Tasked in 1918 as People’s Commissar of Health, Doctor Nikolai Semashko directed the pioneering public health care carried about by the Soviets in the first decade of the Revolution. Serving as Health Commissar until 1930, the preventative, child-focused, dispersed, and research driven system devised by him, the ‘Semashko System,’ would later be taken up in the Cuban Revolution where it remains the basis of their health programs today. In this report, Semashko reports on the Commissariat’s first two years of activity, done in the most arduous circumstances imaginable. Of particular interest will be the response to the multiple epidemics that raged through the former Empire, including the Influenza Pandemic of 1918-1919.

‘The Work of the People’s Commissariat of Health’ by Nikolai Semashko, People’s Commissar of Health from Soviet Russia (New York). Vol. 3 No. 12. September 18, 1920.

GREAT difficulty has attended the carrying out of the work of the People’s Commissariat of Health. Epidemics, the general disorganization left by the imperialistic war, which was much increased by the civil war, and food difficulties, were among the serious impediments met with in the work of the institutions concerned with public health. One epidemic followed close upon the heels of the other, requiring the entire attention of the medical staff, and, as a result, even the most essential reforms and improvements were capable only of partial accomplishments, if they did not have to be postponed altogether.

The year 1918 was marked by a cholera epidemic. The People’s Commissariat of Health undertook the most energetic measures to stop this epidemic and, in spite of very difficult working conditions, the outcome was a success: only 35,619 cases of cholera were recorded in 1918, while the previous cholera epidemic, in 1908, had more than 200,000 such cases. In the autumn of 1918, the “Spanish Influenza” swept over the country; more than 700,000 cases were recorded. In addition to the practical measures, the People’s Commissariat of Health also undertook a far-reaching scientific study of this as yet little known disease; scientific staffs were organized and instructed to gather all possible information concerning the nature and the types of the disease; meetings were held and much material was collected. Now a special commission, including many experts, is digesting this material and preparing it for publication.

After the Spanish influenza came the typhus. This epidemic began in the autumn of 1918 and reached its climax in the Spring of 1919. During the eight months ending with July, 1919, the total number of cases of typhus registered was 1,299,263, of which between eight and ten per cent ended fatally. The cities, whose food situation was particularly grave, were most affected.

In July and August the typhus subsided, only a few cases still being recorded. In October, and more particularly in November and December, the typhus again began to increase. Its revival occurred about the time of the advance of our army in Siberia, and was due to the fact that all the districts that were being evacuated by the Whites were full of typhus. As a matter of fact, it was the friendly relations between our soldiers and the local population and the war prisoners that aided in spreading this epidemic in the army. Serious efforts had to be put forth to prevent it from reaching the rest of the country. When the epidemic subsided in the East, and our army was advancing in the South, the disease began to infiltrate from the South; other epidemics encountered by the advancing army were: intermittent fever, very serious typhoid fever and cholera epidemics. We did not succeed in putting down these South Russian epidemics until late in March, 1920. Other sections of the country had already been cleared of it by the beginning of the same month. No epidemic appearance of typhoid fever were still to be observed in May.

There was no cholera in the summer of 1919, only a few sporadic cases being recorded.

The People’s Commissariat of Health also paid special attention to smallpox infection; from November 1, 1919, to July, 1919, there was 81,851 such cases registered. The most energetic measures were taken by the People’s Commissariat of Health to oppose this epidemic. Former governments had never dared attempt to take such measures; by decree of the Soviet of People’s Commissars of April 16, 1919, obligatory vaccination was provided for in Russia. Large credits were allotted and vaccine distributed with the purpose of exterminating this epidemic. Smallpox is now nonexistent.

Details of the Soviet Medical System

Owing to the extremely hard conditions of work, already suggested above, the People’s Commissariat of Health could never have carried out its duties if the Revolution, which so completely altered the course of the Russian national life, had not also made considerable changes in this field of activity.

The great alteration in question was the complete reorganization of the public service. All medical services were united into a single institution which now exists as an independent department, or the People’s Commissariat of Health.

Already before the war the European medical press was discussing the possibility of such a department. In 1913, a well-known French medical writer, Mirman, in one of the articles contributed by him to “Hygiene” asked what would be the source of information to answer a French deputy who might ask what measures the French Government undertook in order to fight phthisis, and arrived at the conclusion that four ministers would have to answer the question, the Ministers of Labor, Agriculture, Interior, and Public Instruction, possibly, in addition, the Ministers of War and of the Navy. Of course, the sanitary efforts of the hygienic service among various institutions produce clashes and endless expenditures of labor and funds. “The organization of a Department of Public Health,” writes Mirman, “would bring order into this chaos.” The honor of having established the first Commissariat of Public Health belongs to Soviet Russia. Furthermore, such unification was a necessity brought about by the situation, and made possible the task of carrying out a health service at all, by coordinating the work of the military and civil medical services, avoiding reduplication, utilizing in the most economic manner the limited medical staff (reduced by the mobilization and by the epidemics) and the very small supply of medicaments (which could not be increased owing to the blockade).

We see, therefore, that the creation of the People’s Commissariat of Health is important not only from the standpoint of principle, but also from the practical point of view.

There is an additional factor which much facilitated the work of public health. It is the watchword set up by the People’s Commissariat of Health, which has been strictly followed from the very outset: “the workers themselves must take care of their health.”

Everyone understands that in Russia all branches of government, including therefore the Commissariat of Health, are in the hands of representatives of the workers and peasants: “the Soviets of Workers’, Peasants and Bed Soldiers’ Delegates.” But the watchword of the Commissariat of Health means more than this. It means particularly that a great deal of assistance is received in the daily work of the Commissariat from the people themselves. In explanation, let us mention the Workers’ Committees to Combat Epidemics, established in 1918 by the Soviet of People’s Commissars. These committees functioned not only in the cities, but also in the larger villages, assisting the local sections of the People’s Commissariat of Health. During typhus epidemics, the duties of such committees consisted in inspecting the baths, the supply of soap, cleanliness of lodgings, especially of public institutions (stations, jails, boarding houses, etc.), and in spreading among the population correct information and advice on hygiene. Such committees are appointed in all the important districts of large cities; the elected have representatives in the factories. The assistance of women (workers and peasants) is particularly desired, for, being housekeepers, it is easy for them to teach the population habits of cleanliness. We may say without exaggeration that the epidemics of typhus and cholera were stopped chiefly by the assistance of the workers’ and peasants’ committees. But this is not all. Not a single important problem has been carried out without the assistance of the workers. The question of systematic measures to combat social diseases, such as phthisis and venereal diseases, was discussed with the representatives of trade unions, Women’s Organizations, Young People’s Unions, etc. The organization of sanitary protection for workers was carried out by special inspectors, elected from among the workers themselves: inspectors of dwellings were organized in the same way. Not only from the standpoint of organization, but also from the standpoint of its practical value, this system was of great importance. It is a fact that the People’s Commissariat of Health can only overcome the numerous difficulties met with in this impoverished and devastated country by assuring itself of the support and assistance of the population.

The third peculiarity of the Soviet medical organization is this: it is now operating on an entirely different social basis. Formerly, necessary sanitary measures for the benefit of the poorer classes always met with obstacles. For instance, sanitary protection of labor in factories always interferes with the profit of the capitalists. Motherhood and childhood could not be fully protected, even though such protection may be provided for, owing to the merciless necessity of increasing the production of the plant. Private property rights also interfered with the improvements of housing conditions, etc. In Soviet Russia, sanitary reforms do not know such obstacles.

The above circumstances played a very important part in combatting the so-called social diseases. The name “social disease” was derived from the social conditions in a capitalistic state, as even the bourgeois medical service recognizes the fact that diseases, such as phthisis and venereal diseases, are an outcome of these conditions.

The betterment of the economic conditions of the working class, the abolition of the system of exploitation, the establishment of protection of labor, motherhood and childhood — all these measures formed a strong foundation for success in combatting social diseases, this evil of humanity.

Purely curative measures, however, are only one of the links in the long chain of measures for combatting tuberculosis and venereal diseases. A great deal of work has been done in this field: in the year 1919 we had 17 summer sanatoriums with 876 beds; 54 permanent sanatoriums with 4,750 beds; 5 infirmaries for the tuberculous, with 310 beds; 5 children’s sanatoriums with 280 beds and 9 dispensaries.

This summer (1920) beds are installed much more rapidly, as large private estates are used for this purpose, and there is, therefore, sufficient reason to believe that at the end of this year the number of beds will have increased fifty per cent.

For combatting syphilis alone, 3,363 special beds and 29 ambulances were available in the period from January 1, 1919, to May 1, 1920, in addition to 11 laboratories performing the Wasserman test.

In addition, the work of instruction in hygiene has been directed very methodically along the line of combatting these social diseases, thus making the fight particularly against infantile tuberculosis and syphilis effective. Also, the protection of motherhood and infancy has attracted particular attention on the part of the Soviet Government. At present, the following institutions are available in Soviet Russia:

What the Soviet Government Has Done for Public Health

In examining the results attained by the People’s Commissariat of Health, the difficult conditions under which this work has been carried out must again be emphasized. Numerous diseases were called forth by the war and by the starvation conditions. Under these awful conditions, which are serious even for people in good health, it was impossible to employ good, systematic treatment. It was only the methods introduced by the Soviet Government that made it possible to move effectively against these conditions.

We have spoken above of the work done in sup- pressing epidemics; the money spent in this endeavor during one and a half years by the People’s Commissariat of Health was over one milliard rubles (about 1,200,000,000 rubles). Never before had so many patients been admitted to hospitals shortly after their infection.

At present there are 150,000 special beds for civilians suffering from epidemics. In addition, there are 250,000 beds for soldiers.

The organization of treatment has made great progress. The report of the All-Russian Conference of Health Boards shows that during two and a half years the number of treatment beds for civilians increased forty per cent (we must point out that the figures include only permanent beds in therapeutic, surgical, special and other hospitals; special beds for the infected, as above indicated are not included); there are now four provincial physico-mechanical-therapeutic organizations at Kazan, Saratov, Orel, and Kostroma. No fee is taken in any Soviet hospitals or medical institution for treatment. The ambulatories and the hospitals deliver medicaments free of charge. The drug stores are nationalized and all medical goods are distributed in the most economic and systematic manner.

Special forms of medical attention are perhaps best illustrated by the example of the development of dentistry.

Before October, 1917, free dental ambulatories were very few in number and were found only in the large cities, particularly the capitals. By May 1, we already had 1,406 free national dental ambulatories, uniformly distributed throughout the Republic, including even institutions in villages, which employ 1,776 dental surgeons for free dental care of the population. In addition, 160 dental ambulatories have been organized in the Red Army, for which purpose 1,500 dentists have been mobilized. There is also a free dental ambulatory in each provincial capital. The expenses for the organization of dental treatment in 1920 are about 352,000,000 rubles.

The government has been particularly effective in the work done in health resorts. Before the October revolution the health resorts were under the direction of various departments and institutions, such as, for instance, the Ministry of Trade and Commerce, Home Office, The Irkutsk Mountain Department, local government of the Caucasus, military direction of the Cossack Army, and even the clergy. At present, however, all health resorts without exception are under the direction of the People’s Commissariat of Health. Formerly, health resorts existed only for the rich; now not only treatment, but board and lodgings at these health resorts are at the expense of the government. For 1920, the estimated expenses allotted for the maintenance of health resorts are about 2y 2 milliard rubles.

At resorts where formerly there appeared the members of a capitalist society in order to cure their bloated stomachs and gouty limbs, the working people are now restoring their health. According to the statistics of one of the big health resorts, that of Lipetzk, the patients were distributed last year as follows: Workers and working members of the intelligentsia, 70 per cent; Red Army soldiers and invalids, 25 percent ; others, 5 per cent. The People’s Commissariat of Health has made considerable efforts to broaden the work connected with health resorts, and now that the Crimea has been cut off by the White Guards, we have in Central Russia 20,000 beds at these health resorts, in Ukraine 35,000; in the Caucasus 40,000; on the coast of the Black Sea, 30,000; in Siberia, 18,000; total, 143,000 beds.

Special attention is paid to health in general. Free feeding of children below the age of sixteen was decreed by the Council of People’s Commissars. Thousands of children in winter, and many more in summer, enjoy a stay in the children’s colonies and sanitariums, for which purpose the estates of the former landed proprietors are used. The People’s Commissariat is particularly interested in children. It is about to install special institutions, to be called “Institutions for Defective Children,” in all provincial capitals. The decree of the Council of People’s Commissars stipulates that children below the age of eighteen are not subject to trial in court. Their cases are examined by a special committee composed of officers and teachers, which decides either to send them to an educational or a medical institution of the People’s Commissariat of Health, or the People’s Commissariat of Instruction.

What Could Not Be Done

There are many problems still remaining unsolved in spite of the two and a half years of work and the results which have been already obtained. Under the rule of the czar, every inhabitant paid about one ruble in health taxation. Of this sum ninety-five kopeks went for purposes of general treatment, and only five kopecs for sanitary prophylaxis. In other words, all effort was directed toward curing diseases, while only a very insignificant labor was devoted to their prevention. Furthermore the appropriation for health protection was quite insufficient. Of course, this ridiculous condition continued even under the Kerensky Government, where more attention was given to cure than to prophylaxis. But all this now is changed. More than sixty per cent of the appropriation of the People’s Commissariat of Health for 1920 (the total appropriation for the Commissariat runs into several milliards) will be spent for sanitary prophylaxis. The People’s Commissariat of Health will consider it its duty to combat unsanitary health conditions, ignorance, dirt, lice, those wretched vestiges of Czarism and slavery; the Commissariat will do all it can to accustom the people to cleanliness, to improve the sanitary conditions of living, particularly the housing conditions, to put an end to the terrible infant mortality (under the Czar one child out of every four died before the age of one year), to improve the medical systems and make it really accessible to the population and of a nature to be useful to the population. Such are the aims of the People’s Commissariat of Health. The economic disorganization, the war and the mobilization, to be sure, have offered very serious obstacles to the full realization of this program.

Soviet Russia began in the summer of 1919, published by the Bureau of Information of Soviet Russia and replaced The Weekly Bulletin of the Bureau of Information of Soviet Russia. In lieu of an Embassy the Russian Soviet Government Bureau was the official voice of the Soviets in the US. Soviet Russia was published as the official organ of the RSGB until February 1922 when Soviet Russia became to the official organ of The Friends of Soviet Russia, becoming Soviet Russia Pictorial in 1923. There is no better US-published source for information on the Soviet state at this time, and includes official statements, articles by prominent Bolsheviks, data on the Soviet economy, weekly reports on the wars for survival the Soviets were engaged in, as well as efforts to in the US to lift the blockade and begin trade with the emerging Soviet Union.

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