Ivan Ivanovich's Doctor

What kind of medical care does Ivan Ivanovich get if he is wounded? Outside Ivan Ivanovich's Russia, few facts on this subject were known until last fortnight. Then 1) a seven-man commission of U.S. and British doctors began to tell what they saw on a visit to the Soviet Union last summer, and 2) the first issue appeared of the American Review of Soviet Medicine, a bimonthly which will translate and digest Russian medical literature.

No Pampering. The doctors, four from Britain, two from the U.S. (Colonel Elliot Carr Cutler and Colonel Loyal Davis), one from Canada, visited hospitals in Moscow and at the Vyazma front, talked with surgeons and patients. They were enthusiastic about Russian medical efficiency, though for diplomatic reasons all refused to be quoted directly. But highlights from their trip have been reported in their speeches and interviews and in the Lancet and the British Medical Journal:

> Russia, which was once short of ambulances, now has mobile hospitals at the rear and even right behind the lines.

>The Russian system often makes it possible for one doctor to follow a case from the operating room all the way to its cure. (But, the Russians explain, a switch in surgeons usually causes no trouble, as surgical procedure has been standardized in a series of Red Army handbooks.)

>Soldiers get medical discharges from the Red Army with very little red tape.

>Red doctors manage to function even behind German lines, secretly patch many guerrillas.

> The Red Army's inspector general (with the rank of brigadier general) is a woman.

>Russian nurses have to be able to turn their hand to almost anything. The commission saw some of them putting up a new hospital ward in their spare time. One nurse fitted a window frame while they watched.

> Mental casualties are almost unknown in the Red Army. The doctors claim that this mental health is due to lack of pampering of the wounded, high morale among the unwounded.

No Ineptitude, No Magic. The visiting surgeons made it clear that there is neither ineptitude nor magic in Russian surgery. Russians, they said, excelled U.S. and British doctors in some respects, were not so good in others ("We all observe the same principles and differ only in the details"). Some of these "details" from the doctors' reports and the new Review suggest that Russia's doctors have few inhibitions :

> Russian surgeons use more whole blood than plasma for transfusions. They can do this because the blood-giving population is near the front. The blood is preserved by a special underground storage method, is thrown away if unused within three weeks.

> Most surgeons in other countries are chary of interfering with a wound more than ten hours old, but Red doctors do not hesitate to operate even if a wound has gone ten days or so. They merely make sure to keep it open.

> The use of nerves from corpses is not restricted to Russia, but the huge volume of wounded has enabled Russian surgeons to carry the technique to a high point. After a wound has healed (sometimes earlier), an incision is made and, using every precaution against infection, the patches are stitched to the severed nerve ends.* The patches do not serve as nerves themselves, but as channels along which living nerve can regenerate itself at a rate of about one millimeter (1/16 in.) a day. Longest mend reported: twelve centimeters (about five inches).

> A new technique for feeding patients with abdominal wounds while they are still on the operating table has produced good results. The idea is that battle-worn men who have not eaten lately and have lost much blood need food as much as anything. Before the wound is sewed up, a tube is inserted in the intestine--often in a rent--to introduce an eggnoggish mixture of 400 cc. of warm whole milk, 50 cc. of butter, two eggs, 50 grams of sugar, three to five grams of salt, 50 to 70 cc. of distilled alcohol. The wound is then closed. Writes P. A. Panikov in the Review: "In the majority of cases, the patients fell asleep at the end of the operation. The intestines, instead of being flaccid and pale, generally became dilated, plethoric [well supplied with blood] and obviously peristaltic [moving to push food along]. . . . We observed the color return to the cheeks, the lips become red and warm to the touch."

Self-Made Surgeon. Chief Surgeon of the Red Army is tough, hardworking, 67-year-old Lieut. General Nikolai W. Burdenko, the self-made grandson of a serf and son of an impoverished clerk. His specialty is the nervous system, but he is expert in all surgical fields, has just written an army manual on amputations. He served in a medical unit in the Russo-Japanese war and in front-line hospitals in World War I. After the Revolution, Dr. Burdenko became head of the Red Army's medical service, In this war he makes frequent flying visits to the front at all points, was in Leningrad in its worst days.

Dr. Burdenko is a hard driver who expects his students at the Scientific Research Institute of Neuro-Surgery (which he founded) to read six hours a day, his assistants eight hours. He says that he reads all the time. This reading is not solely medical literature; it includes classics, the humanities, everything that will provide a better understanding of man. Dr. Burdenko so seldom praises anybody that one man who has worked for him for 20 years can remember only two occasions when he got grudging approbation--Dr. Burdenko says he swears only at promising men, does not bother with the others. He unbends with children, the only people not awed by him.

Two years ago an illness made him deaf. Shortly afterward he presided over a meeting of the Supreme Soviet, succeeded so well in following brief notes made by an assistant that no one guessed he heard nothing.

* In the Journal of the American Medical Association last month three doctors reported using acacia glue instead of stitches as a fastening. Advantage: delicate nerves are not injured by needle marks.

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