THE MEDICAL FACTS IN RUSSIA.
SO many British visitors to Russia have described their experiences that there is no doubt now in the public mind about the appalling conditions of star- vation, misery, and disease which exist under Soviet Rule. Even those who would like to see Soviets established in Great Britain no longer attempt to dispute the facts ; they merely pretend that the intense suffering is a passing phase and that an equitably reconstructed society will rise from the ruins. Mr. Wells, in a book which we reviewed last week, drew as gloomy a picture of Russia as has been drawn by anyone, but he too seemed to think that a period of what Lenin calls " limitless experiment " would end in the production of some positive good. He attributed the crash not to the ineptitude of those who govern Russia and to the hopeless impracticability of their principles, but to the " Imperialism of Europe." But, after all, an ounce of fact-is worth a pound of theory, and it is instructive to turn from the rapid observations and hasty generaliza- tions of those visitors who spent a few days or weeks in Russia to the observations of a Russian doctor who has served under the Bolsheviks for some two years. We can guarantee the genuineness of this doctor's record which has been placed in our hands and which we propose to summarize. We shall do so not merely because it seems to us to prove the fundamental rottenness and hopelessness of Bolshevik methods, but because Russian disease—most of it arising from pure starvation—is threatening all Europe. Russia is one of the seed-beds of typhus fever, and we think the time is not far off when the establishment of some sort of relations with Russia, cautious though these may have to be, will require a serious grappling with famine and with all those diseases which have their source partly in want of nourishment and partly in filthiness. Probably those who administer the excellent Imperial War Relief Fund recognize that if, as is admitted, it is necessary for our own protection—to put it for the moment on the lowest grounds—to tend Central Europe, it will also be necessary to help the wretched victims of the Russian towns. The Russian doctor explains that all medical men in Russia are in the service of the State. There are no private doctors. One of the magnificent theories of Russian Communism is that as the medical service has been national- ized and public health is the care of the State, everybody receives medical treatment free. How does this work out in practice ? The writer tells us that there was an ancient custom in Russia of paying a small fee to a doctor even when that doctor was a Municipal official who was not supposed to be paid for his ministrations to the poor. The custom lingers. Although, of course, most patients are quite unable to pay the Communal doctors anything, those who can do so. How difficult it is to break with custom I People talk of abolishing " tips " in England, but there are thousands of poor people who to-day go on giving tips to men who are richer than themselves. The writer says that the fee which no Communal doctor can ever bring himself to refuse is a pound of bread. Compared with this treasure a handful of roubles are of no value at all. The Municipal doctors used to be steady and experienced men, but the Communal doctors who have replaced them are mostly young and unpractised. Frequently they are students in their fifth, fourth, or even in their third year. Sometimes they are doctors' assistants. The population has no confidence in such advisers. But even when the doctor's prescriptions are sound there is generally no means of providing them. The materials are everywhere lading. The fact is, however, that nearly all the disease in Russia comes from famine-exhaustion, and if the doctor could hand out food he would rapidly cure his patients in almost every case. The Soviet rulers are very clever at make-believe ; accordingly when the doctors persistently called their attention to the fact that food was the one medicine required they ordained the issue to sick persons of an extra ration of food known as " increased nourish- ment." This " increased nourishment " may take the f orm of a pound of flour or meal, or some tinned. food, or half a pound of hemp-seed oil. The extra ration must not be served out more than once a month. The writer declares, however, that a patient after spending several days in obtaining all the necessary seals and signatures for his " increased nourishment " may arrive at the last stage of his wanderings only to find that no " increased nourish- ment " is obtainable. Still oftener the Soviet doctor at the Food Commissariat, on verifying the prescription, finds that the grounds specified for the " increased nourish- ment " are not sufficiently convincing. The pound of flour or tin of food which the unfortunate patient had dreamed of receiving becomes the torture of Tantalus. There is much contradiction about what are convincing grounds for " increased nourishment." In one part of Petrograd, for example, acute catarrh of the stomach and intestines is convincing ; in another part nothing will be granted in such a case, but " increased nourishment " can safely be counted upon if the patient has suffered from Spanish influenza ; while in yet another part the applicant is shown the door if he pleads Spanish influenza—he receives instant consideration, however, if he is recovering from appendicitis. The writer sums up the sanitary conditions of Petrograd as follows : " Epidemics, a terrible death-rate, dead horses in the streets, left lying there for weeks and torn by wild and starving dogs or sometimes by people maddened by hunger, an unheard-of sanitary breakdown of the city ; courtyards defiled to the utmost, a hopelessly ruined water supply and drainage system, and houses, sometimes several in a row in the same street, dead and deserted— such is the sanitary picture of Petrograd to-day." How do the Bolsheviks cope with such a state of affairs ? As usual, they have a showy remedy. They have formed organizations known as " Disinfection Brigades." These Brigades, originally known as " Disinfection and Repairing Brigades," were formed in March, 1918. The first idea was not merely to disinfect but to repair buildings, pipes, drains, and so forth, where the causes of bad sanitation were structural. The Brigades, however, through more than two years have carried out no repairs worth men- tioning, and their principal task is disinfection. The writer describes the method :— " On an average the disinfection brigade, consisting of three hundred men, disinfects from 10 to 15 flats, half an hour at most being given to the disinfection of a fiat of three rooms, corridor and kitchen, solution of lysol being sprayed over furniture, walls, pictures, crockery, and clothing, regardless of the cries and curses of the owners who have had the misfortune to come under disinfection. Such disinfection can have no practical results, if only because the brigade is too small to satisfy the enormous need in which Petrograd stands of disinfection in connexion with the existing epidemics. In the second place, the city possesses an altogether insufficient supply of disinfectants—in November the brigade had at its disposal only thirty poods (1,080 English pounds) of lysol for a population of 900,000. The brigade possesses no such installation as would allow it to develop publio disinfection in a broad and rational way, and small-pox, scarlet fever, and spotted typhus are all disinfected with one and the same lysol (small-pox calls for formalin disinfection, any other being meaningless). For spraying the brigade uses very incon- venient and easily damaged pneumatic hydropults. In short, the only useful feature of the disinfecting brigade is the fact that it releases from Red Army service and supplies with a one-pound bread ration some three hundred stu&nts of the Military Academy, thanks to which fact the latter are enabled, after a manner, to study and attend lectures. Each of them is free for two or three days at a time, working on the third or fourth. On these free days he is able to attend lectures."
Besides the Disinfection Brigades there is an organization called the " Prompt Aid Institution." This sanitary organization is now under the management of an official known as the Chief of the City Sanitary Transport and Prompt Aid. The writer says that service in the " Prompt Aid " is extremely popular among doctors, as by belonging to it they " armour " themselves against service with the Red Army and are sure of getting more food than falls to the lot of most people. Men who have " armoured " themselves in Russia correspond to those who were known as embusquh in France during the war. Unfortunately, the " Prompt Aid " is by no means prompt, as there tan very few means of transport. And even when good haste is made to the scene of an accident or to the house of someone suddenly struck down by typhus, not much aid can be rendered owing to the dearth of medicines and appliances. There is yet a third medical organization under Soviet Rule—the Communal Out-patient Infirmaries :— " In their nature they are just the old municipal out-patient infirmaries, but in view of the state of their medical equipment they do not fulfil one-tenth of their task. In these infirmaries, as indeed in the majority of the Petrograd medical establishments. all the assistance afforded the population amounts to the most primitive medical aid. It is far from always that the demand even for castor-oil can be satisfied. In the majority of cased operations are performed barbarously, without anesthesia, owing to the absence of anesthetics. There is such a want of dressings that as a rule the bandage once served out to the patient coming to bo dressed is never changed and is finally reduced to the state of a most filthy rag. Afterwards they are simply washed and used for another patient. Iodine is measured out by the drop. Other antiseptic materials, such as benzine and alcohol, are either wanting altogether, or if they make their appearance at all they vanish rapidly, presenting an irresistible attraction in the one case to those who want to fill their cigarette lighters, in the other to those who want a drink, and thus fail to fulfil their medical uses."
Perhaps the most common disease in Petrograd is what the writer describes as a strange dropsical swelling of the face and legs. This is the result of chronic under- feeding. It is a pure hunger disease. " There is only one cure," the doctor must say if he is honest ; " You must eat more and better food." But the irony and mockery of the honesty Naturally, the scientific standard of the doctors has deteriorated as they no longer work under normal conditions, and as they are cut off from the world.they are unable to follow the latest research. Over and above all these disasters the insufficiency of fuel causes a permanent lack of hot water—an essential in all hospital work. The patients cannot be given baths :— " This, of course," says the writer, " is the climax, and means the end of any medical institution as such. The municipal hospitals which even in former days could not boast of particular cleanliness are now in a horrible condition. The stench and filth are such as to render them unbearable to any new-comer. The hospital linen cannot be properly washed without hot water or soap ; it is only rinsed out in cold water. The bedclothes look simply disgusting ; all the stains and traces of the sufferings of the predecessor serve as a constant reminder to the present occupant of the bed. No wonder that to an inhabitant of Petrograd the very idea of being taken to a hospital is worse than death itself. Typhus patients, whom the doctor is obliged by law to send to the hospital, implore to be allowed to remain at home. A visit to any hospital. means—lice. There are no means whatever of overcoming this terrible pest. It destroys both the sick and the healthy. It spreads spotted typhus. The lice attack the medical staff first and foremost. The orderlies, nurses, medical attendants, Red Cross nurses, and doctors drop out of the ranks one by one, many of them never to return. By some inexplicable fatality, if the ordinary death-rate from spotted typhus is, say, 25 per cent., it rises to 35 per cent. among doctors. Apparently the conditions of work, the sense of responsibility, the overstrain and exhaustion, lead to these fatal results. From January to March, 1919, all the doctors of the therapeutical department of the Obukhov Women's Hospital were stricken with spotted typhus. In the Military Clinical Hospital all the assistant professors fell ill and died in the course of one week."
" The Imperialism of Europe," Mr. Wells has pro- claimed, is to blame, but our Russian informant boasts that before the war, under one of the most rigid Imperial- istic systems of the world, " numerous Petrograd clinics were considered. as unique in Europe and attracted specialists from all countries as the perfect organization was the last word in modern science." One of the few institutions which appear to have a successful output in Petrograd is the " State Coffin Factory." After all, human nature in order to work industriously does require some incentive ; and the urgency of the incentive for getting bodies out of the way as quickly as possible in such a place as Petrograd under Soviet Rule is obvious.
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