Table Of ContentDOCTOR AND PATIENT IN SOVIET RUSSIA
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THE RUSSIAN RESEARCH CENTER
The Russian Research Center of Harvard University is supported by a grant
from the Carnegie Corporation. The Center carries out interdisciplinary study
of Russian institutions and behavior and related subjects.
RUSSIAN RESEARCH CENTER STUDIES
1. Public Opinion in Soviet Russia: A Study in Mass Persuasion, by Alex
Inkeles
2. Soviet Politics — The Dilemma of Power: The Role of Ideas in Social
Change, by Barrington Moore, Jr.
3. Justice in Russia: An Interpretation of Soviet Law, by Harold J. Berman
4. Chinese Communism and the Rise of Mao, by Benjamin I. Schwartz
5. Titoism and the Cominform, by Adam B. Ulam
6. A Documentary History of Chinese Communism, by Conrad Brandt,
Benjamin Schwartz, and John K. Fairbank
7. The New Man in Soviet Psychology, by Raymond A. Bauer
8. Soviet Opposition to Stalin: A Case Study in World War II, by George
Fischer
9. Minerals: A Key to Soviet Power, by Demitri B. Shimkin
10. Soviet Law in Action: The Recollected Cases of a Soviet Lawyer, by
Harold J. Berman and Boris A. Konstantinovsky
11. How Russia Is Ruled, by Merle Fainsod
12. Terror and Progress USSR: Some Sources of Change and Stability in the
Soviet Dictatorship, by Barrington Moore, Jr.
13. The Formation of the Soviet Union: Communism and Nationalism,
1917-1923, by Richard Pipes
14. Marxism: The Unity of Theory and Practice, by Alfred G. Meyer
15. Soviet Industrial Production, 1928-1951, by Donald R. Hodgman
16. Soviet Taxation: The Fiscal and Monetary Problems of a Planned Econ-
omy, by Franklyn D. Holzman
17. Soviet Military Law and Administration, by Harold J. Berman and
Miroslav Keiner
18. Documents on Soviet Military Law and Administration, edited and trans-
lated by Harold J. Berman and Miroslav Kerner
19. The Russian Marxists and the Origins of Bolshevism, by Leopold H.
Haimson
20. The Permanent Purge: Politics in Soviet Totalitarianism, by Zbigniew K.
Brzezinski
21. Belorussia: The Making of a Nation, by Nicholas P. Vakar
22. A Bibliographical Guide to Belorussia, by Nicholas P. Vakar
23. The Balkans in Our Time, by Robert Lee Wolff
24. How the Soviet System Works: Cultural, Psychological, and Social
Themes, by Raymond A. Bauer, Alex Inkeles, and Clyde Kluckhohn 0
25. The Economics of Soviet Steel, by M. Gardner Clark
26. Leninism, by Alfred G. Meyer
27. Factory ana Manager in the USSR, by Joseph S. Berliner *
28. Soviet Transportation Policy, by Holland Hunter
29. Doctor and Patient in Soviet Russia, by Mark G. Field *
* Publications of the Harvard Project on the Soviet Social System.
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DOCTOR AND PATIENT
IN SOVIET RUSSIA
MARK G. FIELD
with α Foreword by
Paul Dudley White, M.D.
HARVARD UNIVERSITY PRESS
Cambridge, Massachusetts
19 5 7
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© Copyright, 1957, by the President and Fellows of Harvard College
Distributed in Great Britain by
Oxford University Press, London
This is study number 29 in the Russian Research Center series and a
report of the Harvard Project on the Soviet Social System.
This volume was prepared under a grant from the Carnegie Corporation of New
York. That Corporation is not, however, the author, owner, publisher, or proprietor
of this publication and is not to be understood as approving by virtue of its grant
any of the statements made or views expressed therein.
Library of Congress Catalog Card Number 57—12966
Printed in the United States of America
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TO MY PARENTS
THIS BOOK IS AFFECTIONATELY DEDICATED
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Foreword
Late last summer a small group of medical associates (Herman
Hilleboe, Ancel Keys, Howard Rusk, and James Watt) and I had
the pleasure of visiting Moscow with the author of this book. He
has been for years much interested in medical conditions in the
USSR, having prepared a thesis on the subject for his Ph.D. de-
gree. This book is an outgrowth of that thesis with additions and
amplifications, including the results of his recent visit to Russia.
Our small medical mission visited Moscow for three purposes,
the first two of which were accomplished satisfactorily although
we were able to spend only ten days on the visit. The first object
of our mission was to help to re-establish medical contact be-
tween our two medical professions. The second object was to dis-
cuss with our Russian colleagues two subjects in particular,
namely rehabilitation, especially in cardiovascular disease, and
international cardiovascular epidemiological research. The third
object was to invite to the United States to study and to work
with us four Russian physicians. The invitation was accepted
and we expect that it will be fulfilled in the future. It was gratify-
ing to note the evident sincerity and desire to improve the future
lot of both doctor and patient in Soviet Russia expressed by the
present Minister of Health, Dr. Maria D. Kovrigina.
This book by Mark G. Field is an important contribution to
historical, social, and medical literature, presenting an account of
the state of medicine in Russia from the last days of the tsars
through the various changes of the Soviet rule to the end of 1956.
It is based on the best possible information available during those
forty years, but it has been impossible to obtain exact knowledge
of every detail, largely because of the vicissitudes of Soviet rule.
It is written in an interesting style and includes much factual in-
formation. The book is divided into three parts: first, organization;
second, the doctor; and third, the patient. Case illustrations in
Parts Two and Three are very helpful.
I would like to cite a few of the highlights which have interested
me greatly and which I am sure will interest other readers. First,
there was an obvious difficulty for the regime in getting control
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viii Foreword
of the doctors at the very beginning of the revolution and for some
years afterwards. This situation changed later, especially under
Stalin, to the subjection of the doctors serving the state. Despite
this unhappy situation, however, physicians for the most part have
continued in their efforts through the years to help the sick and to
soften their lot so far as possible, upholding under the most diffi-
cult conditions the honorable traditions of the medical profession.
In the process of eliminating independent medical associations,
the Communist Party depressed the level of the standing of the
medical profession far below that of a "prestige occupation." It
is interesting to note in this respect that the regime tried, first, to
proletarianize the medical profession by facilitating the entry into
the medical schools of students of peasant or worker background.
Many of these students did not have the background, nor perhaps
the necessary motivation (as given to them by their family), to
successfully pursue their studies, and more and more students had
to be recruited from middle-class families. About half of the
medical students had to be so obtained. A second reason for the
depression of the medical profession was the placing of party
loyalty above professional ability, which sometimes resulted in
putting the poorly trained feldshers (physicians' assistants) in the
countryside above the physicians. A third reason was the punish-
ing of doctors for not keeping sick people at work (a good many
doctors were severely penalized and some imprisoned).
Fourth, there was the factor of the very limited time allotted per
patient, possibly unavoidable at the beginning of the revolution,
but quite unjustified later on. This is one of the hazards of any
plan of socialization of medicine. Actually many physicians were
obliged to spend an average of only eight minutes with each
patient. More than three fourths of that very brief time was de-
voted to paper work, with only 1 minute and a half for the his-
tory-taking and examination of the patient. Such a program must
necessarily interfere with a good doctor-patient relationship and
must certainly have lowered the levels of diagnostic accuracy and
of therapeutic success. There was a large personal element, how-
ever, which mitigated the situation in some instances. Interest-
ingly enough, the humorous magazine Krokodil helped the situa-
tion, on occasion, in instances of extreme lack of equipment and
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Foreword ix
of personnel. Without question there has been improvement since
Stalin's death. Such seemed to be the case on the occasion of our
visit to Moscow in September 1956, but we did not ourselves make
an investigation of these difficulties.
A fifth factor in lowering the status of medicine in Soviet Russia
was the abolition of the Hippocratic oath. A sixth was the giving
of a low wage to the doctors, especially in the country, and
a seventh was the giving of a low priority to medical facilities and
supplies, for example, even for stethoscopes and X-ray apparatus.
Despite the lowered position of the physician in the highly so-
cialized (or communized) society of the USSR, the emigres and
displaced persons have expressed a strong preference for Soviet
medicine over that seen freshly on arrival in the United States,
in large part because Soviet medicine is free and readily available,
even though often poor in both diagnostic and therapeutic facili-
ties compared to American medicine. The Soviet citizen has not
been used to anything better, or, indeed, in former days to any
medical care at all. This state of affairs can naturally apply to any
type of socialized medicine, but as the author suggests, the par-
ticular advantages of the two types of medical practice, socialized
and private, may eventually be combined with the clearing out
of at least some of the disadvantages of each.
The collective farmers have apparently been the worst off, for
the doctors frequently felt themselves as exiles in their assign-
ments to remote countrysides without roads or the ordinary com-
forts of life and with the constant danger of punitive action for
any particular failures, economic or otherwise.
One of the problems of the doctor is expressed interestingly in
the chapter entitled "To Certify or not To Certify: The Physi-
cian's Dilemma." Malingering has naturally been common, even
more than in military service. This fact, and the party's constant
close watch over the doctors, have often made adversaries of
doctor and patient at the very start.
In summary, the author has emphasized the great gap between
reality and the claims of Soviet leaders that the welfare of the
individual is one of their major concerns. The gap is narrowing
but is still much too wide. In general, it is the implementation of
the principle and not the principle itself that is at fault.
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χ Foreword
It is obvious that this book presents to the reader the relation
of physician and patient in a society still in the process of change.
What the future will bring, whether a slowly improving evolution
or a more abrupt change in one way or another, it is impossible
to predict, but this volume can be heartily recommended to any
person, medical or lay, who is interested in either the medical or
the social changes in Soviet Russia during the last generation, or
indeed in life as a whole in that country, which has attempted to
compress into a few years changes that usually require genera-
tions.
Paul Dudley White, M.D.
January, 1957
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