Socialized Service

U. S. doctors last week received a close-up report on state Medicine in finest flower. Although the reporters, slim Sir Arthur Newsholme of England and portly Secretary John Adams Kingsbury of the U. S. Milbank Memorial Fund, were biased in favor of state conduct of medicine in general when they visited Russia last year, they were willing to find faults. They found few, they report in Red Medicine.* Those few are mainly due, they believe, to the vast territory and population which Soviet State medicine is trying to cover. Principal findings:

The indisputable right-of-way through Soviet life belongs to the production of farm goods, industrial goods and children. When a child succeeds in getting born his after-care is guaranteed by the state. Mothers are encouraged to have their children nurtured and trained by the state. Working women, and 70% of Soviet women between the ages of 18 and 45 do work, place their children in day nurseries. Among the Soviets these institutions serve as quotidian orphan asylums. When a woman brings her child to a nursery for keeping while she works, the child is given a physical examination, a bath and a clean uniform. If ill in any way, the child is segregated. All the children have individual towels, drinking cups, tooth brushes. All are taught young how to care for themselves. In 1932, there were 3,000,000 Russian children in such nurseries. Concerning this system the reporters comment: "In a good home in which a mother gives intelligent as well as loving care she gives more than can be obtained in full measure otherwise. . . . In the present circumstances of Russia, including not only the industrial occupation of mothers, but the defective housing conditions, [nurseries] undoubtedly are doing highly beneficent work."

A woman need have no more than one child unless she wants to. Except for her first pregnancy, she may have an abortion performed at any time during the first two and a half months of term. Curetting without anesthesia is preferred to drugs. The doctor "is recommended to discourage a woman from abortion if there are no social, economic or medical reasons for it, and particularly if she has fewer than three children, or has adequate means for supporting another child." Usually there is no charge for the abortion, or at the most 40 rubles ($20). The operation occupies three to five minutes. Each patient stays in the hospital three days, refrains from work ten more days. Mortality is trivial.

If a woman goes through with a conception, she has continuous, free prenatal care; gets six to eight weeks off from work, with pay before and after delivery; receives a bonus while nursing.

As projected, and to a noteworthy extent realized, every doctor in Soviet Russia is a state official "and the practice of medicine is concentrated in dispensaries, polyclinics and hospitals in which the individual doctor is never an isolated unit, but is in systematic touch with every branch of medicine."

If a sick individual is utterly unable to leave his home, a district nurse or doctor will visit him. Otherwise, every patient must go to his neighborhood dispensary where he is given a thorough medical inspection. If he needs special attention, he is sent to a central polyclinic or to a general or special hospital. Astonishing is ''the vast provision of convalescent home and sanatorium accommodation, probably larger in proportion to population than in any other civilized country." Health officials are making especially strenuous efforts to "liquidate"' tuberculosis and venereal disease. In all regions are special institutions for the treatment and cure of both.

In the main, the Russian can choose his own doctor within his own district. Doctors can usually choose the districts in which they want to practice. A doctor may practice as a specialist, after passing stiff examinations, and thereby get a slightly higher income from the government. He may practice privately (only 10% do) after his four or six-hour daily stint for the state. Education of doctors and nurses is below U. S. par, but improving. Pure research is encouraged.*

Commissar of Health Mikhail Fedorovich Vladimirsky told the inquisitors emphatically that in the U. S. S. R./- "medical aid is given without payment to all workers and peasants, who form the bulk of the population. For the rest, the desire is to serve all gratuitously but hitherto they have not been included in the general service, the first call being for the workers. Thus in a dispensary an intellectual will have to wait until all the workers have been treated."

Commissar Vladimirsky thrilled Sir Arthur and Mr. Kingsbury with the terrors of his life. At 22 (he is 60 now) he was exiled for pre-Communist revolutionary activities against Tsardom. He shared in the "Decembrist" uprising of 1905, was arrested and emigrated "under pressure." In France he practiced medicine, astonished villagers by occasionally treating them free. He was at Lenin's side and Trotsky's during the terrible days of 1917 when the Bolsheviks took command of Russia. No one is more authentically Russian than he, no one more authentically of the Party.

In conclusion, Sir Arthur Newsholme and John Adams Kingsbury approve the Soviet plan of free, or nearly free, medicine for almost everybody. They point out that "in every civilized country medicine has become more than half socialized . . . and, except in Britain and America, nearly all hospital treatment is a state service. Even in these two countries it is to a very great extent a state service. . . . In all countries west of the U. S. S. R., total official bulk larger than total private medical activities. . . . Other countries may well envy Soviet Russia's elaborately centralized Government . . . in that it has been able to brush aside all past complexities and to initiate a nearly universal national medical service on unified lines, untrammeled by such complications as exist in western Europe and America."

* Doubleday, Doran ($2.50).

* Bacteriologists of Moscow's Metchnikoff Institute last week announced cultivation of the virus of typhus fever, louse-born disease which attacks 30,000 Russians yearly. (In 1920-21 an epidemic affected 4,000,000.) Metchnikoff immunologists are developing an anti-typhus serum.

/-There is a Commissar of Health for each of the seven Soviet Republics. But Commissar Vladimirsky's province, Soviet Russia proper, represents 70% of the nation's people.

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