MONDAY DECEMBER 5TH—MOSCOW
Arrived in Moscow at 9:30. Much unfinished building in suburbs as we came in. Hotel Savoy filled, and so went to an all-Russian hotel where no other language was spoken. Prices expensive, and very few comforts. Went to Narkomzdrav and saw Cheftel, who was very kind. He is the chief of the Bureau of Foreign Relations in Medicine for the Narkomzdrav. . . . Semashko busy with the party meetings of this week, but will be able to see AG sometime during the week. . . . Cheftel said that the visit was principally important for general impressions and contacts, and that no requests [to the Rockefeller Foundation] were likely to be made. He preferred me to go my own pace, but was keen to help as much as possible before he left for America. I said that I had heard that it was not wise to ask to see anyone in Russia, but merely to note what one was shown. He said that on the contrary he wished me to feel free to go anywhere and ask any questions I wished. . . .
TUESDAY DECEMBER 6TH—MOSCOW
Long talk with Cheftel, who gives me idea of general organization. . . . One gets the impression very early that Government Health Service and Medical Schools are permeated with Preventive Medicine to a quite unusual degree. Cheftel asks me if publication of a special brochure in America of information on Soviet organizations would be wise. I said I thought that articles in established journals would be a better method. Cheftel could then have a large number of reprints, and there would be no suspicion of paid propaganda. . . . Met Bronner, who is chief of Medical Education under the Narkompros. Long and interesting talk with him. Object of Medical Education in Russia at the present time is to turn out village or district doctors, and the curriculum is saturated with hygiene and preventive medicine. There are four chairs in hygiene in the faculties of Leningrad and Moscow, as follows: General Hygiene, Social Hygiene, Occupational Hygiene, and School Hygiene. In the small universities there are only two chairs of Hygiene, general and social. . . . It is found that graduates of provincial schools go to the country more readily than those studying [in] Moscow. . . . Being a member of the proletariat is by no means an easy physical existence since there are not enough comforts to go around, but they at least are filled with moral enthusiasm and satisfaction, and have the thrill of being at the center of the stage. Mentally, they remind me more of Methodist missionaries than any group that I had ever met before. In point of fact, in Russia they are a privileged class in the education of their children and in many other ways, but all talk of their living on the fat of the land is unconvincing to me. This is an extraordinary country, in that I have never seen education likely to play a more decisive part in the future of a nation than here where, as in so many other things, the Soviet Government starts from a base line that is zero. . . . From my talk with Bronner, I can see that they are most interested in the hope of increasing their foreign fellowships, and would do nothing to imperil the success of any arrangement we might make with them. I can also realize that a greater separation exists between the professional politicians and the medical school and public health authorities than I had previously thought was the case. Many of the men in authority in both of these services are more realists than politicians, and indeed several of those [in] prominent positions are as bitterly resentful as could be imagined, although they do not risk anything by talking about it.
THURSDAY, DEC. 8TH—MOSCOW
Bronner called and took me out to the first University, where I met the Rector Vyshinsky and three or four professors. Went to the anatomical Institute of Professor Piotr Karusin. . . . Anatomy has been clipped of much of its importance to make room for hygiene. . . . The first University have relatively few changes in the professorates during the revolution. The second University before the war was for women only. Now, both Universities accept women, and the percentage of girls among the medical students varies between 50 and 70%. I have the impression that many girls who with us would be going into nursing take a medical degree in Russia. . . . Interview with Semashko. Told him of two Divisions of Rockefeller Foundation. Said that D.M.E. [Rockefeller Foundation Division of Medical Education] was especially interested in theoretical branches of medicine including hygiene. I said that Cheftel had already given me a general idea of Narkomzdrav’s work and that I would like to see some of the Institute’s clinics and some of the Institutes outside of the University. I asked him if there was anything comparable to County Health organization. His rural physicians are not private practitioners, but are County Health officers with direction of feldchers [sic] and midwives. He seemed rather vague about nurses and what training they have. I don’t believe he understands our term very fully. . . . My impression is that he is a competent and sincere man who has realized that his effectiveness and permanence depend on his devoting a good deal of time to political matters, and getting down his immediate technical work to a minimum. Was reminded of the story of the young man who met the devil. The devil turned out to be rather a kindly and sympathetic gentleman, with whom it was very easy to converse. When asked how it happened that he did not have a long red tail, horns, and the smell of Sulfur about him, the kindly old gentleman replied with a wan smile: “I have often been described, but the pen has always been in the hand of my enemies.” . . . Students get 25 rubles a month when they are on Government pay-roll, and for this they are obliged to take places as County doctors after their student days are over. …
Alan Gregg. Reproduced with permission of Bachrach Photography.
SATURDAY DECEMBER 10TH—MOSCOW
Went with Blumenthal to Bronner’s Institute, for combating venereal disease. Budget, $150,000 a year, one-half of which goes to salary of personnel of about 180, sixty-six of whom are staff doctors. It was begun in December 1921. The out-patient Department has about 200,000 visits a year, and beds in the building provide accommodation for about 23,000 sick days per year. The social side and scientific experimentation are much emphasized. This Institute has 159 substations over Russia, and 149 mobile diagnostic units making venereal surveys over the U.S.S.R. There are accommodations in the building for about 50 postgraduates who live in for a four months course which is given twice a year, and are paid 60 rubles a month, together with their home salaries, which are continued for their families. Laboratories for scientific research are extensive and excellently maintained. This is the first time that I have even seen simple explanatory lectures being given in the waiting-room of an out-patient Department. An excellent idea, it seems to me. There is a dental Department with routine treatment of all patients who will undergo mercury treatment. On the preventive side of the work, there is a home maintained for unemployed women in the infective stage of the disease. Here these women are given work and paid a good monthly wage, undergoing treatment at the same time. 550 women are accommodated, and they prefer entry here rather than [to] continue on the streets. Treatment is given at this home, and when discharged, the women are given first preference at the employment bureau. A good example of the considerable activity in the social side of medicine which is encouraged and supported by the present Government. . . . Then to Institute of experimental biology of Professor Koltsov. . . . Took dinner with Madame Koltsov, the first assistant Lebedieff, and my guide, who told me sotto voce that here was a place where one could talk. I asked a few questions, and got one or two interesting answers. Although Madame K. had lost her fortune from the Revolution, she would not care to go back to tsarist organization of Russian society. Conditions are very hard, but they are improving. The most encouraging thing is the enormous release of spiritual and moral energy as applied to scientific work. Emigres are really no great loss. They don’t know what goes on in Russia. Nobody will ever be able to estimate the losses of the Revolution and the famine. Five million are supposed to have died in the Volga alone, and cannibalism took place in many parts of Russia. The great question now is: what are the young people going to be like? They have no idea of how good life might be, and in the drab uniformity that exists everywhere today in point of ideas and material possessions the younger people see no contrasts. Will it be possible for the party to maintain indefinitely the communist fervor at the present pitch? Communism is more nearly a religion, and is maintained by the methods of catechism and heretic hunting which are not so foreign to our own history as we would like to think. . . .
MONDAY DECEMBER 12TH—MOSCOW
Institute of Social Hygiene and Professor Molkov. He apparently believes that hygiene is best learnt through papier mache models. Orientation in general antiquated and sterile. If surgery was practiced on this method, you would present to the patient with empyema a papier mache model of the chest wall, and two charts of the number of operations carried out on patients for this same disease between 1850 and 1910, but there would be no operation. Then to Department of General Hygiene in the First University. A good impression. Then to first surgical clinic of the First University. Professor N.N. Burdenko. B. feels that higher education of the future is a matter of great concern and that fellowships are of highest importance. Scientific work, i.e. better type of investigative work, is at present poor and interrupted. Younger men can’t continue for economic reasons in this work: there is too much preoccupation among the students with earning part of their living and with self-government, also the clinical courses are being robbed by time devoted to hygiene. Visit to Semashko’s Institute for industrial diseases. My guide told me confidentially that it is not the best in Moscow, which they did not care to show me lest it should create too favorable an impression. Dinner with Blumenthal, my guide. . . . His brother is a lawyer. Things were much better in 1925. Less oppression and less fear. Doctors could charge for private patients with less concern and more likely to be paid. Mrs. B. a physician who, during the famine, had three jobs in separate clinics and walked in the snow 30 kilometers to earn a very precarious living. . . .
MONDAY DECEMBER 19TH—LENINGRAD
In general people have been much relieved to be told that I am not going away from Russia with fixed ideas and the conviction that I knew what the situation was. It is a great and fluid confusion with enormous opportunities. A country extraordinarily far from the point of view of Western Europe. Certain to undergo changes as the body of a child undergoes changes by cellular wear and tear and replacement. The Revolution attracts the best and the worst. Life has to be lived, and those theories which will work will work, and those which are false will have to be discarded. It is a country easy to lie about, but the trouble is that most of the lies arise from prejudice and fear. The cost of Revolution and the changes Russia has been through are quite outside our imagination.