vere registered at tHe ‘tend oa hospitals and

As can be seen in the fields of both municipal
and rural medicine, conditions are still far from ideal.
In the cities, there are not yet enough hospitals to
satisfy requiremsnts, especially where specialties are
concerned. Fowever, in the cities a gigantic task has
been accomplished compared with what has been done in
the villages. This is explained by the peculiar condi-
tions in that villages are much more backward, retaining
the culture of the former régime so far as poverty and
bad roads are concerned,
267 e

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 People's Healthfommissariat
has worked out a series of measures aiming at the eg-
tablishment of a net-work of rural hospitals. These
measures will form the basis for a decree aiming at
the improvement and extension of medical service for
the rural population.

Only slow progress is possible in this di-
rection, the rate of progress dependingexactly upon
the restoration of economic power. But we have obtained
a firm foot-hodd in this field and will never give
way because proper health work among the agricultural
population in a country chiefly dependent upon agri-
culture is the guarantee of economic progress. Putting
the health work among the proletariat and farmers on
a social hygienic and social prophylactic basis, gives
us the data from which we can lay down the general
principles to be followed in the organization of health
work in general,

VIII. Heslth Resorts,

Soviet Russia, extending es it does from
the Baltic to the Pacific, has many and various mineral
springs, salt lakes, radioactive marehes, climatic
resorts, warm sea baths, and finally kumys resorts
beyond the Volga steppes, Many of these are famong even
ovtside Russia, snch as the Mineral Springs of the
Cancasns, the Esgsentukt Alkali Springs, the Believers!
Alkali Wells at °chelesnowodsk and the Salines at
Tambuekan. There are also the Salines at Odessa, the
south-coast of Crimea, where is the All-Russian Con-
valescent Home in Crimea; the Black Sea coast at Kuban,
with its climatic resorts open the year round at -
Sotschi, Gagry, and Suchum; the Darasum Carbonic Acid
Springs in +rangbaikalia; the mountain resorts in
Turkestan, and so forth. These resorts were nntional-
ized by the Soviet Government by decree of April 4,
1919, regardless of who the former owner was, and as a
result the most valuable and famous among them are
government resorts directly administered by the Commiss-
ariat of Public Health, there being 40 such resorts
functioning at the present time. The rest of them are

of only local importance and are administered by the
provincial or county authorities of the Commissariat.
All the resorts have been placed by the Government at
the disposal of the entire body of workers. Funds are
furnished by the Government for building, sanitary, and
administrative requirements. The resorts that were dea-
troyed during the war have thus been rebuilt and put
into condition, together with imperial and private
castles, the country homes of former dignitaries and
rich capitalists, and private sanatoria. All the the-
rapentic equipment in the form of baths, electriy and
mechanical apparatus, ete., has been renovated. <A large
amount of agricultural land has also been given to the
resorts for their support. The industrial 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 and for workers end employees in their shops. The
medical department of the army has also co-operated with
the resorts to provide similar facilities for the members
of the Red Army.

Since the existence of the Soviet Covernment,
227,860 patients have been treated in the Central Govern-
ment resorts, and this only during the summere, The table
below gives details for the different years:

Patients in Russian Health Resorts, 1919-1923

New | Treatments: er

 

Year Beds. Patients. Mineral b. Mud b. Other Total patient.
1919 1,840 4,990 - - - - -

1920 21,024 48 ,435 519,542 257,600 255,803 1,20,370 21.2
1921 29,790 66,515 647,379 220,333 514,587 1,3%,299 20.1
1922 14,367 28,167 230,913 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 figures give an indication of the great
extent to which the attendanceof workers, soldiers, and
others at the resorts has increased since 1920. This increase
coincided with the increased territory of the Soviet
Government, when the minerel springs in the Cancasne,
the Salines at Odessa and the Black Sea resorts became
part of the republic. After that, when the White Army
was driven out of the Crimea, grect numbers of patients,
most of them workers, were for the first time able to
enjoy the southern climate, sen baths, grapes. As the
table shows, the greatest increase in beds took place in
1921, and the whole period of increase was exactly during

the years when conditions were at their worst in the whole
269,

country, due to the two years of civil war, the epidemics,
and the famine. 66,500 patients were treated and reesived
not only treatment free, but lodging, food, and the trip
both ways. The patients were trken to the resorts in the
. Sanitary trains. The year after, 1922, only half as many
patients could be received, due to the change to the New
Economic Policy. However, the number increased again in
1924, in spite of the limited funds the Commissariat was
able to allow the resorts, so that the 22,355 available
beds served abont 80,000 persons, although the new beds
for the year were few:in number.

The degree to which the Central Government
resorts are used by the people, at the expense either of
the Government itself or of the insurance or indystrial
societics, is indicated by the fect that 51% of all the
patients in 1923 received treatment at government expense,
32.3% at society expense, and only 17.6% paid their own
way.

The slogan of the health resort administrations
is, "The health resorts for the reetive workers", and the
Commissariat for Public Health makes every effort to keep
these institutions at the high level, which this purpose
requires, Model institutions, of which there were absolu-'
tely none, have been created to study systematically the
natnral’ therapeutic agents of the place and indicate their
us@. Thers is thus a Belneological Institute at Piatigorsk
in the Caucasian mineral region, an Institute for Physio-
therapeutics at Sebastopol, under Professor Setchenow, a
Ralneological Institute with a clinical department at
Tomsk, a National Tuberculosis Institute at Jalta with 200
beds, and another at Kolosvar with 50 beds. These last
two Institutions do clinical work not only in their own
departments, but in children's sanatoria for bone and joint
diseases, such as 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, hs under the
immediate direction of the central scientific health
resort commission of the Commissariat of Public Health,
that has attached to itself all worth while sources in
this field. This commission runs a central resort clinic
that studies the characteristics of the different localities

and traing physicians for the work in a special_two-year
course, Polyeiinics were opened last year in all a most
270.

important resorts on account of the great need for
better medical service at such places, and the most
highly qualified professors and specialists were ob-
tained for the purpose,

. Physiotherapentiec institutes and institutes
for light, electric, X-Ray, and other treatment, and
diegnostic laboratories have for the same reason been
added to the most important resorts. I shall not stop
here to discuss the scientific research being done
at these model institutions, except to point ont the
success achieved by the use of kumys (horse milk) in
the treatment of tuberculosis, a method of treatment
that has received too little attention, in spite of
having been known a long time. Professors Gorwitz
and Wlasovo, who are doing bacteriological work in the
Orenburg laboratory in the Yhirgiz Republic, have
found a special gas-forming agent of kumys, that they
have called Bacillus Orenburgi, in the cream of this
horse milk. Singe then it has been possible to manu-
facture kumys, this irreplaceable agent ngainst tu-
berculosis, artificially in that whole section of the
country, instead of by the old primitive methods, thus
guaranteeing its qnality and cleanliness. The health .
resort officials have succeeded in carrying ont two
méeasurés that were necessary on account of the lack
of places in the resorts and on account of the poverty
of the country-namely, to see to it that only those
who are in the greatest need of such assistance in the
entireU.S.5.R. ara admitted to the resorts, and these
only if they belong to the real working population.
Health resort committees were appointed for the pur-
pose in the different provinces and large cities,
composed of two or three specialists, together with
lebor representatives. Targe numbers of physicians
whose districts lie antirely ontside the resort loeal-
ities have also been drawn into the work to assist
resort specialists in the task of choosing the most
urgent cases and send them to the place that best
meet their requirements,

The Soviet Government has no commnerchl
interest in the resorts, but is simply actnated by the
desire to furnish the working population with these
advantages that were formerly avallable only to the
271.

rich. A compilation of the figures for the past few
years shows that 83% of all those who were rdmitted to
the resorts have been discharged either entirely cured
or nearly so, feeling perfectly well and aole to go
back to their work. It also appears from the records
that the best results, with 83% cure or great improve-
ment, was achieved in the resorts giving mud bath and
kumys treatments. These statistics must, however, remain
fairly subjective and unscientific, dealing as they do
with such objective facts as the determination of cure,
improvement, or the contrary. The last congress of
health resort physicians therefore decided that scientific
means should be used to determine the physical and
psychic conditions of the patients, and their ability to
return to their regular occupations. A special commiss-
ion is at present working on this question and will soon
be eble to publish its findings.

This reorganization of médical service in
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 have taken place without
the co-operation of all the workers, both in scientific
and practical lines, in the resorts themselves, The
results of this co-operation were revealed at the four
congresses of health resort workers that have been held
in 1921-1924, the last one on January 8-15, 1924. There
were 240 delegates at this convention, consisting among
others of 26 university men, 174 health resort physicians,
end 30 other specialists. The congress listened to 102
reports and voted for 100 resolutions. A number of decis-
ions were taken on question of organization and scientific
methods, and many of the reports dealt with methods naed
in mud baths, physiotherapy, kumys treatment, etc. I
shall not go into details as to the transactions of the
congréss, on account of lack of space, but wish to point
out the enormous importance of the disenssion, of improve-
ment in this field for the enormous territory of the
U.S.S.R.

All the work done in organizing this field,
with the slogan of "The health resorts for the workers",
together with the active co-operation of physicians
and union representatives, served as a basis for a wide-
spread campaign of literary propaganda, and much place
was given in the city and provincial press to discussions
on the aévantages and disadvantages of the measures under
consideration. The need was soon felt for a special profe-
ssional periodical in this field, and the central office
therefore began the publication of the journal "Health
Resorts", in 1923, This journal contains sections on

the scientific, administrative, and other aspects of the
snbjeet, ag well as notes and bibliographical notices
from Russia and foreign countries. Twelve numbers
appeared in 1923, containing between 80 and 100 original
articles. Five numbers have so far appeared in 1924,
each one with a brief German snummry of the original
articles, Aside from this regular publication, there

aré irregular ones appearing from time to time that
describe the subpct. Among these is the reference book,
"The Health Resorts of the U.S.5.R.", published in 1923,
with 350 pages, and offering a really scientific des-
cription of the different localities. This yar the
Government Printing Office has published a number of
separate pamphlets that are well prepared snd richly
illustrated, such as, "The Health Resorts of the Crimea",
"Black Sea Resorts", "The Resorts of the Ukraine", "Guide
to the Resorts Giving the Kumys Treatment". "What Are
Health Resorts snd How Are They Used?" by Professor
Semashko eud others. Individual rssorts had already
published previously "The Health Resorts of Siberia", and
"The Health Resorts of the Far Fast". The scientific
work done under the direction of the central bureau re-
silted in a number of publications of the separate in-
stitutions. Thus, the work of the Balneological Insti-
tute for tne Cancasian Mineral Springs was described

last year, while this year there appears the first vo-
lume of "The Kubano Black Sea Tuberculosis Institute", A
large number of separate pamphi sts on the whole subject
have elso appesred during the past few years, such as:
"The Climate Treatment in Suchum", by Professor Meser-
nizky; "The Climate of Red Poljana", by the meteorolo-
gist Selenin; "The Warm. Mineral Springs of Kuldursk",

by Trofimovitch, ete, All these publications help to
show the great interest of Soviet Rnssia in the immediate
rehabilitation of the health resorts, as also the
scientific research done in this line and its applica-
tion to the welfare of thé workers.
273.

IX. MEDICAL FDUCATION AND CRADUATE INSTRUCTION,

Medicrl education as at present carried on is
very different from what it was before the revolution.

The most important points in which it differs are the
large number of medical schools, the chrnge in the com-
position of the student body, and the raforms in the
teaching program in the way of closer adaptation to pwac-
ticel life and the present state of medical scisnee. Until
1914 there existed in the territory of the praesent U.S.S.R.
only fifteen médical schools, sight of them belonging to
the State end seven to various private persons or insti-
tutions. Nine (?) state schools weré to be found within
the limits of the present R.S..S.R., and four public (7)
and private ones. The relatively large number of private
meéical schools was due to the fact that admission to the
government schools(Medicrl Maculties) was limited, in that
only mele persons having obtained the bschelor's degree
wére admitted; women were not admitted at all, Jews only
up to three percent of the total, ete. The removal of
these prohibitions after the Revolution naturelly result-
ed in a great rush of young people oager for admission,
The walls of the existing institutions could not contain
them all, end medical schools grev up like wesés over the
whole country. The lack of physicians slso added to the
increase in their number. On January 1, 1924, there

wers thirty medical faenlties and institutes in the U.S.SR
23 of them in the R.S.7.S.R.

The growth in the number of higher insti-
tutions of learning snd the students attending them was
mostly of an inchoate, uvorganized nature, so that it had
its dark as well as its bright side, although it proved
to be positive good in the end. The overflow of students
was so great, particularly in the lowest classes, that
the practical departments, such as laboratories and diss-
ecting rooms, covld not keep up with it, while the lack
of financial means, equipment and qualified teachers
hampered the growth of the schools.

This had of course 411 to be chsenged in order
to bring about en orderly development. The number and .
nature of the students. was the first point of attack. The
number of students had to be carefully Limited to the
capecity of the laboratories, clinics and institutes,
and this raised the point of how to choose among the
274.6

hordes of students seeking admission. The social class

of the stndent was chosen as the principle upon which to
base admission, for in a State of peasants and workers

the first place must be ceded, in institutions of learning
as everywhere else, to the persants and workers themselves,

The social composition of the student body has
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 everything in its power td make admission easier for
the workers and their children to the institutions of high-
er education, that were previously closed to them. Funds
for scholarships are furnisheé by the State, and during
the current year 8671 medical scholarships herve been dis-
tributed in the R.S.F.S.R. among 32,136 students, The
professional societies and the unions also furnieh large
amounts for the same purpose. So-called Workers’ Faculties
exist in all large cities, to give thelr workers an oppor-
tunity to acanire a higher education, these faculties
preparing workers who so desire for edmission to the
universities.

We hope that this system of admission will
résult in the formation of the kind of medical men a
proletarian State needs, men who are pert of the proletar-
inn and peasant population, acquainted with its mode of
life and its needs.

The whole net of meé@ical institutions is being
carefully studied. As mentioned above, the number of
schools increased in response to the need for physicians,
But the demobilization of most army physicians and the
decline of the epidemics has decreased this need so much
that we now find many unemployed physicians in the large
cities. On the other hand, we arg unable to increase the
number of medical institutions in the villages as quickly
as we would like, on account of the latters! material
conditions and manner of life. We are thus forced to
bring the number of new gradvates and the country's requi-.
rements into hermony, and previous calculations have shown
that it is possible to limit the number of medical faculties,

The plan in limiting the number of medical schools
will be to distribute them as evenly as possible ever the
whole country. Special emphasis will be placed on keeping
medicel schools alive end helping them to develop in the
275.6

remote parts of the country inhabiyed by national
minorities, where medicrl servico was formerly entirely
lacking.

A reform of medical sduertion had been dis-
cussed in Russia even before the war. But the change
thet took place in the conception of tha neture of medic-
al service with the Revolution, preventive medicine
teking the first place «nd canginez the increased deve-
lopment of maternity end infant and child welfare
centers nd of control work of social nd professional
diseases, this change demanded nev knowledee fron young
physicians, end also naw mathods of teaching.

The plan of studies approved in 1922 differs
from the one of before the war chiefly by the increase
in the number of subjects. New reavired covurses were
added for social hyrisene, nrology, ear, nose end throat
diseases, infectious disesses, odontolozy, torether
with optionel courses in X-Ray therapy, rrdiology,
physiotherspentics, ete. Althovgh this change did bring
with it some improvements, it did not solve the problen
of the reorganizetion of neiicsl studies, but rather
accentuetad the favits of the old plan thet lay in the
too large number of coursos and the overworking of
students.

. A reform of medical educntion is at the
present moment being worked ont in co-operation with the
State Scientific Board, the main lines of the new system
béing as follows:

The five yeer conrse will be retrained, divided
iuto fifteen three-month terms. The first two years
are preparstory, end will be chiefly devoted to morpho-
logy and biology, while the reweining three years will
deal with the specifically medical course. Lectures will
be as few as possible, with a vrert ineresse in the use
of the seminar method, laboratory work snd other practical
exercises. The amount of morphology required in the
preparatory years vill be decreased and biology pro-
portionately increased. The purpose of instruction in
the medicsl period will be to see to it that every single
stndent does active work in the laboratories, clinics,
etc., so 2s to obtain the greatest possible direct skill
ond experience for independent work.

During the lest two years the courses given
at the same hour of the day have been made as few as
possible, and the number of styudents in each course
276.

increased, in order to save the time wasted in going
from one clinic to another end give the students a chance
to become really familirr with the work dons in any one
place. In this way the departments that heave to be cov-
ered during the last two years will not, as formerly

heve their courses sppead out simnitaneously, over the
whole period but will offer them in” regwlar and logical
series.

Lectures in clinical departments will have
to be intimately related to the studies carried on in
professional sociology and economics. The social and
economie status of avery patient must always be included
at his clinical presentation. The study of social and
experimental hygiene will be greatly enlarged. A pro-
posal is at present under considerstion to arrange
coursas in the madicnl faculty according to the group
principle,

A decree of the Council of People's Commissars
_ has made one snmmer term of preetical work obligatory
for University students, including medical students, in
order to give them more treining. In the Ukraine a whole
year of practice is required for obtaining a medicel
license. The question of this required year has been
discussed by the Conncil for the whole R.S.7.5.R., but
the finnncial aspect has mie it necessary to give this
up for the present, as at lenst some of the students
would hreve to be given scholarships to see them through
this additional year.

University reform, involving as it does not
only changes in programs and methods, but slso in the
spirit of the education given, cannot be rapidly accom-
plished. But we are convinced that our médical schools
will improve from y@r to year, poerticularly es their
material position becomes more secure.

However, the reform of meéical schools alone
will not entirely solve the problem of medical sdnecation.
The training of specialists is not the field of the
medical school, but on the other hand science is con-
tinually making such enormous strides that it is very
hard for the practitioner in the provinces to kesp up
with its latest advances. This brings to the fore the
auestion of gradnate instruction, which is of very
special importance in Russin, on account of the short-
course physicians that were licensed during the war and
the revolution (1915-1920), and for the sake of the
physicians in remote districts which even Russian medical
liternture has difficulty in reaching, white foreign
277.

literature precticelly never gets there at all.

The necessity for making physicians acquainted
with the Soviet institntions such as 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 courses.

The Council of Commissars, recognizing the tre-
mendous importance of such action, took up as soon as poss-
ible the problem of organizing this instruction of a large
scale. Courses were given in 1921 when canons were still
rofring in the civil war and epidemics were mowing down
the population, for all physicians who had graduated in
1919 and 1920. These men were transferred from the Front
and the provinces to Moscow, where they worked for six
months, to return after thet to their former posts. Even
eerlier courses had been provided for training physicians
in the new fields of Sovist medicine and ns specialists.
-But no stable organization was given this work until the
autumn of 1922, at which time resular credits were esta-
blished for the support of 600 persons to be trained as
specialists at government expense.

A more complete training is being given phy-
sicinns at present in the following manner. The great
majority of them take the course at the State Clinical’
Institutes for Graduate Instruction at. Leningrad and
¥Yazan. The former was founded about forty years ago, is
well equipped, has large clinics, a fine big library, and
is able to take care of a large number of students, one
thousand having comploted its course in 1923. There are
twenty-six chairs of instruction and over one hundred
end fifty courses given by docents. The Clinical Institute
at Kazan is still young, but although founded in 1920 it
has already a fine reputation among the physicians of the
eastern R.S.F.S.R., and handles a few government stholar-
ships that permit it to send physicians to other places.
Physicians are required to return to practice at their
former posts on compléting a continuetion course. They
nsnelly obtain a three months' leave of absence bnt they
can get one for a Longer period. Aside from these clinic-
al institutes, 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 Leningrad are the Institutes of Fxperimental Medicine,
of Radiology, of Physiothernpantices, of Cynecology and
2786

Obstetrics; at Moscow, the Institutes of Biological

. Physics, of Biologicel Chemistry, of Physioloo'y.sf
Nutrition, of Fxperimental Biology, of Tropical Diseases,
of Microbiology, of Sanitary Control, of Sanitation and
Hygiene, of Tubercnlosis and Venereal Viseases, of
Veaternity and Infant Welfare, of Physical Cultnre, of
Medical Pediatrics, of Physiotherspenties and Ortho-
pedics, ete. The Bacteriological Institute at Rostov
is particularly interested in malrria, ond the Nicro-
biological Institute at Saratov is the center for work
on the plegue. Most of these institutes dispose of
government scholarships for provincial physicians

who receive Leave of sbscnce to attend them.

_ The Government also organized, in addition to
theses regular courses, pé@riodic oncs such as courses for
sanitary physicians, for medico-légal experts, ete, There
is no doubt whetever thet this kind of work will expand
more aud more during the next few years.

X. RESEARCH “ORK IN “HE SCIFVPIVIC INSTITUTIONS.

 

The Soviet Government, aware of the great im-
portance of me@ical scisnce as the basis of all pnblic
heslth regulations, has paid particular attention to
institutions of medical research. The Commissariat of
Public Health hes been able to support the Institute of
Experimental Medicine in Neningrad, that was already in
existence during the old régime, together with a whole
group of bacteriological nd clinical institutes. It has
also founded a large number of new scientific institutes
covering an extensive field, has always kept them in mind
even in the worst periods, and has devoted more and more
funds to them as the general financial level improved.

The State Pasteur Institute of Public Tealth
pnd the Institute of Blological Physics at Moscow aré the
most important of the Soviet Covernment's creations in
this field. The aim of the Commissarist of Public Health
in founding them was to create a scientifie center in
which various public heslth problems could be solved and
genersl lines of action for public health preservation
leid down, aside from the strictly scientific research
work to be done. The intensive work done along such lines
in the various institutes of the Commissariat is evident
in the publications that have appesred in Russian and
foreign journals and in separate collections.

The Institnte of Experimental Medicine (Profess-
or A.A. Vladimfrov, director) is the oldést of these insti-

 

 
279.

tutions, and at once calls to mind the name of Professor
J.P. Pavlov, probably the most famons of living physio-
logists. This great scientist is carrying on his work
along the same lines as for the past twenty years,
making an absolutely objective study by exper imental
méthods of the higher nerve centers and their activity.
This Russian scientist has formulated a doctrine on the
basis of his own experiments end observations that
promises to alter all provious conceptions in this field,
The results of this long period of activity have been
brillisntly recorded in Pavlov's "The Resnlts of Twenty
Years' Objective Study of the Hisher Nerve Activities
of Animals (Quantities), Conditioned Reflexes. A Coll-
ection of Articles, Reports snd Speeches", Intensive
scientific research is also done in other departments
of the Institute, such as the department of General
Microbiolozy, under the direction of the well-~knowm
bacteriologist, ".%. Omielsensky. Wis researches on the
nitrogen fixation and the fermentrtion of call-tissne
are well-known, and a number of his textbooks and
handbooks are widely distrionted. "The Foundations of
Microbiology" heving been translated into several
languages and published in many editions. Another
big scientific achievement of the Institute of Exper-
imental Medicine is the method of vasostomy worked out
by E.S. London, consisting of the formetion of an Arti-
ficial passage into the deep blood vessels, particu-
larly those of tha abdominal cavity. Other pieces of
work worthy of notice are those on srteriosclerosis by
N.N. Anitehkov, on the epidemiology of the ploegne and
other epidemic diseases by D.K. Zabolotny, and on nutri-
tion by B.J. Slovtzov.
The Sclentific Institute of Public Health in

Moscow, consisting of eight different individual in-
stitutes, is the place for a great deal of scientific
research, all done with the idee in mind that it must
be not only of theoretical valve but closely related
to the practicnl needs of the times. The object of
this institute is to serve the needs of preventive
medicine, and the problems with which its workers are
occupied are of interest not only to medical men but
also to the general publics.

_ The State Public Health Institute (Professor
LA, Tarasievitch) is closely connected with other

 
280.

scientific institutes and establishments both inside
end outside Russia, The Serym and Vaccine Control
Institute, one of its eight component parts, carriés
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 Hicroblological Institute (Professor
w.A. Barykin) has fo offer the work done by Berykin
and Nod, Krich on the nature end culture of the typhus
becillus and on the nature of the antigen and the virus
in smallpox. One charneteristic of the kind of work
done in this institute is that immunity manifestations
are studied from the absolute physical-chemicel
point of view.

The work of the Tropical Instit»te (Professor
I. Marzinovsky) must necessarily deal largély with
. Malaria in © country in which there are millions of
melaria cases per year. Methods of treatment and
prevention are particularly dealt with, and the practic-
al side emphasized. The Institute is connected with
a whole network of malaria stations, and the problems
arising in practice are solved both by laboratory work
and by expeditions. This Institute also carriss on
studies dealing with other protozoal diseases and with
chemotherapy.

In the Sanitary Eygiene Institute (Professor
Djatropnov) the kind of work is determined in advence
by its name. Studies are mde dealing with professional
hygiene, conditions of labor, the sanitary statistics
of epidemics; thus, interesting material hes been
collected on the periodicity and seasonal variation
of the epidemics.

The Tuberculosis Institute (Frofessor V.A.
Vorobjev) founded af a later date, Is based on brosdly
sociological grounds. Its main purpose is to investi-
gate the condition of the tuberculous patient from the
point of view of constitutional idiosyncrasies and the
nature of the ground upon which tuberculosis has deve-
loped. The patient is also studied in relation to his
occupation, living conditions, honsing, etc. .

Of special interest at the Institute of
Nutritional Physiology (Professor M.NJ Shaternikovy is

 

 

 

 
281.

the work on the results of one-sided nutrition, which
pushes aside the so-called energetic doctrine of notri-
tion and emphasises the importance of vitamines by
proving that the addition of vitamines to * one-sided
diet immedintely increased the assimilation of the
basic food stuffs.

The work of the Biochemical Institute
(Professor A.N. Bach) is of great importance, particu-
larly in the field of enzymology. Professor Rach,
the greatest supporter’of the theory of enzymology,
has recently worked ovt an absolutely original method
of determining the quantity of ferments, such as cata-
lases, peroxydases, lipases and proteases, in the
ampilest possible amounts of bloo&. These researches,
together with others that open new paths into the sub-
ject of ferments, have arovnsed preat interest and led
to the founding of a new sciontific school. Another
activity of the Institute worth mentioning is Bach's
discovery that the specificity of the antibody is
determined not by the ferment, but by the accompanying
bodies that are supposed to serve as the latter's
carriers.

 

The name of the Institute of Experimental
Fine (Professor N.E. Yolsov) would imply that it was
n any way associated with public heslth quéstions,
bat it has nevertheless succeeded in invading the
field of public health and doing much and important
work in it. Some particularly interesting pieces of
research of this kind heve denlt with inheritance in
general, with the inheritance of constitntion in man
in particular, end with sngenics, The problem of the
relations between the internal secretions and the doc-
trine of rejuvenation also has a large place in the
work of this institute. Reports of the institute's
activities have rlready been published,

The ionic theory of activation occupies the
first place in. the work of the Institute of Bkrological
Physics (Professor P.P. Tazarevy), and consists prin-
cipally in the belief that all processes of activation
are based on an alternation in the Lonic content of the
tissues, which then change from a resting to an active
state. The Institute has formntated a theory of nerve
and muscle process6és, as well as a generel definition of

 
282,

the laws of activation (the “eber-Fechner law general-
ized). The subject of brain activity from this stand-
point of chémical-physical construction, and the subject
of the brain centers, their work and their fatifue are
probiems with which the Institute is at wesent occupied?
One of the Institute's main findings in this field is the
unfatigability of the brein centers,

. The People's Commissariat of Public Health has
under its direction a large number of scientific-prectical
institutions that do mostly practical work, with some re-
search, qnite apart from the Institutes of pure acienca,
Some of the former oxisted during the old regime, but they
are mostly of recent date.

Among the later are the State Institute of
Psychiatry and Orthopedics (Professor S.V. Vermel) founded
a year ago, that has already turned ont a great deal of
research, medical end pedagogic work; the State Institute
of Social Hygiene (Professor A.V. Molkov), “ith which
are Sonnest es a Museum, a permanent popular educetional
exhibit, and shops for the manufacture of objects for
visual instrnotion; the State Scientific Institute for
Maternal and Infant Telfere (CG. Sperensky), that seeks
the seléentific solution of the physiologicel and patho-
logicnl problems of maternity and infeney, and also includes
the related question of maternal and infant mortality. Many
specialists receive their training in this Institute, The
StatqVenereological Institute (Professor Efron) combining
purely pedagogical with fherspeutic and scientific functions,
consists actually of two institutes, the clinical and
the experimental, the latter devoted to pure science in
the form of experimental studies in venoreal disease,

The State Yental Institute (Doctor Jevdomikov)
doés scientific and practical work In dentistry, and strives
to make dental service availsble to the masses, Tha Psycho-
neurologicel Inetitute (Professor Netchadjev), the Medical-
Fedological Institute (Professor Guravitch), and the State
Veccine institute (Doctor Morosov), thet not only prepsres
stock vaccine but cerries on studies on smallpox immunity
and the nature of the virus, all are located in or near
Moscow.

 

 

 

 

The following Institutes are in Leningred: The

Roentgen and Radium Institute (Professor Nemenov), the work
of which is already recognized abroad; the Obstetric and
283

Gynecologianl Institute (Professor Ott); and the

inical Institute for Graduate Medierl Instruction
(Professor S.A. Srustein), that not only toaches but
does @ large amount of scientific work. Another
Institute similar to the last-named was opened in
wasan not long ago. It is called the "Senin Institute", -
and is under the direction of Professor P.A. Turia,

The Provincial Institute of South-Fastern
Russia for Microbiology and Epidemiology (Doctor
Nikanorov), at Saratov, Le the most famous of the prec-
tical-scientific institutions in the provinees. One of
its main objects is the study of the plague and its
control by means of expéditions and the training of
specialists. Finally, there is a whole series of bacte-
riological Institutes that do all kinds of practical
work, such as preparing vaccines and serr, moking dia-
gnoses, otc., and some scientific research ss well, but
it is impossible to go into deteils ss to the activity
of them all. The reports on the snbiect are to be found
in numerons journels and special publicetions that hve
appeared at home and abroad, and give a clearpicture
of the work done in these different places,

This brief account of the scientific and prac-
tical institutions of Soviet Russia wonld be incomplete
without mention of the Scientific Medicnl Council. ‘This
Council, in its cepacity as advisory organ to the People's
Commissariat of Public Health, is closely connected with
the scientific me@ical life of the country. Most of the
above institutions, particularly the new ones, have been
created with the co-operation of the Council, which
worked out their regulation. The Scientific Medical
Council advises the Commissariat in everything relating
to public health regulations throughout the U.S.S.R. that
is referred to itself or to the Council of Commissars, -
The Medical Council consists of twenty-five members,
appointed annunlly by the Council (of Commissars?) from
the ranks of scientific medical men, with the right to
re6lection. The permenent active organ of the Medical
Council is the Praesidium, consisting of the Chairman
(L.A. Tarasevitch, Professor of Bectsriology at the
Second University of Moscow), the vice-cheirman (P.N.
Diatroptov, Professor of Hygiene at the same University),
and the scientific secretary (V.V. Ivanov, Professor of
Skin and Venereal Viseases at the First Moscow University) a
284,

During the past six years the Scientific Medicerl
Council hes expressed itself on a large number of
mecicrl and sanitary questions affectine the whole
country, among others the creation and organization of
the medical snd research Institutes, questions of sani-
tation in connection with the epidemics, auestions
dealing with the control of foodstuffs, vaccines,
drugs, thernpeutic: sera, stc., as well as vith their
domestic manufacturs or importation, quastions of

iegal medicel importance, and so forth.

In conclusion, there is no donbt that
scientific medical activity, which did not cesse even
during the worst years of civil var, is at present
becoming both more intensive and mors extensive, and
there is every reason to believe that thighevelopment
will continue to keep step with the general improvement .
in economic conditions.
Alan Gregg's Diary during trip to
Russia, December

19276

 

 

 

 

 

 

 

 

j Saturday Dei. ord. Base ia.
[lesa | fu [nv a) |__. SRR Sta
: | ail day travelling throuch sithuania ami Latvia. iach imp rover ent
; exe Pig --—- dn the appearance oi thin:a ever three Years ago. Hot muah
i NY A> WS. barved wire and no mora dymmited bridges. “a6 alone in the wager
uo TR rH Ait after Love. Lots of snow. Latvia seoms romrkubly closely
~ pet settled. Almost novar out of sicht of two or three Lanne. Lett
Cy YD ote. 6} Be acout midniznt on 4 geod Lassian-Latylan throu +h-s] eepy
Te to “oscow.

Samisny ec. ath ~ inesia.~

Somer cerenonies few ani eagy. Puopls look «#/ though everybody
AaG the same indgae, ami that was very email], /Stoeck on the
Yallroad in e000 condition. Sverything leors proletarian without
deubé. Food cheap in the oountry (more than I coals. ont fer ene
rouble JO wepexe}, which in approximately 65 amt Py)

  
  
Cheftel.-

2264

i6l.

woniay Desanber Sth.- doscow

Arrived in “oscow at 9.30. such a finished building in sab-
urbs ag Be came in. Hotel Sivoy filled, and so went to an
ali-Russian hotel where no other lunguage was spoken. Piicas
expensive, md very fow comforts. vont to Karkomsdray ani

saw Cheftel, vho was very kind. He is the chief of the

Bureau of foreicn Kelations in Meaicine fer the Hoarkomsdrev.

Ke was & pupli of V. Ascoli, 2¢ Rome, and Trambusti in Genoa,

so wo got slong in Italian. Somaske basy with the party
meetings oY this week, bat will be abl. to see iS sometime
durin; the week. Choftel expects to co to america in January.
is interssted in -Ray equipment amd apparontly in contact with
the Victor Cor-orntion. Said he had waited for 46 to sons

to Russia. 1 axplainsd tiat the delay seomed unavoidable,
although 1 haa beon ready to leavo two weeks earlier. i ax
plained that 1 was principally interested in Hedical scueation,
and that the Lei... nad sov-eons frees to core ut this time to
nussia, dat that the I... at thie tine had no one to make

& visit. Cheftel sald that the visit wae princi.2lly important
for general impressions and contacts, am thit mo recucsts

wers likely to be mde. Ho profoerred me to go my own pace, but
wis keen to help as mach aa cossible befors he left for America,
I said thet 1 had heard thot it wis not wise te ask to see anyenc
in Kussia, but merely to note what one was shown, He said thet
on the contrary he wished me to foel free to go anywhere and agk
any quastions I wished, I had the impression that he is a little
too afiable to be entirely raliable, andi in the way he threw

out hints, i gathered he wa willing to make his visit to smerica
advantageous to himself as well as to the party.

Tho air tm Moscow is filled with the smell of burnin:
things that oucht nos to ve barned. The floors are svoeryrhore
dirty and tre buildings deteriorating. FPsople cuarrel easily
and violently, and there is a geners] »2ir of depression which
one does not feel so sharply the first day. One dilapidated
taxi at the station and aitho'the station is not the princip21
one of Moscow, ons micsht expect more in a canital of 140 million
ceoplo. amember dr. vine, the formar instructor of onclish,
whoss behaviour ‘es now principally tios, fidzats and forget-
fulness. somembar the V:linki? huge felt overshoes, the cherp
clothes in the windows. tho windows tightly clesed with patty.
~ash~bowk with no plus, otc. atc. cheftel, in speaking of tho
very high infant mortallty-rate in the tzarist time, tocether
with the goneral misgovormmnt, roferred to the process of reve-
lution in politely evasive terms:" and this was an explanation
of uhy the poonle decided to...... do what they did". Item of
 

Ryeadan probetarian's tolict on entering houses tne out
pocket~oou snd cor your hair for tuo misutes,

Long talk with ‘thefte), sho cles .« idea of etnera] or mnisntloa
aovered glsewieve, Cne gets the fapression very carly tont
Gevernuent “walth service amd Sedical Gshcols ere per mato
with freventive -edicine to @ ywite unuevel cegree, “hefted
eexe og if publication of a special broahure in ‘sorica of
invomamtion om soviet orenleations wuld be vies, I sald f
thought that artioles in catatlished jourmmsle sould fo 2 better
method, cheftel could then save a incre munber cf reprints,
and there vould be no suspision of psid pronmacemda, it fs a
reat miateke to agate ®erariing Tussis, 58 wo Used to Asez8O
avout Seerany durim: the wer, that the Govornuent was allerise,
sil~seeing, alleaigity, or in feot ell anything, coer emglo,
tie Jovermaoit’s theory and beilef in tuat dostors should do
no private work, and for the ciseravle petty offeniar, there
are Gifficulties exit penalties, but the professcre mid Jest
dostore are known to be prectieing, and indeed wuld be soon~
sulted privately in 21) prohabizity by poeple whose theory it
wag that they should do no private practise,  ‘easenber the
position of the all-powerfy. govarament of the 0,5, on the
prohibition di¢flovlties withis its berdara, “he Solsenhevists
are in e@ sisiler position im sanz weve, «= aystem of fellow
ships is siready in forse for uasinn dcators, tne tate, the
province, ami the loonl institute sontributing, 500 roubles
is the eaxliax si ef theae boureea, About & were civen in
1958, 100 im 2925, 9 ‘They want toe caididates to stiey fn one
plese rather then goest aroond, “he regent syste constlote
in siving ee much coney om tiey oan to a fellow, pushing hin
off usually to Jerveny, ai hoping tant he wii] ome ala song
last ne lone ae popsibie, It seldom enrries more tuen for
three mntna, The cxpensos ore about GO roublos for rn pes
port, 100 roubles ticket to md from cermany, “WO roubles tor

_ food and lodging, and 50 ruables extras, “his is the mziary
- weay, I gather, ere only 30 roulles, “hay want fellovustiips

cosperntely, sii from their enziety L onther would de@ anytulng
to spintain these fellowships in cood etending, “et Sronnor,
wao is the chief of cedica) cduantion wer the Jarkouwsrroa,
Long and interesting talk with Aim, Chjeot of adival
ugeation in Susaie ot the present time is to turn out villece

oy dketeiat doctors, and the curriculum fis entrirated wi th

hygiene and preventive sedicine, Chare are four sicies In
hyiene in tue faculties of louingrad and oscun, aa follows:
venerna, ‘tyckene, coulal Uyiene, Ceoupational ‘yciene, snd
Sehook ityciens, im the supller wmiiversities tusre sre only
guesday wecenbor oth 19 7 = Moscoaven Contd .~

tuo chairs ef Hygiene, general and social. lUadical achools have
found it necazsary to throw out 50 of the students who began
in the yoara 18, 19, and 20, becsusea they had no bsckgrouni oni
could learn so little macicine. ‘boat 00, of the atudents re~
ocive holp from tre State. Another 40° pay nothin: for their
tuition, snd receive no stipenss. About 10: only pay anyth ing
for tuelr Medical Qdusation. it is found th.t graduates of
provincial sohoels ge to the ceuntry more reuadily than those
studying Yoseow. i am impressed by the enommone sine of iuesta.
@arepe is ting and im another world in many wiys. Those pcople
talk ina ossaal way of tha conditions im a indical Scheel oF
§000 miles sway, wiich incidentally they knov, since dronner has
visitec every iedical Scheel in Hussia, which is more than |
Could say of anyone in Italy or france, 1 an beginning to weary
of the face of Lenin, ind ea teig and Bed that. Being a maxber
of the proletariat is by no moans av easy physical existence
since thor: are not omeucth cemferte to vo eround, but they at
least are filled with moral enthuaiess amd setinfaction, and have
the thrill ef Beins at the ceuter of the stage. Nentally, they
rewind mo more of mothodint missionaries than any group that I
had ever mot bafore. In point of fact, in huesia they are a
privileged class in the e:ucation of thely children and in many
othor ways, bat all talk of their living om the fat of the tond
4s unconvincing to mo. this is an extraordinary country, in
that i have newor agen education likely to play a more desisive
part in the gutare of a nation thon hore where, as in 6o may
otLar things, tha Sovist Government starte frou 2 bese line that
ig Saree
BYrONNET —@

289,
16/

ag} .

guseday, Jeceabor 6th (contd.) ~- voscow.-

e-cere chere ig, however, 2 ob difference in point of view
rajaniing scicnces and euucation in suience between the Government
wilch is iniloensed consideracly by industry, and the peosant,
woo ls :ardly at 11 interovted in sciace or ite avplicstions.
Scientitic institutions will ve aided by the Jovernment much
more willingly thin thay would be alded ay the peasants. oscow
soama to suffer fron a surfeit of ideas. Zhey talk always ef
the periphery, which means Kussia outzide of Yoseow. From my
talk with Bronner, 1 can see that they aro most interssted tn
the hope of inorsasins; their toreign fallewstips, and wuld do
nothing ta baperil the success of any arringonent we micht make
with thas. J osn also realise thet a greater separation sxistes
between the proiessions1 politicians and the medical acheel and
pablic sealth authorities than I had previously thouht was the
Gace. “any of the mon in authority in both of these services
aro more realists than the politicians, and indeed several of
those prominent positions are as bitterly resentful as could ba
imysined, altheach thuy do not risk anything by talkiny about it.

hednesday Lec. 7th. Noscowsé

-oved to tho davey Hotel befora breakfast, where there is warm
water, food without cookrosches, end cleanliness. Passpert
returned withoat visa ani loft it again with the Savey sathorities.
Zold by hotel poeple to get o letter frem the Narxomadrav, regasst=
lug parmiasion to leave kussia, and {tméicatin= ¢he date. Thies is
& good point in case of othar people weo wash to vieit Rusela:

&et tha arringomants to leave started 4s soon as you arrive. Same
dalay in arrancing to see people today, so arrangenont for 2 trone-
lator to werk on reprints Srenner had given ma. Tranalater never
turned up, though 1 wmited the traditional two hears. Saw 3remer
in the aiternoon. He saya thit some modioz] institutions are
important here which are not organised howewer ae part of the
Faculties, uit vwiich take students or yom assistants. “L12
arrange Lor mea to see his Institate, shioh is a case of this kint.
sant to the Jallet in the evening. audience quite as nieturescue
as the players, bat noither ss clean nor es beaatiful. 4 good
@¥ampls 9: the thesis that art is an escape from an othorwise
unbearsole axistonce. Ceunted three zvhite collars in the entire
audience. audience was well behaved, punctual, anid extraely
attentive. <ztraordinary faces, and great racial variety, but
depressing in its aniform poverty, and mere particularly in the air
of suppression and anxiety that had almost lapsed into amthy snd
fataliem. Half of the pregramns was devotad to 4 ropresentaticn
AG e 290.

kednesday, Yeo. 7th (ogntd.) — Moscow.

ot the rovwlution. Applause tor the violent scenes wis scant
and scattered. i got the impres:ion that the ettitede of most
peeple was “yes, the revolution has been & fine thing in
theery, but in practice it is not so very say, and in any cas:
we can’$ do amrthing about it". {ty {nterpreter had to cet
permission to be my guest at the Opara from Bronmmer, that is
to say, Doing seon in pablic with 4 stringer aight have mde
things uifilowlt for hia. dann’s goloshes which 1 am wearing,
if they do net sacceed to “épstor” the deurgeois, certainly
agstoums the proletarian.

Thareday, Veco. Sth. ~ Mgasoy o=

Bronmer called and took me to the first Jnivereity, there I mat
th: Keoter Vyahinsky ani three or four professors. “ont te
the amtemical Institate of Frofassor Pletr Karusin. Preamt

 

8 BAY o*
eeninasy
Piotr Karusin~-ballding to be pulled down. Visited the mw building built in

Risolstet £.~

Blamant ha iy
3 ana shico a™

the past two years, and almost finished, which cest ene million
rubles. 6: large rooms. inatemy has beon clipped of much of
its importance to mikes room for hyviene.

thon out to the first University clindos, which were
built by private sabsoription ami ara altogether ina goredek,
or little city. The firet University have ralatively few chunges
in the professorite daria; tho revelation. ‘Yhe secon Univerdlty,
before the war was for wren only. Now, both Universities aceoyt
Komen and the percentages of girls among the medical students varies
batween 50 and 70. Il have the impression that may cirle with us
would be guing into narsing take a medio:1 degree in ussite.

thon to Pharmacelogy of the Pirgt University. Professor
Wicolaisf££, papil of Sahmiedeverg, His salary 250 rablea, or 1%
Golilars a menth. Sslaries ef provessors in clinical branches
80 dollars @ month. Assistunmts, 42, 2nd aspirants, 40 deilares
& menth. Aspirents are + group of younger aseiatants chosen
with 2 view te becomin: teachers or investigators later. Wice=
laieft’s lacnratery gets 66 dollars a month for exponses, bat
only about 5 of this oan be spon§ abroad. This is besanse the
doverment strictly linits the ampunt of rublos te be spent
onteide of Fussin. Wicolateff says there is groat improvane nt
in every wy over conditions three years age, when it vould
hive boon a mistake to visit Eussin and feos on epinion on im
pressions of conditions. Than visited pathological anstomy,
details eleeuhore. Bronner told ay interpreter BSlanenthel that
it soald be oll right for hin to act as guide and interpreter.
Interview with Semsshke. fold him of two Divisions of Rockefeller
Foandation. Said that 0.4.2. was especially interested im thee
rotieal braoches of medicine including hyziene. I said thot
Nart inov.~

279 fessor

Pistnler.~

1é5.

he

Thorsday, vecember Sth (conta -) - OS00R 6

Cheftel bad already given me a generis] ideo of Narkxomsdrav’s work
and thet now I would Like to see sane of tre Institate’s clinics ani.
soce of the Institates outside of the University. I asked him if
there was anything compursole to County Healt! organisation. Fis
rural physicians are not private practitioners, but sre Coanty
lienlth offleers with direction of faldchers ani midwives, He
seered rather vague avout marses ani whet training they have. I
don't believe he understands our torm wery fally. I said that, in
view of the fact thi his time was much taken ani porhapes I wuld
not have the opportunity of 4 seconi interview, that 1 wuld ask

% guestion which world otherwise bo premature, viz. wt possi-
vility of oo-operstion with tho hoekersller Feundation coald he see.
iiie reply was: 1) dissmostic lnstitates In Public Eealth wort; 2)
training of nurses, ami 3) general .id to post-graduate inet ruction.
1 told him what my plans were for the visit, and t'anked him for
the opportanity to mike evon thie briof vielt im Russia. My ime
pYession is that he isa a competent and sincere man who haa realised
that hia effeetiveness ami permanem:: depend on his devoting a
goed deal of time to political mtters, ami setting dow his
immediate technio.l work to & minicum. “ss reminded of the story
of the youn; man who ma§ the devil. Zhe devil turmed oat to be
rabior a Kincly and sympstnetic gentloman, with vhom it was vory
easy to converse. “hon asked hot it happemmaed that he did not

heve a lone red tail, horns, anc a smell of sulpher about Aim, the
kindly old ,entleman replied with a wan avile: "f heve often been
Geacribed, but the pen has alwys beex in the hand of my enomies.

Saw second surgiosl slinis of the iret University,
i‘roxessor axrtinov. First University hes ragular University clinica.
Sevond University utilizes municipal hospitals. Clinic mther well-
run, exeopt in point of view of cleanliness of floers. Student
teaching mach as in imertoa. Interrg aro called ordinators, and
are sinilar to owr house offloors, except that they do not live tn
the hospitsle, and spend a Littles leon or time in this oapaoity.
aftar tw or three years ae ordinutors, a few assistants sre choren
anon, then, and assistants oonnot stoy tor more than ten yesra. Sar
gaall students’ lunch-reom in oms of the big coridors. Cup of tea
sosta 5 kopeka (1.8. one cent and 4 half) with ten Kkopers fer slice

of bread. “tudents at 2b rubles » menth shen they are on Sovern=

nent par-rell, ami for this are oblired to take places ag County
doctora after their studont days sre over. Hediesl clinia of fre-
fessor iletniov.tecellent routines and {nvesticative laboratories,
though young assistant says that the tenmioney im general is “back to
bedside from the lavoratory". sleotro-cardiegraph and Haldane’s
apparatus hawa just been bought. Food inproesion generally.

Briday, Lge . Sth.nm Hascow .~
Wont with my wuide, Ur. Siumenthal, to ceoom University, wich
2926
186.

Friday Leonor Sth (contd.) — <ozcoKwen

was foanded in 1°06 for somen, and visited several laborstories
and Oliniaos. veut 5/4 to 9/10 ef avery class 1 saw was -irls.
These to Institate of exrerimants] biolagy, ubeas chief is

POs oa ayeike GAVMOVSEy, Good worker on gonsties in fishes’ and factors

~— affecting eelor in axolotl. ixcellant little Institute. 76
rubles 9 month is the laboratery cudget. 2 assistants and two
asnirantsa. faeraci.ine in the first three samesters ef the “aedi=
Ga] schoo]. Clase divided inte ton sections, sach having ¢:0
nours 3 wee. Then ta the Thyslolecsy -epartmem, presided over
oy Lina Stern, fercerly of demva. 6 apaeds: enasion, Italian,
Gorman, ‘rench, and cmglish. ‘hon to @ large Inetitrte ef
misroblology, well-equipped, but rather poorly-hoased; details
elsewhere. Thon to medical clinic ov the “econd Univers ity.
Best histerics 1 havo seen in zurone,. Sansery in the same
hoapital under Srefexsor Lewit, who is called here frem irmtek,
8O06 kilometers away. iy guide Sluasnthal pays that qualifica-
tions tor becoming dosent have censiderably chanced. Now it
is not the public defence of tre thesis, but the pablished wrk
and past recerd wiioh counta. There is practiesll: no private
practice in the country, mor wis thare bofore the war, then
his position we considered a grout sacrifice. This has an
eifast on iedicul Schools, wince youny men sre rilling to stay
Om scisntific work at a sacrifice. Hy passport not yot back.
As usual, cromised vor to-morrow.

Baturday December 10th. |.oscgs.-

Sent with Slumonthal to Sronmer's Institate, for combating
vonoreal disease. udet,i150,000 a year, onenhals of hich
goes ta salury oF personnel of sbout 140, nizty~six of uhom
ara staff dosters. it was bagun in December 1921. fhe eut=-
pstient Depsrtuent has about 200,000 visite a year, and beds
in the suilding provide secermodation feF about 25,000 sick days,
per year. The seeisl side ami ecientific experimentation are
mach aaphasisea. This Institute has 159 sub-atationa over
Russia, and 1 49 mobile diagnestic units making vensresl
surveys ever the J.0.5.5. There are acegmmodations in the
building for about 60 veost~graduates who live in fer 4 four
months course which te given twice a year, ani are paid 60
yables a month, tezether with thoir home salariss, which are:
continued for thair families. Laboratorias for scientific
researoh are extonsive ani excellentiy maintained, This is
tae first time that I have evor seen simple explanstory leo
tures bein’ sivon in the wait ing~room of an oat-patient
Department. 4n excellent idea, it seems te me. Phere is a
Geral Department with routine treatment for a1] patiants
2236
167.

Saturdty Deaomber Joti. ( contd. 7 xosoon.=

ahe will undergo morsury treatment. On the orevontive sida
of tea york, there is 2 home mintsined for unemployed soman
in the infective staze of the disoage. ers these somen are
given work ané psid a goed menthly maze, undergoing treitment
at the save time. o50 women sre acocarmodated, and they prefer
entry here rather than centinua on the atrecta,. Troatmonmt is
“ghveu at tiis home, and when discharged, tra vonen are siven
first preference at the omploymont bureaus. 4 ood example
of the sonaidersvle activity in the soolal cide of medicine which
43 cncourazed ami supported by tho presont Sovernment.

Profe Sach cham to Institute of Dio~ohenistry ander Sache. A
model institution, first-rate impression. Sach as sn old
revolutionist enjoys axcaption31 support. Ke talks simply and
without any evidence of fear. lia said that Ineatitations such
as his needed no assistunce, out thet aculpment for olinics
and iostitutes of tee University was most nesossarp and ie
portant, but ths ideal form of aid was followshiss, which should
be for at least one youre Positions coud certainly bo cuaranteed
te the returning fellows. Then to Inetitaute of experiramtal

“rot. Keltsev.-violosy o: Proressor Koltsev. Good ocuipment, excellent library,

ood morale. ain interos.s gemtics and physiasl chenistry,
ne applied to biology. Took dinner with iiadume Keltsev, tre
first assistant Lebotileff, and my guide, who told me sotto yvooe
t?at bere was a plece viisra ore could talk. I sexed a fow queen
tions, aui got ons or tw ixteresting answers. Although “Madane *
ha@ lest her fortarne from the Revolution, she would not cars to x0
back to tearist organization of iussian socisty. Conditions are
very hard, bat they are improving. ‘The most ensourszing thing
is the onormoun release of spiritusx] and morzl anercy 2s anplied
to solontific work. dmlerés aro re.lis no great lose. Thay
don't know wnat sous on in iassla. Nobody will over be ntlo to
Setberte the losses of t:0 i.evolution and t}e famine. ive million
aye supposed te hawe died in the Yolgu slone, and csrmmibaliem
teok place in many parte of hussin. The grest cucation now 133
what are the young peorle “ein: to be lixe? Puey have 56 idea
of how good Live mint be, and in the drab anifomity that exicts
everyenare toduy in point of Ideas and materis] possessionr the
younger ,gople see no contrasts. “111 it be posaldle tke for
tha purty te maintain invefinitely tho comsaniet fervor st the
present pitch? commmiam is more nearly a rolizion, and {is
eAdintsined oy thu matious of Catuchiom and heretic huntin: which
are nob so forviasn to our own history a3 se would like to think.
-cadame Aske 46 @ special favor that If 4. has any rubles te bay
she woulu be dalichtod to secure dollars, since it war so hard to
obtain foreign currency which could bs asad fer purchase ef in
atrancnts, books, or, in rare cases, travel,  inuer- anlivened
Lagaroff

Pro.e 36 3r s*

edt er
iUrinty .”

rn
oD
ne

49s
Satardsy vegemoer 10th (oontd) = “oncov.

by two husky pot tom sats who conducted a runnin: ficht throu
the three reaas in which the ¥'. live.

Surday becember iith .~ Hosogy .~

Visited physics laber:tory of Macaretf, ‘“ell~built, Jarge
institute. Better equipped that anything i have sver seen in
France, although the “Matin” reperts Lazareff Yas reduced tea
misery and hunger with no instruments and with ealaries which
aneant to mething. So process of lying coes om. Jasarefi has
some very interesting werk on an oxperisontal model oi the Gulf
Stream. Other interesting work on mimetics deflexion. Another
departuent wis verkin: on a mochinioal initstion of the human
nerve, ami anethor on viscosity ef glass. Lasareff rather macni>
fied, 1 thought, his close relations vith J. Loeb. Lasareff
sharp but very interesting, ami apparently a considerable prot ecm
tor of scientific men daring the worst period. \hent to Sanday
dinner with Professor Sterm. Sic is mach depmsced by the fact
that hey assistants have positions elsehere .2 assistant, ani
their time is pulwerised into a series of trivial offerts, none
of which are worth while. thinke tient oppertanity te help her
atudert s however is unlimited, and is amased by their eagerness
awl receptivity. fold ma that Pavley wis given large eredits,
indesd practically everything he wanted, because it was balieved
that hie work s:oald obviate the nacessit: for Joo in the minis
of intelligent people, since life could be entirely int orpreted
in tarms of reflexes. Hence the party was anxioug te get on with
the substantiation of this view. Pavlov, it might be sald, draws
exactly the opposite conclusion from his wrk, and hence kis
anzioua te get on with 1t. Dinner with “sltar turanty. Host
interestin: ewening. Durenty very well infomed. D. considers
thay Lenin was really a marvelous person, 1t least his influence
on Husuiang wie almost myical, ami Kis ssnse of real waluss ab=
solately amicae amonz the commnists. Hussin’s interest in China
may be explained by the theory of hoss luxenburg. It was briefly
thet the reason wey tho capitalist ceantriss kat the om of the
war had not bid a classe warfare wie that they possessed colonisl
territory um "colonisl slave laver® on which they could rest

for a moment and «ive to their ovn workin; classes a breathing
space.) Sovwiny being deprived of her colonies would have gone
aixier bad it not been fer the support of her previous enemies

who feared commnism im Jereany oven more tran they hated te help
their anamy. ‘this ie 4 very busy week fer the party. Leonia xnew
that Stalin would mean trouble. Sitastions ohare so rapidly that
noxs ono wonth is completely wrong tvo months later. Britieh
pave t:xLioted great hama on kussia through refusal of credit,
ani now throuch virtaal cessation of trade relations. It is
2956

ic?.

vanday, vecambsar llth 1°°7 (contd) — Yoscet.-

peascible trat wwriean relations with Hussin would have seme
severe Usplications for the aritish pelioy. Yor emuaple, Forouhar
is said to be arranging « forty million dollar credit for Vertical
Steel Trast. Remember stery of Holontai ind the gallant sailor
sentenced by Lenin to five years fidelity.

Lenin was oarsfally embalmed partly becaices of peasante’
belief that great mun do not chan‘e aftor death. “%talinm needs a
+enin tradition. jomamber Juranty's explanation of the need of
morphia, is 4 creliminary to interviews with the “hiness \edspo2re.

Hopay December Lith. ~ soscow.=

Prot, olxove> institute of Secial Hygiens and Frofessor Yoeltew. Ha apporently

 

OIRO

valievas that hygiene is best learnt throwsh papier miohé modele.
Orientution in gomral auticusted and sterile. If sargery we
pragtised on this method, you would present ta the patient with
espyens a papior miché medel of the chest will, amt two charts
of the number of operations carried out on patients for this sane
Gisesse between 1860 and 1910, but there would be no cperstion.

Lhen toe Lapartment of Jenoral Hycfene in the first
iniversity. & good impression.

1 then to first sargio:l clinic of the firct University.

e-lroiesser N.. Burdenke. 3, foels that hivkher e:asstion of the

future is a mittar of jreat concern and that Lellows+i7s ora of
i-hest impertance. Ucientific verk, 1.0. batter type of inves-
tigative work, is st resent poor and interrupted. Younger men
can‘*S sontimue for odono ric yessons in this work! thera is too
meh preeceupstion among the students vith earning pit of

their diving ini with self-Jovermment, alse the clinics] courses
are being robbed by time devoted to hystane.>) Visit to Sansshke's
Institute for industrial diseases. xy guide told mo confident tally
that it 1s mot the best in Joscow, thioh they 444 not care to show
me lest it should groite too favorable an impression. Dinner with
Blamonthal, my quide. Up throuch in appollafgly dirty hall-msy
inte a three-room apartment shared by Blumenthal, his uife and
Sis Drethere His srether is oa lawyer. Thine were mach better in
13.5. Less oppreasion and lase fenr. Jesters sould charge for
private patiovts with less concirm and more likely to be nald.
“vee 3- a physician who, during the facing, hed threo jovs in
searate Clinics ani walked in the anew 40 “Llocethrs Yo aorn a
ver; precarious living. Jke asked mo whut I thoucht of the
accom Vansetti afgair, I said 1 thoucht that an advartace

ov it was that {i showed that Judicisl procedure in ene country
misht not aiwsys remain entirely a family affair, in tha orinion
cnets a1.

ESTE BOW

iiondiy December 1th ( gortd) .— vos-gx om

of the world at large. She replied sith rather a wry malle that
Jsstiee in the U.5 Sail, was not at present open for xorld inanoe-
tion. Bliumthal ssid there were no sbantoned ciildren in Yescor
sinae they had been adleared out entirely for the veeunnial Jubilee.
slssenthal aaid that ha honestly thought ths only thine that could
be Gone with theses children was a mAckine=.um. in spite of tris
sttitede 1 find him levol-headed, vary Kindly ani satisfactory
DGFLeNe

Jmapdey Geo moor 16h “oscor .-

The permission to stzy in “useia has finally come back
fron tho authoritios. daw Cheftel and Groomer at the Marxomsdrav.
i had agaud Sromer whether many of the Professors were relativaly
recently appeinted. He gave we % paper showing ages of 411 pre-
fessors. the average is 63 1/2. This hardly answered the ques
tion as to whether cay of the prefessers dated back te the elder
récine, bat was eseful informtion on anmothsr scere, sinte it is
clear thot many mon within the next ten yosrs will be dreppinc eut
of their positions. Chefta] said that ho wished to explain frem
3 Eussian point of view ideal help, via» diagepatio Inst itutes,
fellewehips, and modicsl literature. 1 started to say thet wo never
vorked rapidly in exteniing into a new field. He intorragted to
say that never for a moment shoulda i suppese that he eas aekiag
ter anything . He was meraly naming wact eas desirable. I said
that perhape medical Literature might be yiven to teaching ivsti-~
tutes, thet bourses were dcubtful ani a guectien te ba decided
later, and that Institutes were out of the question. “9 were
tulking italien, ani when we said good bye [ said “Adio. He
rezonatrated, saying "Sen's any that", so i said “4 Lénine”, but
it did not seem to go very well. ie is goin: te imerioa in January,
aed 4t¢ wald probably be vary aseful for kin to ses something
of the social work thera.

interview at hotel sith I.6.8. followehir candidate
naned Sevetsov. Then went to pictures gallery. Invaluable aid
to ay other impressions here. Paintings in three genvral classes:
landscapes which were beautifully fresh, interme] and vigorous;
extil portraits in whiocr the subjeets were far more Int erest ing
than the artiat'’s treatront ; ani lastly, scons of ental ond
physiesl anguish: prisenore going to Sibsring Prisem eslle, blind
men trying te recegnise their childram by touch; homictda; matri~
cide; parricide, a1) ‘sides:’ of Jartar life axcepting the sunny
On@, ind then, om & mere liveral scale, the ordinary miss scores
of battle, suzder, rayine and sudden death. One woraderful rea
¥

uiice Davis |
voris ob 169 9

ENE E en

Oe?

im.

ae

Susgiay esoumbar Lith (conte. -oscowe™ 1:27.

 

of Yeruse ayuine wit’ costunes more sergsons than any 1 hive ever
sen. of Wa left tie “usoum, wo saw four of the relisious sect
known 38 Gkopteica, Latar nassed sere peasant women rinsta the
family wash thorough a sola in tho foe of the river, with tha wind
blowing a gals. Slamenth31 told them in Eusgstian thot here ewe a
stranger who had nover seen boat before, and they renliod angrily
that Blarenthsi could tell m that things were better in the tive
of the tzar, whan there was a shad built at least to protect them.
So it goss, sontradietion after contradiction. ‘rote uy notes,
then at lunch at o pen. Gne is humsry after these lon wiits.
antil 7.650, And thon went out to the Friomisa ouartars at lb
Beriseglebaky Versolok. 4..). was with HOS in fussis. Is tein
the Surses' course in the Farxomsdraw’s school.for n-rses. “She
thinks toere ils an extraordin ry opportunity for nurse-triinine.
there are no teachers, exospting the dectors, anc the wisest move
would ve to gat & few cectors out of «ussia to sae what can ve
Gone with nurses’ ec ueation. Yhen «a few marses for adyanced
trudning. «auything dono in this model aontax of ths Markomsdravy
Would bo reduplicated inatitutionslly slsost in humireia. In the
uurses' corse thera ia treo hours of what is oslled eenoril litoer=
acy, no other aourse has more than tuo hours © week, except the
Bourse of politiesl literacy, 1.3. @ sort of catochism of Co-mun-
jem, shich takes four hours a week. Zuoh time of the etudents
ig taken by camni-nolitical sm social clubs. There sro s:out
wo thoasand doctors on the unanployment liste, servica in the
country oaing exceodinsly difficult. Tha feldehar ituas et
& isinina@s oF three yoars trainius with considerable thaore, and
they are better in practice than the doctors wis aro poorly=
trsine@. Courses for feldcheritcas ‘ave now chanved hands, and
are in the control of the organization rescongible tor matarnal
ana Ghile walfare. Yoox the night train for Loninerad in the
wlisezard. xcellent train, thoroughly contortavle; on tire.
shat @ Gountzy!] it would not have surorised mo to 360 yolvos
out ov tho car windew, as we vent moerthwards throw h dark, cloak,
tuow-covercd stamps.

‘A LSSGAY, Jacember Lléith.~ Loninrrad

06 &. Gantt at the station. “ent to the iotel surnne, in got

a& room with a dath. Loninvrad imossaursoly more avreastle tran
Vescow in the sleanlinesa and mora choerfal sxprossion on psople’s
faces. ceconsy af stores and tte order And-maintenmoe of avary~
thing on tro etreets. santé rororted ganercl ~-mtal depres ton,
esracially scute tris wi tar. Groast amiety over ]irolihoed

rt Great Sritain vill declors war en hussia. @hia has been
whippod ay into . mitter of almost certainty on the minis of most
peor le. Gantt has studied pablic haalt:. conditions in Russia, and
Ravlov «t

Gantt on

Kenalov

okrobaRaky

ad gon oo

AD eo

jednesday cecember lath (conta. = Loninurad.=

accumisted a lot of mi¢erial. He canmot 2fferd to spans the

tive necessary to bring it together. He is workin: still on

the translation of Pauvlov’s books. is xlmost sure that he vill o¢
throush in the spring, when he vill ge home in america ant try

and find a place te make his living. Pavlov's wrk is ext¢raordi-
marily interesting. 4n item new to me was thet dog with duodenal
fistula ahows s conditioned reflox in biliary secretion after a
few injections of diluted hydrochlorbgdétic acid. This is tupert ant
in that it shows that secretion controlled by the autonomic
norvoas system can fora somlitioned rofloxes tmlependent of cor
aciousnesa. \|Spent evening at vaviov's home. Eo is an axtraordizmry
old man. Vigorous and immediste in all |is resvonses. Uses his
hande most axpreasively in conversation. ‘Seemed delisht fully
iguerant of ceokefeller Foundation. at one of my casations throarh
vantt os my interprotor, Pavlov ulmost bounced eff his chair,
crying cat; “seuld to Sed at loast another mation had a Govarnment
like thie ons, for them someone mi:ht understand our diffloulties.
Young people of the present tics in fusgla are doing nothing

and learning nothins, and all the decent work is cone by persons
witt, pre-war training. Communiam is madness" 7

Thareday Jecomber 2 Sth .- Leningrad .«

¥ith Gantt to Puvlov's laveratory. Splendid new bailding bailt
especially for cenditigned reflexes on animals. Saw an experinont
run through. It wouit have bewildered an antivivisectionist te
see how cheery ami cager the dos was to co throagh his pacers. 3
young assistant, Kupalov, wery interostins and happy. Ris face
beamed with excitement and almest vlory whon wo talked of the pose-
ible applications of the princinies involved in aondtitioned reflexes,
‘Then waut to the Leningrad xedical Institate, where I sot some
general informtion from a group of taschers. ‘Thom to surgical
Slinie. “hey koep « wall~chart of the record year by year of
clean cases thst go septia, and of the denth-rate of the clinic.
in 1923, 40) ef the cleum cases went septic. Now 16%. The death
rete of tha alinic on the basis of admission was 4. . Books for
studente &@ grant problem. 3 copies of 2 text-book in the library
fox 260 students. Then visited tho obstetric clinic (Skrobanaky).
fere all reand the clinic in tew of a delightful pefty little
dictator who was eo excited that ho lecked himself? out of his own
room, aud with trae ebstetric resourcefulness fimilly succasded

in epening the door with an obstetric instrument as a key, Thon
to anatomical muscum. Formerly “‘sinberg’s work, 4 splendid
taaching maseum of Cissections. Bont et its kind I have seen

‘ anyvhere, Two floors ami all the hallewys available. Zhe inssians

find this type ef teaching museum new, and are very enthusiastic
about its walue. Srief visit to Institute of Botany ander Hudson.
hor oteabot ~

wWe Nathalle
Sviashoninot?. 1925 froc. the Hedical institate, ind has boon a cistrict physician

iets 3ece

itechuxetl.~

296

Lee.

thursday Secamber Loth (contd o) Leningrad =

intersating work in mycolesy. Visited Professor of harMeaelocy »
Lishatohef. Small bat wall-e.uipped Institute. Shree assistants,
but avout a halt of the work dena by clinicians woo ira thore as
veoluntesr assistants. «cademic oireors are ereatly ctronmth ened
in Leningrad cy woxk is theoretioal oranches. ingtiture sob 20%
ruglés a month bafere the war, und wre gets 70. Sach student rata
& to & exercises of 4 hours ouch in preatios] phirmacolagy, 20d
this te the cirst place in fivone were the prefensore hove
answered my question in tors of what the pupil gete lmatsad of
what the professors anu taichars <lve. Sumber of students each
yaar Limited to lusoratory facilities. Out of 1600 anplicints,
avout 200 aks ageepted. 160 of them will ve trem the dabfak, 1.26
Secondary Scheol for ti.¢ prolotarint, and the othor half, or 10°
atudents, will be divided in the rollovins order of preference:
2} etdldven of workers in factories, and professors’ sons;
children of Sovermunt employes;
3) shdicren of obhur workers;
4; Ghildren of merchants ind “boorjoai®.

fhe vill te work smgn. the atasenty is an ood as swor
it was, or batter. Took dinaer witr Gantt in tio "roletsricn
nestaarant. Huge, ateaning, perfectly orderlyplace, riers for 6
conte you get . draymn's helping o} oabbage son, pork, notstoss,
and ratbor Ansipia red jelly. lenty of molsa, soos d@al o: uirt,
wt averyens polite aci wallebvonuved. Se suny pliges and customs
rening sv of amoriea,

oa

eriiay cecomber loth Lanne rad =

Pretty strenagus Gold, ade worse by ovanwhe@.ting i.side anc sero
weather qutside. Ke train for tga on ednesday. Llaon't Lixe
leaving so socom, but if 1 had got my vise vor Sussia when it was
prenised, i could have had ty woaks core here. Talked with my
interpretur hare, Dr. Kathalie Sviasianinoff. She craduated in

at Satileve for nearly three years. Gra receives x selary of
vubles 2 month, hor vork sxbence within 6 radius of 2) Kilometers
in all éiveetions. “ha is in charge of a hoopits] with 200 oate
petiente a Gay, with . cistries nopalation of 19000. ‘he las ons
youmger gir] seaistant. In th: vilisnge alous thore ire §,0:6 yaople.
She fe ab present on leawea vith rot inal homerrhage, “che hae never
refused to go om 2 call and Ls oumpiately tired oat. jhe says the
reasen for tho wowillisences of certuin youn: docters to so “to

tho puxiphary", 1.0. into country ploess, is t's cartainty of ovear=
work and a. derpay.

wens to tie ina$itute of sharnacelosy of the Yedical

eademy. Professor 3.4. -nitechketf, Youn: and active. frien of

‘Semde l abarg’s, Jango, onc “aymus’. Somsideradle tnformtion from
dae Orbely £.

toa og
Vy Ae ge os

tat é ae
asah eo

300,

atl o

Exiday Desomber Leth 1957 (cortd) Leningrad »=

him. He was very attractive end direct. Later to laborstory

of pathologioal anatong. cxcelleant show. In te Physlology anter

rrofeasay Lb. Orbely. deed practical nerk. Than te laveorstory of

parasitolegy an@ soolagy umiar Pavlowexi. “as amused to ses

amen the pictures used for cenunetratioa a photograph of a

anoijl bey holdfey « besrd on vist ware x laned 312 She worm he

had veeontly bean acting ap hoct to. & teok this picture .

Ome Sanday morning om the’ Gland ofSenta Catherina (Ceuld GB see iF
‘4%

 

that Srefersor PavlowSeiilnss it ace of Zoolesy and Parasitolesy
of academy, Loniangrad, gots the beck numbers of the If 3,
Salletin’) Then te Clinis ef Oto-laryncelegy of Professor
Velyatehexk. He is tha chtof of the military Medien) ioadeny,
om D2 shrewd civizon, told anitashkoff not te les ne ons ef
hhs Sich® walle Il wis visitine the Vilitary Leademy. Then te
i astitate of Speioxe 2) ater te Inatitute of Spideaa tology
ard Bactarislozy, thadatker bates .a Set end BSR EKG EET
shat 214.¢ went we ths only indepandent theeter in
Leningrad. Hideoze and cull. ood artiste, bat yAthet ia
piepertica., Sarantin song a2o2t Pavds as belonslag to another and
by inferonco, Satter varld. @riangalar lowa affeir present ed
as Optra, Onérette and sovie. Lather elover and amusing. hes
went 80 a movie showin: life in the Cacesmus. weeellend and
very interesting. Larmber fhe Xkeveky Prospekt at aidnicht.
Beggar with nothing bat octtom shirt ativering en the tee. ant
te A misht oleb, Night lew life wct prefersble te niskt hich
Aife, Sase Lustinsts ind meh the aaa Dohavidr. Forse clothes
aul incouperably éirtier floors,

satupdey Desembor Teh Lert xcrad

Br ‘nate skalae Tontreal clinic under lr. “unhneversin. “het mast of the Clinica

need ts Fopaly and agin mere repoire. Than te inatitats of
Patholegigal anatesy ond later exrrrivents! modi cine, and thes
off to State instituse for tie tmrrowarent of AIOtoPas Late
pest-praduate school on the ether atta of Lan ingrad. A remykable
chew, ther: the laboratories are olean, and whom the chief dese |
tor, tharit, kuoxe wat Bis erguniasation is 2oing. dbout tve
thonsiud dectors « year como fro: all over Kugela for post
graduate werk, thick in ran by soparate Institetes. 26: or the
portegradustes come back between their third andl thelr fifth

year after thetr graduation, 26° betroen the ¢th snd the 106h
year, cweé 405 Detwoen the Lith ant the “Oth. GO" ef the post=
Statustes are sen, 40> are rene, a average sge ef death

in busela fer a ph aician is 52 yours, There are abou 28,000
destors in the U.°.0.F.
Slasgunev

Anit sohkg if .~

30l,

 

Went to dinner at Zholatev, a manbor of the party, married to a
former Youtcee artist, & duneer whe was a friend ef Gerton Craigs.
Yary attractive person. Coed doal of explanation fren Xholateov
ef the shepls within, wheels »f the Cocmanist party. Al1 kinds
eof talk anti, 2am, hoiatey said, by the my, that the system
g@uining ground in Awerics of vormars' part omership in infastry
ant. sharing prefite thereof, is the dosp:ir of the Comnniate.
THR Luosistec tat I repeat to him that there was no widespread
tal: in teatarn Agrope of the oersaicty of early way between
Selpain am Mussic.

3 2 ar bem Leningrid

Viett te the winter Palaoe and the Imitage. this a huge musemm
mow orowted with visitors. In 1917, 60,000 people visited it. In
iGaGs Liv,500 puopie came on exeursions, {.¢. csammmiat edasetion,
ami 31,000 ue duiividuals. the treasures of art ero more numerous
and better Gleplaved unfler the present Dovermeam thas defere.
fhia ietucwetion from & worn curator of the fronah cellectten,
who lost most of her posses: ione in the «evolution. Then te

tom Ath Gont$ af tre kovse 94 Gissoanevithe composer. Be and

hia step-daughter played part ef a syaphony on tue grasi planes,
yerteutly magmmifinemily, with tho result that I was oaly two

deura jase $9 Uinnr st initeonior£’s. Cantt ineteted meanwhile
thas i¢ sould make mo ditfercnce shatsoaver., It &1d not apparently.
aniteshkefi iorwerly of nedility, t inferred, bat 1s epem-winded
and unprejudiaed iz compirtson to Comsorvatives in other parts of
tha voryid sho have satferad nothing from tie iovolutlignme. Be saps
the workers, nywadays aro not muck better off, bat feel the pride
sud pleasure o: being 3 privilesed class.

Ronday Ceceaber 10th. Leningrid

Met Professor Keltsev amc his wits (from Hosces), and boagkt 200
rubies ivon thems in a backerour. fhoy hops co collect eneagh te
get to the Jenstiaa Convresg: in iverica. Ne is by mature an
optimist, and so is she. “Vent into the church of Alexander III,
whick wag full ef worshiprers 4¢ 16 c’ slack Nenday morming. Saw
tho etone steps over «hich the Church bas o¢en built, and on whiek
&% is stil) visible the spot of driod vlooé of Alexander III, whe
was mardered by tho revolutioniries of his day. One seuld sappese

JP: Nikgiaie£S tat the Charch woald be closed, Yelrad with Sr. Bikolaieff,

iemengtt.~

representative of the tims, whigi is 2 school of sedicine growing
ont of a psycho~nevrolozicoal Instituia over which Beckterey presided.
in afterncon wont to Niewenoff’s institate for X Ray. mas moe re tnerily
well-ojaipped. inethor om of those model Institutes. Perhaps tér

show parpeses, but nome the less usefal as 0 cemenstraticn and ag
176.

MBs 302.

ota Yad

& Genter fer influence later in the development ef this ouunsi7
Then te Institute of Amatomy of the Nibitery Academy, and a t

with rrefessor Shevkuvenke. 8. was fer 16 yours in life insurance
werk in Mew York, sud is respensible fer sectal inenranse schene

in Russia. Very attractive critical mini, original amd indeperdem.
Piunor vith Geaté aut Jiseassien of many phases of impressions .
hero. in gomty] people have been mnch reliewed te be told that I
“wis nos gelng amy from Saseia with fixes idens and the conviction
thus 2 xuew veut the stéuation was. I8 is a great and finid com
Cees th onsynens eppertunitios. 4 cenmtry extraerdinarlly

tex from the point ef view of Vestern durepe. Certain te undergo
changos as the bedy ef « child undergece changes by cellular weer
and tear and replaceneut. fhe Revolation attracts the best ani

the weret. “a Life has to be lived, ani these theories which

will werk wii} work, aot these shich are false will have to be
aiséarded. is is @ country easy to lie avcut, bat the treable

is that most oi the dies arise frem projadice ani fear. The cost
ef Revolution an the changes ussis has been throagh ave quite
outulee cur imeginuation.

fuenday December 2Cth ~ bauligrad .—
lett honingrad for biga, went to bed, an¢ elept all day ami all
Bight.

Legnesday vecemoor ist
aiga te 5erling do.

Shursduy Oggomoor ¢ and 5~
durlin 60 Paria, and ati12] undsr ths oall of that country.

“nrdetene and the week following with the family in Gyoissgy.