Учебное пособие (Методичка) по Истории Медицины. И.Ю.Худоногов

Theme 13. Formation and development of Soviet medicine

A radical reorganization of social relations, which took place in the conditions of civil war, economic devastation, hunger and epidemics, began in Russia after the February and October revolutions of 1917. The organization of the fight against epidemics and diseases on the scale of such a huge country as Russia required a qualitatively new systemic approach to healthcare organizations. It meant organizational unity, the elimination of departmental disunity, the creation of state hospitals, pharmacies, and filling the shortage of medical personnel.

The first decrees of the Soviet government were aimed at solving the main health problems: eliminating epidemics, combating the most common diseases, training medical personnel, raising the sanitary culture of the people. The preventive direction was the main principle of the construction of Soviet medicine.

Back in 1903, a wide range of issues related to human health was reflected in the first Party Program adopted at the 2nd Congress of the RSDLP: reducing the working day to 8 hours, establishing weekly day off, prohibiting the use of the labor of children under 16 years old, etc. Health protection issues were also discussed at the Prague Party Conference (1912).

The first decrees of the Soviet government were about Peace (peace to all peoples, an end to all wars), about the Land (to give land to the peasants), the Declaration of the rights of the peoples of Russia, about the 8-hour working day, etc. Then followed the decrees on the nationalization of industry (to give factories and plants to workers), pharmacies, “On social insurance”, health insurance, etc.

The medical and sanitary department, headed by doctor M.I. Barsukov, was organized on October 26, 1917 at the Military Revolutionary Committee of the Petrograd Soviet of Workers' and Soldiers' Deputies. Workers, soldiers and peasants began to create health departments at all local councils (new government bodies that appeared instead of zemstvos). Medical Collegiums were organized at a number of people's commissariats (Internal Affairs, Railways, Education, etc.). After that, on January 24, 1918, the Council of People's Commissars signed a decree on the formation of the Council of Medical Collegiums – the highest,

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government medical body. A.I. Vinokurov became its chairman. A.I. Artemenko, E.P. Pervukhin, M.I. Barsukov, V.M. Bonch-Bruevich (Velichkina) and others became members of the Council.

The Council of Medical Collegiums did a great job of organizing and strengthening local medical and sanitary departments, rallying medical workers around the Soviet regime and in a short time proved in practice the expediency of concentrating and centralizing medical affairs in a unified body.

The creation of a unified healthcare system in Russia in the early years of Soviet power required adherence to the following guiding principles:

1) the state character, implying the centralization of management, state planning of health programs, state funding (free and generally available medical care for the entire population of the country), state responsibility for the health of nations and peoples;

2) preventive direction;

3) the unity of medical science and health care practice;

4) participation of the population health protection measures.

The creation of the state system of healthcare management in Russia was expressed in the fact that July 1918 the Council of People's Commissars adopted a decree on the creation of the People's Commissariat of Health, which became the first independent health protection body and united under its leadership all branches of healthcare in the country. The theorist and organizer of health care Nikolai Aleksandrovich Semashko (1874-1949) headed the People's Commissariat of Health of the Russian Federation and directed it for 11 years. Doctor Zinovy Petrovich Soloviev (1876-1928) became his deputy. V.M. Bonch-Bruevich (Velichkina), A.P. Golubkov, P.G. Dauge, E.P. Pervukhin became a member of the board of the People's Commissariat for Health. In 1922 N.A. Semashko organized the first department of social hygiene in our country at the Medicine Faculty of Moscow University (now the First Moscow State Medical University named after I.M. Sechenov) and headed it for 27 years.

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N.A. Semashko identified three features of Soviet health care: 1) the unity of the organizational structure, i.e. rejection of dispersion, departmental fragmentation (the ideas of a centralized system of health care management were developed in our country for many years and were completed in 1912, and later used in the activities of the People's Commissariat of the RSFSR);

2)the unity of curative and preventive medicine;

3)involvement of workers in health care.

The People's Commissariat of Health began to work in the most difficult conditions of epidemics, a huge flow of the wounded, sick and refugees, with an acute shortage of doctors, hospitals and medicines. However, a handful of people, despite all the difficulties, managed to lay the foundations for a system of public

and ways of developing health care is difficult to imagine. Dozens of very

Congresses and conferences, scientific societies, mass organizations – the Komsomol, trade unions channels were used to ensure the success of this gigantic work, which N.A. Semashko, Z.P. Soloviev, members of the commission, as well as doctors M.I. Baranov, M.I. Barsukov, B.S. Weisbrod, V.P. Lebedeva, D.I. Ulyanov, V.A. Obukh, prominent medical scientists L.A. Tarasevich, A.N. Sysin, P.I. Kurkin, N.I. Tezyakov, E.I. Martsinovsky, A.A. Kisel, P.N. Diatroptov, N.F. Gamaleya and others took the lead.

The organization of medical, evacuation and sanitary provision of the Red Army and the fight against epidemics were the main task of the People's Commissariat for Health in the first years of the construction of Soviet health care. On August 30, 1918, the Main Military Sanitary Directorate was transferred to the jurisdiction of the People's Commissariat for Health. The entire system of medical and sanitary support for the army, which provided for the maximum approximation of surgical care to the front line, sorting of the wounded and sick, limiting the evacuation of

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infectious patients outside the front, was created in the shortest possible time. The public and, above all, the Russian Red Cross Society (RRCS), whose chairman in 1919 was Z.P. Soloviev, provided great assistance to the military medical service. The RRCS organized hospitals for the wounded, participated in the fight against epidemics, and provided tremendous assistance to the state in the fight against hunger in the Volga region. In 1920, Z.P. Soloviev headed the Main Military Sanitary Directorate. In 1923, he organized and headed the country's second department of social hygiene at the medical faculty of the 2nd Moscow University (now the Pirogov Russian State Medical University). On the initiative of Z.P. Soloviev in 1925, the pioneer camp “Artek” was organized on the Black Sea Crimean coast.

The First World War and the Civil War, the military intervention and the famine caused by its, the devastation significantly worsened the already extremely difficult sanitary and epidemiological situation. Epidemics, especially typhus and relapsing fever, which spread in the army and among the population, posed a serious threat to the existence of the Soviet state Urgent and decisive action had been needed. In January 1919 V.I. Lenin signed the decrees of the Council of People's Commissars of the RSFSR “On measures for typhus”, “On the fight against epidemics”. The Central Emergency Commission for Combating Epidemic Diseases was created under the People's Commissariat of Health of the RSFSR. All health workers, as well as factory workers, participated in the fight against epidemics. By 1921, the number of typhus diseases had decreased six times compared with 1920.

The fight against tuberculosis and venereal diseases occupied a significant place in the work of the People's Commissariat of Health of the RSFSR. The first tuberculosis dispensary was opened in Moscow in 1918; the first venereal dispensary began to receive patients in 1921.

We can say today with confidence that the health care system in the RSFSR was the best in the world. Thanks to the organizational talent and efficiency of N.A. Semashko and the staff of the new administration, the critical situation in the health care of young Soviet Russia at the turn of the 20s of the last century was

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normalized in the shortest possible time. After the October Revolution and the collapse of all the institutions of the previous government, the civil war and the most severe economic collapse, practically the entire national economy of Russia, including healthcare, was destroyed.

In the first years of Soviet power, the sanitary and epidemic situation in Russia was characterized by a sharp increase in infectious diseases. Frequent outbreaks of typhus and relapsing fever, cholera, plague, smallpox, malaria, syphilis, tuberculosis was observed. About a million Russians have died during the Spanish flu pandemic. Situation with other diseases was no better. The lack of qualified medical personnel, hospitals and medicines was felt everywhere. Severe food and fuel shortages, caused by disruptions in the country's transport system, were an unfavorable backdrop for public health. The water treatment and water supply

Empire until 1917. City medical institutions were financed by various departments and charitable organization the bulk of medical assistance was provided by private practitioners. 28 thousand doctors accounted for the entire population (159 million people in 1913), that is, on average, two doctors provided assistance to 10 thousand people.

But most of the doctors practiced in large cities of the European part of the country. All hospitals had about 208,000 beds (1.3 beds per 1000 inhabitants). More than a third of the cities had no hospitals at all.

In rural areas, according to the official data of the Office of the Chief Medical Inspector for 1909, 24.5 thousand inhabitants were attached to each zemstvo doctor on average. More than tenfold excess of the size of the medical area in relation to the present day was further complicated by the fact that the district system was never introduced in parts of the zemstvos (about 1/3), the doctor went to the villages and villages to each patient separately, which led to big loss of time.

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The foundations of the Soviet organization for the protection of mothers and children were laid in 1918-1920. An important role in the organization of this work was played by the pediatrician Professor A.A. Kissel. The system of protection of mothers and children was absent in tsarist Russia as such. There were only 9 consultation ambulatories for women and children throughout the country. Two million children died each year from disease, and the infant mortality rate reached 300 per 1,000 live births.

In such conditions, the only correct decision was made for the country's survival. The Soviet government created a unified centralized system for the protection of mothers and children, which included a full set of state and public measures aimed at ensuring the health of mothers and children, strengthening the family, encouraging motherhood, creating the most favorable conditions for raising children, their physical, intellectual and moral development.

The pronounced social orientation of state policy became apparent from the first days of the existence of the Soviet Republic. On the initiative and with the direct participation of V.I. Lenin's gigantic work on the construction and equipping with the necessary resources of a network of institutions designed to preserve the life and health of children, them from hunger and infectious diseases, as well as provide the necessary assistance to a woman-mother, was carried out. Thousands of mothers and babies' homes, orphanages, nurseries, children's and women's clinics, dairy kitchens have opened across the country in accordance with the developed standards.

Legal and organizational support for the protection of mothers and children did not lag behind. The decree “On the Establishment of the Council for the Protection of Children”, which, in particular, indicated that the supply of children with food, clothing, accommodation, fuel, medical care should be considered one of the most important state tasks was issued already in February 1919. maternity and childhood protection were transferred from the People's Commissariat of Social Security to the People's Commissariat of Health.

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The further development of the socialist state was accompanied by the implementation of all the necessary measures to protect the health of mothers and children. The legal norms ensuring the protection of the health of a woman-mother were enshrined in such a fundamental document as the Constitution of the USSR of 1937, article 35 of which read: “A woman and a man have equal rights in the USSR”. This norm is reflected not only in the legislative acts of our state, but has become a real norm of life. Women, on an equal basis with men, began to receive education and vocational training, participate in social production and receive equal to male wages. The conditions allowing women to combine work with motherhood were created in the shortest possible time. Targeted recreational activities carried out by qualified medical personnel and nurses had been constantly improved. A wide range of medical and social assistance included medical examination, the creation of rehabilitation treatment rooms, as well as an extensive network of sanatorium and resort institutions.

Significant financial resources, which made it possible to pay in full the benefits for pregnancy and childbirth, additional payments to families with many children and single mothers, families disabled children, benefits for children from lowincome families, disability certificates for caring for a sick child, were given in parallel with the legislative provision for the protection of motherhood and childhood in the USSR. In-kind assistance to children in the form of donor milk, infant formula and other baby food products had being become significant throughout the country.

The government paid much attention to the development of science. The Scientific Medical Council headed by Lev Aleksandrovich Tarasevich (1868-1927) was formed in 1918 at the People's Commissariat for Health of the RSFSR. Its tasks included such activities as: the development and consideration from a scientific point of view of all educational and scientific-practical issues in the field of medicine (development of anti-epidemic measures, nutrition issues, the creation of new medical schools and courses, reform of higher medical and pharmaceutical education, the formation of new scientific and research institutions, forensic

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medical examination, preparation of a pharmacopoeia, etc.), attracting medical scientists of the country to work in Soviet medical institutions and the implementation of state programs on topical problems of practical health care.

The participation of scientists in the construction of Soviet health care, its deeply scientific foundations contributed to the sustainability of those forms and methods of health care that were found in the first years of Soviet power and were tested by life.

Prevention ideas, which helped to choose the right direction and the right forms of work, were at the heart of the Soviet health care system from the very beginning. It was hygienists, epidemiologists, microbiologists who largely determined the direction of development of the entire health care system. First of all, they were N.A. Semashko, Z.P. Soloviev, L.A. Tarasevich, P.N. Diatroptov, A.N. Sysin, N.F. Gamaleya, E.I. Martsinovsky and others. Many famous Russian scientists took part in the restoration and development of Russian science. These were N.N. Burdenko, V.M. Bekhterev, A.A. Kisel, M.P. Konchalovsky, S.I. Spasokukotsky, D.K. Zabolotny, P.N. Diatroptov, N.M. Shaternikov, V.A. Obukh and others.

Questions for self-control:

1.When and why was the People's Commissariat of Health established in Russia?

2.What were the main tasks facing the Soviet health care in the first years of Soviet power?

3.What measures were taken to combat epidemics in the early years of Soviet power and what effect did they have?

4.What decrees on the development of health care were adopted in the early years of Soviet power?

5.What role did N.). Semashko and Z.P. Soloviev in the construction of Soviet health care and in the development of the scientific discipline "Social Hygiene"?

6.On what principles was Soviet health care built?

7.What are the main stages of development of the mothers and children protection system in Russia, what problems and in what way was it able to solve?

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8. What priority tasks did the Scientific Medical Council, created by the

Bolsheviks after the Great October Socialist Revolution, solve?

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Theme 14. The main features and stages of development of Soviet medicine.

Heroism of Soviet doctors

The next stage in the history of Soviet medicine came after the Civil War. The issue of creating a more advanced sanitary and epidemiological service in order to reduce and then eliminate infectious and social diseases arose before the health authorities.

Sanitary and Epidemiological Department of the People's Commissariat for Health of the RSFSR, which was headed by A.V. Sysin, developed a draft decree “On the sanitary bodies of the republic”, which was approved on September 22, 1922. It defined the tasks of the sanitary service for the protection of water, soil, air, dwellings, food. Pasteur, malaria, disinfection stations, bacteriological and sanitary-hygienic laboratories, houses of health education were created in accordance with this decree.

The decree “On the sanitary bodies of the republic”, according to which a constant preventive and current sanitary supervision was established, was issued in 1927. The first scientific base for the sanitary service was created with the active participation of A.N. Sysina. State Institute of Public Health (SIPH), which united eight research institutes: nutrition, control of vaccines and serums, tropical diseases, microbiological, sanitary and hygienic, biochemistry, tuberculosis and experimental biology, was established in 1920. The institutes that were part of the SIPH became independent scientific institutions. 16 new medical institutes and faculties were opened during 1918-1922. The All-Union Institute of Experimental Medicine (AUIEM) was organized in 1932 on the A.M. Gorky initiative.

Medical education from the jurisdiction of the People's Commissariat of Education of the RSFSR was transferred to the jurisdiction of the People's Commissariat of Health in 1929. The medical faculties of a number of universities were transformed into independent medical institutes (including Tomsk, North Caucasian, etc.).

The anti-epidemic administration with the State Sanitary Inspection under the People's Commissariat for Health of the RSFSR was created in 1933. A new type of institution - sanitary-epidemiological stations (SES) - appeared soon. July 20,

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