Red Medicine: Socialized Health in Soviet Russia

Moscow and Leningrad

BEFORE sketching the background and setting of the present regime in Russia we propose to give an outline of our tour of nearly nine thousand miles through several republics and in many different climes, so that the reader may realize with us the characteristics of the people and the facilities for preserving or restoring their health as observed by us. Meetings with medical leaders will be referred to, as also the health institutions we visited, but the statements of these leaders as to medical procedure and our own specific observations in these institutions will be presented in subsequent chaers under their appropriate headings. Occasionally, in these narrative chaers, we shall discuss certain things not treated elsewhere.

Our journey together began on August 2, 1932, in Southamon Water on board the S.S. Bremen, en route from New York to Bremerhaven. We had already prepared ourselves by much reading about Russia and by conferences with others who had recently visited that country. Summaries of information, as well as the questions we intended to ask, had been set down on paper. On board the Bremen was an American newspaper correspondent(1), long experienced in Moscow, with whom one of us had frequently conferred on the way from New York. Both of us now shared the discussion of Russia as viewed by this experienced interpreter of daily events in the Soviet Union.

At Berlin we stopped at the Hotel Adlon. After dinner we talked with a wellknown American publicist who had just arrived by airplane from Moscow. His attitude on the possibilities of eventual approximation between the policies of capitalism and communism is hopeful for the future, and appears to form a not improbable forecast. He forecasted a protracted struggle between the two, in the course of which both sides will modify their positions. Capitalists, he held, will gradually part with a large share of their present profits in industrial enterprise, the workers will take an increasing share in determining the conditions of industry, and will realize that what the present employer and capitalist contributes in enterprise and initiative must be maintained and extended.

In view of reports that there was no unemployment in Russia we noted the effects of industrial depression as seen when we walked along the Berlin streets during our twoday stay. We were repeatedly asked for alms by men who appeared capable and of the type ordinarily desirous of work. Berlin is heavily taxed. At a restaurant we paid a tax on our whole bill and in addition a ten per cent tax on the coffee we had.

On the evening of our second day in Berlin we entrained for Moscow, to be ejected from the train at midnight by a Polish official, who found that the Englishman's passport had not been visaed for travel in Poland. Intourist, Ltd., the Soviet travel bureau in London, had overlooked the absence of this visa. In spite of explanation and argument on our part the official did not help us. So we perforce sat for four hours through the night in the waiting room of a small station, until there was a train back to Berlin. That the Polish official was technically justified in refusing to pass the traveler without a visa is beyond dispute, but the absurdity of the position is illustrated by the fact that in Berlin our hotel porter obtained the Polish visa without the presence of the traveler at the consulate. Later in the summer when one of us reached the Hungarian border without a visa he was able to get one on the spot and proceeded without loss of time. Our unlucky delay on the way to Moscow, we thought, illustrated the strained relations between Poland and Russia, of which we saw other evidence. It is difficult for Western Europeans to appreciate at its full significance the mental strain and the fear of war which characterize Russia, Poland, and also Czechoslovakia and Yugoslavia.

After the return to Berlin and the loss of twentyfour hours we finally got through Poland and reached Negoreloye, a Russian frontier station. Here we noticed a rather large school abutting on the railway. The children were playing a sort of football, and singing seemed to be general. Later in various parts of Russia we noted that men and women often sing together at their work. In the parks communal singing is heard everywhere.

The customs examination was interesting. No objection was made to any articles brought in, but field glasses and camera had to be declared, and we filled out forms stating the exact amount of money in our possession. Then in marched two or three porters with a chief. They gave us checks for our baggage, and after we had paid them a fee that was not too large they carried it to the train. There were no tips.

The walls of the Custom House were covered with murals illustrating the Five Year Plan and the new Russian industries, and with the following exhortation in four languages: "Workers of the world, unite!"

This is not a new slogan. Eugene V. Debs used to preach it in America. It comes from the Communist Manifesto of Karl Marx, the whole passage reading:

Let the ruling classes tremble at a communist revolution. The proletarians have nothing to lose but their chains. They have a world to gain. Working men of all countries, unite!

On the train we met Dr. and Mrs. Moissey Gourevitch. He was formerly Commissar of Health for the Ukraine, one of the leaders in establishing the Five Year Plan in Public Health. He gave us letters of introduction and valuable advice regarding our survey.

At the Moscow station we were met by the local director of The Open Road, an American organization which promotes cultural contacts between American travelers and residents in Europe, and also by the interpreter provided by Intourist.

It is convenient to state at this point something about our travel arrangements. These were made by the Intourist offices in New York, London, and Moscow. As we traveled in the "first category" we fared relatively well. An interpreter was at our disposal throughout our trip. In Moscow and Leningrad we had three interpreters at various times; afterwards one while traveling south; and from Rostovon-Don onwards, we were fortunate in having a lady interpreter who was partly English in origin. In the light of our experience we can conclude that our difficulties would have been much less had we secured one good interpreter for the whole trip. Three out of the five interpreters assigned to us were women of education; and we found them more useful than the men, although one of the latter was a teacher of English in a university! A motorcar was at our disposal everywhere, and berths were reserved for us in trains, usually without mishap.

Impressions of Moscow

In Moscow we were immediately impressed by the moving crowds, which filled the streets and tramcars. The heavy traffic was evidently due both to the hustle of going to and from work and to the rapid turnovers in labor, about which the newspaper correspondents have written. Men, women, and children with their belongings, coming in to the city or going somewhere else; laborers, clerks, intellectual workers, most of them wearing the familiar blouse, but many in nondescri clothing; some men in khaki "shorts," some young women in plain flimsy summer garments supported by shoulder straps; many little boys and girls running about almost naked; a few gay colors here and there, but mostly the drab hue of inferior clothing; the bright eager eyes of idealists, of hopeful workers; the vigorous strides of youthful strength; the tired, bewildered looks of a few old folks; the mischievous laughing faces of children; the curious, yet wellbehaved, attitude toward us foreignersthese were the aspects of the people which we first observed.

Order and good nature were in evidence. On the tramcars, for instance, a reserved section is provided for women with babies, expectant mothers, and old and feeble folk, who can enter at the front end of the car, while other passengers must enter at the rear.

There is a serious housing problem in Moscow. Its population of about three and a half millions has increased about 50 per cent since before the war. Sidney Webb remarks, however, that "measured by floor space per head, the working population of Moscow was even worse housed in 1914."(In Current History, December, 1932.) Although many new apartment houses, ten or twelve stories high, have been built, living accommodation is still so scarce that quarters are rationed to each family according to numbers. Doctors and other professional workers are assigned slightly more space than manual or clerical workers. The rental collected is in proportion to the family income and not to the accommodation provided. It is partly because of these crowded rooms, as we shall see later, that night sanatoria have been established in the cities for convalescent workers and those having "latent" tuberculosis or under suspicion of being tuberculous. Besides the new apartment houses, we saw new business buildings, clubs for workers, and factory buildings. The bustle and stir of all this construction recalled the great boom towns in western America in the latter days of the nineteenth century.

The evident shortage of food was freely discussed by those whom we met on our travels. However, we traveled nearly nine thousand miles in August and September and did not suffer seriously from unsuitable food. Watermelons were abundant, and the muskmelon was delicious. The chief lack was of good meat and milk. Quite often no milk was forthcoming with coffee. Evidently the country has not yet recovered from the wholesale destruction of cattle by the kulaks(2) when they were forced into the collective farms. Dried milk was unknown; and if it had been known, would probably not have been available, as an essential point in Russian policy during these early years of difficulty is to restrict importations of goods from abroad, which have to be paid for in foreign currency. Coffee evidently is not favored officially, for it has to be imported; but good tea is available everywhere and is the national beverage. It is cultivated in the Caucasus, where we watched its gathering and preparation for sale on a wellorganized State farm. In Moscow, as elsewhere, we saw men and women waiting in long lines for their turn to get their rations at butchers' shops and other stations where food was distributed. At large communal kitchens we saw dinners served to all comers, irrespective of means, at a cost of 60 kopecks.(3) Similar dinners are provided at the factories.

Not long after our arrival we surveyed Moscow from Sparrow Hill (now Lenin Hill), the historic spot from which Napoleon watched the burning city. From that height we could see the Moscow River winding through the city. Later on we saw where the old factories along the river had been torn down by the Soviet to give space for the great Park of Culture and Rest.

How this park functions in the health system will be told in a later chaer. But we may anticipate a bit by saying that, according to Soviet philosophy, rest and recreation are developed as means of exemplifying the value of socialized activity. During our visits in the park we saw groups of adults engaged in folk dancing, or community singing, or simply in friendly conversation. We saw the children in their own "village," happy at their games, or in classes receiving instruction. Whenever we stopped to take a picture, a curious circle formed around us. Along a broad walk in the park was an educational display illustrating political aims. Large figures, grotesquely formed of sheet iron or wood, satirized, for example, the disarmament conference, or predicted the "liquidation of the kulaks" by 1937! Along the Moscow River are grandstands from which spectators watch the boating and swimming.

For organized sports the city has about a hundred grounds, besides the new Dynamo Sport Club Stadium, which we visited. Over the entrance to the stadium is a huge legend reading "Be Ready for Labor and Defense," an exhortation with which we were to become very familiar, since it is seen or heard everywhere in Russia. The stadium has seats for about 50,000 spectators, and, like many stadia in Europe, has further accommodation for standing, in this case, for about 25,000 persons. Organized sport and the wide interest in physical culture are post-Revolution phenomena.

One evening we attended a motion picture show. The film was "The Road to Life," which dramatizes the need of suitable education and training for neglected and homeless children to prevent their becoming criminals.

Some years ago travelers through Russia used to come back with terrifying stories of "wild children." At that time there were large groups of "roofless children" roaming the streets and yielding to primitive instincts in getting their living. Although the problem of finding homes for these children has been largely "liquidated," juvenile delinquency has not entirely disappeared. However, the children we saw on the streets were well behaved. In fact, during our entire tour only a few persons asked us for alms. Beggars were so much more frequently seen in other European countries that there is no comparison, in this respect, between them and Russia.

Besides seeing motion pictures, we also attended performances of stage drama. We were thrilled by the great Meyerhold in his theatre in a play full of challenge to the capitalist world. In the Moscow Art Theatre in a play entitled "Fear" we saw the best acting witnessed by either of us in many years of theatregoing. The Russian Ballet in the Moscow Opera House gave an interpretation of "Swan Lake" which was surpassingly beautiful.

It was interesting to learn that workers in heavy industry are given preference in assignment of seats at the theatre and at the opera. There was an absence of dress suits and evening gowns in the audience, but there was no lack of appreciation of the music and the art of the dancers.

While it is not our purpose to describe "sightseeing" in general, we can hardly refrain from saying that in the Kremlin, that beautiful group of medieval buildings, are impressive exhibits of treasure, belying the reports that the imperial jewels were lost, stolen, or sold.

But more impressive than the historic Kremlin is the Tomb of Lenin, in Red Square, just outside the Kremlin wall. There, in a mausoleum of huge blocks of red granite, magnificent in its pure simplicity, lies the great revolutionist within an illuminated glass pyramid, with delicate hands relaxed upon his breast, looking as though he had fallen asleep, plainly visible to the thousands who come every day and bare their heads before him.

Our visits to medical institutions were, as a rule, in the company of the chiefs or other officials of these institutions, and we were given every opportunity for complete inspection. How far we ranged can be seen from the mention, in this preliminary account, of many of these interviews and visits. What we learned on such occasions with specific reference to the health services will be stated in fuller detail under the appropriate headings in other chaers.

On our first day in Moscow we had called at the headquarters of VOKS, the Russian All-Union Society for Cultural Relations with Foreign Countries. Here we had presented our letters and credentials, and an appointment with the Foreign Office had been arranged for us. At the Foreign Office we were courteously received by Mr. Umansky. To him, and likewise to Dr. Vladimirsky, Commissar of Health for the R.S.F.S.R., and to Dr. Zalujsky, Deputy Commissar, we are indebted for the special facilities and exceptional opportunities given us for the important interviews and visits upon which the contents of this book are chiefly based.

Commissar Vladimirsky, wearing a peasant blouse, had the manners of a gentleman of the old Russian school, combined with the confident briskness of a capable executive. Educated in Germany and at the Pasteur Institute in Paris, he practised medicine for many years in France. During the years of the terrible epidemics and famine in Russia, he and Dr. N. A. Semashko, his predecessor in office, used to work until late at night planning the present public health system. It was extremely helpful to us to meet Dr. Vladimirsky and to hear his survey of the present medical situation in Russia, including a reminder that because of the shortage of physicians there had necessarily been delay in progress according to plan.

Basic research in preventive medicine and study of the technique of health education are carried on at the Institute of Health in Moscow. Here we met Professor Landis, the head of the institute, who outlined the methods of public health administration and the functioning of social and sickness insurance.

Dr. Abram Genss, Assistant Director of the Institute for the Protection of Motherhood and Childhood in Moscow, enunciated the Soviet policies regarding maternity work and the care of infants and young children. Dr. Genss also summarized the Soviet experience with abortion, according to the plan which he initiated about thirteen years ago.

A few days later we witnessed a marriage and a divorce in one of Moscow's marriage bureaus, which will be described in Chapter XI. The offices were in a house that had probably been a private dwelling. On the walls of the pleasant waiting room were posters and placards giving advice on the care of babies and promoting general hygiene.

An interview with Dr. Kazaroff, head of the Moscow Institute for Skin and Venereal Diseases, gave us valuable information as to antivenereal organization. The institute, which has 400 beds, is related to five venereal disease dispensaries in the city, and to the factory and other general dispensaries which also undertake some treatment of venereal diseases.

Continuing our study of venereal disease control, we visited a "prophylactorium" for prostitutes, in which there were 500 inmates who receive medical oversight while working at and learning useful occupations. In Moscow and other parts of Russia are many "prophylactoria" of this type. One room of the "prophylactorium" we visited is devoted to historical exhibits of past and present methods of treatment and prevention of venereal disease. In the exhibits the relation of prostitution to capitalism with its associated poverty is stressed. One placard says, "To hell with charity."

The subject of free medical aid was elucidated for us by Commissar Vladimirsky in a second interview.

Then we visited one of Moscow's ten "night sanatoria" and saw how convalescent workers and those needing rest and special care were housed while continuing daily work.

A visit to an antialcoholic station, one of ten in Moscow, revealed methods of caring for those who have drunk too much vodka, and of disciplining offenders as part of the Soviet work against alcoholism.

Our study of Russian tuberculosis control gained its first impetus from a visit to the Central Tuberculosis Institute for the R.S.F.S.R., which is in Moscow. Here Dr. Neslin outlined the organization for the discovery, treatment, and prevention of tuberculosis in Moscow. This institution is related to a network of tuberculosis dispensaries and to a much larger number of polyclinics, as a centre of expert consultation.

In the Park of Culture and Rest we interviewed Professor Popoff, Director of Research in Health, and Professor L. Rosenstein, Director of Research in the Institute for Neuro-Psychiatric Prophylaxis, who explained to us the philosophy of the Russian program for the prevention of disease and the cultivation of positive health. These interviews, coming, as they did, in the midst of the Park of Culture and Rest, a characteristic Soviet institution utilized in carrying out the health program, gave an added vividness to the demonstration.

In the Children's Village, an idyllic part of the park, we saw some three hundred little tots, whose parents are engineers, doctors, and other professional workers. In each group of twentyfive the children were uniformly clad, to identify the individual with the group. On each child's costume was a symbol which corresponded exactly with the symbol on that child's drinking mug and towel. More will be said of this Village later. A special tribute to this institution was expressed by an American woman whom we met with her sixyearold daughter. She said that the girl's worst punishment was to be deprived of her daily visit to the park.

As we walked along we saw a group gathering about a man who had the text of a song unrolled on a large canvas. One of us took a snapshot of the scene. A Russian standing beside us said in perfectly good English, "Did you get a good photo?" "I hope so," was the reply. "What are they singing? Patriotic songs?" "Certainly not," came the answer. "This is a song calling upon the workers of the world to unite." Then he told us the words, and when we bantered him about patriotism he said, "Well, of course, we have songs of defense, which you might call patriotic."

Then he said, "I have been in Manchester. I have been in America, too. I was an iron worker there. I have nothing against capitalists, but only against capitalism. I met Mr. Schiff in the Henry Street Settlement in New York and liked him."

"Are you a worker now?" we inquired.

"Yes, I am a worker. This is my day of rest. I am the Commissar for the Scrap Iron Industry of the Soviet Union."

We report this incident here as typical of the cordiality shown even by those we met casually.

Having heard accounts of remarkable Russian innovations in the rehabilitation of prisoners, one of us visited a "labor commune" at Bolshevo, about thirty miles from Moscow. This is a settlement of men and women (with their families) convicted of theft, arson, and similar crimes. At the time of the visit there was a population of 2,200 in the Bolshevo colony, including about four hundred married couples. They live either in apartment houses or in separate onestory cottages built for two or three families. The workers are engaged in the manufacture of sports goods, this plant probably being the biggest of its kind in Russia. They also engage in farming and stockraising for the needs of the community. The community has a hospital and clinic, cooperative store, and school. Incidentally, the visitor found an excellent exhibition of local art on view in the school building.

The remarkable thing about this colony is that it is selfgoverning and that its members, who have been selected by a Distribution Committee from those confined in prisons, and are, strictly speaking, completing their terms, are free to go and come, and may, indeed, leave the colony forever if they choose to do so.

Mr. Boguslavasky, Director of Education, the administrator of the colony under the jurisdiction of the OGPU,(4) informed the visitor that the inmates prefer to remain with the colony and predicted that the community would be permanent. Naturally it is hoped that additions by way of prisons will be reduced to a minimum.

Besides our interviews with Moscow medical leaders and other officials, we had frequent talks with Englishmen or Americans who from long experience had a good understanding of Russian affairs. Newspaper correspondents, teachers, and other foreign residents gave us valuable advice and information along with their personal opinions on Russian social phenomena. Hence when we left Moscow for the long tour up and down European Russia, our notebooks were already bulging, and Soviet public health work was beginning to emerge as a reality for us.

Visits in Leningrad

We took a night train for Leningrad, the old Tsarist capital some four hundred miles to the north. During the last few hours of our journey we gazed on vast stretches of flat land, with occasional groves of white birchthe national treeand of marshes which furnish peat used for fuel in this part of Russia.

At the station we were met by a slip of a girl who proved to be one of our most efficient guides. Leningrad, the historic seat of science and. culture, is the largest industrial centre in the Soviet Union. On the banks of the Neva River stand the palaces and cathedrals in their rich beauty of imperial times. Near by are being built new apartment houses for the families of former political prisoners, who are to be governed by their own Soviet. In the Hermitage and other museums we saw the priceless collections of pictures, precious stones, jewels, and archaeological objects, and were deeply impressed both by the collections and by the fact that, as our interpreterguide pointed out, notwithstanding the Soviet's great need of foreign money, these treasures have been scrupulously preserved.

There are eight large polyclinics in Leningrad. We visited one known as the Ambulatorium for the Volodarski District, an important manufacturing section. The building itself is a long threestory structure of concrete and steel, rigidly simple in design. Two wings and a central section bound a court formally laid out. Over the main entrance is the legend : "To the Workers of the Prophylactic Centres : You Should Be in the Front Ranks of Those Who Take Part in Socialistic Construction."

This institution was one of the largest of its kind that either of us had ever seen. It aims to provide health service for the entire population of the district, but has proved inadequate, and therefore a second polyclinic of similar size for this district is under construction.

The health work includes all branches of medicine, and also a training school for nurses. One hundred and twentyeight doctors are employed, and all workers in the district are treated free.

We next visited the Leningrad Institute for the Protection of Motherhood and Childhood, in a brick building which has been well remodeled for its purpose. Here we were shown a "creche," which might be described as a combined day nursery and school, similar to others in all the eight districts of the city. We also inspected the maternity department and learned of the care given to expectant mothers as soon as pregnancy is suspected. Here the functioning of the birth control department was also explained to us. This institute serves a district with a population of 200,000. We were told that over 90 per cent of the mothers of the district were registered in the institute.

An example of the conversion of a former palace into use as a night sanatorium was seen in a suburban house which formerly belonged to a German sugar magnate. This night sanatorium, which has 130 beds, is for early cases of tuberculosis. The palace, overlooking the Neva River, is remarkable for its lavish fittings and decorations of German taste. The doctor in charge explained the facilities and routine of the institution.

A similar palace on the Neva, expropriated from its former owner, is a House of Rest, which we visited. The gloriously large drawing room and other rooms of this palace were occupied by workers, on a fourteenday holiday, who were surrounded by abundant evidence of past luxury.

We also visited a House of Culture, a sort of clubhouse for workers. Besides providing reading rooms and lecture rooms, the house also has a room in which mothers may leave their children in care of nurses and teachers while they attend lectures or plays. There was a special Room for Foreign Guests, a combined library and exhibition room, stressing achievements of the Soviet Union. The House of Culture might be described as a glorified Y. M. C. A. and Y. W. C. A. combinedthe C., however, standing for Comrade, not for Christian!

We had long looked forward to a visit with the celebrated Dr. Pavlov, but unfortunately for us the great investigator was absent. However, we were received by his son, a lawyer, who is now chiefly engaged in preparing his father's works for publication. Mr. Pavlov, who spoke good English, gave us much valuable information. Through his kindness we were joined by Professor Orbeli, the distinguished physiologist, now professor in the Military Academy at Leningrad, who also spoke good English. Professor Pavlov and Professor Orbeli are not Communists, and it is generally known that they often disagree with the Government on the merit of measures taken, but in spite of this the Kremlin, recognizing the value of their scientific work, does not discipline them, but, on the contrary, they are given every facility to aid them in prosecuting their scientific research work.

(1) Walter Duranty, Moscow correspondent of the New York Times.

(2) These may be defined as welltodo peasants of individual tendencies actively opposed to collectivization. Kulak means a fist, and thus symbolizes holding in one's fist the exploitation of labor.

(3) A ruble contains 100 kopecks. Reckoning in gold values, one United States dollar is equal to 1.94 rubles; one pound sterling is equal to 9.4576 rubles. However, we found that American or British money, when tendered in Russia, had an actual purchasing power several times higher than its official value on a gold parity.

(4) These are the initials of the Russian words meaning All-Union State Political Department, which is the name of the political police force. This is described in Chapter VI. The initials GPU, pronounced "Gay-Pay-Oo," are officially used when referring to a local State Political Department, and popularly when referring either to the All-Union or a local State Political Department.