Red Medicine: Socialized Health in Soviet Russia

Russia's Travel Towards Communism

IN A survey of medicohygienic conditions we must necessarily have in mind the general social life of the country concerned, especially in relation to marriage and family life, to housing conditions, and to the industrial and agricultural work of the country. Nor can the education and the religious outlook of its people be left entirely out of the survey, for illiteracy is a chief enemy of health, while ethical standards influence health in manifold ways. In subsequent chapters these phases of national life will be mentioned or described.

In this and the next chapter we are concerned with the evolutionary and revolutionary processes which have brought about the present economic and sociological position. In Russia of today this position is one in which private capitalism and individual trading have been almost entirely abolished.

The prerequisites of a communist society have been stated as follows : The abolition of exploitation of men by men, the obliteration of the division of society into classes, the destruction of the conditions from which they arise, i.e., the abolition of private property in the means of production, and the establishment of a classless socialist society. In accordance with this, private ownership of the means of production and distribution has been abandoned, with all the practical consequences that this implies in the planning of national life.

How has this been brought about?

Russians are reputed to be dreamers and talkers; and although the same characteristics are frequently seen in western countries, Russians perhaps to an exceptional extent have the habit of "taking the will for the deed" and of regarding the enunciation of the principle of a reform as equivalent to its accomplishment. It is astounding, then, that a minority of these dreamers have been able to impose a radical reconstruction of national organization on communist lines, and that in doing so they have also succeeded in building up great industry and big machinery; for Russia is making amazing progress towards its goal of overtaking the United States of America in extreme mechanization, in mass production, and in standardization of manufactured articles. In efficiency of work, however, the progress has not been so rapid. Indeed, the difficulty of mastering technique as applied to modern industry appears to be one of the greatest handicaps in the efforts of the Russians "to overtake and surpass" the capitalistic countries.

The events leading up to this vast transformation have an enthralling interest. Many of them go back to the eighteenth century or even farther.

The "Europeanization" of Russia was begun in the reign of Peter the Great (1682-1725). Following a victorious war with Sweden, he annexed the Swedish Baltic provinces and built the new capital, St. Petersburg, which by its position brought Russia into closer contact with western countries. He promoted industry. He established the first Russian newspaper and a number of technical schools, including the Russian Academy of Sciences. He became the "creator of Russian medicine," as we shall see in Chapter XVII. But, despite his remarkable energy and his passion for efficiency, he failed to free his country from corruption.

The Russian mind is partly Asiatic, partly European, for the Russians are an imperfect amalgam of many races, representing civilization at various stages. Hordes of Tartars poured into Russia in the first half of the thirteenth century, and it was not until the fifteenth century (1480) that the Moscow princes threw off the Tartar yoke and the roles of Russians and Tartars were reversed.

Through a lengthy process of curtailing freedom, the peasants of Russia were, in the middle of the seventeenth century, completely attached to the land and the landlords. Called serfs, they were virtually slaves. The landlords' authority over them amounted practically to the power of life and death, and this almost unlimited power was abused quite often; cruelty was not uncommon. Individual serfs fled. to borderlands, while organized insurrections of peasants occurred and recurred at intervals. The great peasant revolts of Bolotnikov, Pugatchev, and Razin all were suppressed but were followed by new ones. Finally, in 1861, the peasants were released from serfdom. But the enactment did not provide them with free land. Many of them migrated into towns, where increasing industries called for their work. But the position of both workers (industrial) and peasants remained very near starvation, and an undercurrent of dissatisfaction steadily grew. Revolutionary doctrines appealed to the masses. But strikes were forbidden, and when they occurred they were suppressed as uprisings, by military force. The Tsarist police imprisoned and punished agitators mercilessly, often without trial. On the land the peasants' position was still semifeudal. They had to pay exorbitantly during long years for the small patches of land allotted to them, and there was pitiful poverty.

Immense contrasts were seen in prerevolutionary Russia. The Russian intelligentsia, a small minority of the total population, were highly educated and had a broad intellectual interest; among them appear great names in art and science. The governing class were notoriously corru.

During the nineteenth century a double current of influences conduced to the overthrow of the Tsarist regime. On the one hand, many of the educated classes, mostly outside of the official circles, were profoundly resentful of Russia's governmental corruption, and out of this intense feeling grew different revolutionary parties. On the other hand, the growth of the class of industrial workers, dissatisfied with the prevailing conditions of their life and inculcated with advanced social ideas, served to accumulate revolutionary material from the lower strata of the country. More and more peasants were sucked into the factory life of towns, and there they became tinctured with the advanced views of factory workers. Some of these visited other countries and learned how the workers in those more fortunate lands lived. The agitation for improved conditions of life increased, notwithstanding the ferocious activities of the secret police.

In the early years of the nineteenth century the so-called "Decembrists," mostly army officers who visited other European countries during the Napoleonic wars, made an attem to force reforms, but being unprepared and betrayed, they failed miserably. A number of them were executed and a still larger number exiled to Siberia by Tsar Nicholas I. Then came into existence, one after another, a number of political parties, formed almost exclusively from the educated classes. Certain of them were known abroad as "Nihilists," though none of them ever adopted that name. Among these parties were the Narodniki, i.e., populists, the party of the "Will of the People"; the party called Zemlia i Volia, or "Land to Peasants and Civic Liberties to All," and others. The aim common to all of them was the improvement of living conditions of the masses, peasants first of all.

One of the latest (1898) and best organized among radical parties was the Party of Social Revolutionaries, to which belonged a number of people who became prominent in the early stages of the Revolution of 1917. One group of the Social Revolutionaries advocated political terror as a means to combat the oppressors; they became known as the "Fighting Organization." This group, however, was not the first to advocate terror, as certain revolutionaries committed a number of political assassinations long before them. In 1881 Tsar Alexander II was assassinated; other victims followed.

The Rise of Marxism

Although the socialist ideas developed by Marx and Engels in the middle of the nineteenth century became popular among the Russians very early, the first Russian Social Democratic Party was organized by Plekhanov and others as late as 1897.

At its Second Congress, held in London in 1903, the Russian Social Democratic Party was split in two; a small majority, favoring more ardent revolutionary activity, became known as the Bolsheviks (from the word bolshinstvo, meaning "majority"), and the minority group, favoring a more moderate course, became known as Mensheviks (from the word menshinstvo, meaning "minority"). The energetic revolutionary policy was vigorously advocated by Lenin and the group of communists who were living in exile abroad. It was distinguished from evolutionary socialism by its will to revolution and by its advocacy of the "dictatorship of the proletariat." The Mensheviks, on the other hand, held that Russia was too inadequately industrialized to undertake a socialist revolution.

The "Bloody Sunday," as January 22 (old calendar, January 9), 1905, became known in Russia, when the troops killed or wounded 1,500 workmen and their wives who had assembled in the main square in front of the Winter Palace to present a peaceful petition to the Tsar, did much to fan the flames of dissatisfaction and revolutionary agitation, already accentuated by the disastrous defeat of Russia by Japan. There was extreme indignation among the workers; they started to organize groups for action, the first Soviets came into being, and the movement culminated in the autumn of the same year in a general strike, the first of the kind in history. This was in reality the First Russian Revolution. The rural population joined in the movement, seizing land from the landowners, organizing uprisings, looting, and committing arson. Under this pressure the Tsar acceed the counsel of Witte and others and conceded a Duma (Parliament) and granted a constitution. But the First Duma, being considered too "radical," was dissolved. The same fate met the Second Duma in 1907, and workers were almost completely disfranchised.

Forced underground, the revolutionary elements continued their work, while the situation in the country went from bad to worse. In 1914 the revolutionary activities became again very marked, and in July a general uprising was considered probable, but it was prevented by the outbreak of the war. In 1917 the patience of the people was exhausted; the horrors of the war, which seemed to be endless, and the misery of life, created by scarcity of manufactured goods and even of food products, promed the outburst of popular indignation which resulted in the February Revolution.

The first Provisional Government, headed by Prince Lvov, and those which followed it, under the leadership of Kerensky, represented the conservative, liberal, and mildly radical elements of the population. They failed to establish themselves solidly and were finally replaced by the Bolsheviks, headed by Lenin.

The transition from nonrevolutionary to revolutionary action in the progress of the Marxian philosophy was a turning point in history; and its success in Russia, if this proves to be permanent, cannot fail to have profound influence on the future of other countries, if in no other way, by inducing governments to hasten the ending of inequitable economic conditions.

The main argument in favor of the "Bolshevik Socialism" was that peaceful evolution to socialism could never be expected to succeed, owing to the supreme advantages enjoyed by the capitalists; and in fact this revolutionary movement succeeded in establishing order where its predecessors had failed.

Lenin's famous slogan, "Loot the loot," represented in part the ethics of Bolshevik methods for securing the ends of Bolshevism. It was by looting those "who had looted" that Lenin aimed to "give history a push." Democracy was not the aim, but communism secured by the instrumentality of the dictatorship of the proletariat.

Whether this dictatorship is entirely consistent with democracy need not detain us; but the following remarks by a highly competent observer may be quoted at this point.

In Current History, February, 1933, Sidney Webb says:

It is useless to discuss whether or not the constitution of the U.S.S.R. is what we choose to consider and to designate democratic . . . On this supreme judgment people in other countries will long continue to differ according to their bias and their information. All that need be said here is that great difficulty will be felt in convincing any thoughtful Soviet citizen, whether or not he is a Communist party member, that the constitutions of the United States, Great Britain, France, or Germany come nearer than that of the U.S.S.R. to securing what is usually meant by democracy, whether emphasis is laid on social equality or on the fulfilment of the popular desires or even on the general consciousness of consent to the actions of government.

But much struggle occurred before the constitution of the U.S.S.R. was successfully established; and we must briefly indicate the stages in this struggle which continued through years of internecine war, of pestilence, and of famine. It was not until December, 1922, that the Union of Soviet Socialist Republics (U.S.S.R.) was formed.

War Communism

The World War gave Lenin and his associates their opportunity. The influences in favor of revolution were all intensified. Thus Russia, as we know, was chiefly an agricultural country selling a large share of its foodstuffs to Europe, and receiving its manufactured goods from the rest of Europe and especially from Germany. This interchange had almost ceased during the war. In the first three years of the war Russia had suffered very severe losses both in men and materials, perhaps more than any other combatant nation, and she was already in the position of a defeated country. It was in these circumstances that the February Revolution of 1917 (March, new calendar) occurred, in which Tsardom was overthrown by relatively moderate revolutionaries. This revolution was rendered possible by the disintegration of the Russian Army, the greatest mutiny in history, and by the almost simultaneous rebellion against civilian government.

As early as in 1915 Lenin had written to his followers that the Soviets (or Councils) of the workers' and other deputies ought to become organs of the revolt and of the revolutionary authority. With the outbreak of the Revolution of 1917 the workers started at once to form their Soviets, and on March 12 (old calendar, February 27) they organized the "Provisional Executive Committee of the Soviet of Workers' Deputies" which was convened for its first session the same day and expressed its determination to acquire the exclusive authority over the State affairs. On the same day the "Provisional Executive Committee of the Duma" was also organized, and the two became rivals for the supreme power.

On March 15 (old calendar, March 2) the two bodies came to agreement regarding the general program and policy, which included complete and immediate amnesty, political (civic) liberties, elimination of all religious, social, and racial discriminations, democratic election for selfgovernment, and a promise to refrain from any steps in determining the future form of government before the convocation of the Constituent Assembly. The clause providing that every nationality inhabiting Russia should have the right of selfdetermination, which was submitted by the delegates of the Soviets, was defeated.

In other words, from the very beginning of the new regime, which was created after the abdication of the Tsar, the power became divided between the Provisional Government and the Soviet, and a struggle between them ensued. The three main issues of discord between them were : the agrarian problem, the war, and the liquidation of the economic crisis.

The Provisional Government was careful not to commit itself by. a definite attitude on any of these issues, but in April a ministerial crisis was brought about by the declaration of Miliukoff, then Minister of Foreign Affairs, that the Dardanelles and the Bosphorus ought to come into Russian possession.

Unable to liquidate the duality of the supreme power, either by persuasion or by force, the Provisional Government placed its hopes in a coalition. The Soviets, which were dominated at that juncture by the moderates, acceed the invitation to join the Cabinet, and a new government was formed, which included, besides Kerensky (as Minister of War), a few other socialists. Still hoping to prevent the social revolution, this new Provisional Government decided to bring about certain reforms, and even demonstrated its willingness to hasten the convocation of the Constituent Assembly. At this time was heard the slogan, "Peace with no indemnity, no annexations," and the plan for an interallied conference to revise the aims of the war was fostered.

The offensive started by Kerensky to satisfy the Allies was futile in results and very costly in human lives; and the growing misery of life (scarcity of food, almost complete collapse of the system of transportation, etc.) spurred the discontent and encouraged the radicals to more revolutionary action.

The rift between the Government and the Soviets became quite acute in July. On July 21 (old calendar, July 8) Kerensky became Prime Minister, after Prince Lvov had resigned in protest against the plan of immediate agrarian reform advocated by Chernov and other socialists.

Maneuvering between opponents of various shades of political opinions and class interests, the Kerensky Cabinet on September 14 (old calendar, September I) declared Russia to be a republic. Early in October the Cabinet was reorganized again on the principle of coalition; and among other measures it decided to appeal to the Provisional Council of the Republic (as the Pre-Parliament was called by some people). In the agenda was included the early convocation of the Constituent Assembly. But it was already too late. The moderate elements lost much of their support through numerous compromises to which they agreed in the earlier days ; the "Rights," always opposed to Kerensky, became violently so after the Korniloff affair, but they had no backing from the masses in their attems to restore the old order and to crush the Revolution.

The radicals, headed by Bolsheviks, came to the front, and after having subdued the very ineffective resistance of the Provisional Government, which was deserted at that time by most of the troops and not supported by any large organized groups, the Bolsheviks seized power and so ended the Kerensky regime on November 7 (old calendar, October 25).

Soon after the advent of the Bolsheviks, in March, 1918, peace with Germany was signed at Brest-Litovsk, but this "peace" was not the end of war for Russia. A series of wars, foreign and civil, began. The Bolsheviks found themselves at war with Russian opponents of their policy, aided at first by troops of the countries which had been Russia's allies against Germany, including French, American, and British forces.

Into the details of this unhappy warfare we need not enter. But in addition Russia was torn between supporters and opponents of communism as represented by the Bolsheviks, in open warfare against each other. When internal fighting ceased, and to some extent during its continuance, epidemics of typhus, smallpox, and cholera swept over Russia, affecting almost one fifth of the entire population. The events of these years have been well summarized by Dr. W. H. Gantt.(1) They included a threeyear famine with acute food shortage for nearly half the total population, during which it is stated that eleven million Russians were being fed by relief from America and England, and to some extent from other countries.

It was during the three war years, 1918-1921, that the application of communism in its strictest form was attemed. The Communists enforced their national policy with unexampled intensity and ferocity. Their difficulties and failures will be further mentioned when we outline industrial and agricultural changes.

Exiles, imprisonments, and executions were frequent, as might be expected when one extreme faction replaced another in a country which was semi-Asiatic and largely feudal, and in which revolutionary doctrines had been smoldering for a century. In Dr. Gantt's words:

The sumtotal effect of these long years of war, revolution, famine, and disease has been obliteration of nearly every custom, form of society, and institution that existed under the old regime. But life pushes, and out of all this a regeneration has slowly begun, astonishingly rapid in some directions and painfully slow in others.

Communism applied in this drastic and rapid fashion created difficulties on a large scale, especially in its application to agriculture. These difficulties were so great that Lenin in 1921 replaced fullblooded communism by his New Economic Policy (NEP) which was a temporary strategic retreat permitting some private trade.

But in the main, the Communist position became firmer, and in December, 1922, as already stated, the U.S.S.R. was formally established and consolidated.

(1) In "A Review of Medical Education in Soviet Russia," in the British Medical Journal, June 14, 1924.