JOINT ARMY NAVY INTELLIGENCE STUDY EUROPEAN U.S.S.R. HEALTH AND SANITATION

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EALTH ANDS, SANITA..TI
ent Contains inf ormat on of f ectin
the meani of the sspio a Act, 50 U.S.C.,
r laatLon tif its contents in any manner to an
pproved For Release 2003/05/14 :
the national de erase 4 'the the Unite i$ t ri
31 and ?32, ais`amend - t guns fission or 'the
un-~~ authoriz sori is- prohibited y jaw.
CIA-RDP79-01144A000200010011
DOCUMEN Mil.
jJ/ D CLA~SWIE~1
CLA$ GN SEA CO. ti
EDITORIAL FILE aum i tin o.a,~ -
 Approved For Release 2003/05/14: CIA-RDP79-01144A000200010011-7
LIST OF EFFECTIVE PAGES, CHAPTER XI
CHANGE IN
SUBJECT MATTER EFFECT
Cover Page . . . . . . . . . . . . . . . . . Original
List of Effective Pages and Table of Contents,
Chapter XI (inside front cover) . . . . . . . . . Original
Text and Figures . . . . . . . . . . . . . . . Original
Figures (inserts, reverse sides blank) . . . . . . . . Original
Text and Figures . . . . . . . . . . . . . . . Original
Text (reverse blank) . . . . . . . . . . . . . . Original
Imprint (inside back cover, reverse blank) . . . . . . Original
TABLE OF CONTENTS
PAGE NUMBERS
unnumbered
unnumbered
pp. XI-1 to XI-18
Figures XI-6 to XI-8
pp. XI-19 to XI-32
p. XI-33
unnumbered
Note: This chapter is based upon material available in Washington, D. C., on 1 July 1946.
Page
110. INTRODUCTION . . . . . . . . . . XI- 1
111. ENVIRONMENT . . . . . . . . . . XI - 1
A. Water . . . . . . . . . . . . . XI - 2
B. Waste disposal . . . . . . . . . . XI - 2
C. Animals . . . . . . . . . . . . XI - 3
(1) Vectors of disease . . . . . . . XI - 3
(2) Dangerous animals . . . . . . . XI - 5
(3) Pests . . . . . . . . . . . XI - 5
D. Plants . . . . . . . . . . . . . XI - 5
E. Food . . . . . . . . . . . . . XI - 5
(1) General . . . . . . . . . . . XI - 5
(2) Collective feeding . . . . . . . XI - 6
(3) Food sanitation . . . . . . . . XI - 6
112. PUBLIC HEALTH AND
MEDICAL FACILITIES . . . . . . . XI - 7
A. Public health organization . . . . . XI - 7
(1) Republic . . . . . . . . . . XI - 7
(2) Oblast (territory) and kray (region) . XI - 8
(3) Rayon (rural districts and
city boroughs) . . . . . . . . XI - 8
(4) Village . . . . . . . . . . . XI - 8
(5) Commissariats of Transportation
and Defense . . . . . . . . XI - 8
B. Hospitals and medical institutions . . . XI - 8
(1) Hospital facilities . . . . . . . XI - 8
(2) Medical institutions . . . . . . XI - 10
C. Medical personnel . . . . . . . . XI - 13
(1) Professional medical personnel . . . XI - 13
(2) Subprofessional medical personnel . XI - 14
D. Rest and recreation facilities . . . . . XI - 15
(1) Health resorts . . . . . . . . XI - 15
(2) Red Corners, clubhouses, and parks . XI - 15
E. Social service agencies . . . . . . . XI - 15
(1) General . . . . . . . . . . . XI - 15
(2) Social insurance . . . . . . XI - 16
(3) Care for mother and child . . . . XI - 16
(4) Red Cross and Red Crescent . . . . XI - 16
113. DISEASES XI - 16
A. Diseases of military importance . . . . XI - 16
(1) Malaria . . . . . . . . . . XI - 16
(2) Sandfly fever (pappataci fever) XI - 18
(3) Rickettsial diseases . . . . . . XI - 19
Page
(4) Dysentery and diarrheas . . . . . XI - 20
(5) Frostbite . . . . . . . . . . XI - 21
(6) Venereal diseases . . . . . . . XI - 21
B. Diseases of potential military importance. XI - 21
(1) Endemic diseases . . . . . . . XI - 21
(2) Diseases which may be introduced XI - 23
C. Diseases of minor military importance XI - 23
(1) Typhoid fever . . . . . . . . XI - 23
(2) Scarlet fever . . . . . . . . . XI - 23
(3) Diphtheria . . . . . . . . . XI - 23
(4) Measles . . . . . . . . . . . XI - 23
D. Diseases common among the
civil population . . . . . . . . . XI - 23
(1) Tuberculosis . . . . . . . . . XI - 23
(2) Helminthiasis . . . . . . . . XI - 24
(3) Influenza . . . . . . . . . . XI - 24
E. Miscellaneous diseases . . . . . . . XI - 25
(1) Tularemia . . . . . . . . . . XI - 25
(2) Leprosy . . . . . . . . . . . XI - 25
(3) Trachoma . . . . . . . . . . XI - 25
(4) Smallpox . . . . . . . . . . XI - 25
(5) Rabies . . . . . . . . . . . XI - 25
(6) Anthrax . . . . . . . . . . . XI - 25
115. RECOMMENDATIONS . . . . . . . . XI - 27
A. Water . . . . . . . . . . . . XI - 27
B. Waste disposal . . . . . . . . . XI - 27
C. Food sanitation . . . . . . . . . XI - 27
D. Venereal disease control . . . . . . XI - 27
E. Prevention of frostbite . . . . . . . XI - 27
F. Control of mosquito-borne diseases . . XI - 27
G. Control of flies . . . . . . . . . . XI - 28
H. Sandfly control . . . . . . . . . XI - 28
I. Control of louse-borne diseases
(typhus and relapsing fever) . . . XI - 28
J. Control of tick-borne disease . . . . . XI - 28
K. Control of flea-borne diseases . . . . XI - 28
L. Cholera control . . . . . . . . . XI - 28
116. PRINCIPAL SOURCES . . . . . . . . XI - 28
A. Evaluation . . . . . . . . . . . XI - 28
B. List of references . . . . . . . . . XI - 28
C - J.
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Original
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Chapter XI
HEALTH AND SANITATION
Prepared by the Medical Intelligence Branch,
Office of the Surgeon General, War Department.
110. INTRODUCTION
This chapter deals with environmental conditions which
affect health, including water, sewerage, animals, plants,
and food, and with public health administration, medical.
facilities, and diseases. The area covered is the European
part of the U.S.S.R., extending from the Barents Sea and.
Beloye More (White Sea) to the Black and Caspian Seas,
and from the Ural Mountains and Ural river to a line
which would connect the Frisches Haff with the estuary of
the Danube (river). This territory includes the entire
European U.S.S.R. and contains the following political
units: The European part of the R.S.F.R., the Ukrainian
S.S.R., the White Russian S.S.R., the Karelo-Finnish S.S.R.,
the Moldavian S.S.R., the Estonian S.S.R., the Latvian
S.S.R., and the Lithuanian S.S.R.
Water and sewerage systems, although present, are
neither modern nor sufficient in number. The quantity of
water available is abundant, because of the large rivers,
numerous springs, and adequate rains and snow. Euro-
pean U.S.S.R. has some of the most fertile regions of the
world, the Ukrainian S.S.R. being an example; and the
supply of food in normal times is adequate. The canned
food industry is in its infancy, but is growing rapidly and
steadily.
Malaria-transmitting mosquitoes and sandflies are pres-
ent in great numbers. The louse population is consider-
able, and there are innumerable pests, such as cockroaches,
bedbugs, ants, and beetles. In the southeastern part of
European U.S.S.R. the rodents and domestic animals con-
stitute a reservoir for plague. This disease is transmitted
by fleas, which abound in that region. The ticks in Euro-
pean U.S.S.R. are incriminated in the transmission of en-
cephalitis. Dangerous animals include poisonous fishes
and snakes, bears, wolves, foxes, and rabid dogs and cats.
Medical and public health services are almost entirely
state controlled and supervised. The Soviet Union in
1941 had 130,348 physicians, 661,431 hospital beds for
general medicine and surgery, 73,992 beds for psychiatric
patients, and 141,873 maternity beds. The Narkomzdrav,
or Ministry for Public Health, controls all the medical
activities in the country.
The most important diseases of the Union are tubercu-
losis, malaria, and dysentery. Louse-borne typhus is still
present, although much better controlled than ever before.
The venereal disease rate has been considerably reduced
in the last 25 years. There are still some small foci of
Page XI-1
trachoma, plague, and leprosy, particularly in the south-
eastern and central-eastern parts of European U.S.S.R.
In general, the Soviet Union has exerted strenuous
efforts toward the solution of its health and sanitation
problems and has attained some measure of success. The
medical facilities of the country are still in the process of
rapid growth.
111, ENVIRONMENT
Despite the vast extent of the Soviet Union, climatic
conditions in large parts of the country have much in
common. The situation is different near the Black Sea,
across the Caspian Sea, and in the Far East, where winters
are longer and precipitation lower than in the rest of the
U.S.S.R. Occasional frosts which extend into the summer
or come early in the fall, lack of adequate spring rainfall or
ground moisture from melting snow, and drying winds
foster crop uncertainties.
Only a few areas in the west and in the higher moun-
tains receive more than 20 inches of rainfall. If it were
not for the low summer temperatures and limited evapora-
tion, very little of the entire country would be suitable for
agriculture.
Changes of latitude and altitude are not always accom-
panied by corresponding climatic variations. For exam-
ple, the yearly average temperature in Moskva (Moscow)
is 3 ? F. lower than in Leningrad, which is 400 miles to the
north, and winters in the delta of the Volga are colder
than in the Gulf of Finland where the north wind brings
warmer weather. Stations on the Azovskoye More (Sea
of Azov) have the same January average as the northern
coast of Kol'skiy Poluostrov (Kola Peninsula).
Winter is the predominant season. The frost-free pe-
riod is only 90 to 120 days in the northern half of European
U.S.S.R. In the central European area and the Ukraine,
only 120 to 180 days of each year are frost-free. Snow-
fall is not heavy but, since thaws are rare in winter, snow
accumulates and may be blown into formidable drifts.
In the European part of the Union, except for the Ukraine,
the snow persists for 100 to 200 days.
Summers are warm almost everywhere, with July iso-
therms extending east and west. Alon,g the Arctic Coast
long hours of sunshine raise the day and night monthly
average temperature to 50?F. From Arkhangel'sk to
Kiyev (Kiev), July temperatures are 60?F. to 68?F.; in the
steppes they reach 75?F.
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JANIS 40
A. Water
The first water-supply systems were built in Moskva
(Moscow) and Pushkin during the eighteenth century.
The amount of water supplied by all systems in Russia
during the eighteenth and nineteenth centuries was gross-
ly inadequate and expensive to the consumer. Important
changes did not take place until 1920.
In 1924 and 1926 the numbers of water-supply systems
in operation were 278 and 325, respectively. The numbers
of town inhabitants benefiting from municipal water-
supply systems during these same years were 12.5 millions
and 14.9 millions, respectively. Thus, the number of
townspeople benefiting from municipal water-supply sys-
tems increased by 16 percent. On the other hand, the
quantity of supplied water increased by 2', only, since the
entire Russian water supply per 24 hours was 714,000
cubic meters (approximately 188,500,000 gallons) in 1926
as compared to 700,000 cubic meters (184,800,000 gallons)
in 1924. The average water consumption of the individual
as the result of urbanization seems, therefore, to have
been reduced. It was 55.2 liters (14.57 gallons) per 24
hours in 1924, and 51.3 liters (13.54 gallons) in 1926. The
low capacity of water production during this period in the
U.S.S.R. can be judged by comparison with Chicago's
water supply. The daily output of water in the entire
U.S.S.R. was 714,000 cubic meters (188,500,000 gallons)
in 1926, while for Chicago it was 3,200,000 cubic meters
(844,800,000 gallons) per 24 hours in the same year. The
safeness of the drinking water in those years, particularly
river water, can be questioned seriously. The typhoid
epidemic of 1926 was caused by the poor water system of
the city of Rostov-na-Donu (Rostov-on-Don). For that
reason a decree was issued which established a special
body in charge of "z:nes of sanitary protection." By
establishing zoning regulations for protection of reservoirs,
this body had jurisdiction over the sanitary control of
municipal water-supply systems and the sources from
which those systems were fed.
For about 12 years before World War II municipal water
supplies had been developing rather rapidly in volume
and in potability. By the end of 1938, according to
Soviet figures, 411 cities had central water systems with
approximately 14,000 kilometers (8,700 miles) of water
mains. This indicates that the majority of Russian cities
had central water supplies, as the number of cities in the
U.S.S.R. with. populations exceeding 50,000, according to
the census of January 1939, was only 174. The third Five-
Year Plan proposed to increase the daily water supply to
5.25 million cubic meters (1,386 million gallons) by 1942.
Moreover, two years before the war (1939) legal stand-
ards were finally set for the minimum requisites of water
for drinking and household purposes.
During the war, expansion of water supply and main-
tenance of existing water systems continued in the un-
occupied cities, except in a few areas. In Moskva (Mos-
cow), for example, 54 kilometers (33.5 miles) of water
mains were laid during 1942 and 1943. No breakdowns in
main supply during 1941-1943 were reported. In the towns
of the Volga, which had to absorb many refugees and evac-
uees, water delivery doubled during the war. On the
whole, no serious threat to health was traced to the func-
tioning of water systems in the unoccupied U.S.S.R. during
the war period. The following cities are among those
which received new water systems in the past 15 or 20
years: Bronnitsy, Gor'kiy (Gorki), Ivanovo, Krasnodar,
Mozhaysk, and Murmansk. The following cities, among
others, had/their water-supply systems improved: Buk-
hara, Lenilftgrad, Moskva (Moscow), Rostov, Stavropol',
and Stalinrad.
The very few rural water-supply systems always were
poor. 'Villages obtain their water almost exclusively from
wells, the majority of which are of wooden construction
and of inferior design. The Russian Government has
initiated an ambitious program of water improvement in
rural areas. Thus, the building of concrete wells has been
encouraged, particularly around Moskva (Moscow) and
Pskov. During the second Five-Year Plan, 318 new rural
water mains, 99 of which are in the Crimea alone, were
under construction. A great improvement in rural water
supply may be anticipated in the near future, even if
temporarily interrupted by the war.
In the entire U.S.S.R. in 1936 water was obtained from
various sources in the following proportions: rivers 35.2'( springs 20.7', ; subsoil water (wells) 10.5 artesian water
13.3' ; subsoil spring water 6.7', artesian-spring water
4.7'> ; the remaining 8.9': from combined sources. These
percentages are not constant but change continuously;
nevertheless, rivers continue to be predominant as sources
of water supply in the Soviet Union. The European
U.S.S.R. is abundantly equipped with such natural sources
of water supply.
B. Waste disposal
The first sewerage system in the U.S.S.R. was built in
Odessa in 1862; sewerage systems for the cities of Kiyev
(Kiev), Moskva (Moscow), Rostov, and Khar'kov followed
in the years 1894, 1898, 1906, and 1914, respectively. As
late as the year 1930 there were only about 42 cities
equipped with sewerage systems, which represented an
almost insignificant, number compared to the number of
Russian cities without them.
The number of buildings served by the canalization sys-
tem in 1928 was very small. Thus, in Moskva (Moscow)
9,612 out of 29,449 dwelling units were connected with the
sewerage system; in Gor'kiy (Gorki), the number was 641
out of 9,199; in Rostov-na-Donu (Rostov-on-Don) 2,014
out of 16,170; in Sevastopol' 706 out of 5,749; in Kiyev
(Kiev) 4,582 out of 17,209; and in Khar'kov 1,648 out of
21,418.
The control and planning of major canalization projects
is partly in the hands of the NKVD (Department of In-
terior) and partly under the supervision of the Narkomz-
dray. Minor projects are planned and controlled by the
individual city or town councils. Rural communities do
not have any sewerage systems at all. and waste disposal
methods there are still extremely primitive.
The sanitary position of Soviet cities on the eve of World
War II apparently had a background of inadequate devel-
opment followed in 1925 by large-scale expansion, includ-
ing improvements in standards and regulations. In spite
of its extension, sanitation lagged behind growing urban
needs.
By the end of 1938, approximately 107 cities had sewer-
age systems with about 5,000 kilometers (3,100 miles) of
sewage mains. The most striking increase was in the
number of cities equipped. Between 1928 and 1938 their
number had more than doubled, but it should be noted
that the total of 107 reported for 1938 represented only
three-fifths of the number of cities with a population of
more than 50,000.
An example of the increasing official attention paid to
sanitation was shown in 1937 at the All-Union Conference
which recommended municipally controlled disposal of
sewage. At about the same time sanitary facilities were
unified within the administrative system of some cities
where the same department became responsible for rub-
bish collections, removal of wastes, general sanitation of
the city, street cleaning and washing, snow removal, and
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10 ime, HEALTH AND SANITATION
cemetery maintenance, as well as the preparation and pub-
lication of technical instructions and studies in these
fields.
During World War II insanitary conditions were rather
prevalent, although, with the favorable turn of the war,
serious efforts were reported to have been made to improve
unsatisfactory conditions all over the Soviet Union. There
are no data available on either the destruction or recon-
struction of the sanitation systems in the Soviet Union.
C. Animals
(1) Vectors of disease
(a) Mosquitoes.-Mosquitoes are numerous in Euro-
pean U.S.S.R. Positive identifications recorded for the
region include 9 species of Anopheles, 27 of Aedes, 7 of
Culex, and 11 of other genera. Many of the 54 species
are numerous enough to become serious pests in some
localities, but the only important vectors of disease in
European U.S.S.R. are five species of Anopheles respon-
sible for the spread of malaria. The breeding and other
habits of these species are described below.
The larvae of A. maculipennis maculipennis are present,
particularly in fresh sunlit water, but also in other types
of standing water. The larvae avoid thick horizontal
vegetation such as Lemna and prefer thin and vertical
vegetation such as Ranunculus, Myriophyllum, and Cera-
tophyllum. The adult mosquito is mainly active after
sunset and before sunrise. The species appears in April
and is most abundant from August to September. The
females start hibernation at the end of September.
The larvae of A. labranchiae atroparvus are found in
brackish water, coastal marshes, the fresh water of rice
fields, and upland streams. The adults enter houses in
large numbers. They bite animals but prefer human
blood. This species is an important vector of malaria.
The larvae of A. messeae thrive in cool, standing bodies
of fresh water, and in large inland river valleys, lakes, and
marshes. Adults prefer the blood of animals to that of
human beings. Hibernation occurs in barns and houses.
The species is believed to be an important vector of malaria.
A. sacharovi, because of its anthropophilic tendency, is
an important vector. It feeds on man and domestic ani-
mals, and breeds in coastal marshes, even if strongly
brackish, or in inland marshes which are open to sunlight
in midsummer. Adults enter human habitations and bite
man freely at ni,ght.
A. hyrcanus hyrcanus is considered to be a minor vector
of malaria in European U.S.S.R. The larvae of this species
are found not only in marshes and rice fields but also in
ponds and other collections which are exposed to the sun.
Adults are especially active at sunset and sunrise.
In the malarious regions of European U.S.S.R. (Ukraine,
Lower Volga region, Crimea, Moldavia) it has been estab-
lished that there are definite characteristic seasonal fluc-
tuations, sometimes considerable, among the various spe-
cies of Anopheles. Two distinct maxima are noticeable for
A. labranchiae atroparvus, one in April and May, and a
greater one around September. The species is considered
a "warm" type of Anopheles which cannot withstand the
cool nights of springtime. The autumnal increase is
coincident with the disappearance of A. messeae, which
commence to hibernate around this time of the year. In
summertime in the vicinity of Odessa A. labranchiae atro-?
parvus slightly outnumbers A. messeae.
The seasonal quantitative changes of the different types
of Anopheles can be studied by the typical "fli,ght curves."
These can be: 1) a pure type of flight curve representing
flights of A. messeae only; 2) a, pure type of flight curve
Original
Page XI-3
representing flights of A. labranchiae atroparvus only;
and 3) a mixed type of curve due to flights of both A.
messeae and A. labranchiae atroparvus.
The A. messeae type of flight curve is characterized as
low in May with the peak in June and July. The curve de-
scends in August and reaches its lowest point around the
last half of September, when A. messeae retires for hiber-
nation.
The flight curve of A. labranchiae atroparvus has two
peaks, one in July and a second one in September. The
September peak often is higher.
In the third curve which represents the flights of mixed
populations of Anopheles, there is no autumnal (Sep-
tember) rise because in mixed populations atroparvus is
less abundant. In Nikolayev (Nikolaev) for example, dur-
ing 1937 A. messeae outnumbered A. labranchiae atro-
parvus about two to one.
The morbidity rate of malaria noted in different regions
shows a definite peak in the second and third quarter of
the year. This corresponds also to the flight curve of
Anopheles which always starts to rise in April to reach its
peak between June and September and falls to its low in
the last and first months of the year.
(b) Flies.-Flies are extremely common in the Soviet
Union and represent a serious health problem. Their
numbers can at times increase to myriads, and reports
from German occupation forces in White Russia stated
that "it was impossible to avoid flies and that flies would
creep into the mouths of soldiers, or cover completely their
faces, food, etc." Sandflies (family Psychodidae) are
vectors of sandfly fever and certain flies like Sarcophaga
carnaris and species belonging to the families of Oes-
tridae and Gasterophilidae cause different forms of myia-
sis.
Some 39 species distributed among 15 genera in 9 fami-
lies have been recorded for the U.S.S.R.
Calliphoridae:
Calliphora erythrocephala
Do. vomitoria
Lucilia caesar
Gasterophilidae (gadflies) :
Gasterophilus intestinalis
Do. veterinus
Do. pecorum
Hypodermatidae (gadflies) :
Hypoderma bovis
Do. lineata
Muscidae (common flies) :
Entire European U.S.S.R.
do.
do.
Entire U.S.S.R.
do.
do.
Entire U.S.S.R.
do.
Stomoxys calcitrans
Musca domestica
Fannia canicularis
Oestridae (gadflies) :
Rhinoestrus purpureus
Piophilidae:
Piophila casei
Psychodidae (sandflies):
Entire European U.S.S.R.
do.
do.
Phlebotomus
chinensis
Crimea
Do.
major
do.
Do.
minutus
do,
Do.
papatasii
do.
Do.
perfilievi
do.
Do.
sergenti
do.
Do.
sergenti var.
do.
alexandri
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JANIS 40
FAMILY AND SPECIES GEOGRAPHIC DISTRIBUTION
tContinued)
Sarcophagidae:
sarcophaga carnaria
Do. haemorrhoidalis
Wohifahrtia magnifica
Entire European U.S.S.R.
do.
Southern European U.S.S.R.
Tabanus tarandinus
Do. fulvicornis
Do. tropicus
Do. ?nontanus
Do. solstitialis
Do. bovines
Do. bromius
Do. peculiaris
Do. erberi
Chrysops caecutiens
Tayga, northern regions
Tayga and forests
do.
do.
Forests and steppes
do.
do.
Around rivers in half-deserts
do.
Entire European U.S.S.R. except
deserts
do.
Do. quadratus Entire European U.S.S.R. except
deserts
Do. nigripes Tayga
Chz/rsorona pluvialis Entire European U.S.S.R. except
deserts
Do. crassicorois Tayga and forests
Do. italica Forests and steppe forests
(c) Lice.--The usual lice that infest man are found
in the U.S.S.R. They always have claimed a prominent
place in the history of Russian wars, revolutions, postwar
periods, migrations, etc., which were associated with
crowded living conditions and poor sanitation. The
species found are: Pediculus humanus capitis, Pediculus
humanus corporis, and Phthirus pubis. The most im-
portant diseases spread by lice are typhus fever, relapsing
fever, and trench fever.
(d) Fleas.-Approximately 35 species of fleas have
been identified in European U.S.S.R. Of these, Xenop-
sylla cheopis and species of Ceratophyllus, Ctenophthal-
mus, Ctenopsyllus, and Meropsylla are important as vec-
U. S. S. R.
DISTRIBUTION OF TICKS
Northern limits of distribution of the genera:
Ixodes
Hoemophysolis
DBrmocenlor
Rhipioepho/us
5. Booph/lus
6. Hyolommo
FIGURE XI - 1. Geographical distribution of ticks.
Northern limits of the genera represented in the U.S.S.R.
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tors of plague and typhus. However, flea-borne typhus
is rare in European U.S.S.R.
(e) Other insects.-Cockroaches, bedbugs, and ants
may serve as mechanical vectors of disease. Cockroaches
and ants transfer organisms by crawling over filth and
food indiscriminately. While the ability of the bedbug
to transmit disease is debatable, the ingestion or crushing
upon the skin of infected bedbugs may give rise to infec-
tion in man. The more numerous species of cockroaches
include Blatta orientalis, Blatella germanica, and Peri-
planeta americana. The bedbug, Cimex lectularius, is
found throughout the U.S.S.R.
Ants are a very considerable nuisance to man and ani-
mal. The following types are found in the territory of
the European U.S.S.R.: Monomorium pharaonis, Tetra-
morium caespitum, as well as Iridomyrmex humilis and
others. Monomorium pharaonis, imported to Europe from
tropical climates, is mainly found inside dwellings, par-
ticularly in bakeries, restaurants, hotels, and laboratories.
Sometimes these ants become particularly destructive to
the deep foundation of a dwelling and increase their popu-
lation to such an extent that the dwelling becomes unin-
habitable. Monomorium latinode can harbor the live
cholera bacillus for eight hours, and Monomorium de-
structor, which devours rats that died from plague, spread
this disease while the ant itself remains immune to it.
(f) Ticks and mites.--The importance of ticks as
vectors of disease in European U.S.S.R. is manifested in
the transmission of tick-borne encephalitis. Ixodes per-
sulcatus, whose larvae also may be infected with enceph-
alitis virus, is the main vector; Dermacentor sylvarum,
Haemaphysalis concinna, and Haemaphysalis japonica
are less important. These species are found in thick un-
cultivated forests. They attack man, cattle, horses, sheep,
pigs, dogs, and wild rodents. The geographical distri-
bution of ticks in the U.S.S.R. is shown in FIGURE XI-1.
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HEALTH AND SANITATION
The itch mite, Sarcoptes scabiei, and the follicle mite,
Demodex folliculorum, are common throughout the Euro-
pean U.S.S.R. The importance of mites as vectors of
rickettsial infection has not been established in this area.
Russian authors consider it as almost nonexistent.
(g) Mollusks.-Snails, clams, and other mollusks are
present in the European part of Soviet Russia. The Rus-
sian literature does not indicate that they are important
as hosts for flukes or other parasites.
(h) Rodents.-The rodents are the most important
group of mammals associated with spread of disease, par-
ticularly plague and certain forms of typhus. This ap-
plies especially to the southeastern part of European
U.S.S.R., but also to the rest of the Soviet Union. Mice, rats,
jerboas, marmots, rabbits, polecats, and weasels are some
of the most common rodents of the area. The genus
Citellus is represented by three species, namely Citellus
citellus, Citellus suslicus, and Citellus pygmaeus. Mar-
mota bobak is also present. The family Gerbillidae is
represented by two species, Pallasiomys erythrourus and
Meriones tamaricinus.
Mus musculus, Lagurus lagurus, Microtus socialis, and
Microtus arvalis have periodic mass migrations which
sometimes do not reach human habitations but terminate
in the steppes of southeastern U.S.S.R.; nevertheless, they
represent an abundant reservoir of plague.
(2) Dangerous animals
The dangerous animals of European U.S.S.R. include
two species of venomous snakes, certain fishes, and wild
animals.
(a) Reptiles.-The only poisonous serpents of Euro-
pean U.S.S.R. are two small vipers, true vipers or members
of the family Viperidae. Both are members of the same
genus, Vipera. There are no pit vipers.
The common viper or adder, Vipera berus, seldom grows
longer than twenty-four inches. The color is variable,
ranging through gray, olive, and brown, sometimes to
reddish. The color pattern may be uniform or dotted with
small spots. A bold, zigzag pattern of dark hue usually
extends the length of the back, thus distinguishing it
from the harmless snakes. This species has an X-shaped
mark at the back of the head, like a St. Andrew's cross.
Another viper, V. renardi, is particularly characteristic of
the southern parts of the European U.S.S.R.
The bite of these vipers is not always fatal; the venom
is reported to be hemotoxic.
(b) Dangerous and poisonous fishes.-The fishes
which are found off the shores of the various seas and
lakes of European U.S.S.R. are dangerous only in their
ability to injure by cutting or puncturing. The Trachinus
vipera (weaver) is frequently present in the Baltic Sea.
The Black Sea contains the following species: Dasyatis
pastinaca (sting ray), Scorpaena porcus (scorpion fish),
and Trachinus draco (weaver).
Some of the river fishes may prove deadly upon ingestion
because they contain an alkloid. The Dnepr (Dnieper),
Volga, and Kuban' rivers contain species of Barbus and
Schitzothorax (minnows) which may be poisonous.
From 50'% to 100`% of the perch, bass, burbot (eelpout),
pike and pike-perch in the estuary of the Neva are in-
fected with Diphyllobothrium Tatum.
(c) Mammals.-The usual domestic animals, such
as horses, cattle, dogs, cats, donkeys, and camels, can all
become quite important as sources of infections. This
applies particularly to the Volga valley and the steppe
regions of southeastern European U.S.S.R. where most of
these animals may become a source of infection for plague.
Page XI-5
There are still many rabid dogs, cats, and wolves in the
country, and about 70,000 people are bitten every year.
The European wolf, Canis lupus, is found in the north, and
the bear, Ursus arctos, in the tayga region. The fox is also
encountered in the northern regions.
(3) Pests
Some of the insects mentioned previously, such as ants,
bedbugs, and cockroaches, may become pests when suffi-
ciently numerous. Other pests include blackflies, cock-
chafers and other beetles, spiders, and scorpions.
(a) Blackflies.-Blackflies appear in great numbers
and become an almost unbearable nuisance, particularly
in the southern parts of the U.S.S.R. Among the species
found, two particularly are ubiquitous; namely, Simulium
vittatum and Simulium reptans. When they become very
numerous, these species are often so annoying that the
working capacity of the people is reduced.
(b) Beetles.-Altogether 28 species of beetles, distrib-
uted among 9 families, have been identified in European
U.S.S.R. These families are: Anobiidae, Cleridae, Curcu-
lionidae, Dermestidae, Histeridae, Ptinidae, Scarabaeidae
(cockchafers), Silphidae, and Tenebrionidae.
Some of these Coleoptera are pests only because they
damage food, clothes, and furniture. Others are inter-
mediate hosts for certain types of worms, particularly
nematodes. Many are agricultural pests.
(c) Spiders.-Spiders are universally present. Latro-
dectus tredecimguttatus (a species of Black Widow) is
frequently found on the beaches of the Azovskoye More
(Sea of Azov), Caspian Sea, Black Sea and in the Ukraine
south of Khar'kov. This spider is most active in summer,
especially in thinly inhabited regions where there is abun-
dant grass vegetation. Hay used as a spread on which to
sleep often contains spiders. Severe local and general
symptoms result from the bite of this species, but a fatal
result has never been reported.
Another spider found in southern European U.S.S.R is
the Trochosa singoriensis, often called the South Russian
Tarantula.
(d) Scorpions.-Buthus cupeus is found in the area
of Astrakhan' and in the Volga Valley. Euscorpius italicus
lives along the shores of the Black Sea, and Euscorpius
tauricus populates the Crimea, particularly the area a-
round Sevastopol'. The sting of these scorpions, though
painful, is said not to be fatal.
D. Plants
Scant information has been found concerning poisonous
plants in European U.S.S.R. The darnel, Lolium temu-
lentum (family, Gramineae), is subject to infection of its
inflorescence by the fungus ergot, the ingestion of which
by man or animal may be fatal. Any of the pollen-pro-
ducing trees and grasses may be sources of allergic re-
actions in susceptible individuals.
E. Food
(1) General
In the U.S.S.R., the supplying of food is a public service.
The state feels responsible for the production and dis-
tribution of food to individuals according to their needs.
An attempt is made to provide the entire population with
a rational diet designed to conform to physiological needs
and hygienic standards. The health authorities play an
important part in the solution of the food problem.
The food situation has always been a very serious matter
in the U.S.S.R. Famines occurred about once in every 10
years, and serious crop failures about once in every 5 years.
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JANIS 40
In the nineteenth century alone, famines occurred in the
years 1822, 1833, 1840, 1873, 1880, 1883, 1891, 1892, .1898,
and 1899. The disturbance created by civil war, foreign
intervention, and boycott, after the Russian Revolution,
resulted in the disastrous famine of 1920 to 1922 which
cost the country numberless human lives and created end-
less suffering. The famine caused mass migration in a
search for food and contributed to the spreading of epi-
demics.
The Soviet Government decided to solve the problem
of food and famine by collectivization and mechanization
of agriculture. This proved to be a failure at the end
of the first Five-Year Plan, and in 1932 the U.S.S.R. ex-
perienced a disastrous famine again. The failure was
caused by lack of cooperation on the part of the "kuiaks"
(rich peasants), who openly sabotaged the government's
plan. However, in 1933 all forces were mobilized to rem-
edy the kulak situation, and since then the U.S.S.R. has
been having record crops and no major food problems
except those resulting from war and drought.
Bread is one of the most important foodstuffs of the
Russian. The government reduced the export of grain,
so as to make more bread available for the population.
In addition, in peacetime, the government attempts to
keep a reserve equal to a full year's supply for emergencies
such as war or crop failure. Mechanized bakeries were
instituted. The Commissariat of Food Industry controlled
about 170 mechanized bakeries in 1936, exclusive of local
establishments. In 1937, 78' of all bread consumed in
the Union was produced mechanically. The whole process
is under strict medical supervision, and laboratories are
attached to the bread factories to test ingredients. The
workers are subject to medical control each day as a
matter of routine.
Meat is rather scarce in the Soviet Union. A great deal
of livestock was lost during the years when the farms be-
came collectivized. The number of sheep and goats was
particularly low; pigs were more numerous. This was
the situation in 1937. The war undoubtedly has created
more critical conditions as a result of retreat and "scorched
earth" policy.
The meat consumption of the population in 1937 was
higher than in preceding years. There are about 40 meat-
packing plants (government controlled) in European
U.S.S.R., the largest of which is the "Meat Combinat" in
Moskva (Moscow) where 1,250 head of cattle, 3,500 pigs,
and 1,500 sheep are slaughtered daily, producing a total
of 500 tons of meat daily. Forty-three veterinarians are
responsible for the quality of the products of this factory.
Fishing is another extremely important branch of the
Soviet food industry. Both seas and rivers are very rich
in fish. However, the chief center of fishing is not in the
European, but in the far eastern part of the Union. Fish-
eries, like farms, are collectivized. Fish is sold to the
population fresh, frozen, dried, salted, and canned.
Previous to the Soviet regime canning was an unknown
industry in Russia.. In 1936 the U.S.S.R. produced about
600 million cans of meat, vegetables, fruit, tomatoes, and
milk, and about 225 million cans of fish.
Fresh mill: is being delivered to dairies in the larger
cities, where it is analyzed and tested by chemists and
physicians. About, 75;, of it is delivered in pasteurized
form. The ice cream industry is small; total Russian
ice cream production in 1936 was 15,000 tons. The ice
cream production is under strict medical supervision.
Butter production is divided among mechanized factories
and homes. Complete figures can not be reported be-
cause no information on the home-made butter output
is available.
In the production of beet sugar the Soviet Union ranked
first in the world before World War II, and the output
was of such magnitude that, sugar could be exported in in-
creasing quantities.
Fruits and vegetables are scarce in the cities because of
transportation difficulties; they are abundant in rural
regions. Citrus fruits are very scarce throughout the
U.S.S.R. Potatoes, cabbage, cucumbers, melons, and
strawberries are abundant. Tea still must be imported,
but in increasingly smaller quantities. Coffee is imported,
but is not a popular beverage.
(2) Collective feeding
Collective feeding is a widespread practice in the Soviet
Union since it is considered the best method of providing
a correct diet for the people. It is believed to contribute
to the welfare of workers as well as to the increase of their
productivity. Every large working place, factory, office, or
school has its dining hall. Collective meals are the rule
in state farms and are becoming increasingly popular
on collective farms. The direction and supervision of
collective feeding is in the hands of Narpit (Nardonoe
Pitanie: People's Nutrition). It consists of representa-
tives of various government departments involved, such
as Agriculture, Food, Internal Trade, and Public Health.
In 1931 collective feeding embraced 42.8 of all industrial
workers, 251( of office employees, and 801,( of university
students.
The scientific foundation for collective feeding is promul-
gated by the Central Institute for Nutrition. Its program
is the study of nutrition of man in health and illness. It
has departments of physiology and biology, food hygiene,
cooking, diabetic-therapeutic nutrition, nutrition of moth-
ers and infants, education and training of technical staffs,
and economics. It not only has laboratories, but also an
infirmary with 120 beds.
The nutritional standards worked out by the Institute
are outlined in TABLE XI-1.
Carbo- Total
hydrates calories
Workmen and residents
of cities:
1-3 years
52
54
200
1,530
4-7 years
72
57
300
2,060
8-13 years
83
52
380
2,380
14-18 years
118
60
536
3,250
Adults
120
108
525
3,644
Maximum for very
heavy work
Rural districts:
Average adults
115
96
592
3,800
Workmen in over-
heated premises
130-150
In rural districts more carbohydrate and less protein
are given than in cities. Twenty percent of the protein,
according to the Institute, should be animal protein.
Vitamins ordinarily should not be added to the food.
However, in the northern districts where the diet is de-
ficient, it may become necessary to add them. Lenin-
grad has two factories producing vitamin A and vitamin C.
(3) Food sanitation
The supervision of sanitary conditions in large restau-
rants and kitchens attached to factories is very strict.
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HEALTH AND SANITATION Page XI-7
The same applies to bakeries and canneries. Workers
must bathe and wash thoroughly before starting their
daily work. The bathing facilities (showers and baths)
are attached to the food plant or restaurant. This ideal
condition of sanitation is found, however, only in large
industrial centers and large cities.
112. PUBLIC HEALTH AND
MEDICAL FACILITIES
A. Public health organization
(1) Republic
The public health organization of each republic is
headed by the Narkomzdrav (NKZ) (People's Commis-
sariat for Public Health), divided into a number of depart-
STRUCTURE OF PUBLIC HEALTH ORGANIZATION OF THE U.S.S.R.
Sovietsky Narodnyy Kommissariat U.S.S.R.
(Sovnarkom)
(Council of the People's Commissars of the U.S.S.R.)
Narodnyy Kommissariat Zdravookhraneniya
(Narkomzdrav)
(People's Commissars of Public Health of an SSR or an ASSR)
ments (FIGURES XI-2 and XI-3). The Narkomzdrav con-
trols all health work in the republic-preventive, diag-
nostic, and curative. It also controls medical education,
medical research, and medical industries. The adminis-
trative organization is as follows :
1) People's Commissar of Public Health
2) Two vice-commissars of public health
3) Collegium, consisting of:
Commissar
Vice-commissars, each one of which acts as chief
sanitary inspector for his oblast or kray
President of medical workers' union
Head, bureau of finance, commissariat for public
health
Peasant delegate
Planning commission, to work out details of
Collegium's policies and plans
4) Scientific medical council
Oblastnoy Otdel Zdravookhraneniya
(Dept. of public health of an Oblast)
Kraevoy Otdel Zdravookhraneniya
(Dept. of public health of a kray)
Gorodskoy Otdel Zdravookhraneniya
(Gorzdravotdel)
(City dept. of public health)
Rayonnyy Otdel Zdravookhraneniya (Rayzdravotdel)
(Rural district and city borough depts.of public health)
Legend
? ? ADVISORY FUNCTION
..~~~ DIRECT CONTROL
FIGURE XI - 2. Structure of Public Health Organization, U.S.S.R.
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JANIS 40
STRUCTURE OF COMMISSARIAT OF PUBLIC HEALTH OF THE U.S.S.R.
Administration and Management
of
The People's Commissars for Public Health
Chief Inspector for
Sanitation Education
Inspector for
Controls and Complaints
Sanitation;
water, sewage, living conditions, etc.
Conscriplion and Mobilization
(Secret)
Dept. of Construction
(Finances)
Dept. for
Planning and Finances
Dept. for Medical
and
Sanitation Statistics
Dept.
of
Cadres
b'IGURE XI - 3. Structure of Commissariat of Public Health, U.S.S.R.
Chief Inspector for
Obstetrics and Gynecology
--A
Dept. of Administrative
and Economic Problems
Teaching of personal hygiene.
Development of physical culture.
Appointment of trustees for insane persons.
The selosoviet has the following functions in relation
to social insurance.
(2) Oblast (territory) and kray (region)
Each oblast and kray has its own narkomsdrav in
charge of its own department of health. The Department
carries out policies and plans laid down by the narkomz-
drav, controls health departments of cities (gorzdravotdel),
and controls health departments of rural districts (rayz-
dravotdel).
(3) Rayon (rural districts and city boroughs)
Each rayon has a department of health (rayzdravotdel)
subject to the respective oblast or kray department of
health (FIGURE XI-4) . The rayon department of health
controls medical institutions within the limits of the
rayon. The administration includes a rayon inspector
of public health, and, in cities, one sanitary inspector to
every 25,000 inhabitants, under the jurisdiction of chief
sanitary inspector for the oblast or kray.
(4) Village
Village health matters are administered by the selo-
soviet (village soviet), which has the following functions in
relation to public health.
Supervision of all hospitals in selosoviet budget.
Organization of sanitation inspection.
Control of venereal diseases.
Keep register of insured persons.
Disburse benefits.
Form associations (artels) of invalids.
Place war veteran invalids in groups for collective
farming.
Appoint trustees for deaf, dumb, and blind.
(5) Commissariats of Transportation and Defense
The Commissariats of Transportation and of Defense
have subsidiary health administrations independent of the
Commissariat for Public Health. The Commissariat of
Defense provides health and medical service for the army,
and navy.
B. Hospitals and medical institutions
(1) Hospital facilities
Hospital facilities were inadequate in Tsarist Russia.
Though considerably improved, hospital facilities in the
Administration of Pediatric Services
Government Sanitary Control
and Inspection
Administration of Offices
engaged in epidemic control
polyclinics in towns and villages
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HEALTH AND SANITATION
Page XI-9
SAMPLE OF ORGANIZATION OF RURAL MEDICAL DISTRICT OUTSIDE OF REGIONAL CENTER
Selskiy Soviet
(Village Soviet)
Feldshersko-Akusherskie Punkty
(Feldsher and midwife aid stations)
Dizinfektor
(Sanitation Officer)
Sanfeldsher
(Asst. Sanitation Officer)
Hospital and ambulatory,
internal medicine, surgery,
infectious diseases, obstetrics,
laboratory X-ray.
Rayonnyy Otdel Zelravookhraneniya
(Rayzelravotdel)
(Rural District Dept. of Public Health)
Chief of rural medical
district in a village
Oblastnoy Aptekoupravlenie
(Pharmaceutical Administration for Oblast)
Office of consultation
for women and children
Dairy kitchen
Sanitary activities
in school, village, etc.
Legend
DIRECT INTERDEPENDENCE
SUPERVISION AND CONTROL
FIGURE XI - 4. Rural Medical District.
Sample of organization outside of regional center.
U.S.S.R. are poor by American standards even today. Cer-
tain diseases and services have received special consider-
ation because they were completely neglected in pre-
Soviet Russia. The number of beds has been increased
more rapidly for tuberculosis, venereal diseases, and ob-
stetrics than for other specialties.
(a) Hospital beds.-The total bed capacity of hos-
pitals exclusive of sanatoria and health resorts was 185,374
in Tsarist Russia (1913). This number was increased in
1941 to 877,296 (according to another source, to 710,000).
The Five-Year Plan which was started in 1945, provides for
a further increase to 985,000 beds by 1950.
Of the 877,296 hospital beds accounted for in 1941,
491,543 served cities and 169,888 were located in rural
communities; 73,992 beds were set aside for psychiatric
cases and 141,873 beds were located in maternity hos-
pitals. These numbers do not include the beds of the
various sanatoria, permanent and seasonable nurseries,
dispensaries, and emergency agencies.
Of the 491,543 beds in cities of the U.S.S.R. in 1941,
the R.S.F.S.R. had 320,283 beds, the Ukrainian S.S.R.
88,759, the White Russian S.S.R. 15,731, the Karelo-Finnish
S.S.R. 1,775, and the Moldavian S.S.R. 861. The greatest
relative increases in bed capacity took place in the White
Russian S.S.R. and Moldavian S.S.R. (TABLE XI-2). The
Original
number of hospital beds in the U.S.S.R. per 1,000 popula-
tion in cities rose from 3.9 in 1913 to 8.2 in 1941. The
ratio in the R.S.F.S.R. was 8.2, in the Ukrainian S.S.R.
7.5, in the White Russian S.S.R. 10.9, in the Karelo-Finnish
S.S.R. 9.1, and in the Moldavian S.S.R. 11.5 per 1,000 popu-
lation in 1941 (TABLE XI-2). The Caucasian republics
are not mentioned individually; they are included in the
numbers referring to the U.S.S.R. The numbers referring
to the R.S.F.S.R. include Siberian republics also.
Of the 169,888 beds in rural hospitals in the Soviet
Union in 1941 approximately 114,094 were located in the
R.S.F.S.R., 30,726 in the Ukrainian S.S.R., 3,069 in the
White Russian S.S.R., 1,144 in the Karelo-Finnish S.S.R.,
and 277 in the Moldavian S.S.R. In 1913 the number of
hospital beds in rural localities was small, but by 1941
it had shown some increase (TABLE XI-2). The most
impressive developments again are seen in the southern
European constituent republics. In rural localities the
number of beds per 1,000 population was 0.44 in 1913 and
rose to 1.47 by 1941 for the entire territory of the U.S.S.R.
The individual republics in 1941 ranked in the following
order with respect to beds per 1,000 population : The Kare-
lo-Finnish S.S.R. with 2.69, the R.S.F.S.R. with 1.58, the
Ukrainian S.S.R. with 1.51, the White Russian S.S.R. with
0.73, and the Moldavian S.S.R. with 0.48 (TABLE XI-2).
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U.S.S.R. and
Constituent
Republics
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JANIS 40
in cities
1913 1928 1932 1938 1941
R.S.F.R. 65,467 115,792 176,697
Ukrainian S.S.R. 19,556 21,122 42,289
White Russian
Karelo-Finnish
S.S.R. 305 559 1,097
Moldavian S.S.R. 64 86 147
Remaining
Beds
per
1,000
293,925 320,283 8.2
82,963 88,759 7.5
1,576 1,775 9.1
786 861 1.1.5
U.S.S.R. 93,223 158,514 256,158 450,694 491,543 8.2
R.S.F.S.R. 38,653 42,859 84,007 104,452
Ukrainian S.S.R. 8,668 11,269 20,524 27,720
White Russian
S.S.R.
Karelo-Finnish
114,094 1.58
30,726 1.51
1,144 2.69
277 0.48
S.S.R. 132 241 380
Moldavian S.S.R. 156 162 195
Remaining
republics
U.S.S.R
49,087 59,230 116,075 153,129 169,888 1.47
A certain percentage of beds in the hospitals is devoted
to certain specialties. As shown in TABLE XI--3, obstetrics
and pediatrics have gained. in importance, a fact which
reflects the increasing attention being paid to care for
mother and child. On the other hand, the number of beds
devoted to dermosyphilopathy had decreased very con-
siderably, which would correspond to the Russian claim
that the venereal disease rate has been lowered as com-
pared with prior years.
PERCENTAGE OF CITY HOSPITAL BEDS DEVOTED TO
CERTAIN SPECIALTIES, 1928 TO 1941
S P E C I A L T I E S
i
hD
.0
i
O. I
~
on I
i
R3
d
n
?
.
11
N
Q1
~
.y
Ld
0
I 0
Republics I Year
I
0
0
0
A
a z j 0
0 0
R.S.F.S.R.
1928
20.2
19.4
5.4
6.5
6.6
3.3
4.1
2.9
1.7
29.9
1941
16.2
16.4
15.1
5.6
2.2
17.4
1.8
2.5
1.2
21.6
Ukrainian
1928
17.6
21.4
8.3
7.4
4.3
5.6
3.2
4.0
1.4
26.8
S.S.R.
1941
14.1
17.8
14.4
7.1
2.8
13.2
1.8
2.3
1.7
24.8
White Russian 1928
18.9
24.9
6.6
6.5
7.2
2.2
0.6
7.4
3.2
22.5
S.S.R. 1941
15.0
13.6
16.0
4.9
2.1
9.4
1.2
3.9
1.7
32.2
(b) Rural medical centers.-The number of rural
medical centers in the U.S.S.R. was 13,512 in 1941. With-
in the U.S.S.R., the R.S.F.S.R. had 7,963, the Ukrainian
S.S.R. 2,445, the White Russian S.S.R. 539, the Karelo-
Finnish S.S.R. 116, and the Moldavian S.S.R. 28 (TABLE
XI-4).
(c) Technical equipment.-The technical equipment
of the hospitals in the U.S.S.R. must be regarded as poor.
Information on such equipment for rural hospitals, pre-
sumably inferior to that of urban hospitals, is not avail-
U.S.S.R. and
constituent
republics
U.S.S.R. total
R.S F.S.R.
Ukrainian S.S.R.
White Russian S.S.R.
Karelo-Finnish S.S.R.
Moldavian S.S.R.
Year
4,367 7,531 9,883 11,594 13,512
3,069 4,940 5,442 6,992 7,963
1,007 1,751 2,641 2,148 2,445
131 188 314 467 539
- - - Included in R.S.F.S.R. - - - 116
- - - Included in R.S.F.S.R. - - - 28
able. In the cities of the entire Soviet Union. in 1941 it
was reported that 25.5'j,, of all the hospitals had physio-
therapy equipment, 36.2';' had X-ray equipment, and
41.9 had laboratory equipment. The figures for the con-
stituent republics in European Russia are given in TABLE
XI-5.
CITY HOSPITALS WITH PHYSIOTHERAPY, X-RAY, AND
LABORATORY EQUIPMENT, 1941
U.S.S.R. and Percentage of total number of hospitals
constituent With With With
republics physiotherapy X-ray laboratories
U.S.S.R. 25.5 36.2 41.9
R.S.F.S.R. 27.5 38.2 40.1
Ukrainian S.S.R. 27.8 36.3 48.2
White Russian S.S.R. 20.9 36.6 '77.6
Karelo-Finish S.S.R. 45.5 63.6 36.4
Moldavian S.S.R. 57.2 71.4 71.4
(d) Health propaganda.-Health propaganda was
virtually unknown in Tsarist Russia and the number of
outpatient clinics for medical consultation was small.
By emphasizing health propaganda and free medical ad-
vice to the population, outpatient, clinics have increased
very considerably in number. The absolute number of
clinics is still inadequate, but the tendency is to further
develop these facilities. (TABLE XI-6)
U.S.S.R. and
constituent
republics
U.S.S.R.
1,230
5,673
7,340
12,645
13,461
R.S.F.S.R.
893
3,307
3,988
7,543
8,160
Ukrainian S.S.R.
187
1,276
1,712
2,554
2,600
White Russian S.S.R.
24
276
337
487
476
Karelo-Finnish S.S.R.
3
35
31
44
65
Moldavian S.S.R.
..
10
13
34
30
(2) Medical institutions
(a) The Academy of Medical Sciences.-The Academy
of Medical Sciences comprises 60 of the most outstanding
medical scientists of all branches of medical science, all
of whom were confirmed in 1945 by the Narkomzdrav as
Academicians. The nature of the activities of this body
are not yet known.
(b) Research institutions and medical schools.-The
research institutions and medical. schools in the U.S.S.R.
in 1941 numbered 223 separate institutes whose medical
research was carried on under the authority of Narkomz-
drav and whose personnel amounted to 19,500 scientific
workers. The institutes operate 'with the advice of 16 or
17 committees of the Medical Research Council (Uchonyy
Meditsinskiy Soviet), which is a body of outstanding
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HEALTH AND SANITATION
scientists selected by Narkomzdrav. The council examines
their research plans, personnel and equipment needs, and
budget, after which its decisions are transmitted to the
Narkomzdrav where final decisions are made.
There are four kinds of institutes under the Narkomz-
drav: Central Institutes, Special Institutes, the All-Union
Institute of Experimental Medicine (VIEM), and Medical
Institutes (Medical Schools) .
1. CENTRAL INSTITUTES.-Central Institutes are en-
gaged chiefly in clinical work. There are 12 of them and
all conduct research in their own fields; tuberculosis, skin
and venereal diseases, microbiology and epidemiology, on-
cology, neurosurgery, endocrinology, otolaryngology,
ophthalmology, plague, malaria and tropical diseases,
obstetrics and gynecology, and pediatrics. A branch of
each Central Institute must be established in each re-
public of the U.S.S.R., budgeted and coordinated through
the Narkomzdrav of the republic, but directed by their
respective parental institutes. Vaccines, sera, and other
biologic products are manufactured in the Central Insti-
tute of Microbiology and Epidemiology.
2. SPECIAL INSTITUTES.-Matters such as trauma-
tology, prosthesis, orthopedics, industrial hygiene, and
sanitation education are dealt with by Special Institutes.
These organizations do not have branches in the republics
and usually are limited to a single laboratory. Each
Narkomzdrav has its own Special Institutes which are
directly under its jurisdiction and are not connected with
the national institutes.
3. ALL-UNION INSTITUTE OF EXPERIMENTAL MEDICINE
(VIEM).--This organization does most of the fundamental
medical research. The Moscow branch has 13 departments;
the Leningrad branch, 6 departments; and at Sukhumi
in the Caucasus there is a monkey station. The depart-
ments of the Moscow branch are: General physiology,
physiology of the nervous system, physiology of the special
Page XI-11
organs, biochemistry, organic chemistry, morphology,
general experimental biology, biophysics, general pathol-
ogy, virus diseases, microbiology, brucellosis, and tula-
remia. There are small physiology laboratories which
work on problems in electrophysics, vitamins, endocrines,
and ferments. Two hospitals are attached to VIEM in
Moskva (Moscow), one for surgery and the other for neu-
rosurgery. The departments of the Leningrad branch
are : Physiology, special physiology, chemistry of microbes,
microciology, morphology, and general pathology.
The VIEM personnel numbers about 2,000, of whom
500 are scientific workers including 85 professors. The
VIEM publishes a monthly journal, the Arkhiv Biologi-
cheskikh Nauk (Arch. Biol. Sciences), as well as brochures
and collected works.
4. MEDICAL INSTITUTES.-In 1941 there were 72 medi-
cal institutes. known as Medvuz (Meditsinskie vishie
Uchebhie Zavedeniya), of which 51 were general medical
schools and 21 were stomatologic institutes and pharma-
cologic institutes. In addition there is a Medico-Military
Institute in Moskva (Moscow), which gives a complete
medical course. This school is under the direction of
military authorities. Each republic has at least one gen-
eral medical school. The total enrollment of students
in the general medical schools in 1941 was approximately
106,000, the largest enrollments being in Moskva (Mos-
cow), Leningrad, Kiyev (Kiev), and Khar'kov. The total
enrollment in 1939 in the Institutes of Stomatology and of
Pharmacology was about 14,000.
Each department of a medical institute is required to
conduct scientific work as well as to teach students. Tlp
institutes are directly under the jurisdiction of the re-
public Narkomzdrav, and their research programs are
examined and supported by the respective local narkomz-
drav. The 46 medical institutes located in European
U.S.S.R. are listed in TABLE XI-7.
TABLE XI-7
MEDICAL INSTITUTES IN EUROPEAN U.S.S.R., 1935
Republic or Oblast
Town
Specialty taught
Rostovskaya Oblast'
Rostov-na-Donu
Meditsinskiy Institut
All specialties
(Medical school)
Voronezhskaya Oblast'
Voronezh
Meditsinskiy Institut
do.
(Medical school)
Gor'kovskaya Oblast'
Gor'kiy
Meditsinskiy Institut
do.
(Medical school)
Smolenskaya Oblast'
Smolensk
Meditsinskiy Institut
Therapy, general medicine
(Medical school)
Ivanovskaya Oblast'
Ivanov
Meditsinskiy Institut
Therapy, prophylaxis,
(Medical school)
pediatrics, general
medicine
Kuybyshevskaya Oblast'
Kuybyshev
Meditsinskiy Institut
Therapy, general medicine
(Medical school)
Kurskaya Oblast'
Kursk
Meditsinskiy Institut
Therapy, general medicine
(Medical school)
Leningradskaya Oblast'
Leningrad
Pervyy Meditsinskiy
All specialties
Institut (1st medical
school)
Do.
do.
Vtoroy Meditsinskiy
General medicine, therapy,
Institut (2nd Medical
prophylaxis, hygiene
school)
Do.
do.
Tretiy Meditsinskiy
Therapy, general medicine
(3rd medical school)
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JANIS 40
TABLE
XI-7 (Continued)
Republic or oblast
Town
Name of institute or school
Specialty taught
Leningradskaya Oblast'
Leningrad
(Continued)
(Continued)
Do.
do.
Pediatricheskiy
Pediatrics
Institut (Pediatrics
school)
Do.
do.
Medvuz pri bolnitse
Hospital and school
Mechnikova (Medical
school attached to
Mechnikov Hospital)
Do.
do.
Stomatologicheskiy
Stomatology
Institut (School for
stomatology)
Moskovskaya Oblast'
Moskva
Pervyy Meditsinskiy
All specialties
Institut (1st Medical
school)
Do.
do.
Vtoroy Meditsinskiy
General medicine, therapy,
Institut (2nd medical
pediatrics
school)
Do.
do.
Medvuz pri Krasno
Hospital and school
Sovetskoy Bolnitse
(Medical school attached
to hospital)
Do.
do.
Medvuz pri Bolnitse
Hospital and school
Babukhina
Do.
do.
Farm. Fakulbet
Pharmacology
(Pharmacological faculty)
Do.
do.
Stomatologicheskiy
Stomatology
Institut (Stomatological
institute)
Saratovskaya Oblast'
Saratov
Meditsinskiy Institut
General medicine, hygiene,
(Medical school)
therapy, pediatrics
Arkhangel'skaya Oblast'
Arkhangel'sk
Meditsinskiy Institut
Therapy, prophylaxis
(Medical school)
Astrakhanskaya Oblast'
Astrakhan'
Meditsinskiy Institut
Therapy, prophylaxis
(Medical school)
Stalingradskaya Oblast'
Stalingrad
Meditsinskiy Institut
Therapy, general medicine
(Medical school)
Tatarskaya A.S.S.R.
Kazan'
Meditsinskiy Institut
Therapy, general medicine
(Medical school)
Bashkirskaya A.S.S.R.
Ufa
Meditsinskiy Institut
Therapy, general medicine
(Medical school)
Krymskaya Oblast'
Simferopol'
Meditsinskiy Institut
Therapy, general medicine
(Medical school)
Udmurtskaya A.S.S.R.
Izhevsk
Meditsinskiy Institut
Therapy, general medicine
(Medical school)
Ukrainian S.S.R.
Vinnitsa
Meditsinskiy Institut
Therapy and pharmacology
Vinnitskaya Oblast'
(Medical school)
Dnepropetrovskaya
Dnepropetrovsk
Meditsinskiy Institut
Therapy and prophylaxis
Oblast'
(Medical school)
Do.
do.
Farmatsevticjeskiy
Pharmacology
Institut (Pharmaco-
logical school)
Stalinskaya Oblast'
Stalino
Meditsinskiy Institut
Therapy and general
(Medical school)
medicine
o
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TABLE XI - 7 (Continued)
Republic or oblast Town
Kiyevskaya Oblast' Kiyev
Do. do.
Do. do.
Do. do.
Odesskaya Oblast' Odessa
Khar'kovskaya Oblast' Khar'kov
Do. Poltava
White Russian S.S.R. Minsk
Name of institute or school Specialty taught
Meditsinskiy Institut All specialties
(Medical school)
Farmatsevticheskiy
Institut (Pharmacology
school)
Stomatologicheskiy
Institut (Stomatology
school)
Pharmacology
Stomatology
Proizvodstvennyy Therapy, prophylaxis,
Meditsinskiy Institut general medicine
(School for industrial
medicine)
Meditsinskiy Institut Therapy, prophylaxis,
(Medical school) hygiene, pediatrics
Mediko-Analiticheskiy Laboratory work and
Institut (School for sanitation research
medical analysis)
Proizvodstvennyy Medit- Therapy, prophylaxis
sinskiy Institut
(School for industrial
medicine)
Meditsinskiy Institut Therapy, prophylaxis,
(Medical school) pediatrics, hygiene
Farmatsevticheskiy Pharmacology
Institut (Pharmacology
school)
Stomatologicheskiy
Institut (Stomatology
school)
Psikho-Nevrologicheskiy
Institut (School for
neuropsychiatry)
Stomatology
Neuropsychiatry
Proizvodstvennyy Therapy, prophylaxis
Meditsinskiy Institut
(School for industrial
medicine)
Proizvodstvenny Therapy, prophylaxis
Meditsinskiy Institut
(School for industrial
medicine)
Meditsinskiy Institut Therapy, prophylaxis
(Medical school)
Meditsinskiy Institut Therapy, prophylaxis
(Medical school)
In addition to medical schools there are "postgraduate
institutes" for physicians, and they are entirely separate
from the medical schools. Specialists in clinical subjects
and research workers are trained in the medical schools
or in the many research institutes of the Soviet Union. Of
the scientists and teachers working in the medical and
research institutes, 87% have been medically trained and
the remainder were biologists, chemists, economists, and
engineers. Sixty percent of the workers at these insti-
tutes were women.
Original
C. Medical personnel
(1) Professional medical personnel
(a) General.-The physicians (general practitioners
and specialists), dentists, and veterinarians who have been
educated in institutions of university standard, constitute
the higher medical personnel.
(b) Preparation for medical practice.-In 1930 during
the first Five-Year Plan, the modern period of medical
education began in Soviet Russia. Emphasis on medical
education was deemed essential and radical changes were
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JANIS 40
made in its administration and curriculum. Medical
schools were placed under the jurisdiction of the Com-
missariat of Public Health (Narkomzdrav). The medical
course was shortened to four years. The subjects were
reduced in number and were coordinated, duplication
was eliminated, recitations and lectures were restricted,
and use of Latin terms discontinued. Moreover, the usual
subjects of medicine were curtailed while hygiene and
preventive medicine were alloted additional time. Social
sciences, economics, physical culture, and military train-
ing occupied almost 40%v of the time. Students worked
in groups and carried out collective tasks. Examinations
again were abolished. Since specialists were desired in
all institutions, three faculties of medicine were estab-
lished : general medicine and prophylaxis, hygiene and
sanitation, and pediatrics including maternity and child
protection. The results achieved from the curriculum
were not satisfactory.
By 1935 the medical course was again lengthened to five
years. Lectures and recitations were increased, group
projects were reduced, Latin was resumed for medical
terms, and individual examinations were reintroduced.
At the same time, the number of instructors and the
amount of medical equipment were increased.
With the beginning of 1945 the course of study in all
medical universities was advanced to cover six years. The
new curriculum was to pay particular attention to anat-
omy, physiology, and biochemistry. Intensified instruc-
tion was to be given in clinics for internal diseases, in-
fectious diseases, surgery, pediatrics, and obstetrics and
gynecology. Radiology, urology, and physiotherapy was
to be taught only in basic surgical and therapeutic clinics.
(c) Physicians.-In 1913 there were 19,785 physicians
in Russia; in 1941 the number was 130,348. Despite severe
losses medical education continued without interruption
throughout the war. During the first 18 months 32,000
graduates took their places in the ranks of military and
civilian medicine of the Soviet Union. No information on
the territorial distribution of physicians in European
U.S.S.R. is available.
For medical students and doctors, three. types of prac-
tice are to be introduced : 1) practice as a feldsher (doc-
tor's assistant) after termination of the third year of
study; 2) practice preliminary to becoming a doctor, after
four years of study; 3) practice as a doctor, after five years
of study. Every physician in the U.S.S.R. is required to
take three to six months of postgraduate instruction
every three years.
(d) Dentists.--The dentists, like the. physicians, are
under the jurisdiction of the Narkomzdrav. Since 1918
the dental profession has been subdivided into two groups :
1) stomatologists, and 2) dentists (zubnoy vrach). The
stomatologists are fully trained doctors who have special-
ized in dentistry and stomatology. The dentists receive
their training in dentistry only and do not study in medical
schools.
The number of dentists in European U.S.S.R. reported
by the Soviet authorities in 1937 was 10,508, or 881yc of
the total number of dentists in the entire territory of the
Soviet Union. In that year it was planned by 1942 to in-
crease the total number for the entire Union from 13,000
to 32,000. Whether this goal was reached cannot be
determined from available literature.
(e) Veterinarians.-The department of veterinary
affairs in the Soviet Union is part of the NKZ or Narkom-
zem (People's Commissariat of Agriculture). Each con-
stituent republic has its own individual NKZ and thus its
own attached department of veterinary affairs which has
the task of managing, administering, and supervising all
veterinary activities of that particular republic. Each
kray, oblast, and rayon has also its own individual veteri-
nary department. Among other activities the veterinar-
ians take care of slaughterhouses and meat inspections
as well as the inspection of industries engaged in process-
ing animal products.
No recent data are available on the present veterinary
manpower in European U.S.S.R. The veterinary feldsher
has the same position in the veterinary profession as the
regular feldsher in the medical profession.
(2) Subprofessional medical personnel
(a) General.-Apart from the professional personnel
there are other medical workers comprising the "middle
medical classifications," apparently so-called because they
receive their training in middle schools (preparatory or
high schools). Middle, or subprofessional, medical work-
ers consist of the following categories: Feldsher, midwife,
medical nurse, child nurse, laboratory technician, dental
technician, and pharmacist.
(b) Feldshers.-The position of the feldsher and the
feldsheritsa is a peculiarly Russian institution. The word
"feldsher" is of German origin and literally means "field
barber." Before the nineteenth century all European arm-
ies had surgeons who had not been trained in universities
but had received their preparation through apprentice-
ship and special courses. On account of its size and the
general lack of trained physicians and surgeons, however,
the Russian Army still makes use of the feldsher. He prac-
tices not only in the arm; but among civilians.
The special functions of the feldshers always have been
to assist physicians, carry out their instructions, practice
minor surgery, vaccinate, and assist in fighting epidemics.
Because of the lack of physicians, some rural medical
stations are headed by feldshers. The number of aid
stations headed by feldshers and midwives in 1941 is shown
in TABLE XI-8.
NUMBER OF AID STATIONS HEADED BY FELDSHERS
AND MIDWIVES, 1941
o
Ca
a)
U.S.S.R. and
o
3 0
o
cu
o
o
constituent
c
a
Cd -1-1
U)C
-E! ig
Ca
o
republics
W ca
W fl m
H
D
H
U.S.S.R.
19,683
8,885
5,117
4,577
170
980
39,412
R.S.F.S.R.
11,552
6,218
2,534
3,564
90
183
24,141
Ukrainian S.S.R.
4,759
998
1,744
18
13
14
7,546
White Russian S.S.R.
48
901
55
179
1,183
Karelo-Finnish S.S.R.
116
83
11
210
Moldavian S.S.R.
52
5
10
67
In 1937 the number of subprofessional medical personnel
trained in feldsher schools was 44,770; in schools of mid-
wifery, 13,300; in schools of nursing (medical and child),
95,000; and in courses for laboratory technicians, 5,200.
These figures apply to the whole of the Soviet Union: No
information covering European U.S.S.R. alone is available.
In 1941 there were in the Soviet Union 985 subprofessional
schools which graduated 85,000 students per year.
The
majority of the 460,000 middle medical workers in
were women.
1941
(c) Nurses.-The exact number of nurses in European
U.S.S.R. is not known from available sources, but it is
known that there is a great shortage, probably because
factories, offices, and social services absorb a large number
of the women workers. Medical nurses and children's
nurses are now being trained in two-year courses.
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(d) Dental technicians.-Although trained for tech-
nical work only, dental technicians perform some clinical
work because of the shortage of fully qualified dentists.
Some technicians have acquired considerable skill in
clinical dentistry and help to relieve the dental manpower
shortage. The number of these workers in European
U.S.S.R. is not known.
(e) Midwives.-The midwife is an essential factor in
obstetrical practice in the Soviet Union. The large num-
ber of midwives which existed prior to the era of trained
obstetricians is steadily decreasing, but in rural localities
the midwife is still the only practitioner available. No
information as to the number of midwives in European
U.S.S.R. has been found.
(f) Laboratory technicians and pharmacists.-These
workers in the Soviet Union occupy a position comparable
to that in other countries.
D. Rest and recreation facilities
(1) Health resorts
The U.S.S.R. has only a few elegant resorts, but is rather
rich in localities which provide good conditions for differ-
ent types of therapy. The broad area extending from the
Arctic Ocean to the Black Sea and to the Pacific Ocean
contains innumerable varieties of mineral springs, beaches,
mountain resorts, and other resorts where climatic treat-
ment, balneotherapy, and radioactive mud baths are
available. Of the 1,400 mineral springs spread over the
entire continent of Europe, 534 are within the territory
of European U.S.S.R.; many other such springs are situated
in the Asiatic part of the Soviet Union.
Although the most numerous health resorts of the entire
Union are in the Caucasus, the most important in the
European part of the U.S.S.R. are the Crimean resorts.
The latter are located mainly along the southern beaches
of the Crimean peninsula, and are operated all the year
round. The numbers of health resorts in different parts
of the U.S.S.R. are shown in TABLE XI-9. Next in impor-
tance are the resorts near Odessa, such as the towns of
Kuyal'nik, Proletarskoye Zdorov'je, and Kholodnaya Bal-
ka, known for their therapeutic muds. Farther to the
north are Slavyansk near Khar'kov, Osipenko and Yeysk
on the Sea of Azov, and El'ton and Tinaki in the lower
Volga region. An extensive strip of health resorts is
represented by the Black Sea coast of the Caucasus, ex-
tending as far south as Batumi (Batum), and including
the towns of Sochi, Gagry, Sukhumi, and Krasnaya Poly-
ana. These places are considered to be equal in their
climatic advantages and other features to Nice and the
rest of the French and Italian Riviera.
Sanatorium care is available in the health resorts for
patients who need it, but ambulatory patients live in
hotels, villas, and country homes attached to the sanatoria.
Polyclinics have specialists on their staffs, including bal-
neologists and special physiotherapists who are well
trained for the particular type of work carried on in the
health resort where the clinic is located.
There are several research institutes which occupy
themselves with the exploration of the different thera-
peutic factors of any type of health resort; they are under
the general direction of the "Tsentral'nyy Institut Kurar-
bologii" (Central Institute for Balneology), located in
Moskva (Moscow). The institutes in Yalta and Krasno-
dar concentrate on research connected with health resorts
for tuberculosis. The "Sechenovskiy Institut" in Sevas-
topol, does research in physiotherapy among other things.
These institutes also train doctors for practice in health
resorts.
Original
Page XI-15
The purely scientific activities of such institutions are
under the jurisdiction of the Narkomzdrav, which also
controls those specialities which are secondarily connected
with health resort activities, such as geology, chemistry,
biology, climatology, engineering, and construction. The
official paper of these health resort institutions is the
"Kurortuoe Delo".
YEAR-ROUND HEALTH RESORTS FOR ADULTS
AND CHILDREN, 1935
Health Resorts
Health Resorts
for Adults
for Children
Tubercu-
Tuber-
Ne
uropsy-
losis
All other
culosis
c
hiatry
All other
sana-
toria
resorts
sana-
toria
s
ana-
toria
resorts
U.S.S.R.
Number of resorts 113 439
127
32 306
Number of beds 13,471 80,715
R.S.F.S.R.
9,311
1,838 34,260
Number of resorts 92 297
89
24 172
Number of beds 10,195 56,775
Ukrainian S.S.R.
6,480
1,459 18,299
Number of resorts 12 81
27
4 73
Number of beds 1,853 15,867 1,781
244 8,531
White Russian S.S.R.
Number of resorts 2 2 1
4
Number of beds 411 150 200
285
(2) Red Corners, clubhouses, and parks
The U.S.S.R. was the first country to organize a program
of rest and recreation on a large scale as part of the general
public-health program of the nation. Every working place,
small as it may be, has its "Red Corner", or social center;
larger enterprises have their own clubhouses built with
money earned by the factory. These clubs have rooms
for dining, rest, study, and games; a dance hall, library,
cinema, and theatre. The workers' clubs are organized by
trade-unions and are exceedingly active.
There are also many rest and recreation opportunities
outside of the working places, including one-day rest
homes and parks. All cities take pride in having good
"Parks of Culture and Rest," the prototype of which is
the "Maxim Gorki Park" in Moskva (Moscow). These
parks are centers of recreation and entertainment, and
have become institutions of great hygienic significance.
In addition, physical culture and sports have become
highly popular. It has been estimated that about 25,000,-
000 people take some active part in sports in the U.S.S.R.
Some of the factories begin their day's work with physical
exercises, and gymnastic periods of three to five minutes
are held during working hours. The trade-unions, in ad-
dition, have clubs outside the factories and mills, such
as yacht, rowing, and football clubs where the workers
of various plants meet. Corrective physical exercises are
utilized in the factories to counteract the effects of certain
occupations, and to increase the productiveness of labor.
E. Social service agencies
(1) General
Social service activities in the U.S.S.R. are largely state-
controlled and state-supported except for the Red Cross
and Red Crescent organizations. Governmental social
service is a part of the national medical service program
and includes such features as social insurance and care
for mother and child. The health of the individual is con-
sidered just as much the responsibility of the government
as the health of the nation as a whole. The state-financed
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Page XI-16 JANIS 40
health system has several characteristic features, as fol-
lows: Medical service is free to all; the prevention of di-
seases is its principal goal; all health activities are directed
by central bodies (People's Commissariats of Health) ;
and promotion of health is being planned on a large scale.
(2) Social insurance
About 30% of the population of the Soviet Union con-
sists of wage-earners. Their health service is financed
primarily through social insurance which is administered
by the trade-unions. Social insurance in the Soviet
Union includes : 1) Medical care, 2) benefits in case of
temporary disabilities, 3) additional benefits to families
having children beyond a certain number and for funerals.
4) unemployment benefits, 5) invalid pensions, 6) old-age
pensions, and 7) pensions to families in case of death of
the breadwinner. Social insurance extends its benefits
not only to the insured workers but to their dependents
as well.
In case of temporary disability the insured person is paid
full wages from the first day, the allocation amounting to
the average of the wages paid during the last three months.
In case of permanent disability, whatever its cause may be,
the insured worker or employee is entitled to a pension.
Pensions range from 40 to 100%, of former wages ac-
cording to the degree of disability and its cause. Further-
more, pensions are paid to family members who have lost
their main source of support.
All insured persons are entitled to old-age pensions of
50 to 60% of the last year's wages upon reaching the age of
60 (women 55), or 50 if they were employed in unhealthy
or underground work. They must, however, have worked
for not less than 25 years (20 years for women).
While social insurance is administered by the trade-un-
ions, the medical services given to the insured workers
and their families is controlled by the Commissariats of
Health. They are responsible for providing such services,
and they receive the financial means required from the
social insurance funds.
The health work for the agricultural population is
financed by the so-called "indivisible funds" which the
kolkhozs (collective farms) have in their budget. These
funds constitute between 10'%% and 20%/% of each kolkhoz'
earnings, a part of which is used for acquiring and im-
proving equipment, and part of which is used for building
nurseries and dispensaries, and for health work at large.
Since these funds are not sufficient for a full health pro-
gram, they must be supplemented by mutual aid funds
and state medical service through a network of health
stations financed primarily from public funds.
(3) Care for mother and child
The special health problems and needs of women and
children are the concern of a number of specialized insti-
tutions. Health centers usually have Women's Consulta-
tion Bureaus attached to them, to which women can apply
for advice and treatment. Before World War II almost
all ? the children born to city women were delivered in
maternity hospitals, but the country districts were not
so well equipped. There were special polyclinics, dis-
pensaries, and hospitals provided for children, and in
many cases children's consultation bureaus were attached
to health centers. It was the duty of these bodies to
supervise the health of the child from the day of its birth,
to, see that the necessary vaccinations and inoculations
were administered, and that medical aid was given either
at home or in the hospital when required. Nurseries
and kindergartens cared for the preschool child in town
and country, while a special team of school doctors as well
as the general network of health centers looked after the
school child, and special group treatment was arranged
for delicate children. Regular medical examinations and
special health care were prescribed for adolescents, and
their health was further protected by labor legislation
controlling their hours of work and vacations. Research
centers such as the Central Scientific Research Institute
for the Protection of Motherhood and Infancy study all
problems connected with health of women and children,
and establish norms and set standards to be observed in
their health and care.
There are no statistics at present available on the care
of children in European U.S.S.R. alone. The statistics
for the whole of the Soviet Union give an inaccurate pic-
ture if used as an indication since the European part is
far in advance of the rest of Russia.
The war had a very detrimental effect on the health of
Russian children, particularly in the front areas and in
German-occupied territories. Insufficient food, prolonged
cold, bad living conditions, and the psychological shocks
inflicted by bombardment all took their toll, and most of
the children treated in children's hospitals and polyclinics
were found to be suffering from alimentary dystrophia,
avitaminosis, and similar diseases. Children subjected to
the German occupation also suffered grave mental dis-
abilities. Institutional facilities for children, including
nurseries, were criticized in Soviet papers for lack of man-
power and general equipment. The noticeable effects of
war conditions on the health of children may prove a
handicap to the Soviet efforts for postwar reconstruc-
tion.
(4) Red Cross and Red Crescent
The Russian Red Cross, called in Moslem regions the
Red Crescent, was organized in 1867. It is a philanthropic
society that follows the pattern of the Red Cross societies
in other countries.
The Soviet Red Cross is a member of the International
Red Cross and has representatives in Geneva and New
York. A delegate of the International Red Cross has an
office in Moskva (Moscow). In 1934 the Red Cross and
Red Crescent of the U.S.S.R. were admitted to the League
of Red Cross Societies.
Activities of the Red Cross and Red Crescent include
nursing sick and wounded soldiers and aiding prisoners of
war. During the famine period 1921 to 1922 they organ-
ized large-scale relief operations in the Volga region and
fed 130,000 people daily. They work in close cooperation
with authorities, and supplement and integrate the gov-
ernment medical services. Their membership in the
Soviet Union grew from 75,000 in 1926 to over 5,000,000 in
1934. In addition to the activities mentioned above, the
Red Cross occupies itself with health education, teaching
of first-aid measures, and training of nurses and health
instructors. In 1935 the Red Cross established 48,282
stations, mostly in villages, where they performed sani-
tation work. No statistics are available for the activities,
personnel, and equipment controlled by the Red Cross and
Red Crescent societies in European U.S.S.R.
113. DISEASES
A. Diseases of military importance
(1) Malaria
(a) Distribution.-The U.S.S.R. contains a large ma-
larious area which extends from the Asiatic steppes to the
plains around the Caspian Sea; from Astrakhan' along
the banks of the Volga River on the one side to the Cau-
casian valleys on the other. It reaches the northern
Original
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HEALTH AND SANITATION
400
1900 1902 1904 1906 1908 1910 1912 1914 1916 1918 1920 1922 1924 1926 1928 1930 1932 1934 1936
FIGURE XI - 5. Malaria in the U.S.S.R.
Incidence per 10,000 inhabitants, 1900-1936.
shores of the Black Sea and extends along the banks of
the Dnepr (Dnieper) and Dnestr (Dniester) rivers into
the Ukraine and Volhynia, continuing along the Danube
River to the Balkans.
The Ukrainian swamps offer favorable breeding sites for
mosquitoes. The overflowing of the big rivers in spring
creates new swamps each year and plays an important
part in increasing the incidence of malaria to epidemic
proportions. The important malaria vectors in European
U.S.S.R. are discussed in Topic 111, C, (1), (a).
Before the revolution, malaria was the predominant
communicable disease with a morbidity rate of 215 per
10,000 population. In the six years (1918 to 1923) follow-
ing the revolution, the U.S.S.R. had a severe outbreak of
malaria (1923). The greatest number of cases occurred
from April to August, with the maximum in June. The
officially reported morbidity rate for malaria in 1923
was 474 per 10,000 population (FIGURE XI-5), an estimate
which appears to be too low. The total number of malaria
patients in the entire U.S.S.R. in 1923 was 12,500,000, of
whom some 62,000 died. The morbidity rates per 10,000
population for various regions of European U.S.S.R. in
the 1923 outbreaks were reported as follows: Lower Volga
Original
Page XI-1'7
ARIA
MAL
IN THE U.S.S.R. 1900-1936
INCIDENCE PER 10,000 INHABITANTS
A
L
MMN
1,548.8, Don 921.9, Central Volga 812.0, Ukrainian S.S.R.
232.2, Northern Provinces 184.6, Moskva (Moscow) 178.0,
Crimea 84.3, White Russian S.S.R. '22.4, and Sea Regions
(Baltic) 9.4.
In the 1923 epidemic all three common types of malaria
were found, but falciparum infection, which in nonepi-
demic years is almost completely absent, was variously
estimated to account for 50 to 90% of all cases. The
case fatality rate varied from 0.5 to 0.8%. The greatest
number of falciparum cases occurred in August; the peak
for vivax infections was noted in May and June.
Following 1923 malaria cases became less numerous and
the morbidity rate per 10,000 population for the following
six years showed a steady decline as follows: 446.5 for 1924,
229.4 for 1925, 164.4 for 1926, 130.7 for 1927, 92.5 for 1928,
and 58.0 for 1929.
(b) Endemicity.-The morbidity rate and predomi-
nant type of malaria differ from year to year in various
geographical regions of the U.S.S.R. The disease is en-
demic in the Ukraine, the Crimea, and the Lower Volga
region. In these regions the falciparum type of infection
usually predominates. Troop movements and traffic be-
tween the various provinces promote the transfer of an-
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JANIS 40
opheles mosquitoes and (alciparum carriers from one re-
gion to another. It is by these means that the falciparum
type of malaria is transplanted to the northern provinces
of the U.S.S.R. The extent of the disease is shown in
appended maps (FIGURES XI-6 to XI-8, inclusive).
In most of European U.S.S.R. malaria is hypoendemic,
though in some localities such as Odessa and Dneprope-
trovsk, it sometimes may become endemic. Occasionally
there occurs an extensive outbreak which, however, never
assumes the proportions which normally might be expected
in endemic or hyperendemic regions. In European U.S.-
S.R. the vivax type of malaria predominates. The intro-
duction of the falciparum type of malaria by carriers from
other regions such as the Caucasus may result in small
epidemics which are limited in the number of cases and
the area involved. An example of this type of localized
epidemic is reported from Poltava where 52 cases of falci-
parum infection in 1936 and 32 cases in 1937 were reported.
The number of cases decreased each year, and by 1943
no falciparum cases were reported.
The Ukrainian S.S.R. has the highest malaria morbidity
rate among the European Soviet Republics. The average
annual number of malaria cases from 1900 to 1914 was
231.6 per 10,000 population in nine Ukrainian districts
as compared with 181.0 per 10,000 population in the re-
mainder of European U.S.S.R. The average number of
cases according to districts in the same years appear in the
accompanying tabulation:
Number per
Number per
10,000
10,000
District population
District
population
Yekaterinoslav
438.2
Tavrichanskiy
361.0
(Dnepropetrovsk) *
Kherson
198.2
Khar'kov
392.7
Kiyev (Kiev)
81.8
Poltava
383.6
Podol
68.9
Chernigov
361.4
Volhynia
(Volynskaya
42.3
Oblast') *
*Present name
The malaria epidemic which occurred in the southern
European and Caucasian provinces and republics of the
Soviet Union during 1923 was ascribed to: a) an unprece-
dented movement of population masses brought about by
the Russian civil war; b) particularly hot summers in 1921
and 1922 which favored the numerical increase of anophe-
line mosquitoes; c) increase of mosquito breeding places
created by war destruction of houses and cultivated
fields; d) the wholesale slaughtering of domestic animals
upon which certain species of Anopheles fed; e) scarcity
of quinine during the blockade during and after the civil
war; and f) the reduction of natural resistance to disease
by famine.
An epidemic of malaria which occurred in 1935 followed
a period of famine during which there was mass slaughter-
ing of livestock, and the people's resistence to disease was
at a low ebb. Since 1935 the malaria morbidity rate again
has steadily diminished. An investigation by the Ger-
mans during their military occupation revealed only one
carrier among 850 persons examined in a zone which was
considered to be malarious.
(c) Malaria control.-A systematic campaign of ma-
laria control was instituted in 1920 with the establishment
of a Central Institute for Tropical Diseases. The struc-
ture of the malaria control organization in the U.S.S.R. is
shown in FIGURE XI-9. Cooperating in the malaria control
campaign is the Commissariat of Agriculture and Trans-
portation. The campaign includes oiling or draining
swamps, examining inhabitants in infected areas, and dis-
tributing quinine. A perceptible lowering of malaria mor-
bidity became apparent only after 1936.
Malaria stations have been built in malarious districts.
Each station is equipped with a laboratory, dispensary,
hospital, entomological department, and propaganda mu-
seum. The staff of a malaria station consists of a malari-
ologist who is a physician, an assistant malariologist, and
a subordinate staff which varies according to the size of
the station. Airplane dusting with Paris green is utilized.
Most of the malaria stations remain closed during the
winter. The numbers of sanitary and epidemiological
institutions, including malaria stations, are listed in TABLE
XI-10.
NUMBER OF SANITARY AND EPIDEMIOLOGICAL
INSTITUTIONS, 1941
Cd
rd v
x'60
U.S.S.R. and
Gd
0
0
0 0
O d
s
constituent
O v]
a
U v~
U
. 0
p
1
republics
c
d 0
4,
Cd
~a 4
o
4a
a
.tt 0
Pi Q
W C10
60 iu m
C] ~
A'cd c
d
U.S.S.R. 1,760
181 2,107
1,405 1,086 1,859
R.S.F.S.R. 746
69 905
726 579 602
Ukrainian S.S.R. 677
101 551
450 150 180
White Russian
S.S.R.
36
Karelo-Finnish
S.S.R. 6
23
7
Moldavian S.S.R. 8
1
7 3
Much of the antimalarial work was disrupted because
of the war. In 1943 there were indications of an increase
in the incidence of malaria in the U.S.S.R. The areas
specifically mentioned in published reports include the
Tatar A.S.S.R., and the oblasts of Voronezh, Kuybyshev,
Rostov, and Stalingrad. The Ukrainian S.S.R. has re-
corded a tenfold increase over the incidence reported for
1940; .in the Lisichansk rayon, for example, about 3,500
of its 4,000 inhabitants were stricken with malaria, and
in the village of Sirotino 250 of the 400 inhabitants were
afflicted with the disease. Efforts are being made to re-
establish malaria-control measures wherever they are
needed.
(2) Sandfly fever (pappataci fever)
This is a virus disease spread by a species of sandfly
belonging to the genus Phlebotomus. In European U.S.-
S.R. sandfly fever is encountered only in the Crimea where
it is sometimes called "summer grippe".
The disease has a tendency to break out suddenly, in-
volving numerous persons simultaneously. It has an in-
cubation period of three to nine days and a short prodromal
period. During convalescence the patients remain greatly
weakened for a long time. An extensive outbreak occurred
among the troops of the Red Army stationed in the Crimea
in 1922. Sandfly fever was first found in Sevastopol';
later many cases were found in Bakhchisaray, Yalta, and
other points of the southern coast of the Crimean penin-
sula.
The disease occurs predominantly in the beginning of
the summer, and again around the first of August, coin-
cident with the appearance of two different generations
of sandflies in the course of the current year. It was es-
tablished in 1932 that cases of pappataci fever were noted
soon after the first sandflies appeared; it is therefore
assumed that the virus hibernates in the larvae of the
sandflies.
The diagnosis of sandfly fever is very difficult and small
isolated outbreaks are often mistaken for influenza. No
figures on the incidence of the disease during recent years
Original
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 Approved For Release 2003/05/14: CIA-RDP79-01144A000200010011 URE XI-6
MALARIA MORBIDITY, 1902-1911
JANIS 40
40? 50? 60? 70?
pa 0 60
Ad Barents Sea BARENTS SEA
ARCTIC
v
OCEAN .'.,? t
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AREA OF MAP ,: .
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BOUNDARIES,1937 `??.~ Arabrarl '.
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FROM: BOL'SHAYA MEDITSINSKAYA ENTSIKLOPEDIYA, 1936 Vol. 16
IRAN
30? 40? 50?
EUROPEAN RUSSIA
MALARIA MORBIDITY Number of patients per 10,000 persons; yearly average
r77777779
1
111
~'~II
1902-1911
1.50 50100 100-200 200400 400600 600-1000 1000 or more
200 400 BOUNDARIES, 1911
MILES
2 4 ---?-? International -??-??-?? Guberniya
KILOMETERS
Names in parentheses are current usage.
curiFiDFNTIAI
 Approved For Release 2003/05/14: CIA-RDP79-01144A000200 IGURE XI-7
WAIMORBIDITY, , 1924
JANIS 40
i"v'J,~Cherepovetsn l ~.: i` ..:
ljli iiil i !,;I;, i~iu'IIIiy~r~ I i skO O
..i Novgorod f r. ~' _ fsr c:?
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EUROPEAN U.S.S.R.
MALARIA MORBIDITY
1924
0 Ryaza
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BOUNDARIES, 1924
-.-International _- Uniorepublic -...-Autonomous republic, oblast' kray,etc.
Names in parentheses era currant usage.
O
Sta ingrad
Kazan'
Astrakhan
 Approved For Release 2003/05/14: CIA-RDP79-01144A000200010011-7
FIGURE XI-8
MALARIA MORBIDITY AND CONTROL STATIONS, 1929
JANIS 40
20' 30" 40' 50' 60'
h.gd
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73. 79. ?80. ?
.~ ? . ... ? 82. ? 81. 089 .
' ? 83. ? '86. ? 9o
~? ?? `?'
.
(l
85.
87
. ?91.
0
B L A C K S E A
92 094.
`
? 93. ? 98 10. 101 . ' . to
~
0
..
09-1' i99\ .0
105. 95
0
.
98 0
? 0106 . ?
107. /
0110. 'V
116
?
0
'
.
,
?
109. ?114.
112
103.
; ?111. (]0 ~
?
.
40'
..
.
113. 117. ?.128.
.. .
'^?^ .,r'.T '??~
132.
29.
~(i 118.
?;126.
130
?
0
.
031.
T U R K E Y
?127
1'
40'
.
137 ?
119.:
!
120
? 121. ? 135. F ?.
`
122.' 'Y ??.~'
133.
?
8OL'SHAYA MEDITSINSKAYA ENTSIKLOPEDIYA
1936 V.L 16 x
134
FROM
?
'
1
.
,
.
:
~
123
136..-,.
?
124
\
/
12
'
5 ??
~
` ?
,
30" 40' 50"
EUROPEAN U.S.S.R.
MALARIA MORBIDITY AND CONTROL STATIONS
1929
BOUNDARIES
Number of patients per 10,000 persons; yearly average:
? Malaria Control Station -.- International (1937)
Tropical institute -
- Union republic (1929)
_
Sanitary and d Bacteriological Autonomous republic, Oblast;
1-50 50100 100-200 200-400 400600 6001000 1000 or more institute kray,etc. (1929)
INDEX
1. LENINGRAD 21. MOLOTOV 41. SARATOV 61. STAROBEL'SK 81. KRASNODAR 101. MAKHACHKALA 121. YEREVAN
2. KAASSOM INSTITUTE 22. SVERDLOVSK 42. ENGEL'S 62. VOROSHILOVGRAD 82. NOVOROSSIYSK 102. BUYNAKSK 122. KAMARLU
3. MOSKVA 23. CHELYABINSK 43. VOLSK 63. ARTEMOVSK 83. GELENDZHIK 103. DERBENT 123. ARARAT
4. BOLSHEVO 24. UFA 44. PUGACHEV 64. KONSTANTINOVKA 84. GORYACHIY KLYUCH 104. SUKHUMI 124. NAKHICHEVAN'
5. N0GINSK 25. CHKALOV 45. DERGACHI 65. STALING 85. TUAPSE 105. OCHEMCHIRI 125. MEGRI
6. KUDI NOVO 26. BUZULUK 46. NOVOUZENSK 66. MARIUPOL' 86. MAYKOP 106. GALI 126. KAZAKH
7. OREKHOVO-ZUEVO 27. BUGURUSLAN 47. URAL'SK 67. DNEPROPETROVSK 87. SOCHI 107. ZUGDIDI 127. KIROVFBAD
8. SHATURA 28. KUYBYSHEV 48. KAMYSHIN 68. KRIVOY ROG 88. KROPOTKIN 108. POTI 128. ALIABAD
9. MIKHNEVO 29, SYZRAN' 49. STALINGRAD 69. NIKOLAYEV 89. ARMAVIR 109. MIKHA TSKHAKAYA 129. NUKHA
10 RYAZAN' 30. UL'YANOVSK 50. YENOTAYEVSK 70. TIRASPOL' 90. LABINSKAYA 110. KUTAISI 130. AGDASH
11. TULA 31. PENZA 51. KRASNYY YAR 71. ODESSA 91. GEORGIYEVSK 111. MAKHARADZE 131. GEOKCHAY
12. SKOPIN 32. TAMBOV 52. ASTRAKHAN' 72. KHERSON 92. PYATIGORSK 112. KOBULETI 132. KUBA
13. VLADIMIR 33. RANENBURG 53. LI MAN 73. YALTA 93. NAL'CHIK 113. BATUMI 133: KALAGAIN
14. IVANOVO 34. LIPETSK 54. KIYEV 74. KAMENSK-SHAKHTINSKIY 94. MOZDOK 114. GOBI 134. DZHEBRAIL
15. KOZINO 35. RAMON' 55. SUMY 75. ROSTOV.NA-DONU 95. ARDON 115. TBILISI 135. ABDUL'YAN
16. GOR'KIY 36. VORONEZH 56. MOGILEV-PODOL'SKIY 76. NOVOCHERKASSK 96. DZAUDZHIKAU 116. TELAVI 136. SAL'YANY
17. CHEBOKSARY 37. KUR5K 57. KREMENCHUG 77. YEYSK 97. KOSTA-KHETAGUROVO 117. KARAYAZY 137. BAKU
18. YOSHKAR-OLA 38. OSTROGOZHSK 58. POLTAVA 78. LENINGRADSKAYA 98. ORDZHONIKIDZEVSKAYA 118. IDZHEVAN
19. KAZAN' 39. PAVLOVSK 59. KHAR'KOV 79. ANAPA 99. GROZNYY 119. LILIZHAN
20. IZHEVSK 40. BALASHOV 60. IZYUM 80. SLAVYANSKAYA 100. KHASAVYURT 120. ECHMIAOZIN
0 200 400
MILES
00 2y IN
KILOMETERS
Cartography
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on Branch
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HEALTH AND SANITATION
STRUCTURE OF ORGANIZATION FOR MALARIA CONTROL IN U.S.S.R.
Narodnyy Kom m issariat Zdravookhraneniya U.S.S.R.
(People's Commissars of Public Health of the U.S.S.R.
Tsentrazlriyy Institut Malyarii i Meditsinskoy
Parazitologii (Central Institute of Malaria and
Medical Parasitology)
Narkomzdravy Soyuznkh Respublik
(People's Commissars of Public Health of the
individual republics)
Respublikanskiy Institut Malyarii i Meditsinskoy
Parazitologii (Institute of Malaria and Medical
Parasitology of an individual republic)
Oblastnoy, Kraevoy Otdel Zdravookhraneniya
(Oblast and kray depts, of public health)
Oblastnaya, Kraevaya, Malyariynaya Stantsiya
(Oblast and kray malaria stations)
Gorodskoy (Rayonnyy) Otdel Zdravookhraneniya
(City and rayon depts. of public health)
Legend
ADMINISTRATION 'I NTERDEPENDENCE
SUPERVISION OF METHODS AND ORGANIZATION
Malyariynyy Otryad
(Malaria squad)
Page XI-19
Gorodskaya (Rayonnaya) Malyariynaya Stantsiya
(City and rayon malaria stations)
Khinizatory i Bonifacto
(Personnel for quinine
administration and
malaria field work)
are available. However, in Sevastopol' there were 200 to
250 cases of sandfly fever during July and August of 1932.
(3) Rickettsial diseases
(a) Typhus.-Famine, overcrowded living conditions,
and migration of troops and civilians favor the appearance
of louse-borne typhus epidemics. Conditions produced by
civil war, such as dislocation of populations, helped spread
the disease, and the U.S.S.R. experienced one of the great-
est typhus epidemics known in history during 1919 to
1922. Although the figures are admittedly incomplete,
some 20 million persons were estimated to have contracted
the disease in those years. The morbidity rate in 1920
was said to be over 260 per 10,000 population. A graphic
Original
Malyariynyy Otryad
(Malaria squad)
representation of typhus incidence in Russia from 1900
to 1936 is shown in FIGURE XI-10.
Since 1925 the morbidity rate for typhus has remained
at a relatively low level for the U.S.S.R. as a whole, al-
though some localities have had numerous cases at times;
there were said to be 1,000 cases in the hospitals of Kuy-
byshev in March 1942, for example. ? A League of Nations
report noted that in 1942 typhus was "markedly on the
increase" in the endemic countries of eastern Europe,
and it is probable that European U.S.S.R. shared this
general trend because the sanitary and living conditions
in such cities as Kazan', Leningrad, Moscow, and Penza
had noticeably deteriorated.
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JANIS 40
TYPHUS
IN THE U.S.S.R. 1900-1936
INCIDENCE PER 10,000 INHABITANTS
1900 1902 1904 1906 1908 1910 1912 1914 1916 1918 1920 1922 1924 1926 1928 1930 1932 1934 1936
FIGURE XI - 10. Typhus in the U.S.S.R.
Incidence per 10,000 inhabitants, 1900-1936.
In all the epidemics mentioned above, the highest inci-
dence of typhus occurred during the winter months.
Flea-borne (endemic or murine) typhus is a rare disease
in the Soviet Union and particularly in European U.S.S.R.
Only occasional cases have been reported, although many
infected rats have been found in the larger cities. Tick-
borne and mite-borne typhus are not reported from Euro-
pean U.S.S.R.
(b) Trench fever (Volhynian fever).-In World War
I, enormous numbers of cases of a febrile disease appeared
among troops on the German front in Poland and Vol-
hynia. Because the disease attacked front-line troops al-
most exclusively it was spoken of as trench fever or Vol-
hynian fever. A characteristic of the disease is pain in
bones and joints not accompanied by signs of inflamma-
tion. Fever curves are very irregular, sometimes show-
ing a sharp rise every five days (hence another name,
"Five-day fever") and in other cases developing a typhoid-
like pattern. Another characteristic is the frequency of
relapses, which may come on after weeks or months.
The disease has been shown to be caused by an organism
of the Rickettsia group, which is transmitted chiefly by the
body louse, Pediculus humanus corporis. The organism
is introduced by the bite of the louse or by rubbing louse
feces into the skin when scratching.
Prevention of trench fever, like the prevention of typhus,
depends upon delousing.
(4) Dysentery and diarrheas
(a) Dysentery.-Bacillary dysentery is endemic and
large numbers of cases are seen annually, but the amebic
form occurs only sporadically in European U.S.S.R. The
following remarks refer to bacillary dysentery only. The
types of organisms reported from the U.S.S.R. include the
Flexner, Hiss (y) , Shiga, Strong, and Stutzer-Schmitz
strains.
The disease assumes epidemic proportions from time to
time in various localities. The Ukrainian S.S.R. has con-
tinuously maintained a morbidity rate higher than that
in the rest of the Soviet Union. The morbidity rates
for the Ukraine from 1903 to 1917 ranged between 34.0
and 47.7 per 10,000 population. The case incidence in
the U.S.S.R. was highest in 1913 and 1920, but no adequate
figures are available for recent years. The number of
cases was said to be high in 1940 and 1941 and the disease
assumed epidemic proportions in the winter and spring
of 1941 to 1942. Seasonal incidence in European U.S.S.R.
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Wmlyllmm HEALTH AND SANITATION
is, greatest from June to September; in the Ukrainian S.S.R.
the season extends into October.
Mortality rates for bacillary dysentery fluctuate within
rather wide limits, but no reliable figures have been found
to indicate case fatality rates. A large proportion of the
deaths are reported to occur among young children and
adults beyond the age of 50 years.
(b) Diarrheas.-Various forms of diarrhea and enter-
itis are commonly reported from all parts of the Soviet
Union. In some instances this classification may errone-
ously include cases of the more serious enteric diseases.
There have been reports of acute gastro-enteritis caused by
Staphylococcus aureus carried by dairy products such as
cheese, ice cream, custard, and pastries. The incidence
of mild diarrhea is great, and is aggravated by poor water
systems. Infections caused by Salmonella breslau or S.
suipestifer also have been recorded.
(5) Frostbite
The effects of frostbite on the human and animal organ-
ism have been under extensive investigation in the Soviet
Union since 1934. The investigations, experimental as
well as clinical, were intensified during the Russo-Finnish
war and during the fall, winter, and spring of the first year
of the Russo-German war. The entire research was cen-
tralized under the People's Commissariat for Public Health,
and the work has been carried on systematically through-
out the war.
Studies on the effect of cold on the human organism
demonstrate that adequate, warm clothing which does
not interfere with circulation protects the wearer against
frostbite. Footwear that is properly fitted and kept dry,
and a diet high in fats and carbohydrates, were found
to be essential. Various ointments used by infantrymen
during severe frosts did not prove efficacious.
(6) Venereal diseases
No adequate data are available concerning the. preva-
lence of venereal diseases in the U.S.S.R. as a whole, nor
in European U.S.S.R., at the present time. It is believed
that all five venereal diseases are present in sufficient
numbers to constitute a threat to the health of personnel
operating in the country despite the facts that prostitu-
tion is no longer officially sanctioned and that the Soviet
Union has greatly increased the number of institutions
for treatment and control of venereal diseases. Such
statistics as are available refer only to cities in some in-
stances, only to rural areas in other cases, and occasionally
deal with venereal diseases in an all-inclusive manner
without separate reference to the individual diseases.
The number of cases reported includes only those patients
who have sought treatment and have been officially
registered.
The number of registered syphilis and gonorrhea pa-
tients per 10,000 population in the U.S.S.R. was reported
for various years as follows:
Syphilis 74.7 42.8 32.2 29.5 24.7
Gonorrhea 40.0 31.0 25.7 24.3 20.5
No similar figures are available for the other venereal di-
seases. It is stated that in 1936, the morbidity rate per
10,000 population in cities was 18.6 for syphilis and that the
incidence of gonorrhea in 18 of the large cities of the
U.S.S.R. in 1940 was 25.3% lower than the 1936 figure
(which is not revealed). The morbidity rate in 1913 for
chancroid in cities was 51.4 cases per 10,000 population.
The incidence for only two cities is reported for 1931 when
Moskva (Moscow) had 2.6 and Leningrad 1.8 registered
cases per 10,000 population. In 1941 it was officially re-
ported that only isolated cases of chancroid were found in
the entire U.S.S.R.
The number of registered cases of venereal disease in the
whole of Russia averaged 180.4 per 10,000 population in
1913. The figures for Moskva (Moscow) alone were stated
to be 388.7 in 1914 and 75.1 in 1934, both per 10,000 popu-
lation. No comparable data are available for recent years.
The Soviet Union officially does not sanction prostitu-
tion and has provided a program for the reeducation of
prostitutes. The reduction of the number of infections
acquired from prostitutes is exemplified by statistics con-
cerning such infections in Moskva (Moscow), shown in
TABLE XI-11.
Page XI-21
NUMBER OF PATIENTS TREATED IN ANTIVENEREAL
DISPENSARIES IN MOSKVA (MOSCOW), 1914 TO 1934
Average number per 10,000 population
Patients infected
Total by prostitutes
Percentage of
patients infected
by prostitutes as
compared with 1914
1914 388.7 221.0 56.9 100.0
1925 190.0 60.0 31.6 27.1
1927 132.0 35.0 26.5 15.8
1934 75.1 9.0 12.0 4.1
The number of institutes doing antivenereal work is
reported variously. Such institutions include the Cen-
tral Institute for Skin and Venereal Diseases (established
in Moskva (Moscow) in 1919) ; venereal disease clinics
established by the various Constituent Republics, by the
Provinces, and by regions; dispensaries established by
districts; and aid stations. Apparently all of these units
are included in the term "venerealogic institutions." In
1941 there were 2,605 venerealogic institutions under the
supervision of the Narkomzdrav of the R.S.F.S.R. alone.
The increase in the number of dispensaries and aid sta-
tions in European Russia from 1913 to 1941 is shown in.
TABLE XI-12.
NUMBER OF VENEREAL-DISEASE DISPENSARIES AND AID-
STATIONS, 1913 TO 1941
U.S.S.R. and
constituent
republics
1913
1928
1932
1938
1941
U.S.S.R. 12
800
683
1,351
1,498;
R.S.F.S.R. 11
509
412
728
828
Ukrainian S.S.R. 1
205
146
282
295
White Russian S.S.R.
14
15
40
38
Karelo-Finnish S.S.R.
1
4
5
Moldavian S.S.R.
3
1
5
61
The functions of the venerealogic institutions include
the registry, examination, and treatment of patients. Hos-
pitalization is compulsory for patients found to have com-
municable forms of syphilis. Periodic examinations are
conducted in schools, dormitories, and institutions, and
antivenereal propaganda is disseminated by radio, cinema,
newspapers, posters, and other means.
B. Diseases of potential military importance
(1) Endemic diseases
(a) Relapsing fever.-All parts of the U.S.S.R. have
experienced epidemics of louse-borne relapsing fever at
one time or another, but the morbidity rate has been
highest in Leningrad, Moskva (Moscow), and the Ukrain-
ian S.S.R. The disease appears to reach its highest level
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Page XI-22 JANIS 40
in the winter and early spring months. The morbidity
rate, which normally is between 1 and 2 per 10,000 popu-
lation, has been as high as 117 per 10,000 population dur-
ing some epidemics (1922). The mortality rate per 10,000
population, was 5.8 in Leningrad, 4.9 in Moskva (Moscow),
and 6.8 in Odessa, during the last great epidemic of
1919 to 1922.
No recent information is available concerning the oc-
currence of relapsing fever in the U.S.S.R. The availa-
bility of salvarsan in sufficient quantity to treat such
cases as do occur has reduced the threat of epidemic
spread of the disease.
(b) Tick-borne encephalitis.-Encephalitis is indige-
nous to the forest regions of the Far East, Siberia, and parts
of European U.S.S.R., including the Urals, Karelia, West
Ukraine, and White Russia. Its seasonal incidence begins
in April, increases to epidemic proportions in May, and
reaches its height in June. Only sporadic cases occur
between August and May. The greatest incidence and
mortality occur in new settlements situated in virgin
forests. The disease is contracted through the bite of in-
fected ticks that live in the forest. The most important
tick vector is said to be Ixodes persulcatus, the larvae of
which also may be infected with the encephalitis virus.
Other less important vectors are mentioned in Topic 111,
C, (1), (f)
The virus of tickborne or spring-summer encephalitis
may be harbored by birds and animals, including certain
rodents, goats, and sheep, all of which serve as reservoirs
of infection for the ticks which transmit the disease to
man. The eradication of rodents and ticks has proved
effective in controlling spring-summer encephalitis. Pre-
vention of the disease by means of a formolized vaccine
prepared from the brains of infected animals has been
reported in the Russian literature.
The fatality rate among patients who have contracted
spring-summer encephalitis ranges from 20% to 30%. The
disease appears to be less severe in European U.S.S.R. than
in eastern Siberia. Patients who survive the disease may
have residual paralysis and atrophy of the cervical mus-
cles and those of the shoulder girdle.
(c) Asiatic cholera.-The U.S.S.R. has experienced
many great epidemic outbreaks of cholera, the last of
which occurred in 1921 to 1922, the number of cases then
reaching 173,398. According to Russian reports, the dis-
ease has been under control since 1930. No cases have
been reported after 1926.
The epidemic of 1921 to 1922 was centered in the area
of European U.S.S.R. embracing Voronezh, Kursk, Tambov,
and the Lower Volga region. The seasonal incidence is
usually highest from June through August but in the
regions just mentioned cases were reported in the winters
of 1919 and 1920. In those epidemic years when famine
occurred fatality rates averaged about 50%.
Even though water and sewerage systems have been
improved since the last cholera outbreak, sanitation con-
ditions are far from perfect, and cholera still must be
considered a potential danger in the Soviet Union.
(d) Plague.-This disease occurs in the southeastern
territories of the U.S.S.R. and in Zabaykal'ye (Transbai-
kalia).; it is endemic in the Astrakhan' region where cli-
matic conditions are favorable and great numbers of
carriers are present among the local fauna. The number
of cases reported for the years 1924 to 1927 inclusive were,
respectively, 266, 257, 179, and 118 for all of U.S.S.R., and
these were distributed over the following areas: Volga
delta, Astrakhan' region, and Turkestan in 1924; Volga
and Don valleys in 1925; northern banks of the Caspian
Sea, northern Caucasus, Stalingrad area, Astrakhan'
area, and the Ural valley in 1926; and the Ural valley in
1927. The location is not stated for 1928 to 1930 inclusive.
In the southeastern parts of European U.S.S.R., plague
appears in the summer and fall when mice, rats, squirrels,
and other rodents are abundant, and the flea population
has greatly increased. The squirrel, Citellus citellus, is
most numerous from March to July while the yellow sand-
mouse, Pallasiomys meridianus, is most abundant during
the fall months. The rodents and fleas found in the
U.S.S.R. are referred to in Topic 111, C, (1), (d) and
(h), respectively. Various German investigators have re-
ported the rodents which serve as intermediate hosts of
plague in the Don and North Caucasus regions together
with the more important species of fleas involved in the
transmission of plague. The list from German sources
is summarized in TABLE XI-13.
RODENTS AND FLEAS INCRIMINATED
IN THE DISSEMINATION OF PLAGUE
IN THE DON AND NORTH CAUCASUS REGIONS*
Families
Subfamilies
Dipodidae Alactaga elater
do. jaculus
Meropsylla spp.;
Ophthalmopsylla
volgensis
Dipus sagitta
Scirtopoda telum
Leporidae* Lepus europaeus
Muridae Rattus norvegicus
do. rattus
Cricetinae Cricetulus migratorius
Cricetus cricetus
Gerbillinae Meriones tamaricinus
Pallasiomys
meridianust
Microtinae Ellobius talpinus
Lagurus lagurus
Microtus arvalis
do. socialis
Murinae Mus musculus
Ceratophyllus fasciatus
Xenopsylla cheopis
Ctenophthalmus spp.
Ctenophthalmus spp.
Xenopsylla mycerini
Ceratophyllus laeviceps
Ceratophyllus consimilis
Ceratophyllus spp.;
Ctenophthalmus spp.
Ceratophyllus
mokrzeckyi;
Ctenopsyllus segnis
Citellus pygmaeust i Ceratophyllus
tesquorum;
Neopsylla setosa
Compiled from German sources.
Regarded by many as belonging to the Order Lagomorpha.
-i Secondary plague reservoir.
i t Primary plague reservoir.
The Institute of Microbiology and Epidemiology in the
city of Saratov reports that livestock as well as wild ani-
mals may become infected with plague. Domestic animals
such as the cat and the dog may acquire the disease by
direct contact from rodents they have caught; camels and
donkeys become infected through ingestion of hay or other
fodder contaminated with feces of rodent carriers. A
source of infection for man is said to be the Kirghizean
wheat, Argyrophyllum arenarium, which becomes con-
taminated with the feces of infected rodents. Workers in
the wheat fields may acquire plague by inhalation of dust
from such contaminated wheat.
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HEALTH AND SANITATION
(2) Diseases which may be introduced
Filariasis and kala-azar are endemic in the Caucasus,
and Japanese B-encephalitis occurs in the Siberian Re-
publics. The movement of troops and the migration
of people from one part of the Soviet Union to another
easily may introduce such diseases into European U.S.S.R.
The introduction of falciparum malaria has been dis-
cussed in Topic 113, A, (1).
C. Diseases of minor military importance
(1) Typhoid fever
No data are available to show the incidence or prevalence
of typhoid fever in recent years. Following the revolution
of 1917, the morbidity rate increased considerably, reach-
ing about 34 per 10,000 population in 1920, but official re-
ports indicate a decreasing incidence after 1924. Fatality
rates have always been higher in the smaller communities,
probably because of inadequate medical care. Typhoid
immunization is now practiced extensively throughout
the U.S.S.R. and is compulsory for certain groups of work-
ers living in camps. New water and sewerage systems
have been built, and food inspection has been introduced.
Despite these measures, typhoid fever remains an endemic
disease in the Soviet Union and still represents a serious
sanitation problem.
(2) Scarlet fever
The incidence of scarlet fever has fluctuated within wide
limits in the U.S.S.R. for many years. In the period from
1920 to 1939, distinct peaks of increased incidence were
noted in 1926, 1930, and 1936 with a maximum of 41 cases
per 10,000 population in 1930. A study of the seasonal in-
cidence of scarlet fever in the central zone of the R.S.F.S.R.
during the period 1931 to 1937 showed that 36.2% of the
cases occurred in the autumn (September to November
inclusive), 27.4% in the winter (December to February
inclusive), 21.3%, in the spring (March to May, inclusive),
and 15.1% in the summer (June to August inclusive).
School children make up the majority of cases occurring
in the autumn. Fatality rates appear to be highest in
winter and spring, and lowest in autumn. Mortality is
highest in infants under the age of one year, and next in
the age group of one to five years.
Some attempts to control the disease have been made
in cities where mass immunizations have been carried out.
Immunization of children is carried out by institutions
for the protection of infancy and childhood and by the
increasing number of nurseries.
(3) Diphtheria
The incidence of diphtheria has been below 10 per 10,000
population in the U.S.S.R. for many years. The last no-
ticeable increase in incidence of diphtheria was noted in
1931 to 1932. A study of the seasonal incidence of diph-
theria in the central zone of the R.S.F.S.R. during the
period 1931 to 1937 showed that 34.5% of cases occurred
in the autumn, 28.4% in winter, 22.3% in spring, and
14.81/c in summer. Among children below three years of
age, diphtheria is more common in winter than in spring;
in the age group of three to four years, the winter and
fall incidences are about even; in the age group of five
to seven, the autumn incidence shows a marked increase
(31.1%, of reported cases) ; and the age group of eight to
fourteen has the highest morbidity in the autumn (43.5%,
of reported cases). Fatality rates appear to be highest
in winter and spring, and lowest in autumn. Mortality is
highest in infants under the age of one year and next
highest in the age group of one to five years.
Immunization against diphtheria is compulsory
throughout the U.S.S.R. However, the incidence of the
Original
Page XI-23
disease increased in 1942, and remained at a high level
in 1943. Inadequate immunization and late hospitali-
zation have been blamed for this state of affairs. In ad-
dition, the quality of diphtheria vaccine was said to be poor
during World War II.
(4) Measles
No comprehensive data are available, but it is said that
the morbidity and mortality rates for measles had notice-
ably increased during World War II. The incidence re-
ported for the U.S.S.R. reached about 66 per 10,000 popu-
lation in 1930, then declined sharply but in 1936 was on
the increase again.
D. Diseases common among the civil population
(1) Tuberculosis
Tuberculosis long has occupied a leading place as a
cause of death in Russia. The number of registered cases
has increased annually, probably as a result of improved
methods of diagnosis and increasing efforts to discover
cases. The incidence of tuberculosis in the country as a
whole from 1900 to 1929 is recorded in TABLE XI-14.
TABLE XI - 14
TUBERCULOSIS IN SOVIET RUSSIA, 1911 TO 1929
No. of
cases
Cases per
10,000 pop.
No. of
cases
Cases per
10,000 pop.
1911
676,602
47.3
289,462
18.0
1912
775,123
53.0
309,960
18.9
1913
824,817
55.3
315,728
19.4
1914
775,904
51.6
1915 to 1920
- No informatio
n available.
1921 to 1925
- Registration i
ncomplete.
1926
940,893
65.4
307,059
21.4
1927
1,326,204
90.1
458,460
31.2
1928
1,361,268
90.5
457,120
30.4
1929
1,385,905
90.3
491,969
32.1
It is stated on questionable authority that in 1913 the
death rate per 10,000 population for pulmonary tuber-
culosis alone in Moskva (Moscow) was 22.6; in St. Peters-
burg (now Leningrad), 28.6; in Saratov, 29.9; and in Yaro-
slavl', 30.9. Mortality rates for tuberculosis (all forms)
have been recorded for the city of Moskva (Moscow) from
1911 to 1931, and for purposes of comparison, similar rates
for Berlin, London, and New York are included in TABLE
XI-15.
TABLE XI-15
TUBERCULOSIS MORTALITY RATES PER 10,000 POPULATION
IN SELECTED CITIES, 1911 TO 1931
1911
19.9
17.7
26.9
21.0
1912
19.3
17.1
28.1
20.1
1913
18.4
16.5
26.6
19.9
1914
19.4
17.7
24.9
20.0
1915
20.7
18.9
23.6
19.6
1916
22.2
17.4
24.4
18.2
1917
32.3
18.9
23.2
18.8
1918
32.0
19.1
20.2
18.4
1919
27.3
13.9
28.5
15.2
1920
17.6
12.8
39.7
12.5
1921
15.0
12.8
24.5
10.2
1922
16.6
12.8
26.1
9.7
1923
18.4
11.6
18.0
9.3
1924
14.9
11.6
16.8
9.0
1925
12.4
11.2
16.0
8.6
1926
10.7
10.3
14.8
8.5
1927
10.7
10.5
15.7
7.8
1928
10.1
10.4
15.5
7.9
1929
11.5
10.3
15.6
7.5
1930
9.1
9.9
15.2
7.3
1931
9.1
10.2
14.6
6.9
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JANIS 40
In 1918 a Central Tuberculosis Institute was established
in Moskva (Moscow) by the Commissariat of Public Health
of the U.S.S.R. The Institute has an experimental de-
partment devoted to research in the pathological anatomy,
physiology, microbiology, and epidemiology of tuberculosis.
It has a clinical department for the study of pulmonary
tuberculosis, bone tuberculosis, and tuberculosis of chil-
dren. In 1937 the Institute controlled five sanatoria, of
which three were for children and two for adults.
The constituent republics have established Central
Tuberculosis Institutes in Kharkov, Minsk, Tbilisi (Tiflis),
Samarkand, and Alma-Ata, and regional institutes have
been organized in Moskva (Moscow), Ivanovo, Kazan',
Sverdlovsk, and in many other places. All the tubercu-
losis institutes give postgraduate courses to physicians
and train about 500 specialists a year. Dispensaries and
sanatoria employ about 27,000 physicians, all of whom
have had some specialized training.
The basic unit in the campaign against tuberculosis is
the dispensary, of which there are two types. About half
of the dispensaries are independent organizations (TABLE
XI-16) ; the other half are operated in connection with
health centers. No dispensary has fewer than 10 to 25
physicians. There is generally one dispensary for every
district of 150,000 to 350,000 inhabitants; Moskva (Mos-
cow) has 20 dispensaries. Rural regions have or will
have a dispensary for each rayon.
NUMBER OF INDEPENDENT TUBERCULOSIS DISPENSARIES
AND AID STATIONS, 1913 TO 1941
U.S.S.R. and
constituent republics
U.S.S.R. 43
498
498
925
1,048
R.S.F.S.R. 36
286
'281
587
669
Ukrainian S.S.R. 5
161
151
287
238
White Russian S.S.R. 2
15
16
22
29
Karelo-Finnish S.S.R.
1
1
2
4
Moldavian S.S.R.
1
4
5
The dispensary keeps an individual record of all patients
in the area under its jurisdiction. The patient is under
obligation to follow the instructions of the dispensary
doctor. If he refuses to accept the treatment prescribed,
he is denied a certificate entitling him to sick benefits
during his illness. The dispensary registers patients, ar-
ranges for treatment, and keeps patients and contacts
under observation. The district nurse calls regularly on
those patients who are living at home, educates families
in hygienic measures which will safeguard others from the
disease, and sends contacts to the dispensary for X-ray
examination.
In the whole Russian empire in 1914, there were only
43 tuberculosis dispensaries and 18 sanatoria with 307
free beds. In the area of the R.S.F.S.R. where there were
only four tuberculosis dispensaries in 1914, the number
had increased to 84 by 1924 and to 500 by 1936. In 1936
the total number of such dispensaries in the Soviet Union
was 750. They were equipped with X-ray and labora-
tories, and generally had their own clinical facilities.
Where such facilities were lacking, the dispensaries had
at their disposal observation wards, clinics, hospitals, re-
search institutes, or sanatoria, which were bound to ac-
cept any patients recommended by the dispensaries.
Existing sanatoria have an inadequate number of beds
for open tuberculosis cases. In 1936, there were about
35,000 beds in the R.S.F.S.R. and some 6,000 such beds in
the Ukrainian S.S.R. Special institutions called lupo-
soria have been established for the treatment of cutaneous
tuberculosis. There were three luposoria in 1934; one
with 170 beds in Leningrad, one with 120 beds in Moskva
(Moscow), and one with 30 beds in Sverdlovsk. A labor
colony where patients may find employment is attached
to the Moskva (Moscow) institution.
The antituberculosis campaign was somewhat disrupted
by the war which broke out in 1941, but by 1944 the rising
incidence of the disease was once more reduced to the 1941
level. Early in 1943 hospital accommodations for tubercu-
losis cases were increased, and patients were granted extra
rations. Workers with a history of tuberculosis were not
required to work night shifts or to engage in trades that
might be harmful to health. In some cases, their working
day was shortened without reduction of wages and, when
necessary, they were given care in so-called night sana-
toria established by various factories.
(2) Helminthiasis
Intestinal worm infections are common throughout the
Soviet Union, but no adequate studies have been made by
Russian or other scientists to establish an adequate picture
of the prevalence of the different varieties of helminth in-
fections. It is stated that nearly 100% of the population
of the central part of European U.S.S.R. are infected with
Enterobius vermicularis and that about 80% of the people
have Ascaris lumbricoides infection. Other nematodes
found in central European U.S.S.R. include Trichostrongy-
lus instabilis, T. orientalis, T. probolurus, and T. vitrinus.
Tapeworms are much more common in the northern
regions of the country. An examination of children in
Moskva (Moscow) in 1936 showed 3% to be infected with
Hymenolepis nana. The pork tapeworm, Taenia solium,
is not as prevalent as the beef tapeworm, Taenia saginata.
Infection with Echinococcus granulosus appears to be en-
demic in the Baltic areas from which occasional cases
of Necator americanus infection are reported. Fasciola
hepatica infections are rather frequently found in the
region of Ivanovo. Dicrocoelium lanceatum infections are
reported from the Donbass region, Ivanovo, Moskva (Mos-
cow), Penza, Sverdlovsk, and Kalinin.
In the northern part of European U.S.S.R., infections
with Enterobius vermicularis and Diphyllobothrium latum
have been commonly reported among the populations of
Arkhangel'sk, Leningrad, and the Karelo-Finnish S.S.R.
Examination of fishes from the Neva (river) showed Di-
phyllobothrium latum in 50 to 82% of the bass, perch,
and ruffs examined; in 50 %c to 91 % of the burbot, eelpout,
and lings; and in 100% of pickerel and pike examined.
Helminth infections in the White Russian S.S.R. appear
to parallel the figures reported for the central part of
European S.S.R. with the addition of Trichinella infec-
tions. Cases of loiasis have been reported from Astra-
khan', Zaporozh'ye, Khar'kov, Krasnodar, and from some
localities of the Asiatic republics.
(3) Influenza
Influenza is an endemic disease throughout the entire
territory of the Soviet Union. European U.S.S.R., like
the rest of Europe, experienced a particularly severe epi-
demic during the years following World War I.
The morbidity rate in "normal" years seldom is lower
than 200 per 10,000 population, and was 400 to 500 per
10,000 population in 1929 to 1930. In absolute numbers,
3,500,000 to 5,000,000 cases of influenza per year are not
unusual. Although the highest incidence of influenza in
southern regions as a rule occurs in February and March,
the northern regions may have a maximum number of
cases in January, and maintain a high morbidity rate
even as late as April.
Original
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E. Miscellaneous diseases
(1) Tularemia
The spread of tularemia from Asia into Europe has
taken place within the past 20 years. The first epidemic
of tularemia in the U.S.S.R. occurred in 1926 when numer-
ous epidemic outbreaks, mainly in regions along the Dnepr
(Dnieper), Don, Kuban', Ural, and Volga rivers were re-
corded. The incidence of tularemia in 1941 in the south-
eastern part of European U.S.S.R. was greater than ever
has been observed in Europe or North America (TABLE
XI-17).
In the 1926 outbreak the water rat (Arvicola amphibius)
was considered the main reservoir of infection, but by
1940 it was established that the field mouse (Microtus
arvalis) and the house mouse (Mus musculus) were pre-
dominant as carriers of the disease. Because of lack of
storage space in 1941, crops were only partially harvested,
and those which were left in the fields furnished favorable
conditions for the increase of the number of rodents.
The southeastern part of European U.S.S.R. offers con-
ditions favorable to the maintenance of a large rodent
population and may become a permanent focus of tula-
remia infection.
1935
Between Cherkassy and Kanev
..
Water rats
1935-36
Cherkassy and vicinity
100
Water rats
1941
Bobruysk, Gomel', and Sumy
Field mice
1941-42
Khar'kov, Kursk, and Shchigry
Field mice
1942
Right bank of Dnepr (Dnieper)
around Kirovograd
100
Water rats
Water rats,
rabbits
field and
house mice
1941-42
Rostov-na-Donu and vicinity
37,000
Field and
house mice
1938
1940-41
Aleksandrovskiy
Entire Kuban' Valley
34,206
Field mice,
rats, cats,
hares,
squirrels
1926
1928
1934
1938-41
1942-43
Bolshoy, Churki, and Mogol
Villages on Oka (river)
Stalingrad
Orel
Orel
200
800
..
5,000
..
Water rats
Water rats
Squirrels
Field mice
Field mice
Original
Page XI-25
(2) Leprosy
In 1939, according to official Russian sources, there were
some 3,000 cases of leprosy in the entire territory of the
U.S.S.R., of which about 1,000 were in Turkestan, 700 in
the Caucasus area, and 600 in the Estuary region of the
Volga. Astrakhan' is one of the important foci of the dis-
ease. In 1923 it was estimated that there were between
250 and 500 lepers in the Astrakhan' area; in 1926 the
estimate ranged from 500 to 600. About 30 cases were
reported from Saratov in 1926 and some cases from a few
of the villages around Stalingrad.
Second to the lower Volga valley in the incidence of
leprosy is the Kuban' valley where the disease is known
as "Krymka," probably because it was thought to have
been introduced from the Crimea. The number of lepers
in the Kuban' area in 1901 was 187, and in 1926, 175; the
greatest number reported in 1913 was 289. Most of the
lepers were found among the rural population.
Sporadic cases of leprosy have been reported from the
Crimea, Odessa, the Don valley, and the Caucasian Re-
publics. There are no official statistics concerning the
number of lepers in the Baltic Republics. In 1936 Russian
sources estimated that there were 226 lepers in Estonia,
210 in Latvia, and 21 in Lithuania.
Institutions for the care of lepers have been established
in Astrakhan', Leningrad, Moskva (Moscow), and the
Ukrainian S.S.R.
(3) Trachoma
The officially reported number of trachoma cases in the
whole of Russia in 1913, admittedly based on incomplete
registrations, was 1,029,333. Of this number 885,789 were
registered in European Russia. In some areas such as
that which now makes up the Chuvash A.S.S.R. and the
Tatar A.S.S.R., it was said that nearly 25% of the popula-
tion were trachomatous.
The number of cases reported for the U.S.S.R. in 1927
was 846,750. The reduction in the number of cases, as
compared with 1913, was most noticeable in those regions
where the disease formerly was particularly prevalent;
namely, the Chuvash A.S.S.R., Mari A.S.S.R., and Udmurt
A.S.S.R., and surrounding areas.
(4) Smallpox
The formerly large number of smallpox cases reported
annually has dwindled to a negligible figure since the ad-
vent of compulsory vaccination in the U.S.S.R. No data
are available for recent years, but in 1938 the total number
of cases in the whole of the U.S.S.R. was officially reported
as 223. The smallpox incidence per 10,000 population
reached a maximum of 14 in 1919, but has since declined
steadily except for an outbreak in 1932.
(5) Rabies
There are still many rabid dogs, cats, and wolves in the
country, and about 70,000 people are bitten every year.
There are several Pasteur Institutes in the U.S.S.R.; the
three most important are in Moskva (Moscow), Lenin-
grad, and Rostov-na-Donu (Rostov-on-Don).
(6) Anthrax
Anthrax still occurs in cattle breeding regions. The
morbidity rate for this disease is about 1 per 10,000 popu-
lation. In rural regions the greatest number of infections
are observed during the summer months. In 1938, the
entire U.S.S.R. had 2,558 cases of anthrax, of which 385
were reported from the Ukrainian S.S.R., and 16 from
White Russian S.S.R.
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Page XI-26 JANIS 40
114. THE BALTIC REPUBLICS
The Estonian S.S.R., Latvian S.S.R., and Lithuanian
S.S.R. comprise the Baltic Republics. Available data con-
cerning these territories are incomplete and inconclusive.
Official reports made to the League of Nations during the
few years these countries were independent States con-
stitute the major source of information for this discussion.
Late in 1939 these territories were occupied first by the
U.S.S.R., then by the Germans; and finally by the Russians
who incorporated them into the Soviet Union. No infor
mation concerning medical and sanitary conditions in the
Baltic Republics has been reported by Russian sources.
Such information as has been found concerning the
Karelo-Finnish S.S.R. has already been cited. The only
available data referable to the Estonian S.S.R. deal with
the number of cases of certain diseases in 1929; these are
summarized in TABLE XI-18.
INFECTIOUS DISEASES REPORTED IN
THE ESTONIAN S.S.R., 1929
4
.
o a;?o
~
C
1
d (U
x P
Typhoid fever 471
4.22
37
7.9
Paratyphoid fever 202
1.81
19
9.4
Measles 3,705
33.21
48
13.1
Scarlet fever 2,179
19.53
(?)
Diphtheria 405
3.63
(?)
Influenza 1,425
12.77
(?)
Dysentery 11.
0.10
3
27.3
Leprosy 19
0.17
4
21.0
Erysipelas 44 (?)
0.39
(?)
(?)
Encephalitis lethargica 1
0.01
(?)
Epidemic meningitis 22
0.20
(?)
Tuberculosis, respiratory 1,532
13.73
(?)
Tuberculosis, meninges & CNS 2
0.02
(?)
Syphilis 1,118
10.02
8
0.7
Soft chancre 95
0.85
(?)
Gonococcus infection 3,660
32.81
(?)
Data referring to the Latvian S.S.R. include a report of
the number of doctors and dentists registered in 1938,
and the. hospitals and diseases reported for 1929. Of the
1,566 physicians reported in 1938, there were 1,092 males
and 474 women. The distribution of physicians and den-
tists in the Latvian S.S.R. shows a large concentration
in Riga and a few other cities, with the remainder scattered
among smaller towns and rural areas (TABLE XI-19).
DISTRIBUTION OF DOCTORS AND DENTISTS
IN THE LATVIAN
S.S.R., 1938
No.
I %
No. I
%
Riga 830
53.0 489
60.4
Liepaja 86
5.5 33
4.1
Daugavplis 64
4.1 35
4.3
Jelgava 45
2.9 24
2.9
Small towns and rural areas 541
34.5 229
28.3
The Latvian S.S.R. in 1929 had 65 general hospitals with
nearly 5,000 beds, a ratio of 26.25 beds.per 10,000 popu-
lation. Next in bed capacity were 6 lunatic asylums with
2,334 beds, a ratio of 12.28 beds per 10,000 population.
Specialized hospitals, sanatoria, and convalescent homes
comprise the remaining institutions, all of which are
listed in TABLE XI-20.
HOSPITALS AND OTHER MEDICAL INSTITUTIONS
IN THE LATVIAN S.S.R., 1929
Institutions
Beds
Type
No.
No.
Ratio per
10,000 pop.
General hospitals
65
4,988
26.25
Surgical hospitals
13
324
1.71
Gynecological hospitals
11
162
0.85
Maternity hospitals
3
11
0.06
Children's hospitals
1
465
2.45
Hospitals for contagious diseases
3
70
0.39
Leper hospitals
2
220
1.16
Venereal diseases hospitals
1
120
0.62
Hospital for nervous diseases
1
30
0.16
Lunatic asylums
6
2,334
12.28
Eye hospitals
2
21
0.11
Tuberculosis hospitals
1
150
0.79
Sanatoria for pulmonary tuberculosis
10
408
2.15
Sanatoria for bone tuberculosis
2
151
0.79
Sanatoria for internal diseases
3
58
0.31
Sanatoria for respiratory and
nervous diseases.
Sanatoria for children with
pulmonary tuberculosis
Sanatoria for children with
bone tuberculosis
1
60
0.32
Sanatoria for debilitated children
1
27
0.14
Institutes for hydrotherapy
and dietetics
3
90
0.50
Convalescent homes
7
307
1.62
The number of cases (and deaths) of certain infectious
diseases in 1929 as reported to the League of Nations for
Latvian S.S.R. are recorded in TABLE XI-21.
INFECTIOUS DISEASES REPORTED IN
THE LATVIAN S.S.R., 1929
Typhoid fever
Typhus
Malaria
Measles
Scarlet fever
Whooping cough
Diphtheria
Influenza
Dysentery
Leprosy
Erysipelas
Poliomyelitis
Encephalitis lethargica
Epidemic meningitis
Anthrax
Tuberculosis, respiratory
Tuberculosis, miliary
Tuberculosis, bone
Tuberculosis, other
Syphilis
Soft chancre
Gonococcus infection
Morb
per
idity rate
10,000 pop.
Fa
tality
rate
619
4.84 94
15.2
25
0.13 3
12.0
5
0.03 0
0
302
1.59 8
2.6
942
4.96 11
1.2
245
1.29 12
4.9
277
1.46 26
9.4
1,797
9.46 6
0.3
22
0.12 1
4.5
276
1.45 28
10.1
276
1.45 27
9.8
134
0.71 21
15.7
9
0.05 6
66.7
85
0.45 36
42.4
2
0.01 0
0
4,495
23.66 379
8.4
36
0.19 8
22.2
768
4.04 15
1.9
564
2.97 42
7.5
1,192
6.27 17
1.4
160
0.84 0
0
1,566
8.24 0
0
The Lithuanian S.S.R. is essentially an agricultural
country. The 1923 census showed that 76.7% of the in-
habitants live in the rural areas and engage in agricul-
tural activities. The 1938 population estimate was
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HEALTH AND SANITATION
2,549,668. In 1929 there were 22 rural health centers
under the jurisdiction of the Department of Labor and
Social Insurance (supervised by the Ministry of the In-
terior) conducted by the Union of Maternity and Child
Welfare Organizations. The hospitals and other medical
institutions in the Lithuanian S.S.R. in 1929 are listed
in TABLE XI-22.
HOSPITALS AND OTHER MEDICAL INSTITUTIONS
IN THE LITHUANIAN S.S.R., 1929
Ra
10,0
tio per
00 pop.
General hospitals
41
1,889
8.19
Mental hospitals
2
500
2.46
Children's hospitals
2
80
0.32
Hospitals for contagious
diseases
1
50
0.21
Tuberculosis hospitals
2
72
0.31
Homes for lepers
1
20
0.08
Gynecological and obstetrical
hospitals
8
172
0.74
Maternity hospitals
2
17
0.07
Eye hospitals
2
45
0.18
Total
61
2,915
In 1938 some 210 health stations were opened, each
serving an average of 10,000 inhabitants. Patients afflicted
with venereal diseases were given free treatment. The
number of cases of certain infectious diseases as reported
in 1929 to the League of Nations is listed in TABLE XI-23.
duce safe water, but it should not be considered safe until
a thorough sanitary engineering survey has shown that
the system is properly located and constructed, and that
proper operating practices, including adequate analytical
control, are in effect.
B. Waste disposal
Except in larger cities and a few towns, sewage-dis-
posal systems may be considered inadequate or nonexist-
ent. Hence, suitable plans must be made for local waste
disposal wherever troops may be stationed outside those
cities with sewerage systems. Careful waste disposal is of
essential importance in view of the prevalence of enteric
infections.
C. Food sanitation
Because of the prevalence of flies and the high incidence
of enteric infections, special care must be exercised in the
storage, handling, and preparation of food in military in-
stallations. Artificial ice, if used to chill drinks or food,
should not be used in such a way as to contaminate the
food or drinks, or their containers. Personnel should be
cautioned as to the risk of eating in other than approved
establishments. Native employees of the military forces
should be examined periodically for evidence of intestinal
infections. Recommendations given for the control of
flies (Subtopic G below) are especially important for the
protection of food from contamination.
D. Venereal disease control
Venereal diseases are sufficiently prevalent to warrant
control measures. Adequate supplies of prophylactic ma-
terials will be needed, and easily accessible prophylactic
stations should be established. Comprehensive educa-
tional programs and adequate recreational facilities are
important. To a great extent the success of control meas-
ures will depend upon the accessibility and efficiency of
prophylactic stations and on the availability of prophy-
lactic devices.
Page XI-27
INFECTIOUS DISEASES REPORTED
IN THE LITHUANIAN S.S.R., 1929
Typhoid fever
Typhus
Relapsing fever
Smallpox
Measles
Scarlet fever
Whooping cough
Diphtheria
Influenza
Dysentery
Leprosy
Erysipelas
Epidemic meningitis
Rabies
Tuberculosis, all forms
Syphilis
Soft chancre
Gonococcus infection
M
r
10
orbidity
ate per
,000 pop.
Fatality
rate
1,013
4.37 28
2.8
420
1.81 35
8.3
1
0
0
1
0
0
749
3.23 4
0.5
1,094
4.72 16
1.5
1,015
4.37 6
0.6
555
2.39 26
4.7
5,883
23.39 19
0.3
79
0.34 15
19.0
2
0
0
414
1.74 1
0.2
51
0.22 11
21.6
1
1
100.0
1,051
4.53 31
2.9
1,749
7.54 0
0
48
0.26 0
0
1,637
7.66 0
0
115. RECOMMENDATIONS
The following recommendations are for personnel oper-
ating in European U.S.S.R. and are intended to supplement
the general sanitary precautions ordinarily in force in all
areas.
A. Water
All water supplies should be considered unsafe as found.
Some municipal systems may be properly equipped to pro-
E. Prevention of frostbite
The winters are extremely severe in most of European
U.S.S.R. Suitable precautions must be taken to avoid
frostbite whenever troops are exposed to temperatures
below 20? F. Proper clothing includes long underwear,
shoes roomy enough to allow the wearing of two pairs of
wool socks, windproof jackets, and warm clothing. Frost-
bite of the uncovered parts of the face cannot always be
avoided. Frequent warming of the face by covering with
the hand is necessary. The wearing of a mask has some
disadvantages. It protects the face but often becomes
frozen after saturation with vapor from the expired air.
Tight shoes, straps, or leggings, or even too many socks
or wrappings may reduce circulation and cause the toes
or feet to be frozen. Ski-trooper's trousers with knitted
cuffs protect against the wind and prevent snow from
sifting into the boot. Stamping and moving the toes
inside the boots improve the circulation and help prevent
frostbite.
F. Control of mosquito-borne diseases
Mosquito control is of paramount importance in Euro-
pean U.S.S.R. from April through October. Control meas-
ures should include :
1) : Elimination of mosquito breeding.
2) Location of camp sites preferably one or two miles from
important breeding places and human habitations so as to
be beyond the effective flight range of mosquitoes.
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3) Screening of military buildings and use of mosquito
sprays where needed. As soon as possible after arrival in a
new area, all habitations for troops should be treated with
DDT residual spray. Entrance vestibules with a screened
door at each end. (mosquito lock) will prove invaluable in
excluding mosquitoes from buildings.
4) Liberal use of insect repellents.
5) Wearing of protective clothing such as long-sleeved
shirts, trousers, and high shoes after sundown in mosquito-
infested areas. Head nets and mosquito gloves hould be worn,
when feasible, by personnel especially exposed to mosquitoes.
6) Use of bed nets issued as individual equipment.
7) Provision of a supply of antimalarial drugs sufficient for
100% suppressive treatment to be used at the discretion of
the surgeon.
G. Control of flies
Because of the prevalence of enteric diseases, fly con-
trol is imperative during the summer months. Thorough
screening of buildings, mess halls, kitchens, and latrines is
necessary. In addition, all garbage should be deposited
within covered containers and disposed of by burial or
incineration. The use of DDT residual spray should con-
stitute an essential part of all fly-control programs. In
mess halls and kitchens, it is advisable to apply the residual
spray thoroughly to the walls, window and door screens,
ceilings, crossbeams, light wires, light cords, and similar
places where flies rest or where fly specks are seen. All
food, cooking equipment, eating utensils, and tabletops
must be covered before spraying is begun. All breeding
places and their immediate surroundings, where the newly
emerged adult flies may alight, should be treated with
DDT.
H. Sandfly control
Sandflies are known to exist in the Crimea, and the
possibility that sandfly fever may occur must not be over-
looked. The disease may cause a high ineffective rate
in military personnel. The sandflies are too small to be
restrained by ordinary mosquito-netting. Recommended
measures to control sandflies include:
1) An insect repellent issued by the quartermaster is effec-
tive in protecting from bites of sandflies. It should be ap-
plied to exposed parts of the body. One application is effective
for three or four hours.
2) Spraying of the walls of tents or dwellings with DDT
residual spray furnishes effective protection.
3) Metal screening also may be sprayed or painted with
DDT. Sandflies which attempt to pass through the mesh
will be killed.
4) Care should be taken to choose a camp site on high,
dry ground with good ventilation.
5) The ground surrounding the camp site should be cleaned
of rubbish. Crevices in buildings or in the ground may serve
as breeding spots and should be filled, smoothed, or treated
with DDT.
6) Use of bed nets of special sandfly mesh.
1. Control of louse-borne diseases (typhus and relaps-
ing fever)
Enforcement of the utmost personal cleanliness possible
under the circumstances is essential. Ample facilities for
bathing and laundering are urgently necessary. Complete
equipment for delousing clothing, bedding, and other gar-
ments, and facilities for disinfestation of personnel should
be provided. Delousing powder to be dusted into the
clothing should be available. Typhus immunization is
essential. Adequate stocks of vaccine for stimulating
doses should be maintained.
J. Control of tick-borne disease
Spring-summer encephalitis is acquired from ticks in
forested areas. Control measures include the use of an
insect repellent, wearing of protective clothing, rodent
control, and the burning of grass around encampments.
K. Control of flea-borne diseases
Rodents and fleas are prevalent in European U.S.S.R.
Plague is endemic in southeastern European U.S.S.R. and
occurs in epidemic outbreaks from time to time. All build-
ings should be of ratproof construction so far as possible,
and rat-control programs should be enforced in all
camps. Native public buildings, habitations, and ware-
houses should be considered as harboring rats and other
vermin. Such,buildings should be sanitized before use
for living quarters or offices. Adequate stocks of plague
vaccine should be available for use as a control measure
in the event of a plague outbreak.
L. Cholera control
Cholera has been endemic in the Soviet Union. Be-
cause of the ease with which it could appear in epidemic
form as a result of break-down in the usual sanitation
procedures, preventive measures are indicated. All medi-
cal officers should be alert to detect the disease and, if it
occurs among either military or civilian personnel, stimu-
lating doses of vaccine should be administered to all troops.
Strict attention to water and food sanitation, to disposal
of excreta, and to control of flies (Topic 115, A, B, C, and
G) will be essential to reduce the risk of spread.
116. PRINCIPAL SOURCES
A. Evaluation
Officially reported Russian statistics have been used to
a considerable extent although their reliability is not
always clear. Russian medical statistics under the Soviet
regime frequently compare morbidity and mortality figures
with those of the Tsarist regime and such comparisons
usually glorify the achievements of the present govern-
mental system. The recording of cases and deaths due to
the various diseases is not universally practiced and offi-
cially reported statistics are correspondingly incomplete.
It is not known how much of the failure to present com-
prehensive statistics may be based on a desire to credit
local health organizations with effective disease-control
measures. If bias exists in official reports, it is no less
evident in many reports from non-Russian sources which
often are either so laudatory or so derogatory in tone
as to cause one to suspect their reliability.
Only a limited amount of original Russian source ma-
terial is available in the United States and almost no perti-
nent medical reports written since the onset of World War
II have been found. Free use has been made of infor-
mation obtained in interviews with persons who have
lived or visited in the U.S.S.R.
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i Sanitariya, Nos. 7-8, pp. 18-25. Moscow. 1944.
162. Zaporozhenko, A Y.
PROTIVOEPIDEMICHESKAYA RABOTA SANITARNO-EPIDEMIOLOGI-
CHESKIKH STANTSIY, SANITARNYKH UCHASTKOV, AMBULA-
TORIY I POLIKLINIK (Anti-epidemic activities of the
sanitary and epidemiological stations, sanitary districts,
ambulatories, and polyclinics). Gigiena i Sanitariya,
Nos. 10-11, pp. 44-46. Moscow. 1944.
163. ZDROVE I ZDRAVOOKHRANENIE TRUDYASHCHIKHSYA SSR (Health
and preservation of health of the working people of
the U.S.S.R.) Redaktsionno-Izdatelskoye Upravl. Tsu-
nkhu Gosplana SSSR i u/o "Soyuzorguchet," 221 pp.
Moscow. 1936.
164. Zilboorg, G.
SOME ASPECTS OF PSYCHIATRY IN THE U.S.S.R. Amer. Rev.
of Sov. Med., vol. 1, No. 6, pp. 562-575. New York. 1944.
165. Zumpt, F. and Minning, W.
DER FLUGZEUGEINSATZ IN DER MEDIZINISCHEN SCHAEDLINGS-
BEKAEMPFUNG (Use of airplanes in vector control).
Dtsch. Trop. Ztschr., vol. 47, Nos. 13-14, pp. 360-369.
Leipzig. 1943.
MALARIABEKAEMPFUNG IN DER UKRAINE (Fight against ma-
laria in the Ukraine). Dtsch. Trop. Ztschr., vol. 47,
No. 9, pp. 205-215; No. 10, pp. 237-241; No. 11, pp. 265-
283. Leipzig. 1943.
In addition to the materials listed above, interviews with people
who have lived in various parts of Russia and data on file in the
Medical Intelligence Branch, Preventive Medicine Division, Office
of The Surgeon General, U. S. War Department, were used in
preparing this chapter.
Original
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