Red Medicine: Socialized Health in Soviet Russia

The Background of Russian Life

AFTER the preceding sketch of our Russian travels we may observe that in our visit to the U.S.S.R. we found it of inestimable value that we had familiarized ourselves with some of its national literature, with its stormy progress towards greater liberty, with the history of its successive revolutions, and with the racial and geographical features of this vast country; and our study of medicine and social conditions in Soviet Russia can be better understood if one constantly remembers this background of Russian life. In this and the next two chapters it is proposed to outline briefly for our readers some main elements in this background, although the sketch must necessarily be incomplete. It will, however, we think, make more understandable the revolution in medical aid and in medicohygienic administration which is an outstanding feature in Soviet Russia today.

Russia is 150 times as large as England and Wales. It embraces an area more extensive than the United States and Canada combined, it comprises a sixth part of the land surface of the earth, and it contains over 165 million people.

Russia is a landlocked empire during winter; and in summer European Russia has no direct access to the wider seas except on its northern border above the Arctic Circle. Its outlet from the Black Sea can be blocked at any time in the Dardanelles. The outlet from the Baltic may be similarly blocked. This means that for world commerce Russia is almost in the position of a beleaguered city. It can have little foreign trade except at the will of its neighbors. This landlocked position needs to be remembered as exerting a psychological influence on Russians; and now to this is added the notion, carefully and continuously instilled into the minds of the entire people, that because Russia has abandoned capitalism, the capitalistic powers, one or all, are only awaiting a convenient opportunity to attack and destroy her communist organization.

A country which has natural boundaries on the shores of the Arctic, the Pacific, the Caspian Sea, and the Black Sea necessarily presents great variations of natural cultivation as well as of intellectual culture. While the "black earth" of its southern lands fits Russia to be one of the greatest granaries of the world, its vast forest regions in the north have a relatively low fertility and hence produce little of value except timber. In the subtropical climate of the Crimea, of the Caucasus, and of Turkestan, tobacco, grapes, tea, and cotton are grown; and in many parts are vast, chiefly undeveloped, mineral deposits, including oil fields. It has also great potential wealth in hydraulic power,, the "white coal."

The vast extent of Russia was more fully realized as we steamed for four days down the Volga, then went by train to Rostovon-Don, thence to Vladikavkaz (recently renamed Ordzhonikidze), and then motored through the Caucasus Mountains to Tiflis, and afterwards steamed along the coast for two days on the Black Sea to the Crimea. Yet our itinerary shown on the map carves out but a small segment of this farflung empire. Nevertheless these travels revealed the vast range of nationalities and languages embraced in Soviet Russia and served to impress upon our minds the magnitude of the land.

Although more than half the population of the Soviet Union consists of "Great Russians" (52.9 per cent) and "White Russians" (3.2 per cent) and one fifth (21.2 per cent) of Ukrainians, who are ethnologically closely related to the Russians (though they have a distinct language), there are in addition to these about one hundred and eighty nationalities, ranging from the Tartars, Armenians, and Turcomans, people with a long history, to but little known mountainous and desert tribes.

In the valley of the Volga, Tartars and other nationalities are commingled with Russians. Of the 147 million people of the Soviet Union in 1926, 78 per cent were Slavic (including Poles, a few Czechs, Serbians, etc.), while more than a million people of German origin live principally in compact groups near the Volga. According to the Guide-Book to the Soviet Union, issued officially,(1) the population in 19262 included 2.7 million Jews, 1.6 million Georgians, 1.3 million Armenians, and 1.5 million mountaineers of the Caucasus. Next to Slavs the largest ethnical group in the population of the Soviet Union are the Turko-Tartars (about 11 per cent).

In passing from north to south we found the different national characteristics very marked. Since the Soviet Government was established, language differences are respected and even encouraged, in contrast with the policy of Tsarist Russia. In Georgia, the Ukraine, and elsewhere, we found the language of the region being used officially. But with varying languages and races, governmental organization in essentials appears to be on identical lines in all 'parts of Soviet Russia.

The theory of the Soviet Government is that the Union is international, that its constituent parts are joined solely by their common aims and objects. In theory, also, "any nation may join the Union." Similarly any one of the seven allied republics which at present constitute the Union theoretically can secede from it.

The seven constituent republics of the Union of Soviet Socialist Republics, and their populations according to the census taken in December, 1926, are as follows :

1. The Russian Socialist Federated Soviet Republic (R.S.F.S.R.) 100,593,800
2. The Ukrainian Socialist Soviet Republic 28,887,000
3. The White Russian Socialist Soviet Republic 4,924,600
4. The Trans-Caucasian Socialist Federated Soviet Republic 5,810,300
5. The Uzbek Socialist Soviet Republic 5,058,200
6. The Turcoman Socialist Soviet Republic 1,030,500
7. The Tadjikistan Socialist Soviet Republic 663,000

To the exceptional geographical and the complex racial constitution of Russia should be added its low standard of elementary education, the vast majority of its population prior to the Revolution being illiterate. Religious influences also were largely representative of superstition and magic, and of the technique of ceremonial more than of the spiritual teachings of Christ, though doubtless there were many exceptions to this statement.

It is in the light of sympathetic interpretation of the above general facts that the recent events in. Russia need to be studied. A picture is distorted when its background is not developed and understood.

In judging what one may at first be inclined to condemn, the knowledge of Russia's antecedents is especially important; and it is thus that one can appreciate the undoubted high value of some of the Russian developments of medical practice and their bearing on future progress in other countries.

One finds occasionally an isolated community which until recently had no means of artificial illumination except candles or oil lamps, and which has skipped the period of illumination by coal gas, and now furnishes itself with electric lighting. Similarly, Russia has lagged behind other European countries in medicosocial reforms; it has remained semi-Asiatic or Eurasian; now with lightning speed it has instituted in its best organized cities provisions for medical care for approximately the entire population which are more complete and freer from inhibitions to readily accessible help than hold good in any country known to us.

Even Denmark is only a partial exception to this statement. It is no refutation of this sweeping statement to suggest that in actual practice this completeness is only very partially realized. The answer is that the organization to this end exists; and that in the cities visited by us it is in large measure functioning; and that there is reasonable prospect that, given continued progress on present lines, in a few years a complete medical service for all will be provided in both rural and urban Russia.

(1) Guide-Book to the Soviet Union, compiled by A. Rado. Issued by the Society for Cultural Relations of the Soviet Union with Foreign Countries. New York, International Publishers Company, 1928.