Red Medicine: Socialized Health in Soviet Russia


THE genesis of this sketch of medical and public health administration in Soviet Russia(1) is soon stated.

Sir Arthur Newsholme had undertaken and carried out for the Milbank Memorial Fund an investigation into the relation between the private practice of medicine and the various activities of public authorities and social workers in medicine, including public health administration, the results of which were embodied in three volumes published under the auspices of this foundation.(2) These volumes consisted in the main of an account of actual methods and procedure of medical practice in the chief European countries, with comment on them.

In a fourth and independent volume the problems involved in the various points of contact between private and public medicine were critically discussed in the light of the international facts previously collected, and certain definite conclusions were drawn as to desirable action for future guidance.

In this study of medicine and public health in European countries Russia had not been included; in part because the author, being solely responsible for the international investigation, was obliged to restrict his review within practicable limits; and also because at that time he scarcely thought that Russian experience was likely to give important guidance as to the direction and character of advances and reforms needed in American or English communities; for these had a history of advanced and widely diffused medical and social work not shared by Russia. Later inquiries threw some doubt on this a prioriconclusion; and a joint visit of inquiry was then initiated on behalf of the Milbank Memorial Fund. The dual personnel of this inquiry has given the advantage of both medical and lay approach to the problems concerned. Both inquirers have had extensive experience in social investigations.

The results of this joint inquiry are embodied in the following pages. It could scarcely be that two independently minded men, looking at Russian problems, each from his own viewpoint, should entirely agree as to the wisdom or expediency of all the remarkable new developments of medico-social policy which the U.S.S.R. has created, especially on their social side; and as the chief value of these pages lies in the authors' observations and not in their individual opinions, their remarks are in the main objective in character.

Although we were in Russia only during August and part of September, 1932, we had special facilities accorded to us which enabled us during this relatively short period to sample and to some extent to appraise public health and medical work in the chief towns of the U.S.S.R., from Leningrad to the Caucasus, i.e., from its most northerly great city to its southern extremity.

One of us had introductions from Lord Passfield (Sidney Webb) and other Englishmen; the other a special letter from Senator Borah, then Chairman of the Committee on Foreign Relations of the United States Senate. This led to our being received by Mr. Umansky of the Foreign Office and Dr. Vladimirsky, Commissar of Health for the R.S.F.S.R.;(3) and on our way south by steamer on the Volga, and afterwards in Georgia and in the Crimea, we found that the introductions and instructions sent from the Foreign Office and Commissariat of Health opened every door to us. For instance, at each town at which our steamer stayed for a few hours on our four-day trip down the Volga, the local Commissar of Health, or members of his staff, met the boat and we were taken to inspect the chief medical institutions of the place. Opportunity was thus also given to obtain details of local medical administration, which are set forth in subsequent chaers.

Our description of what has been accomplished in medical administration may easily be regarded as giving a distorted and too favorable view of medico-social developments in Russia. Our statements are open to this accusation, which has been similarly urged against the particulars given in the many earlier volumes which have described personal observations made by foreign visitors to the U.S.S.R. Doubtless we were shown the best of what exists in Russia. The same would hold equally good if any foreign visitors came with influential introductions to inspect medical and public health work in England or America. We realized all the time that we were seeing the best that the U.S.S.R. had succeeded in developing. But when this best was seen repeated in many cities visited by us, and when it was everywhere frankly stated that their arrangements were not yet complete, that the dearth of doctors made more adequate provisions difficult for a few years; and when we were told openly of the great difficulties which were being experienced in extending the medical provisions of cities to the vast rural communities of Russia, and of the only partial success hitherto achieved in overcoming these difficulties, we were forced to the conclusion that we were not being victimized by a "window-dressing" display; and that, indeed, a marvelous reformed and extended medical service had been organized in Russia, the methods and procedures of which the rest of the world would do well to study.

It will be noted that we confine our remarks on administration, in the main, to medical provisions; and that in regard to other branches of social work-education, for instance-we can give only slight information; though in our earliest chaers we have thought it wise to give a somewhat detailed account of social and economic life in Russia, in order that its medicine of today may be seen in its natural setting. For the same reason, we have introduced a short historical statement of the steps leading up to the formation of the Soviet Republics.

Although we seldom stayed in a town more than two or three days, we had the great advantage of immediate access to the chief medical officials, and as a rule searching inquiries into details of administration were fully and, alas! too profusely answered; and we had little reason to suspect that information was being withheld or given with a markedly greater desire to "put the best foot forward" than would have been experienced in our own countries.

It was our object to obtain accurate information, and the question naturally arose: Were we getting it? As we necessarily depended on interpreters, we had not the clue which would have been in our hands with even the most elementary knowledge of the Russian language. We had, however, the check given by intimate knowledge and experience of the problems of our inquiry; and this knowledge every day enabled us to avoid many misapprehensions.

There were two further difficulties. Our precise and concise questions commonly led to a protracted disquisition in answer; and at the end of it the interpreter's version often appeared to be a meagre representation of these outpourings. This we tried to avoid, by urging the interpreter to obtain information and to give his translation of it in sections with intermediate pauses; but success in this direction was trifling. A final difficulty was that each interpreter was a Government official, sometimes a member of the Communist Party. Was he, when interpreting, giving an unvarnished statement, or was he giving us an admixture of intentions and accomplishments, with a slurring of statements of serious defects? We think this slurring may sometimes have occurred; but we had opportunities for correcting these errors by our own observations and by comparison of statements made in successive places visited by us.

In the first two chapters is given an account of our wanderings and visits, with short descriions of what we saw. Much of it does not deal directly with medical problems; but indirectly it does, for the medical problems and their partial solution can only be fully understood and appreciated in the light of knowledge of the Russian people; and we always need to remind our-selves that solutions of medical and other social problems which are appropriate for Soviet Russia may need much modification in the circumstances of life of the populations of Britain and the United States.

This point applies especially to methods of control and administration of medico-social work. The workers (that is, industrial workers) and peasants of Russia's vast population of one hundred and eighty-two races represent on the whole a more primitive and simpler civilization than that of western countries; and when one recollects this fact, one is filled with wonder and astonishment at what has been accomplished in so short a time. But it does not follow that in countries in which local and central government has for long been elaborately organized, similar results could be obtained in exactly the same way, even though the main principles are identical. But on this point our summary in the last Chapter should be read.

In concluding this introduction we claim that in making our investigations we had no previous bias, except some measure of scepticism as to the possibility of the western world deriving useful lessons from Eurasia. We belonged and still belong to neither of the schools satirized by MacFlecknoe in a recent number of The New Statesman and Nation:

"The sights that X selected
Bore out what he expected-
Great factories rising;
An enthusiasm surprising
For welfare and education;
A New World in formation
Much better than the Old-
Just as he had foretold."

While in similar manner

"Mr. Y saw what he expected-
Breakdowns in transportation;
A growing indignation
With the Communist oppression;
A steady retrogression
To chaos, bloody and red-
Just as he had always said."

We place ourselves rather among those

"Who believe NO `Truth about Russia'
Which harnesses every fact
To a formula exact;
And proves, in the end, to be
What the writer had wished to see."

(1) In this book the terms Russia, Union of Soviet Socialist Republics, abbreviated U.S.S.R., and Soviet Union are used interchangeably. The authors are, of course, aware that officially there is no longer any government known as Russia.

(2) International Studies on the Relation Between the Private and Official Practice of Medicine, with Special Reference to the Prevention of Disease. London; George Allen & Unwin; Baltimore, Williams & Wilkins Company, 1931, 3 vols.

The countries surveyed are: (Volume I) The Netherlands, Denmark, Sweden, Norway, Germany, Austria, and Switzerland; (Volume II) Belgium, France, Italy, Jugo-Slavia, Hungary, Poland, and Czecho-Slovakia; and (Volume III) England, Scotland, Wales, and Ireland.

A separate volume, entitled Medicine and the State. London, George Allen & Unwin; Baltimore, Williams & Wilkins Company, 1932, reviews the entire subject, with a careful consideration of the general principles underlying medical problems.

(3) The Russian Socialist Federated Soviet Republic, or "Russia Proper," one of the seven constituent republics of the Soviet Union. It contains about 70 per cent of the population of the U.S.S.R.