Table Of ContentEdited by Susan Gross Solomon
and John F. Hutchinson
Health and Society
in Revolutionary Russia
Edited by Susan Gross Solomon and
John F. Hutchinson
For the last century social and political dimen¬
sions have figured prominently in our under¬
standing of medical practices; few would
attempt to account for developments in medi¬
cine by reference to biology alone. From the
first days of the October Revolution, the Bol¬
sheviks declared that Soviet medicine would re¬
ject the individualistic, patient-centered prac¬
tices of the capitalist West and would respond
instead to the medical needs of the proletariat.
Yet, reform of Russian medicine under state
auspices had already begun in the tsarist period.
The ten original essays included here, all
based on primary research, focus on the social
and political aspects of public health and medi¬
cal reform in late Imperial and early Soviet Rus¬
sia. Among topics covered are social influences
on psychiatric theory and practice in late Impe¬
rial Russia, the regulation of urban prostitution
by the tsarist regime, tsarist and early Soviet
efforts at providing health care to peasants
deeply suspicious of modern medicine, Soviet
experiments in eugenics, and the administration
of health insurance and industrial hygiene. The
book reveals, on the one hand, the breadth and
commitment of the Soviet regime to innovative
approaches to health care in a revolutionary so¬
ciety and, on the other, the formidable array of
obstacles encountered by the reform effort—in¬
stitutional rivalries, scarcity of economic re¬
sources, the entrenched interests of the medical
profession, and conflicting political priorities.
An important resource for students of Soviet
social history and the history of medicine and
public health, Health and Society in Revolution¬
ary Russia will also interest readers following
the current crisis of health care in the Soviet
Union.
(continued on back flap)
Jacket illustration:
Soviet poster promoting inoculation
against cholera, S. Ivanov, 1920.
Indiana-Michigan Series in Russian and East European Studies
Alexander Rabinowitch and William G. Rosenberg,
general editors
Advisory Board
Deming Brown Zvi Gitelman
Robert W. Campbell David Ransel
Henry Cooper Ronald Grigor Suny
Herbert Eagle Roman Szporluk
A. Benoit Elkof William Zimmerman
Published in cooperation with the
Centre for Russian and East European Studies,
University of Toronto
HEALTH AND SOCIETY
IN REVOLUTIONARY RUSSIA
EDITED BY
SUSAN GROSS SOLOMON
AND
JOHN F. HUTCHINSON
INDIANA UNIVERSITY PRESS
Bloomington and Indianapolis
This book was brought to publication with the assistance of a grant from the Andrew W. Mellon Foun¬
dation to the Russian and East European Institute, Indiana University, and the Center for Russian and
East European Studies, University of Michigan.
© 1990 by Indiana University Press
All rights reserved
No part of this book may be reproduced or utilized in any form or by
any means, electronic or mechanical, including photocopying and
recording, or by any information storage and retrieval system, without
the permission in writing from the publisher. The Association of American
University Presses’ Resolution on Permissions constitutes the only
exception to this prohibition.
The paper used in this publication meets the minimum requirements of American
National Standards for Information Sciences—Permanence of Paper for Printed
Library Materials, ANSI Z39.48-1984.
Manufactured in the United States of America
Library of Congress Cataloging-in-Publication Data
Health and society in revolutionary Russia / edited by Susan Gross
Solomon and John F. Hutchinson.
p. cm. — (Indiana-Michigan series in Russian and East
European studies)
“Published in cooperation with the Centre for Russian and East
European Studies, University of Toronto.”
Includes bibliographical references.
ISBN 0-253-35332-7 (alk. paper)
1. Social medicine—Soviet Union—History. 2. Soviet Union—
History—Revolution, 1917—1921. I. Solomon, Susan Gross.
II. Hutchinson, John F. III. University of Toronto. Centre for
Russian and East European Studies. IV. Series.
RA18.3.S65S63 1990 89-45410
362.1 '0947'09041 —dc20 CIP
12345 94 93 92 91 90
CONTENTS
ACKNOWLEDGMENTS vii
INTRODUCTION ix
The Problem of Health Reform in Russia
Susan Gross Solomon and John F. Hutchinson
Part I: Public Health in Tsarist Russia
“Who Killed Cock Robin?” 3
An Inquiry into the Death of Zemstvo Medicine
John F. Hutchinson
Social Influences on Psychiatric Theory and Practice in 27
Late Imperial Russia
Julie V. Brown
Yellow Tickets and State-Licensed Brothels 45
The Tsarist Government and the Regulation of Urban Prostitution
Laurie Bernstein
Part II: Building the New Soviet Medicine
The Science and Politics of Soviet Insurance Medicine 69
Sally Ewing
Origins of Soviet Health Administration 97
Narkomzdrav, 1918-1928
Neil B. Weissman
Feldshers and Rural Health Care in the Early Soviet Period 121
Samuel C. Ramer
Economics of Soviet Public Health, 1928-1932 146
Development Strategy, Resource Constraints, and Health Plans
Christopher M. Davis
Part III: Varieties of Soviet Social Medicine
Social Hygiene and Soviet Public Health, 1921-1930 175
Susan Gross Solomon
Eugenics as Social Medicine in Revolutionary Russia 200
Prophets, Patrons, and the Dialectics of Discipline-Building
Mark B. Adams
. fV-Y
l V A ■- & ,;—
VI Contents
Okhrana Truda 224
Industrial Hygiene, Psychotechnics, and Industrialization in the USSR
Lewis H. Siegelbaum
Afterword 246
Susan Gross Solomon and John F. Hutchinson
CONTRIBUTORS 251
INDEX 252
Acknowledgments
This book had its origins in a conference on the the history of Russian and Soviet
public health held May 7-10, 1986, at the University of Toronto. The conference
brought together thirty scholars from Britain, Australia, the United States, and
Canada. In planning and running the conference, we accumulated a number of
institutional debts which we take pleasure in acknowledging. We are grateful to
the National Council for Soviet and East European Research which generously both
supported the conference and the editing of the volume and to Massey College (and
its bursar, Colin Friesen) of the University of Toronto which so graciously hosted
the conference. In a true spirit of international cooperation, the Centers for Russian
and East European Studies of the University of Michigan (under the directorship
of William G. Rosenberg) and the University of Toronto (under the directorship of
Timothy Colton) jointly sponsored the conference. The Michigan center shouldered
the job of administering the National Council grant; the Toronto center responded
with sympathy to the periodic pleas of one of the editors for contingency funding.
The conference was greatly enriched by the presence of a kollektiv of outstanding
commentators from the fields of Russian and Soviet history and the history of
medicine and public health: the late Kendall Bailes, Mark Field, Loren Graham,
David Joravsky, John Keep, Judith Leavitt, Russell Maulitz, Pauline Mazumdar,
Peter Solomon, Barbara Rosenkrantz, Ronald Suny. Their combination of enthu¬
siasm and high standards guided us as we edited the volume. To the authors of the
essays, we express our special thanks for the good humor with which they endured
the repeated queries we raised and the intellectual vigor with which they pursued
the leads we suggested. To Edith S. Klein of the University of Toronto we are
deeply indebted for the intelligence and care with which she undertook the tasks
of editorial assistant and conference assistant. The staff of the Department of Po¬
litical Science, University of Toronto, cheerfully executed a variety of technical
tasks indispensable in bringing a volume such as this to fruition.
Introduction
The Problem of Health Reform in Russia
The Soviet health crisis of the 1980s has led the Soviet government to assign high
priority to the reform of public health and medicine. This is not the first time that
the reform of public health was high on the agenda of a Soviet leadership. Almost
immediately after the Revolution, concerted attempts were made to transform the
system of public health in order to deal with the devastating effects of war and
revolution. Not surprisingly, the current commitment to health reform in the Soviet
Union has directed the attention of Western observers to the earlier attempts at
change. But those with an interest in history would do well to look back beyond
1917 for, as the essays in this book suggest, the problems encountered in reforming
public health after the Revolution had important roots in the period before the
Bolsheviks took power.
By the beginning of the twentieth century, thoughtful Russians had come to the
conclusion that making their country healthy would require a struggle with the
tsarist regime. In their view, it was the deadening hand of the St. Petersburg bu¬
reaucracy that was largely responsible for Russia’s appallingly high morbidity and
mortality rates. The country’s most prestigious medical society, the Pirogov Society
of Russian Physicians, propagated and perpetuated a credo according to which St.
Petersburg bureaucrats were the embodiment of all evil whereas community phy¬
sicians (those employed by zemstvos and municipalities) were the repository of all
virtue. At the International Medical Congress in Moscow in 1899 and then at the
International Hygiene Exhibition in Dresden in 1911, the community physicians
successfully convinced their Western colleagues that they were the leading force
for health reform in Russia and that the chief obstacle they faced was the tsarist
regime itself.
The image of reform-minded community physicians standing firmly on the side
of science and progress, battling a bumbling, recalcitrant, and obscurantist regime
emerged in bold relief in Nancy Frieden’s authoritative book, Russian Physicians
in an Era of Reform and Revolution, 1856-1905.' However bold the relief, the
image was tempered by Frieden’s admission that community physicians strenuously
resisted government attempts to raise the quality of local health programs even when
those attempts “reflected current thinking among health planners and epidemiol¬
ogists.”2 In the years since the publication of Frieden’s book, the portrait of the
“progressive” community physician has been called even more seriously into ques¬
tion. A study of the development of Russian psychiatry has shown that psychiatrists
found community physicians aggressively hostile to both their scientific claims and
their professional aspirations.3 Moreover, according to research on the bacteriolog¬
ical revolution in Russia, community physicians initially opposed bacteriology on
the grounds that it threatened the social and environmental orientation of their
X Introduction
program of health reform. Only when they realized that the threat had been ex¬
aggerated did they come around to accepting the new field.4
Just as a review of the evidence suggests that the conventional portrait of com¬
munity physicians bears revision, so too recent research points to the need for a
more nuanced analysis of the attitudes of tsarist officials toward health reform and
of the structural possibilities for bringing reform about. A full reassessment of these
issues requires recognition that although the Russian empire was, by European
standards, an unhealthy place to live, neither the tsar nor his ministers wished to
keep Russians in an unhealthy state. Richard Robbins has drawn attention to the
fact that the famine of 1891-92 was a considerable embarrassment to the regime,
as was the cholera epidemic that followed it.5 The government could only have
welcomed the idea of making Russia healthier. A healthy people, as seventeenth-
century mercantilists had argued, were likely to be industrious in their work, thrifty
in their habits, stable in their moods, and valiant on the battlefield. The problem
was not a lack of good intentions but, rather, that so many of the proposed avenues
to better health conflicted with the traditions, ideology, and structure of the autoc¬
racy.
As an absolutist regime, tsarist Russia clung to a traditional medical police
approach, in which state regulation of matters of health and disease was considered
part of the “well-ordered police state.”6 (In this, the Russia of Nicholas II had
more in common with the Prussia of Frederick the Great or the Austria of Joseph
II than it had with the England of Joseph Chamberlain or the United States of
Theodore Roosevelt.) This approach rested on two premises: the belief in the im¬
portance of centralized state direction and the conviction that health affairs consti¬
tuted a branch of the general civil police. From the latter premise followed the
belief that matters of public health could be best directed by a trained civil admin¬
istrator and that the medical police administration properly belonged as a department
within a ministry of the interior. Thus conceived, the medical police approach did
not challenge monarchical authority, the estate structure of society, or the con¬
servative teachings of the established church.
In contrast to the medical police approach, most proposals for health reform in
tsarist Russia began from the assumption that matters of health ought to be the
exclusive prerogative of physicians, to whose expert judgment lay persons—in¬
cluding, or course, civil administrators—ought to defer. For their part, officials of
the enormously powerful Ministry of the Interior refused to defer to “expert medical
opinion” even within the ministry and blocked any attempt to establish a separate
ministry of health beyond their control. In this context, even the most conservative
reformers found their proposals blocked. Fittle wonder then that the far more am¬
bitious plans of the community physicians did not receive a positive hearing! It was
not merely that the Pirogov physicians saw themselves as the representatives of a
field which demanded expert knowledge, or even that they recited, like a litany,
their opposition to centralized direction. It was that, at bottom, these reformers,
with their insistence on the dictates of reason and science, appeared to threaten the
monarchy, the social order, and the established church. Not surprisingly, health
reform under the tsarist regime was severely limited.
