Anna J. Haines

Dr. N. A. Semashko

The Commissar of Health

Source: Health Work in Soviet Russia
Publisher: Vanguard Press, New York, 1928
Transcription/Markup: Brian Reid
Public Domain: Marxists Internet Archive (2007). You may freely copy, distribute, display and perform this work; as well as make derivative and commercial works. Please credit “Marxists Internet Archive” as your source.

Chapter IV

TO THE leaders who are making history in the Russia of today, institutions, ideas, and people in collective masses constitute the interesting and determining factor in life, but to Americans, a greater value always seems inherent in the individual. If Nikolai Alexandrovich Semashko had accomplished in any other country what he has done in Russia, he would probably be a well-known figure in the medical circles of the world. The initiation and growth of the Commissariat of Health from nothing to its present enormous size is a monument to Dr. Semashko’s mental energy and tact in handling men.

Before the Revolution there had been no central health organization although several different departments like the army and the railroads, were doing unrelated health work. In general, doctors, like other professional men in Russia, were not sympathetic to the workers’ revolution, which deprived them of their property and private practice, and offered them in exchange hard work and low salaries as state officials. Out of this disaffected personnel and unorganized material setting Dr. Semashko has created an integrated Department of Health with a loyal group of men and women carrying out its complicated details over a wider area than that which any other state controls. He has been able to do this because everyone recognizes the sincerity of his interest in the health of Russian people, whether they be Slav or Semite, Communist or Cossack, peasant or professor. He is everywhere recognized as a party man of old standing, but in his appointments and his support of efficient fellow-workers he seems never to question anyone else’s politics. Therein is probably the secret of his having gained the respect and loyalty of so many of the medical profession in Russia to whom the theory of Communism is still abhorrent.

Dr. Semashko was born in the Orlov Gubernia in 1874. Growing up in the country he laid the foundation for a rugged good health which many radical leaders of Russia have lacked. Another characteristic which one senses on meeting him, and which was probably developed in his early years close to primitive conditions, is a quiet self-reliance, a practical ability to take care of himself and of others in any emergency, and this also is not a characteristic of all Russians. It is told of him that he showed very early much sympathy for the peasants and an intolerance for the way in which they were treated by the landowners. Once when he was quite a little boy he doubled his fists and started to fight a local official who had sent a young peasant, a friend of his, to jail because he had outraced the official’s horse on the road. And yet this sympathy with the peasants’ joys and sorrows never became sentimental. Perhaps from his very closeness to them he learned their weaknesses as well as their strength—their very human devotion to people rather than to ideas or ideals, and that selfish individuality bred by generations of wrestling single-handed with nature which makes them so uncomprehending of the meaning of socialism. Semashko never became a Populist, although many educated people of his generation, inspired by Tolstoi, gave themselves to this movement.

The nearby schools gave him his early education—a rather formal and bookish education under strict, almost military, discipline. During the last years of his course at the gymnasium (a school which corresponded to our high school and junior college years combined) he sought mental stimulus outside of the state supervised curriculum. With a number of other eager young students he organized a club for the study of political and social questions. Although their attitude was not very radical the young men took themselves seriously, and since those were the days of suppression of free thought and speech their professors also took them seriously. When the existence of the club was finally discovered most of the members were expelled from the school with a document prohibiting their entrance to any university, but Semashko was luckier than his fellows. He was an excellent student and had stood at the head of his class for several years, so that he escaped to the medical school of the University of Moscow with only a severe reprimand.

Coming to Moscow in 1893 he found a great many other students full of the same dissatisfaction with current political and social conditions as himself. This more mature group of young people was not content with a passive study of problems, but carried on a campaign of active propaganda. Reading clubs were organized and libraries of illegal books circulated among the intelligentsia, and much radical literature secretly distributed among the workers. Nikolai’s father had died while he was still at school and his university education was obtained by his own efforts, this necessity to work making it all the more difficult for him to find time to participate in the activities of radical circles. By his third year, however, he was already well known, and after some slight clash between the students and the police he was imprisoned for some months, together with several other leaders. The regimen was severe—small dark cells, no exercise, no reading matter, but finally they prevailed on the warden to give them one book. On unwrapping it they found it to be the Bible, in French. However, the Bible is more interesting than many would believe, and besides, Semashko became a very good French student during the next three months. At the end of that time he was exiled to his old home in the Orlov Gubernia, to be under police surveillance for a year and a half, and permanently expelled from the Moscow University.

While in the country he read omnivorously in science, history, philosophy and political economy, and also conducted a Sunday-school for workers on the railroad. These Sunday-schools were very popular and a legal means of educating illiterate adults, their political, social or religious significance depending largely on the personality of the teacher. By this time Semashko was teaching Marxian Socialism in his school. It is significant that he chose railway workers, and not his old friends the peasants, for pupils.

In 1897 his exile was over and he immediately entered Kazan University in order to complete his medical course. Again throwing his energy into radical channels we find him organizing secret political clubs among the city workers. In these activities he met and became the friend of Rykov, the present prime minister of Russia. Also he met an enthusiastic young woman student burning with zeal for social service, who became his wife. In those early days she helped him with his clubs and with the underground distribution of literature, until in 1901, during a sympathetic strike of the students on behalf of some poorly paid factory workers, Semashko was imprisoned as one of the leaders of the demonstration. After several months’ imprisonment he was released, but was refused permission to enter the city of Kazan or any other center of commerce. Owing to this prohibition he settled in the suburbs of the city and with considerable difficulty finished his medical studies and took his final examinations.

His first independent medical practice was in the Samara Gubernia, but in 1904 he moved to Nizni-Novgorod where he immediately became active in underground political work. The next year he was arrested again, and imprisoned for about a year. Having now the reputation of being a dangerous radical he knew that he would be so watched that further activities would be almost impossible, and on his release from prison he left Russia to join the group of emigrant Russians in Geneva.

Plekhanov, his mother’s brother, was there the leader of the Menshevik Socialists and as such distinctly cold toward his Bolshevik nephew. But there also he met and became the personal friend as well as the co-worker of Lenin. Pamphlets and journals were prepared here for distribution in Russia and other countries; party policies were fought over and adopted in semi-secret all-night sessions. It was a frugal, feverish life, exceedingly intellectual and unpractical, but very satisfying to the eager spirits of the participants.

In a few years the split in the Socialist Party was so serious that the Bolshevik group under Lenin’s leadership moved to Paris and the Semashko family joined them there, settling in the suburbs where their home and their children provided happy recreation for the serious idealists who were the parents’ friends. Dr. Semashko supported himself by his medical practice, but found time to be secretary of the Foreign Bureau of the Central Committee of his party and to devote much energy to the founding of a school for workers in Paris, and to speak publicly for social insurance, and for the eight-hour day. By 1913 the group of agitators were under such suspicion from the French government that it was necessary to find another home, and this time Dr. Semashko left the central cities of Europe for the Balkans where he worked as a doctor more or less obscurely until the March Revolution in Russia.

As soon as possible he tried to reenter Russia, but found that the Kerensky government was not especially hospitable to such a well-known Bolshevik as himself. He was detained at the frontier for several months, but finally entered Moscow in September and resumed both his medical and his political activities. He became a councilman for the Zamoskovresky ward, took part in the October Revolution and immediately afterwards was made head of the Moscow City Health Department.

This was an unorganized jumble of private hospitals without funds on which to operate, a few wretchedly equipped public hospitals and a dwindling staff of disgusted doctors, feldshers and nurses. While he was trying to bring some cohesion and plan of work to this mass of material the whole Soviet government moved down to Moscow from Petrograd, and almost immediately Lenin asked his old friend Semashko to draft a scheme for a Department of Health on a nation-wide scale.

To one who had been thinking in collective terms for so many years the paper plan for such a department was not difficult. The really great accomplishment has been to vitalize the plan. Socialized medicine has never been and cannot be a source of revenue to the state; on the other hand, like a public school system, it is tremendously expensive, and from the beginning even some of the Communists could see it only in that light. Semashko had Lenin and several others behind him in the fight for the recognition of the People’s Commissariat for the Protection of Health, but after it was created there remained the problem of making it work. Here Dr. Semashko was more alone, for the majority of people with whom he had to deal belonged to the aristocraticminded, old medical profession among whom Lenin’s approval was not a conspicuous help. The health conditions in Russia at that time, though exceedingly bad for the country, were perhaps of some assistance to the newly established Commissariat. Epidemics of typhus, cholera and malaria were raging; typhoid fever, smallpox and scarlet fever were increasing. In such a crisis it was easier to appeal to any physician’s loyalty to his profession, and also easy to make everyone appreciate the necessity for state control of the medical situation. By the time the worst years of plague and famine were over and a more constructive policy of prophylactic work brought into consideration, the Commissariat of Health was firmly marching, and the Commissar was granted by all to be a wise general of forces.

From 1922 to the present time have been years of gradual expansion and consolidation. Formerly famous specialists found themselves again at the head of their profession, irrespective of their political beliefs—that is, so long as they gave their scientific activity their whole attention, which the majority wanted to do. Dr. Pavlov is head of the Institute for Preventive Medicine in Leningrad, Dr. Speransky director of the Institute for the protection of Motherhood and Infancy in Moscow, and they with many others have wider opportunities and facilities for research than was possible in their former days of private practice. There are positions open to every doctor in Russia; two women physicians at least who were formerly nuns and who still wear their religious costume are now being employed by the government.

Much of the doctors’ willingness to work when people of other professions have sabotaged, much of the tolerance toward them on the part of a somewhat politically suspicious government is due to the general confidence in Dr. Semashko. Of all the Commissars he is the easiest to approach, the only requirement being that one put into writing one’s reason for seeking an interview with him, and then wait one’s turn in an ante-room decorated with signs “Smoking Not Allowed in the Offices of the Commissariat of Health”, “Do Not Shake Hands; It Is a Waste of Time and May Spread Disease”—slogans which are directed against two of Russia’s favorite habits. The Commissar himself is short, fat and jovial, definite in his questions and answers, showing a close and realistic knowledge of the many details of his department. One comes away from an interview feeling that one has been face to face with one of the real builders of the new Russia.