We publish below an article relating to the evolution of the health situation in Soviet Russia in July 1919, one year after the establishment of the Public Hygiene Commissariat. It was in a very unfavourable context that this health policy was then implemented since, after the seizure of power by the proletariat in October 1917, Russia had suffered the counter-revolutionary activities on its territory supported by the Entente governments. Thus, at the beginning of 1919, Russia was completely isolated from the rest of the world and confronted with the activities of both the white armies and the troops of the "western democracies". Despite all this, in the most difficult material conditions that it is possible to imagine, the method implemented by the proletariat - our method, in every way opposed to that of the bourgeoisie today confronted with the coronavirus pandemic - achieved results which, at the time, were a considerable step forward. If it seems appropriate to us to underline how the two methods are opposed, - that of the proletariat and of the bourgeoisie - it is not only to highlight the incapacity of the bourgeoisie to bring humanity out of the barbarism into which it plunges the world. It is also to defend the honour and the achievements of the revolutionary working class when it set out to conquer the world during the first world revolutionary wave, when since its defeat, the lies of the Stalinist and democratic bourgeoisie have never ceased, each in their own way, to soil and distort its objectives.
Certainly, there are concepts and formulations appearing in the article which we don’t share today: for example, the idea of nationalisation as a step towards socialism or even the claim that capitalist exploitation had already been abolished in Russia, as well as some of the “medical” language (“abnormal” or “retarded” children etc). The measures taken by the Soviet power in this period were essentially of an emergency character and they could not on their own escape the pressures of a still dominant capitalist world system. But despite this the determination of the new Soviet power to centralise, repair and rapidly improve health services, to take them out of the hands of the exploiters and make them freely available to the entire population, flowed from a fundamentally proletarian method which remains valid today and for the future.
I. General working conditions of the Public Hygiene Commissariat
The Public Hygiene Commissariat, created by the decree of the Council of People's Commissars on 21 July 1918, drew up a balance sheet of its annual work in July 1919.
The unfavourable external conditions in which the work of the People's Commissariats is accomplished has had visible repercussions on the most sensitive apparatus intended to protect what is dearest to man: his life and his health. The heavy legacy bequeathed to us by the capitalist regime and the imperialist war, while hampering the work of soviet creation, has weighed very heavily on the medical and health organisation. The difficulties encountered in supply, economic disorganisation, the blockade of Soviet Russia by the imperialists, the civil war - all these have painfully thwarted measures taken to prevent and cure diseases. It is difficult to implement preventive health measures when insufficient food weakens the human organism and predisposes it to diseases, when the population lacks the things most essential to the accomplishment of the elementary proscriptions of hygiene; or to organise a rational medical treatment, when, thanks to the blockade maintained by the "allies", we are deprived of the most essential drugs, and the difficulties in the food supply do not allow us to organise dietetic treatment.
And nevertheless, the state of health of Soviet Russia is at this moment just as good and even much better than that of those bordering territories under the yoke of White Guard "supreme governors", countries abundantly supplied and largely provided with products of all kinds, in drugs and medical personnel. This summer, Soviet Russia had almost no cases of cholera; while in Denikin's satrapy, cholera, comparable to a large torrent, wreaked havoc. Soviet Russia this summer almost completely came to an end of the typhus epidemic. In Siberia, in the Urals, in the territories we liberated from Kolchak, the typhus is raging; almost all prisoners of Kolchak's army are infected with epidemic diseases. We easily endured the Spanish flu epidemic, much more easily even than Western Europe; the cholera epidemic of the past year was relatively short, and only the typhus epidemic last winter assumed a fairly serious character. The reasons why we have fought with some success - in spite of difficult conditions, against epidemics and diseases, those inevitable by-products of imperialist slaughter - consist in the new methods applied by the Soviet power.
Epidemics, at all times and in all places, wreak their devastation above all among the poor, among the labouring classes. The Soviet power is the power of the workers. By defending the interests of the underprivileged class, it at the same time protects the health of the people. The abolition of capitalist exploitation made it possible to establish regulations for occupational health protection: it made it possible to use the most effective measures for the protection of motherhood and childhood; the abolition of movable and landed property made it possible to fairly resolve the question of housing: the monopoly of bread resulted in allowing the distribution of the reserves available first of all to the working classes; the nationalisation of pharmacies made it possible to distribute fairly and economically the meagre reserves of drugs, snatching them from the hands of speculators, etc ... It can be said that no other provider in the present difficult circumstances could have overcome the immeasurable and apparently invincible obstacles which existed in the field of public health protection. However, there is one more circumstance which facilitated our work in these conditions: it is the concentration of all the medical services in the hands of a single duly authorised body: the Public Hygiene Commissariat. A single body had been created which led the struggle according to a unified plan with the greatest economy of force and means. This organ replaced the disorderly and fragmented work of the various institutions, the ill-combined actions of the various organs which dealt with the health of the people. Science and medical practice have long demonstrated the need for such centralisation of work in a single competent body. This subject was especially hotly debated before the war in Russian and international specialist works. Thus, the French doctor Mirman wrote in 1913 in Hygiene:
“Very often it happens that a prefect is interested in public health and wants to help. Wishing to gain the support of the government, he had to visit all the ministries in Paris and meet with all the heads of service of a dozen administrations. It takes great perseverance not to give up the journey, not to throw the handle after the axe, so much does one end up being made desperate by all these formalities. This mainly concerns the fight against social diseases, tuberculosis and alcoholism, for example. Let us see in which ministerial department the fight against tuberculosis can be prepared, started and organised. It currently depends on: the Ministry of Labour (low-cost housing, mutual insurance, hygiene of workshops and shops), the Ministry of Agriculture (food hygiene and milk analysis), the Ministry of the Interior (sanitary requirements for municipalities and disinfection), the Ministry of Public Education (medical inspection of schools). When the government is questioned on the measures it intends to undertake for the defence of the race against its most bitter enemy, four ministers will have to take part in the debates (not counting the army, the navy and the colonies); in short, as a result of the distribution of public health services between different ministries and administrations, there is no one among the members of the government who is directly responsible for hygiene and public health. The organisation of a Ministry of Public Health will bring order to this chaos and create a system instead of the current arbitrariness.”
This centralisation of medical work was carried out in Russia by the decree of the Soviet government of 21 July 1918. This created "the Commissariat of Public Hygiene" endowed with all the rights of an independent ministry and comprising the following sections: Sanitary-Epidemiological Section, Medical Treatment Section, Pharmaceutical Section, Medical and General Supplies Section, Social Disease Control Section (Venereal Diseases, Prostitution and Tuberculosis), Child Protection Section (school health inspection, special care for abnormal children, organisation of physical culture, etc ...), Section of military health services and communication routes, etc ...
The practical administration of all medical and health work is in the hands of the workers’ organisations of the Soviets of Workers' Deputies and Red Army Deputies. All the fundamental health measures are carried out with the energetic assistance of the workers' organisations (let us recall, for example, the work known to the Commissariat, work which has rendered the most invaluable services in the liquidation of cholera and typhus).
These are the fundamental causes, creating new conditions in health and medicine work and which, despite the particularly difficult external conditions, facilitate the work. In the next chapter, we will give a brief overview of the work of the Commissariat. Here, we will compare, as a concrete example, the medical and health organisation of the city of Moscow before the October revolution with this same organisation in its current state, after two years of existence of the Soviet power.
Number of hospital beds (exclusively for civil population). Before the October revolution: Around 8,000. Current: Around 22,000
Medical beds before: around 100,000. Current: around 150,000;
Ambulances before: around 15,000. Current: around 46,000;
Sanitary doctors before: around 20,000. Current around 34,000;
Assistants to these doctors before: none. Current 50,000;
Food inspector doctors before: around 10,000. Current 29,000;
School sanitary doctors before: around 31,000. Current 37,000. Etc.
To this must be added the new medical and health organisations created by the Soviet power for the use of the poorest population; free home assistance (this question was on the agenda for 10 years and before October 1917 it was still under discussion). Currently, 80 doctors and nearly 160 nurses are engaged in this assistance and are distributed across the various districts of the city; it is also necessary to cite first aid stations for urgent cases, and for this purpose permanent medical services and medical vehicles have been established. Let us also mention the recent struggle against tuberculosis and syphilis, as social diseases; an important action, intended to popularise health knowledge; free and widely organised assistance for dental treatment (10 ambulances with 25 chairs); making psychiatric assistance available to the population (treatment by means of rays); the management of nationalised pharmacies, as well as the good distribution of their products, etc ...
And this enumeration of examples does not yet exhaust all that was newly created by the Soviet power in Moscow in the field of public health during its two-year existence. What has just been mentioned relates to the quantity. As for the quality, it has been equalised by the fact that the use which divided medicine into two classes has been eliminated: that known as “first order” for the rich and “third order” for the poor. The best specialists in Moscow now receive patients in city hospitals; and it can be said that there is not a great specialist - doctor or professor - who any inhabitant of the Soviet capital cannot turn to for free advice.
This medical aid is organised on a similar basis, but naturally on a different scale, in all the other towns. This is how the Soviet power was able to organise medico-sanitary work during the past two years, in the midst of essentially unfavourable conditions.
II. A year of work
The development of the work of the Public Hygiene Commissariat, its organising work and the fight against the epidemics which followed one after the other, were simultaneous. Last summer, a wave of the Spanish flu swept through Russia. Commissions were sent to various places to study this still little-known disease, as well as to combat it effectively; a whole series of scientific conferences were organised and surveys were carried out on the spot. As a result of these studies, it was possible to establish the relationship of the Spanish flu to influenza (flu); special works were published dealing with this disease in a scientific and popular form.
The Spanish flu epidemic passed very quickly and relatively well. Much longer and much more difficult was the fight against the typhus epidemic which spread widely, especially during the winter of 1918-1919. Suffice it to say that before the summer of 1919 nearly a million and a half people were affected by this disease. This epidemic having been foreseen, the Public Hygiene Commissariat was not caught unawares. As early as the autumn of 1918, a series of consultations with representatives of local sections and with specialist bacteriologists took place; the plan of the struggle was sketched out, which made it possible to send precise instructions to the provinces. A decree on measures to be taken in the fight against typhus was submitted for ratification by the Council of People's Commissars. Scientific meetings were organised at the same time as experiments were attempted with the application of a serum to prevent and treat typhus. Numerous scientific pamphlets, popular books, and typhus literature were published. The cholera epidemic which had spread noticeably in the summer and autumn of 1918 and which was expected in 1919 did not spread widely that year, in spite of the direct danger of contamination which came to us from the troops of Denikin where cholera was raging. As a preventive measure drinking water was purified (chlorination), at the same time as cholera vaccinations were carried out on a larger scale. Finally, a decree on compulsory vaccination was promulgated and confirmed by the Council of People's Commissars on 10 April 1919, thus filling a major gap in our health legislation. The purpose of this decree was to prevent an epidemic of smallpox which threatened to develop in 1918-1919; to implement this decree, instructions were drawn up for local institutions, regulations on maintenance, stables for the rearing of young calves intended for the preparation of the vaccine. Nearly 5.5 millions were assigned to carry out this decree and nearly 5 million vaccines were distributed against smallpox.
It was materially impossible in our republic, isolated from Europe, to obtain medical vaccines and serums. The Commissariat of Public Hygiene promptly nationalised all the important bacteriological institutes, as well as the stables where the calves intended for the preparation of the vaccine were raised; special stables were created (especially in the Saratov region): they were provided with everything necessary, their work was extended; the supply of these institutions with the necessary material was centralised and organised so that, during epidemics, the country did not lack either serum or vaccine.
It should above all be emphasised that the whole practical fight against epidemics was carried out on new principles, namely, on the principles of the direct participation of the whole population and above all, of the working masses and peasants. Even the correspondents of the bourgeois newspapers staying in Russia had to admit that the Soviet power was fighting against epidemics in a completely new way, by mobilising the whole population for it. Irreplaceable and inestimable services were rendered during the fight against epidemics by the commissions, known as "Workers' Commissions", made up of representatives of unions, factory and factory committees and other proletarian and peasant organisations. The Workers' Commissions, assigned to the sections of the Public Hygiene Commissariat, actively watched over the maintenance of cleanliness, took energetic measures for the organisation of steam baths and laundry rooms for the use of the population, facilitated the possibility of get boiling water during the cholera epidemic, and worked on health propaganda.
The Commissariat of Public Hygiene, in order to lend financial support to its collaborators on the spot, assigned 292 million roubles to the local Executive Committees for the fight against epidemics from 1 October 1918 to 1 October 1919.
In order to prevent the development of diseases and epidemics, the Commissariat took care of the sanitary monitoring of water, air and soil; it devised and applied measures accordingly, dealt with questions of food hygiene, etc. The care concerning the accommodation intended for the working population was of particular importance here. The Commissariat of Public Hygiene had the Council of People's Commissars ratify the decree on the sanitary inspection of dwellings, prepared inspections and regulations relating to housing, and organised courses for the preparation of housing inspectors.
All the anti-epidemic and sanitary work was carried out in parallel with the most energetic sanitary propaganda within the popular masses; pamphlets were published in Moscow and in the provinces; museums of social hygiene and exhibitions on health conservation were organised. A scientific institute of public hygiene is being prepared and will be opened very soon. Scientific questions of hygiene and the fight against contagious diseases will be studied in this institute.
In the field of medical treatment, the Commissariat took care last year to centralise all the medical institutions, separated up until then in the various ministries and departments. In spite of all the unfavourable conditions for the development of this kind of treatment, it was organised according to a uniform system, and in several places not only did not suffer from this, but on the contrary, improved and expanded; much was done, in particular, to obtain free and accessible medical treatment.
The fight against venereal diseases and tuberculosis was the object of particular attention by the Public Hygiene Commissariat: it created special bodies in the provinces, provided ambulances or hospitals for the sick, intensified the production of special preparations for the treatment of syphilis (more than 60 kilograms of 606 were used), increased the number of sanatoria in the centre as well as in the provinces to fight tuberculosis, organised ambulances and dispensaries in several places and paid special attention to infantile tuberculosis. But the main point was the undertaking on a large scale of the work of health propaganda, which made it possible to establish a living link with the workers' organisations, which is of very great importance in the fight against social diseases. Denikin cut us off from the main spa towns in the South; all the other spa towns, Lipez, Staraïa-Roussa, Elton, Sergievsk, etc., were widely used by workers. Where previously the bourgeoisie treated themselves for obesity and the consequences of debauchery, where they burned their candles at both ends - the workers and peasants of Soviet Russia now find refuge and relief.
We know that Russia received all its medicines from abroad (especially from Germany). We had almost no pharmaceutical industry. It is easy to understand the catastrophic situation Soviet Russia was put in by the imperialist blockade. The Commissariat of Public Hygiene promptly nationalised the pharmaceutical industry and trade and, thanks to this measure, saved the pharmaceutical supplies from plunder and speculation. In collaboration with the Superior Council of the National Economy, new factories were quickly organised, where the production of drugs was intensified. The remedies were requisitioned by tens and hundreds of kilograms from speculators. Over a period of 10 months (September 1918-June 1919) the central depot of the Commissariat of Public Hygiene sent to the provinces, just for the civilian population, 24.5 million medicines, 9 million dressings, 1.5 million surgical instruments, almost 1 million of all kinds of equipment for the treatment of patients, 1.5 million vaccines and serums, 300,000 roubles of Rœntgen devices, etc. And each month the delivery of supplies increases.
The military medical service in this war, unlike the others, was organised on a new basis. The State power having adopted as a principle the creation of a medical service organised on a uniform plan, logically included the military health service in the general organisation of the Commissariat of Public Hygiene, by withdrawing military health services from the immediate and exclusive jurisdiction of the organs of the military administration, as it had been until then. By such an organisation, a uniform direction of all the medico-sanitary work of the Republic is ensured by the Commissariat of Public Hygiene. A united health front is being created in the country, which is essential above all for the systematic accomplishment of anti-epidemic measures.
Such a structure made it possible to save the army from the ravages of epidemic diseases that reigned in the country (famine typhus, abdominal typhus, recurrent typhus, smallpox, dysentery, cholera and other diseases), despite the extremely difficult general conditions of the transitional period we are going through. There were in the army 20 to 30 cases of cholera; cases of famine typhus reached, before the autumn, a maximum of 4 to 5% in the entire army; cases of dysentery 0.01%; recurrent typhus nearly 0.5%. The military health service was in a position to prepare a large number of sick beds, well provided materially, the proportion of which in relation to the strength of the Red Army is 1 to 7. All evacuation points with more than 2,000 sick beds have hospitals or sections for different kinds of special assistance. The principle of using doctors according to their specialty is being realised day by day.
All evacuation points are equipped with chemico-bacteriological laboratories. Almost all have a cabinet for Rœntgen radiation treatment.
General sanitary and hygienic measures are applied on a regular basis.
The vaccination campaign against cholera and typhus equalled, in percentage terms, the results of the 1914-1917 campaign.
For the treatment of soldiers with venereal diseases, there are 11 special hospitals with 4,630 places; further, in 49 hospitals, sections for these patients are installed; ambulatory treatment was created for venereal patients and the First Ambulatory model of the Military Department for the treatment of skin and venereal diseases was opened. In order to fight against the spread of venereal diseases, an active campaign is being carried out, by means of light projections, to make known the nature and the dangers of these diseases.
For the first time, dental assistance is widely organised in the army. In the military districts 68 ambulances for dental treatment were opened and 62 on the front. In addition, special workshops were created for the preparation of dentures. The centralisation of all the medico-sanitary work in a single special and autonomous commissariat made it possible to rationally organise medical treatment and sanitary work during the year without causing any damage to the interests of the civilian population. This principle was so widely realised that, even during the mobilisation of medical personnel, the interests of the civilian population were carefully protected, and essential medical workers were exempted from military service. Nearly 25% of the doctors were thus released in cases where they were recognised as essential.
The number of doctors mobilised and sent to the front provides one doctor for 300 or 400 soldiers of the Red Army.
The work of health propaganda is the object of particular attention. In all the organs of military health administration, sections or persons responsible for the health education of the corps of troops have been introduced. A large quantity of health propaganda literature is distributed, courses, popular conferences are organised, as well as mobile and permanent health and hygiene exhibitions. The preparation of junior and secondary medical personnel, primarily Sisters of Charity and Red Nurses, is being carried out on a large scale.
Nowhere is the preservation of children's health more prominent than in Soviet Russia. Not only doctors but the entire population are invited to join this work. A Council for the Conservation of Children's Health was created in November 1917. It was made up of doctors from the Public Hygiene Commissariat and representatives of proletarian organisations (trade unions, factory committees), the Communist Youth Union and representatives of the working masses.
The interest in preserving the health of children was greatly strengthened among doctors and educators thanks to the two All-Russian Congresses of School Sanitary Hygiene (in March and August). Everywhere - not only in the centre, but also in the provincial towns - sub-sections for the conservation of children’s health were opened, sub-sections attached to the public health sections of governments and to most district sections.
The work of preserving children’s health is divided into three main branches: 1. sanitary inspection in all children's institutions, schools, day-care centres, nursery schools, nurseries, etc.; 2. physical culture; 3. classification of children according to the state of their health and their distribution among medico-educational institutions (forestry schools and auxiliary schools, colonies for morally defective children, etc.).
In order that all the tasks concerning the preservation of children’s health, tasks which the Soviet Republic has set itself, are accomplished according to a definite plan, twelve model medico-educational institutions were organised in the center, close to the Section, to inform the provinces of scientific and practical developments of issues and measures in the conservation of children’s health. In October 1918, a physical education institute with experimental schools (urban and suburban) was opened for physically and morally healthy children. This institute is a laboratory for children's work and physical exercises (sports and gymnastics) and at the same time an instructor of socialist workers' education for the younger generations. All experiments on schoolchildren are carried out at this institute where work processes are practically developed in the unique school of work of Soviet Russia. Courses for physical education instructors are also given there.
Children's (school) ambulances are bodies for investigating children as well as treatment bodies. These ambulances classify children whose condition requires treatment or relief from the education programme: a) sick children are placed in hospitals and sanatorium schools; b) weak and tuberculous children are directed to open-air schools (forestry schools, steppe schools); c) another part is sent to auxiliary schools and to medico-educational colonies. Where there are sufficient resources, dental treatment is given in special children's ambulances. In a special ambulance, children with tuberculosis are examined by a group of doctors (tuberculosis control group). Dispensaries: we study the family life of the proletarian child at the same time as we give them the care they need; food (refectory clubs are installed for this purpose), clothes, shoes, medicines, cod liver oil, etc.
The Section for the Conservation of Childhood Health takes as an unchanging principle of its action that no child who has fallen ill should remain without receiving an educational direction in a corresponding medico-educational institution. All the institutions intended to fight against defects, physical (deafness, blindness), intellectual and moral, are united around a general centre - the Institute for weak and retarded children. This institute has an experimental observation section and five other institutions, namely: an auxiliary school for minor intellectual defects, a school-hospital for profound intellectual defects, a school-sanatorium for psychiatrically ill and neurotic children, a medical and educational colony, and a deaf-mute institute. In these institutions, doctors and specialist teachers educate future teachers about the education of abnormal children.
For the first time in the whole world, and only in Soviet Russia, it was decreed from the beginning of 1918 that children under the age of 18 who had broken the law could not be recognised as criminals, although they may be socially dangerous or even harmful to society. These children are the tragic victims of the abnormal conditions of the past, of bourgeois society, and simply need re-education. The offenses of these juvenile delinquents cannot be judged by ordinary judges and must be submitted - exclusively - to the Commission for juvenile delinquents, with the obligatory participation of a psychiatrist and a teacher, having the same rights as justice representatives. Such Commissions with a staff of home educator-inspectors are now being created everywhere, both in government towns and in district towns. Distribution and evacuation points are placed near these Commissions. Child delinquents are, from these points, returned to their parents or sent to medical and educational colonies. In general, like all other medico-educational institutions, establishments for debilitated and retarded children are opened in government towns and in district towns.
Currently there are in many government cities: infant ambulances (schools), auxiliary schools and colonies for morally defective children. Forest schools and sanatorium schools are found more rarely. The infant (school) ambulance is the most common type of medico-educational institution in district towns.
How can we achieve the preservation of children's health in the food crisis that Russia is going through at the moment? The Child Health Conservation Section attached to the Public Hygiene Commissariat paid the most serious attention to the solution of this question from the outset. At the beginning of 1918, the first convoy of children from Petrograd was sent by this section to the colonies. The Section started from the principle that in urban conditions it was necessary above all to ensure food for the child and then to place them in hygienic conditions. Three Commissariats were called on to collaborate in this great task by the Soviet power. They are: the Commissariat of Public Instruction, the Commissariat of Supply and the Commissariat of Public Hygiene (organisation of dietary canteens for sick children and those recovering from serious illnesses). The Council of People's Commissars instituted free food for infants by its decree of 17 May 1919. Free food for children under 10 is in force in the two capitals and in the industrial districts of non-producer governments. This decree gave birth to the socialist distribution of products among children. But without waiting for this decree, the Section for the Conservation of Child Health had received 50,000,000 roubles in 1919 for free feeding of children.
In November 1918 the Section obtained for this purpose the levying of a special tax.
If we take a look back at what had been done before the revolution in Russia for the conservation of children’s health, we can say that it all boiled down to nothing or almost nothing. The state budget did not even have a special paragraph. After the revolution, the young socialist country set about organising this new action with energy. Over the course of two years, in the centre as well as in the provinces, the need for the most careful preservation of children's health was recognised. This result was achieved despite the difficult conditions created by economic disorganisation. Children’s health should be the work of the workers themselves - this is the principle of Soviet Russia, and it is no less dear to the workers than to the peasants. The Workers’ and Peasants State’ takes the preservation of the health of children to the highest degree, realising fully that the young communists are the pledge of the future Socialist Russia - and that only a generation healthy in body and mind can preserve the conquests of the Great Socialist Revolution of Russia and bring the country to a complete realisation of the communist regime.