Red Medicine: Socialized Health in Soviet Russia

From Moscow to Georgia and the Crimea

FROM Leningrad we returned to Moscow, where we spent a few days making further investigations before starting southward on our journey which was to take us down the Volga River, across the Caucasus Mountains, and down to the Black Sea. It has been said that he who has seen Moscow has seen in miniature what is taking place throughout the Soviet Union. We desired, however, to see, not in miniature, but in full scale, something of the health work in various republics, and under varying conditions.

We began our southern trip by spending twelve hours in a night train from Moscow to Nizhni-Novgorod. Incidentally, this city has since been renamed Gorky, but we find it convenient to use the old name. In this "Detroit of Russia" we visited the great new automobile factory. The works are on a gigantic scale. Construction was progressing on acres of large apartment houses in which the employees and their families will live. As we drove through the housing development we thought that, from English and American points of view, at least, it would have been more appropriate to build homelike cottages, each with its own garden, especially as there seemed to be vacant land available for an unlimited number of cottage homes. However, we realized that the plan adopted will probably meet the present housing emergency more rapidly and at less expense than could be done by separate buildings.

We visited the factory hospital and polyclinic in temporary quarters and saw the new buildings nearing completion. The local Commissar of Health explained the medical service in the city as well as in the factory.

The voyage down the Volga, famous in song and story, will always be remembered as a unique experience. The natural scenery, the historic towns and villages, the picturesque life along the way, the succession, as we traveled, of one race after another, the river traffic, the singing and merriment of the Russian passengers on board the steamer, our receions in cities visited, the institutions inspected, the interesting leaders with whom we talkedall contributed richly to our enjoyment and to our understanding of the Russian people and of the Soviet public health ideals and accomplishments.

From Nizhni to Kazan the Volga flows eastward in a deep channel. On the south are wooded palisades of sand and clay, or hills retreating and exposing undulating highlands, with abundant fields of grain and thatchroofed hamlets nestling in great ravines. The north bank resembles a wide sandy seashore, with deciduous woods in the background and rolling plateaus rising in the distance.

Passing from the political division called the Nizhni-Novgorod Area, through a part of the autonomous region of the Mari, a Finnish-Ugrian people, we reached Kazan, ancient stronghold of the Tartars, capital of the Tartar Republic, and cultural centre of the Volga.

Kazan has a population of 179,000, of which 50 per cent are Tartars. We learned that at the time when the Soviet Government proclaimed the Tartar Republic there was almost no hospital provision for the Tartar population. Now they have twenty large hospitals and sanatoria, while the hospitals for non-Tartars have increased in number.

We were met by the Commissar of Health, a huge finelooking Tartar. He took us to visit a large university clinic, including all the departments of medicine, in which students are taught special subjects. About 1,500 patients are treated daily at this clinic. It has 70 beds for inpatients. We got glimpses of other health institutions in the city, and we carried away an impression of an Oriental city in the course of transition, with signs of modernization already visible.

An interesting example of Soviet wholesale preventive measures is the fact that the entire population of Kazan was vaccinated or revaccinated in June, 1932, following some fifteen cases of smallpox the preceding winter. Through similar mass work typhus has disappeared from this city.

Kazan having been reached on the next day after our Volga voyage began, we were already getting acquainted with fellow passengers, and the scenes on board were becoming familiar. There were many hundreds of third- and fourthclass passengers who appeared to be chiefly peasants. Many of them were burdened with small stores of fruit and food besides other personal belongings. Their outfits commonly included bedding, two big wooden boxes, small parcels, a bottle, and a kettle. How they avoided injuring one another as they hurried aboard was a marvel. They crowded the decks, sleeping in the open at night. The secondclass passengers, having more privileges, sle in our dining room.

The colorful smocks and kerchiefed heads of the women lent a picturesque quality to the crowd. At night the men and women sang plaintive airs. And interspersed with these sad refrains on board were snatches of song recalling the Volga boatmen or faint strains floating across the still waters from groups of peasants on the sandy shores. As we sat and listened in the moonlight the effect was peculiarly romantic. But the plaintive songs on board were interrued by gay laughter. And at times some man or woman would jump up and dance with astonishing vigor.

When we docked at Bogorodsk, about sixty miles south of Kazan, a thousand people struggled for a place aboard our already overladen boat. It was distressing to see poor women, some in advanced pregnancy, others with crying babies, and all with heavy burdens, fighting to get a place on the gangplank. The caain and the mate mounted the railing and pleaded for order, explaining why it was impossible to receive them all, and at last got the mob under control.

During the night a woman who had come aboard in the crowd gave premature birth to a child; and the next morning at Ulyanovsk in the midst of a similar dock scene we saw the mother and baby carried ashore on a stretcher, both alive, thanks to the help of the ship's doctor, a woman.

Earlier in the morning a fine example of gallantry was shown by a young porter who stripped himself in an instant and jumped overboard to rescue a huge bundle of family possessions dropped by an old peasant woman.

This aquatic exploit reminds us of an amusing incident of the previous day, not far south of Kazan. The river there is shallow, and the channel frequently shifts. The ship had gone aground, and after the caain managed to get her afloat again, he decided to tie up at a dock while a boat crew searched for the channel. During this delay a number of the passengers went to a nearby beach for a swim in the Volga. One of us was among them and caused a sensation, for a reason which he could not immediately discover. But after some inquiry he learned that the natives had never before seen a man in what they called a "lady's bathing suit," because it covered the upper part of the body! As a matter of fact, nude bathing by men and women, though not in mixed parties, is very common in Russia, as we observed on the Volga, the Black Sea, and elsewhere.

In the river were all sorts of craft: steamers deluxe like ours; ferryboats, jammed with peasants and animals; extensive booms of logs carrying permanent floating cabins for the workers, and dugout canoes packed with singing peasants.

Between Kazan and Ulyanovsk the right bank of the Volga in places reaches a height of more than five hundred feet, reminding one of the Palisades of the Hudson River. Then, at Ulyanovsk, it suddenly emerges from the highlands, which retreat to a great distance, exposing vast fields of grain. But the highlands return and retreat again and again, revealing and hiding thatchroofed villages, with one or more white churches or cathedrals set off by tall poplars.

Along other stretches the landscape looks wild and lonely. Human figures are seen roaming in and out among the woods. Cattle, goats, sheep, and horses graze, often unshepherded, or come down in great herds to drink from the river, giving idyllic touches to the picture.

Ulyanovsk, scene of many battles during the civil wars, is the birthplace of Lenin, and the house in which he was born and lived as a boy is now a museum, revered as a national shrine.

The high rugged banks ended in the Samara. Bend, a horseshoe curve more than a hundred miles long, where the Volga rounds a range of the Zhiguly Mountains. At the eastern point of the bend is Samara, chief town of the Middle Volga region. This city, with a population of about 172,000, has also been the scene of recent battles. Here we were met by the Deputy Health Commissar, Professor Batrastshenca, an ophthalmologist, and Dr. Katzenellenbaum, the Director of Medical Research. They told us of activities to control trachoma, formerly prevalent in the Province of Samara, and gave us a good survey of all the other medical activities and facilities. We also had an opportunity to view one more of the famous parks of culture and rest.

West of Samara are many industrial plants working the rich deposits of chalk, gypsum, combustible shale, and phosphorites. At the village of Batraki is a railroad bridge nearly a mile long, and, as our steamer approached this, we were all ordered under cover. This seemed extraordinary, but we understood it when we learned that two spans of the bridge had been blown up by enemies and that there had been counterrevolutionary threats from time to time. The incident illustrates the "war mentality" which still continues in many parts of the country.

In the afternoon of our third day on the Volga we entered the Autonomous Republic of the Germans of the Volga. Here live half a million Germans, speaking their own language and preserving their own characteristic culture. This was evident in the general aspect of Saratov, a city of about 215,000 population.

Here the Health Commissar and practically his whole staff came aboard to meet us, a woman doctor acting as chairman and spokesman. As the boat was several hours late we were unable to make any inspection ashore, but we were fortunate in having a twohour conference with the deputation. We were informed that there is no typhus and very Iittle typhoid in Saratov, Tuberculosis is declining. Our visitors gave a very clear and concise descriion of the hospitals, sanatoria, night sanatoria, ambulatoria, consultation centres, the medical technicums (for training nurses), and antialcoholic dispensaries in Saratov. They also described the work in maternity care, birth control, and the control of prostitution.

From time to time, as the boat glided down the Volga, we had interesting discussions with fellow passengers. An Englishspeaking Russian chemical engineer talked to us about taxation, hours of labor, health facilities in factories, and the coordination of preventive and curative medicine in industry. This man had worked up from the ranks of labor, having qualified himself technically at the Workers' University. That he was important in his field was indicated by his statement that he was on his annual leave of one month with full pay.

From this discussion we turned to one with an American financier from Wall Street. He had been able to make thorough investigation of the new iron and steel works at Magnitogorsk, east of the Urals, and of other great new factories. Magnitogorsk (the Magnetic Mountain), it may be recalled, refers to a new industrial town being built around the steel plant, which is designed to be the most powerful in the world, with a projected production of 4,000,000 tons of pig iron a year. The Wall Street man was as amazed at the industrial developments he had seen as we were at the developments in the public health field. He had been impressed, among other things, by the freedom with which workmen were permitted to criticize the general management of factories as well as their coworkers. He spoke particularly of the "wall newspapers'' to which we shall refer again. The American held that the future of Sovietism was to a great extent dependent on maintaining this freedom of individual criticism. Although in the factories visited he had seen considerable inefficiency, he believed this to be of a kind which will be remedied.

A Russian jurist, whom we met on the boat, gave us much illuminating information on marriage and divorce, which is discussed in another chapter.

From Saratov to Stalingrad the Volga winds its sluggish way through vast desertlike steppes. However, the soil is productive, particularly of melons. At Bykovy-Khutor we saw peasants vending veritable mountains of delicious watermelons and muskmelons.

As we voyaged southward there were increasing evidences of subtropical life. We saw a caravan of camels drawing kola-like wagons. When the camels came down into the river, it actually seemed to subside as they drank! We did not see any sturgeonfishing, which is carried on in the lower reaches of the Volga, but we feasted daily on caviar. Indeed we were astonished that there could be so much caviar in the world!

After four days and nights on the Volga, passing through many republics and seeing many different races in their natural setting, we left our boat at Stalingrad. Although we reached this city in the evening too late to visit institutions, it was not too late to be received most cordially by Dr. Sokolova, Deputy Commissar of Health, a brilliant and attractive woman doctor, who heads the Institute for the Protection of Motherhood and Childhood for the entire Stalingrad region. We dined with her in the crowded Park of Culture and Rest, where we had an opportunity of seeing the "night life" 0f this famous tractor centre.

Stalingrad is a city of 250,000 people. It has a great number of new factories, the most celebrated being the tractor plant, with a capacity of 50,000 tractors per year. The "night life" which we saw in the Park of Culture and Rest consisted of folk dancing, bowling on the green, song fests, and great crowds strolling on the boulevard. During the evening Dr. Sokolova gave us an illuminating account of the work being done in the entire Stalingrad district in connection with motherhood and childhood. She also discussed the general work of the medical centres and the control of tuberculosis and venereal disease. She confirmed the general statement as to the similarity between the medical procedure here and elsewhere, this evidence tending to convince us that Moscow was indicating the chief outlines of the work for the rest of the country.

Through Northern Caucasus

Shortly before midnight we took a train from Stalingrad for Rostovon-Don. The next day was spent en route, traveling second category ("soft"), since there are no wagon-lits or first-class carriages on these trains. They stop at every little village and stay as long as necessary to load or unload. At every station were throngs of people, much like those we had seen at the floating piers on the Volga. Our way led across steppes, somewhat resembling the plains of the Dakotas in the United States, apparently very fertile. Here we saw sovkhozes (State farms) and kovkhozes (collective farms). On one sovkhoz we counted twenty large trucks in a long column apparently led by a commander in a Ford touring car, and obtained a good photograph of them. We were struck by the construction in progress everywhere; even in the great fields, apartment houses, granaries, and silos were rising, and evidently among them creches, nurseries, dwelling houses, schools, parks of culture and rest, and hospitals. The cities which particularly struck us were Sokhaya, Sulin, and Novocherkask.

In the evening we reached Rostovon-Don, a city of 425,000 people, which is the political, industrial, and cultural centre of the Northern Caucasus. We went to a very good hotel on Engels Avenue, which is a veritable Champs-Elysees. From the dining room on an open balcony stretching above the broad sidewalk we looked down upon the thousands of people strolling in the cool breeze of late August in this southern town near the Sea of Azov.

At Rostov we took leave of the young man who as an Intourist interpreterguide had accompanied us from Moscow. His successor, fortunately for us, was Mrs. N. Nicolich, a cultivated woman, Assistant Director of VOKS at Rostov. Through her assistance and the friendly interest of Mr. Salin, Director of VOKS, our stay in this city proved especially profitable.

Our first visit was to Selmashstroy, the great Mc-Cormicklike agricultural plant, producing harvesters for use in the great State farms such as Verblud and Gigant, which alone cover about a million acres. The head of the health service for this huge plant was a woman physician, a fact which struck us as typical of the new Russia. This leader, Dr. Marcus, explained the procedure in caring for the employees. A summary of what we learned about Selmashstroy from her and others who received us is presented in Chapter VII.

Our visit to a great medical centre in Rostov proved particularly stimulating. In its modern housing and equipment this compared quite favorably with the new medical centres in New York. Although not so large it was equally complete, so far as we could judge. The Babies' Hospital and the Hospital for Bone Tuberculosis were certainly among the finest either of us had ever seen. A characteristic of the construction is that each hospital of the aggregation is a separate and generally detached building.

A feature of the Babies' Hospital is the system of glass cubicles for isolation of children developing temperatures, and with provision in every case for nursing mothers. In the majority of cases seen by us in the Babies' Hospital the mother was with the baby. Discussing with us at some length the merits of this plan, the doctors insisted that the practice of having mothers stay with their babies hastened recovery of the infants and in many cases saved their lives.

Another splendid institution in Rostov is the polyclinic called The Unitary Dispensary, the name indicating a higher degree of unity than we usually find in polyclinics. This is admirably equipped in all departments of medicine and has a staff headed by the university professors of medicine. Dr. Rubinstein, the director of the dispensary, which handles about i,800 patients daily, explained the setup and procedure. Dr. Rubinstein also gave us statistical information on the decline of venereal disease in Rostov, which is discussed in Chapter XXI.

In Rostov we saw an educational exhibit regarding the dangers of abortion, which in its frankness, its implied outlook, and its exhibition to the public without discrimination is likely to shock many visitors.

The stay in Rostov was particularly stimulating to us and yielded a large amount of information on a variety of subjects.

Our next destination was Vladikavkaz. We had planned to fly, but could not make arrangements to do so. We left Rostov by a night train and, after a long but fascinating ride through the Northern Caucasus country the next day, we left the train about midnight and motored through the sagebrush, mysteriously beautiful in the starlight, to Vladikavkaz, the point where the Greater Caucasus Mountains begin.

Next day we took a motorcar bound for Tiflis, 135 miles away, beyond the mountains. No attem will be made to describe the scenic splendors of this towering range, extending from the Black Sea to the Caspian Sea, which is no longer a barrier to the land trails between Europe and the Near East. Our route was over the Georgian Military Highway up along mighty gorges, with their roaring torrents. Passing the famous springs from which the Narzan mineral water is obtained, we made our next important stop at the Kazbek Station, which affords a splendid view of Mt. Kazbek, an extinct volcano, higher than Mont Blanc. At Gudaur Pass, nearly 8,000 feet above sea level, we were surrounded by snowclad peaks, equaling in grandeur and somewhat resembling the Dinaric Alps. Then our route led downward among the deeply forested foothills that look down on Georgia, with its fertile farms and vineyards. Following the Kura River during a sunny afternoon, we reached Tiflis in the evening.

Subtropical Georgia

Tiflis, the capital of the Trans-Caucasian Socialist Federated Soviet Republic, as well as of the Republic of Georgia, has an interesting mixture of ancient and modern buildings, with a fascinating mixed population of Georgians, Armenians, Persians, and representatives of many other racial groups that inhabit this Eurasian borderland. In olden times Tiflis lay in the path of the trade caravans between Europe and Asia. During the past generation it became conspicuous as the scene of much revolutionary activity. Here Stalin grew up. He was born not far away in the village of Gori. Today a city of 350,000 people, Tiflis is rapidly developing as a centre of industry and culture.

Our study of health services in Tiflis began with a conference with the Commissar of Health for Georgia, Dr. G. L. Kuchaidze. We were oriented as to the character of the city, the rapid mechanization of industry, the development of the university, which now has about 16,000 students, and the preventive and curative medical services. The Commissar pointed 0ut that, except for adaation to local circumstances, the plan for health work was the same here as in the R.S.F.S.R. In Georgia, as elsewhere, there is a chain of ambulatoria, polyclinics, and hospitals, general and special, all linked together. He discussed with us at some length the education and training of doctors at the Medical Institute connected with the university, the education of midwives, instructed in Russian as well as in their native languages, maternity and child care, welfare work, and in general the procedure in preventive work and in the treatment of patients.

We visited the Tuberculosis Institute, in a beautiful new building of Renaissance style, splendidly equipped. The other tuberculosis institutions in Georgia are closely affiliated with this central institute. A day sanatorium for adult patients was under construction on a site adjoining the institute.

We next visited a creche connected with a silk factory. Although this nursery was housed in a part of the factory not built for this purpose, it seemed to function with success. Since there were two shifts of workers at the factory the creche was open from morning until 10 p. m. About 160 children were received each day.

The Hospital for Railway Employees, which we visited, was an interesting example of a hospital for a special occupational group. Its 500 beds are available for all grades of railway employees in the Republic.

This hospital is well organized and equipped, particularly the obstetric and gynecological divisions.

The special hospital for railway workers is only one instance of many in which, inside the wider community of workers, the closer community of the workers in a particular industry is encouraged. The railway workers, we found, had their own club, consisting in the main of a beautiful garden, with fountains and flowers, and playgrounds for the children. There were facilities for music and outdoor motion pictures. We saw some two hundred "Octobrist" children, aged about six to ten, who had been in this garden since 6 a. m., march away singing at 8:30 p. M. In charge of these youngsters were several "Pioneer" girls about fifteen or sixteen years old.

A method for encouraging efficiency among the railway workers was conspicuously illustrated in this garden. On a red board were listed those workers who had been exceptionally good, and on a black board those who had been notoriously bad. Such public display of names is supplementary to the posting within the factories or offices.

After completing our survey of the health services in the city of Tiflis, we took a long drive into the country to observe the health work on a typical State farm and on a collective farm. We made this trip into a sagebrush desert, now being reclaimed by a large irrigation project, in the company of the Secretary of the Communist Party of Georgia and two doctors assigned to us by the Commissar of Health. After a journey of some two hours over a rough, dusty country road, on which our automobile passed only picturesque kolas and heavily laden camels, we arrived at a State cattle farm, comprising several thousand hectares. There were a thousand head of cattle, in charge for the most part of women organized in shock brigades to compete with one another for the largest production of milk. The farming operations, including grain production, and the development of the irrigation project seemed to be largely in the hands of men. This State farm had been only recently established. Most of the buildings were new, and many of the cow barns and silos were still in the process of construction.

Notwithstanding its recent organization, however, we found the usual creche, in charge of a trained teacher, who spoke to us in French, assisted by a trained nurse. We found there a country doctor, evidently risen from the ranks of the workers. He was, however, conducting a wellordered dispensary and a small pharmacy, much of the ingenious equipment of which he had constructed himself. He assured us that all the medical needs of workers and children were being adequately met. When we inquired about dentistry and other specialties, such as nose and throat work, he informed us that he personally took care of emergencies or saw that difficult emergency cases were promly transferred to Tiflis, and that at stated intervals a group of specialists visited this and other State and collective farms. He informed us that he reserved most of the cases needing the attention of specialists for these occasions.

Although the facilities were somewhat crude, we were convinced that a genuine effort was made to provide the health needs of this community, which consisted of about a hundred families. The only serious criticism we felt was the lack of screens for the creche and the clinic and the failure generally to control the flies. But we recognized that this was not an easy matter on a cattle farm. While we did not express this criticism, it was expressed for us in no uncertain terms by the Secretary of the Communist Party, who put the responsibility squarely up to the director of the farm to "liquidate the fly nuisance" before we made our return visit, which he hoped would be in the following year.

We were interested to observe on this farm tractors and other modern agricultural machinery, and many evidences of efficient administration. The agronomist in charge was a Communist 0f German origin and Germantrained.

On our return, in the outskirts of Tiflis we visited a collective farm consisting of several hundred hectares and comprising what had formerly been 153 separate little farms. This was a general farm, but it was primarily devoted to a magnificent vineyard producing luscious grapes. This farm, all under irrigation and having every appearance of efficient administration, was under the direction of a handsome and highly intelligent young Georgian woman, a recent graduate of the Agricultural College in Tiflis. She was eager for information about irrigated farms in America and expressed her desire to visit that country and study its methods.

Although our special interest was in the health services, we undertook a long walk, in the course of which we were obliged to jump over ditches; but we were rewarded in the end by a visit to a comfortable pergola in the corner of the great vineyard, where we were protected from the hot sun's rays by the heavyladen grapevines.

Returning to the central buildings, we were taken by the doctor of the collective through the creche and the clinic and into the various clubrooms, decorated with the usual health posters and large pictures of Lenin and Stalin. Here again we were impressed 'by the order and cleanliness, by the character of the teachers, nurses, and the doctors, and by the fine, healthful appearance of the children. The children, however, seemed more interested in the leader of the Communist Party than they did in their foreign guests. It was obvious that he had a way with him which caured the children. A typical, handsome Georgian man, of charming personality, he would greet the children with, "Are you ready for labor and defense?" Rising as he entered and saluting, they would respond in chorus, "Always ready!"

From Tiflis we traveled by train to Batum, on the Black Sea. Here came into view a marvelous "Riviera" of beauty. Subtropical trees, palms, magnolias, eucalyus, and camphor laurels, gave an exotic charm to the scene. All along the coast extending northwestward to the Crimea is a continuous succession of health resorts and rest homes. Magnificent palaces which once belonged to the wealthy and the noble who came here from the north to take their ease have been confiscated and now, as sanatoria or vacation homes, are thronged by the workers.

As no special arrangements had been made for observing health work in the city of Batum, we took advantage of an opportunity to visit another State farm, a large tea sovkhoz covering many hectares, spreading over the fertile undulating, palmbordered hills rising above the Black Sea. Here we witnessed for the first time tea cultivation and harvest, and we were shown the modern process of curing tea in the large new plant situated in the midst of tropical gardens and surrounded by the usual mixture of primitive homes and modern apartments, in the midst of which we found the usual creche, health centre, clubrooms, and cultural facilities. We had no time to inspect these, but we found that they were in existence here as elsewhere. In answer to a question put to one of the doctors as to how general these health and welfare facilities were on the State and collective farms, we were told these were the first things to be established, just as in an army health facilities must be given primary consideration.

On the Black Sea

Returning to Batum, we were driven through an extensive and magnificent subtropical botanical garden. Before returning to the city itself, we visited the famous bathing beach, where one of us and our guide went swimming in the Black Sea. After dining at the hotel and walking about the city, mingling and talking with the people here and there, shortly after dusk we boarded the steamer bound via Sochi for Yalta, in the Crimea. For two days we skirted the coast, most of the time keeping in view the lovely subtropical garden scenes along the shore and the vast snowcapped Caucasus Mountains in the background.

On the boat we had interesting discussions with distinguished Russians on vacation. Mr. Minkow, one of the editors of the Radio Labor Newspaper, dwelt 0n freedom 0f publicity for everything which was not "counterrevolutionary" in effect. He stressed the liberty of criticism in factories, of which we had seen illustrations, through the medium of the "wall newspaper." As to the "black board" listing of inefficient workers, he said that there was n0 danger that men would be unfairly blacklisted because of feeble health, since the list is made up in open shop meetings.

Another fellow passenger who gave us valuable opinions on the position of scientific workers was Abraham Prigozhine, Lecturer on History in the Leningrad University. We also had a very comprehensive discussion with Dr. Olga Borisowna Lepeschinskaya, Professor of Histology in the Communist Academy, Moscow. She devotes herself entirely. t0 research, being especially interested in the study of cellular constituents. At the time we met her she was about to publish a work on the minute structure of the cell. The present proletariat Government, she remarked, does not impede the scientific work of professors. Professors' children now receive the same preferential rights as those of workers. Most professors, she said, hold two, and some hold three, positions, and thus have adequate salaries. The Government is gradually increasing salaries, thus discouraging the holding of more than two positions. The principle of "shock brigades" setting the pace for other workers, she said, is applied in scientific work. Individual scientific workers, for example, in a laboratory, may get premiums for efficiency. Nominations for such premiums are made at "production meetings" of all the workers. These nominations are discussed at professors' meetings, and finally the premiums are awarded at a grand meeting of all the workers.

Besides the comments above reported, Dr. Lepeschinskaya also gave us her considered judgment on the problems of marriage and divorce, birth control and abortions, which has helped us in interpreting the facts concerning these subjects discussed in other chapters.

After two days on the Black Sea we reached the Crimean peninsula, landing at Yalta, the workers' paradise, beautifully situated and showing palaces, gardens, and woods, with the towering Yaila Mountains rising abruly from the shores of the Black Sea. The climate is always mild, and there is said to be more sunshine than on the Mediterranean Riviera. In the Crimean region centring in Yalta there are tens of thousands of workers on vacation, living in palaces that once were the pleasure resorts of the wealthy few, from the Tsar himself down into lower ranks of nobility and wealth. Here too are sanatoria for the tuberculous and rest homes for convalescents in general.

Our first interview was with Dr. S. J. Jacobson, chief of the Social Insurance Organization for this region, who is stationed here in the summer. During the winter he is assistant surgeon in a Leningrad clinic. His exposition of the aims and methods of social insurance in emphasizing the preventive side of medicine and in developing more sanatoria and rest homes is discussed in other chapters. Incidentally, we were in. formed that workers in heavy industries and technicians had been given decided preference in dispensing aid.

Besides the private palaces formerly maintained at or near Yalta there .had also, under the imperial regime, been constructed sanatoria for aristocrats and the rich. These old sanatoria, now used by the workers, were as a rule built at sea level. But the new ones are built about 1,700 feet above sea level, in order to get the advantage of altitude as well as the other benefits of this region.

We visited Dolossy, a large sanatorium at an altitude of nearly 1,600 feet in the mountains above Yalta. This sanatorium, which was constructed with funds from social insurance, is excellently organized and equipped. Its patients number about three hundred in winter and nearly five hundred in summer. Although the ordinary "wall newspaper" of factories is not permitted here, for fear of bad psychological effect on patients, criticisms of the management can be made to the doctor.

Dr. Karpenko, the Director for State Sanatoria in the Crimea, explained the management and operation of the Crimean rest cures while accompanying us on a visit to Livadia, the former Crimean residence of the Tsars. This is certainly a most magnificent palace.

Situated in the midst of a lovely garden high on a precipice overlooking the Black Sea, Livadia is now the paradise of workers. They come here from various parts of Russia for a rest of a fortnight or longer. There were fifteen hundred of them at the time of our visit, men and women roaming about the gardens, playing games and singing, always singing to the accompaniment of the mandolin or guitar, or the balalaika, or reading, watching a motion picture, some of them resting on couches in the Tsarina's bedchamber, with its great arched plateglass windows, framing the most beautiful picture imaginable of mountain, sea, and cedars of Lebanon.

We learned that the workers admitted in the summer are chiefly from factory "shock brigades," while in the winter men and women from the collective farms preponderate, Livadia then becoming a "peasants' palace."

Besides being a rest home, Livadia is also a home for convalescents, with added facilities for patients needing special care. Patients are sent both by Social Insurance authorities and by the Health Commissariat of the R.S.F.S.R.

Incidentally, Dr. Karpenko, our companion on the visit to Livadia, is an interesting example of a class of doctors developed under the new regime. He was formerly a sailor and became a medical student at the age of twentyfour. We found him an important medical official.

In connection with our visit to Livadia we had illuminating discussions with members of its staff, especially with the medical superintendent. His preference for state medicine as contrasted with private practice and the reasons he gave harmonized with all the other testimony we heard from doctors.

Leaving Yalta, we motored to Sevastopol through the Crimean Mountains, which are a little higher than the Catskills and as rugged as the Rockies. As we drove along the side of great precipices we saw, nestling in every nook, cypresses and pines, figs and olives, vineyards and tobacco fields, and beyond these the gleaming Black Sea stretched far out to the horizon.

At the end of our drive we entered the historic "Valley of Death," the celebrated battlefield where many thousands of British, French, and Russian soldiers were killed in the Crimean War, and which, for British and American readers, has been immortalized in Tennyson's "Charge of the Light Brigade." Passing Balaklava at a distance, we arrived at Sevastopol and thence took a night train for Kharkov, the new capital of the Ukraine.

The Capital of the Ukraine

The Ukrainian Socialist Soviet Republic, one of the seven constituent republics, is important not only as the "fuel, metallurgical, and grain base of the Soviet Union" but also for its advanced position in the cultural realm. The old capital was Kiev. Kharkov, where the Soviet Government has established the new capital, is a city of about 440,000 people, threefourths of whom are Ukrainians. The rest are mainly Great Russians and Jews, with smaller proportions of Poles,

Germans, and other nationalities. Ukrainian, which resembles Russian, is the official language.

In this city we first visited a day preventorium for children, accompanied by Dr. Lifschitz, a professor in the Medical Institute, and by a public health inspector in the Commissariat of Health of the Ukraine. The preventorium, housed in a large and beautiful garden in the outskirts of Kharkov, has accommodation for 700 children, who are from six to fourteen years old and come from the public elementary schools. The children have been selected because they have symoms of weakness, of incipient tuberculosis, or have been exposed to the disease at home. The selection of children considered for admission is made by school doctors with whom sits a committee including a representative of the parents; and the final selection for admission is made by the polyclinic doctor. They are met by an officer at certain streetcar centres in the morning and are similarly escorted back to these centres in the evening.

We were informed that these day sanatoria, of which there are many in the Ukraine, were instituted about 1923. Children in these institutions are periodically examined by medical experts. Dental and other treatment is given. There is instruction in physical sports and also, we were told, a certain amount of "political education."

Dr. Lifschitz, a consulting physician, was somewhat exceptional, he told us, in that his earnings from private and public practice are about equal. Most doctors, he said, have very little, if any, private practice.

We were informed later at the Commissariat of Health of the Ukraine that private practice comprised only about 10 per cent of the total medical work in the Republic. Dr. Lifschitz and his medical associate gave us a concise survey of medical organization in Kharkov, which at the time of our visit had 3,000 physicians, and in the whole of the Ukraine. Compulsory vaccination against smallpox has been enforced throughout this Republic since 1920. Since 1930 immunization against diphtheria has been obligatory, and no child is admitted into a school or sanatorium without such immunization. Dental treatment is obligatory at all schools, though perhaps not always completely carried out.

We next visited the Roentgen Institute, under the guidance of its vicedirector, Dr. B. Warshawsky. This institute, with its 500 rooms and 150 beds for patients, we found admirably equipped both for research and clinical work. There were special departments for X-ray diagnosis and treatment, for biological research, and for physical and medical treatment. The institute had 580 milligrams of radium for treatment of cancer. The staff of this institute numbered 100. In the ambulatorium there were some 80,000 attendances during a year. In other parts of the Ukraine, we learned, there are similar Roentgen institutes, though less elaborately arranged than the one we saw in Kharkov.

Further evidence of the efficient scientific work under way in Kharkov was given us at the Institute of Hygiene and of the Pathology of Labor, which was built in 1925-1926 and serves both for research and teaching. It has an admirable educational museum, which displays the chief occupational risks and the methods of avoiding them. There were also exhibits concerning the reduction of noise. This museum has a number of small traveling exhibits.

We next visited the so-called Third Labor Polyclinic in Kharkov, in a magnificent new building four stories high, which is described in Chapter XIX.

Near this new polyclinic were the immense new Tractor Works employing some 16,000 men and women. This plant had a separate polyclinic and a hospital with 400 beds.

After our personal inspection of the important public health and medical facilities in Kharkov we went, with a background of information, to the Commissariat of Health for the Ukraine, to inquire further concerning the administrative setup. There we had a conference lasting nearly three hours. The Commissar, Dr. Kantorovitch, was accompanied by the heads of all departments under him, and we were thus enabled to get direct and specific answers to our questions. We were given a clear and complete analysis of the organization of health work in the Ukraine, its divisions of responsibility, the relation between the local budgets and that of the Republic, the sources of funds and their distribution, the personal relation between doctor and patient, the education of medical personnel, and other allied subjects. What was said on all these subjects is summarized elsewhere in this book in the general discussion of the organization of medical and health work in Russia.

Leaving Kharkov on a night train, we reached Moscow about noon of the next day. We immediately plunged into a round of calls and conferences to gather up loose ends and to supplement the studies made on our long but fascinating tour up and down European Russia. It was during this third visit to Moscow, incidentally, that we saw the Moscow Art Theatre play "Fear" and the ballet "Swan Lake," mentioned earlier in our account. On the last evening in Moscow we had a late conference with foreign newspaper correspondents and other foreign observers of life in Soviet Russia.

At dawn of September 7 we boarded a plane at the Moscow airport bound for Berlin. Our notebooks contained a multitude of records, and in our memories were thousands of impressions of the means by which Russians in towns are helped to keep well and happy through a combination of abundant recreation and sports with a unique system of public health and medicine which in planning and to a large extent in accomplishment is more comprehensive and better unified than any we have found in making our surveys of other countries.

Our readers, having been taken over the ground covered by us, will appreciate the variety of problems presented and also the variety and character of sources of information. In the following chapters we propose to present, subject by subject, our findings and our interpretations.