Red Medicine: Socialized Health in Soviet Russia

The Treatment and Prevention of Venereal Diseases

THE consideration of the treatment and prevention of venereal diseases is closely wrapped up with the problems of marriage and divorce discussed briefly in Chapter XI. One general comment may be made. However seriously the objections to the great facilities for divorce in Russia may be regarded, it appears highly probable that temporary unions such as occur in Russia, whether with or without registration of marriage, are likely to be associated with much less spread of venereal infection than the casual sexual promiscuity which had been widespread.

Statistics of incidence of venereal diseases are notably untrustworthy, but the following figures taken from the International Health Year-Book may be quoted:

Prior to the Revolution many parts of Russia are stated to have been devastated by syphilis, a very large part of which was "innocent," i.e., spread otherwise than by sexual congress. This, we were informed, was so in the Samara districts. Now the amount is greatly decreasing.

At Rostovon-Don there was also formerly much "innocent" syphilis, acquired for instance through kissing or breastfeeding, but its amount, Dr. Rubinstein informed us, has declined from 45 per 10,000 in 1924 to 0.5 in 1930.

On a visit to the Moscow Institute for Skin and Venereal Diseases, Dr. Kazaroff, the head of this institution, gave us valuable information as to antivenereal organization. Both syphilis and gonorrhoea, and especially the former, are declining. The registered number of cases of syphilis in Moscow and district in-

1927 was 57.75 per 10,000 population.
1928 was 46.42 per 10,000 population.
1929 was 44.30 per 10,000 population.
1930 was 38.5 per 10,000 population.
1931 was 31.0 per 10,000 population.

Treatment is seldom neglected. It is always gratuitous and unrestricted, whatever the social position of the patient. Much educational work is done to ensure continued treatment, including home visits when needed. It has never been necessary to enforce continued treatment.

At the Moscow institution there are 400 beds. There are also five venereal disease dispensaries in the city, and in the factory and other dispensaries some treatment of venereal disease is carried out. Freedom from syphilis is determined by examination of blood and cerebrospinal fluid.

The decrease in venereal diseases is ascribed by Dr. Kazaroff not only to treatment, but also to the facts (a) that the workers themselves have control of the antivenereal provisions, and thus realize the need for selfcontrol; and (b) that there has been a general "liquidation" of prostitution, as unemployment has disappeared. Now very few prostitutes are to be found in Moscow.

Talks on venereal diseases are given at factories by the staff of the institute, and it is noticed that this is followed by an increase of patients. Moving pictures as well as printed matter are utilized for educational work.

Laboratory diagnosis is also gratuitous, and special studies on the gonococcus are being made at the institute.

Dr. Kazaroff hopes to "liquidate" syphilis as a mass phenomenon before the end of the second fiveyear period.

A certificate of health is required at marriage from each partner, but this requirement is not generally enforced. If the certificate is not given, then, if either partner becomes venereally infected, the responsible partner is subject to imprisonment. Similarly, if a man and woman live together without marriage, this penalty for infection can be enforced.

As the cultural level of the people rises, marriage consultations are becoming more common. These are held at venereological dispensaries.

Prophylactoria for Prostitutes

In Moscow we visited a "prophylactorium" for the reclamation of prostitutes. There are 500 resident women to whom medical treatment is given. Girls come voluntarily. They are first examined by the doctor and may be transferred to a hospital if their condition calls for special treatment. Other cases are treated here while pursuing their daily work. Much knitting and sewing work is done at the institution, for which the workers are paid, the average amount paid being 70 rubles a month; 35 rubles are deducted for maintenance. All the inmates must attend school if illiterate. About to per cent are said to be defective.

Fifteen doctors work here, including dentists, each attending from three to seven hours.

Many of the inmates go to work in a factory for seven hours a day, and on discharge they generally continue factory work. About 5 per cent run away, but they generally return. Inmates may go out for the day once in four days. Patients are kept track of and are visited at home. Also conferences are held at the institution for expatients.

The majority of the patients subsequently marry and have children. Some women have children with them in the prophylactorium, and pregnant women are admitted.

There are several institutions of this type in Moscow.

At Rostovon-Don there is a special venereal disease centre which has four, dispensaries or ambulatoria in different districts for treatment of these diseases. One of these is at The Unitary Dispensary (see page 235), thus securing direct collaboration with the doctors in other departments of this dispensary.

The statistics and clinical records from all the dispensaries in Rostov are collected in one office for reference and for statistical inquiry.

We noted that venereal disease is regarded as a misfortune, not as a cause for shame.

The following figures were supplied by Dr. Rubinstein as to the incidence of syphilis and its decline in the city of Rostov:

In Tiflis there is a venereological institute with branches throughout the Republic of Georgia. In addition there are special departments for treating venereal diseases at the various polyclinics. Some prostitution still occurs, and prostitutes may be placed, in reformatories.

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