Transport workers of the Volga region vs social diseases: the experience of the 1920s.

Kezhutin Andrei Nikolaevich ORCID: 0000-0003-0793-7181 Doctor of History Doctor of Science in History, Associate Professor of Social Science and Humanities Department, Federal State Budgetary Educational Institution of Higher Education «Privolzhsky Research Medical University» of the Ministry of Health of the Russian Federation 603000, Russia, Nizhny Novgorod region, Nizhny Novgorod, Minin and Pozharsky pl., 10/1 kezhutin@rambler.ru Other publications by this author

The widespread spread of infectious diseases in modern society makes it relevant to turn to the historical experience of fighting diseases, the mass spread of which depends to a certain extent on socio-economic conditions. In Soviet science, based on the long-term developments of pre-revolutionary doctors, the concept of "social diseases" was formulated. According to this theory, a number of diseases (tuberculosis, malaria, venereal diseases, etc.) become particularly acute and topical due to the absence or neglect of public hygiene measures, low level of awareness of the population about these diseases. The crisis socio-economic situation can greatly enhance the destructive nature of social diseases. The Soviet Union in the 1920s I have already encountered these problems. Transport and transport medicine played a special role in overcoming the widespread spread of social diseases. The historical experience of the Soviet period provides an opportunity to enrich ideas about the past and use certain developments at the present stage.

Within the framework of Soviet historical science, a huge amount of research was conducted on the creation and development of the healthcare system both at the all-Union, as well as at the republican and regional levels. The historians' field of view included the problems of organizing a new system of medical care, combating certain diseases, the work of outstanding doctors and health care managers, etc. Soviet historiography is heterogeneous depending on the specific historical period. But the history of medicine differs from other sections of Soviet history in its great conservatism, which is manifested in a number of features. Firstly, the history of Soviet healthcare was presented as a progressive movement forward, which was closely linked to scientific and technological progress. Secondly, the red thread through most studies was the interpretation of the major shortcomings of Soviet medicine as a "bourgeois capitalist legacy" that goes back into the past as Soviet society develops. Real social problems were often left in the shadows. Thirdly, there was a strong ideologization. This situation generally persisted until the era of Perestroika, but even now many educational publications on the history of medicine reproduce the concept of linear progressive development of Soviet healthcare aimed at overcoming the shortcomings of pre-revolutionary society.

Modern Russian historiography is characterized by a pluralism of opinions and approaches, depending on the angle of research. The history of medical and social practices is one of the promising areas of modern historical science. Unlike the Soviet period, the attention of modern historians is attracted by new topics and aspects: gender, national, socio-psychological, cross-cultural, sociological, etc. The history of transport medicine also enjoys the attention of researchers [see.: 1; 2; 3; 4; 5]. At the same time, the problem of institutionalization, which served as one of the main directions of Soviet historiography, is far from being exhausted at the present stage. The history of medical care of the river fleet was especially "unlucky" in this regard. The problem of combating social diseases on waterways in the first decades of Soviet power is practically untouched. Meanwhile, there is a gradual process of declassification of archival materials, and their involvement in scientific circulation is an urgent practical task.

The source base of the issue is extremely heterogeneous, which is associated with the historical features of the formation of the health care system in the water transport of the Volga basin.

The creation of a new national healthcare system began immediately after the events of October 1917. However, the Civil War and economic devastation that followed in 1917-1921, succinctly characterized by the American historian Abraham Asher as "dark years" ^{[6, p. 193]}, postponed the solution of medical problems of river transport. Sources for the development of water transport healthcare have been extremely scattered over the years.

It was only in 1921 that the Volga District Health Department for the Management of Inland Waterways of the Volga Basin (hereinafter referred to as the Volga Vodzdravotdel) was created, and since 1923 it has been deploying full–fledged activities. The territory served was quite extensive and included the Volga River with its tributaries (including the Oka, Kama, Sura, Vetluga, Unzha) from Yaroslavl to Astrakhan and the northern coast of the Caspian Sea, as well as the Ural River with a total length of up to 7,500 km. ^{[7, l. 17]}. The Volga Water Health Department was responsible for 13 sanitary sites with hospitals for inpatient treatment and specialized outpatient clinics. The district hospital and the administration of the Volga Water Health Department were located in Nizhny Novgorod. Therefore, it was in the Nizhny Novgorod archives that the materials of the Volga Water Health Department were deposited.

In the Central Archive of the Nizhny Novgorod region (TSANO), the most extensive is the fund F. R-1246 "State Institution Central Basin Hospital of the Upper Volga River Basin of the Ministry of Health of the Russian Federation", which includes 5 op. and 3655 units of XP. Since its creation, the fund contained documents of the Volga Water Department and had the appropriate name "Medical and Sanitary Department of the regional Department of water transport of the Volga basin". In the first three inventories of the fund, office materials and personal files of doctors, secondary and junior medical personnel of the Volga River water transport, correspondence with higher-ranking and other bodies and organizations are accumulated. Many documents have been classified for a long time. This fund is the most informative in the aspect of countering social ills, since it includes documents from both central bodies (People's Commissariat of Health, OGPU, etc.) and specific medical institutions: sanitary stations, hospitals, paramedic stations and specialized outpatient clinics. Among the latter, the largest amount of information on the fight against tuberculosis, malaria and syphilis is contained in the cases of Nizhny Novgorod medical institutions, as well as the Astrakhan outpatient clinic. The documents of other regional institutions are extremely fragmented. In most documents of local medical institutions, digital data on morbidity and mortality from various diseases, as a rule, not social, prevail.

The Volga District Health Department worked closely with the Health Department of the Moskovsko-Oka basin (hereinafter – the Moskovsko-Oka vodzdravotdel), which covered the territory of the Moskvoretsky, Ryazan, Vyaznikovsky and Murom water and sanitary sites. The Moscow-Oka Water Health Department had a very limited staff of medical personnel (46 employees, including 12 doctors) and in 1928 became part of the Volga District Health Department ^{[9, pp. 2, 14]}. The fund of the Moscow-Oka Water Health Department has also been preserved in the Central Research Institute. Foundation R-1980 "Water Health Department of the People's Commissariat of Health of the Moskovsko-Oksky district. 1922-1927." contains 127 units of xp., mainly office documentation. It reveals a significant amount of information on the problem of combating tuberculosis and malaria.

Of the funds of local medical institutions of the Volga vodzdravotdel, deposited in the Central Research Institute, funds are of particular interest: P-2480. "Volga Shipping Hospital of the Upper Volga Water Health Department. 1920-1932."; P-1981. "Health center No. 31 of the Upper Volga water department, Nizhny Novgorod. 1927-1929."; P-2438. "Gorky polyclinic of the Upper Volga water department. 1926-1939."; P-4437. "Medical observation station of the Upper Volga water Health Department, Gorky. 1937-1940.". The materials of these funds are not informative enough in relation to countering social diseases and relate mostly to the period of the turn of the 1920s-1930s and later.

The documents of the party control over the work of bodies and institutions of the Volga basin healthcare system, as well as over the activities of specific medical workers, have been deposited in the State Socio-Political Archive of the Nizhny Novgorod Region (GOPANO). The most informative in this regard are F. R-1. "Nizhny Novgorod Provincial Committee of the CPSU(b) (11889 units). 1917-1929." and F. R-2. "Gorky (until October 1932 – Nizhny Novgorod) Regional Committee of the CPSU(b) (14831 units). 1929-1936." These funds include documents from Meetings of the Transport Sub-Department under the Nizhny Novgorod Provincial Committee of the Russian Communist Party(b), Correspondence with the Volga Transport Department of the OGPU. Most of the documents were classified as "Top secret". A characteristic feature of these records is the increased attention of their compilers not only to the actual state of medical and preventive care in water transport, but also to the perception of the rivermen of the work of medical personnel, their responsiveness, selflessness and honesty. In this regard, the bulletins often contain not only responses from the field, but also entire investigations of adverse incidents due to non-provision of medical care.

Documents of medical institutions of the Volga basin for the period under study were practically not deposited in the funds of GOPANO. Even in later years, they are fragmented. Thus, F. R-2331 "Primary organization of the CPSU vodzdravotdela, Kuibyshevsky district, Gorky" includes 32 documents for 1936-1943 and 1949-1956, and F. R-5296 "Primary organization of the CPSU vodzdravotdela hospital, Sovetsky district, Gorky" contains only 6 documents for 1955-1959.

The totality of these materials makes it possible to clarify previously unknown issues of countering the spread of social diseases in the water transport of the Volga basin.

In the conditions of post–war devastation, social diseases such as malaria, tuberculosis, and venereal diseases became widespread. In the early years of the work of the water health department, the situation was complicated by the lack of reliable statistics. In 1923-1924 . The medical service of the water department identified 2,253 people. patients with malaria. A general examination of 785 children and adolescents in the Moscow-Oka basin in 1924 allowed the diagnosis of 109 cases of malaria, including 12 in acute form ^{[10, pp. 73-74, 77]}.

A similar situation was taking into account tuberculosis patients. The peak of registration of patients with social illness occurred in 1924-1925, which was associated with an improvement in the quality of statistics and new clinical opportunities for medical examination of a large number of people. In 1924, 2,317 tuberculosis patients were identified, but only 110 of them were hospitalized, in 1925 – 3,415 and 212, respectively ^{[11, l. 20]}. Among water workers, tuberculosis has become predominant among mechanics, motorists and oilers of river vessels due to the most unfavorable and difficult working conditions ^{[10, l. 9]}.

Initially, the management of the water department intended to carry out the confrontation with social diseases on the basis of broad public involvement. The most widespread and effective events were tuberculosis three-day days. At first, this initiative was an undoubted success, as it caused a certain public outburst, supported by the media, agitation and propaganda from responsible government agencies and medical institutions. So, a tuberculosis three-day event held in the autumn of 1923 in the Nizhny Novgorod-Volga section of the water health department was successfully carried out thanks to the participation of the Sormovsky district health Department, which allocated 500 memos, 200 tokens worth 20 rubles, 200 tokens worth 10 rubles, a certain number of abstracts, mandates, and other materials, and also independently conducted a Mug collection funds for the fight against tuberculosis. County doctors gave 4 public lectures on tuberculosis control, which gathered interested listeners: in the office of the Sormovo zaton, on the pier, on the Fulton steamer and in the vodnikov dormitory ^{[12, l. 9]}. Similar events were held in the zaton named after Karl Marx, in the Sobchino and Lyulekhovo backwaters (donations amounted to 17,159 rubles), as well as in the floating docks, where 25,639 rubles were collected as a result of the mug collection. [Ibid.].

On the contrary, the three-day event was not held in Zhukovsky and Vasilsursky medical centers due to the lack of support from local health authorities and personnel movements of medical workers [Ibid.]. An attempt to hold a tuberculosis three-day event independently by water workers without the participation of professional and economic bodies in the Novouslonsky zaton was also unsuccessful: a public lecture did not take place due to the lack of listeners, despite numerous announcements, and subscription lists and a mug collection brought minimal results – 2 rubles. 30 kopecks and 62 kopecks. accordingly ^{[11, l. 32]}.

By the mid-1920s, it became even more difficult to maintain public interest in the problem of social diseases, as the severity of the problem decreased somewhat, the spontaneous mass impulse was exhausted, and the everyday problems of organizing work and everyday life came to the fore. The attempt of the water health department to get out of a difficult situation was the decision to involve the newly created departments of labor protection and safety at enterprises and transport institutions, as well as commissions for the improvement of labor and everyday life, social assistance councils and other similar organizations in a joint campaign for labor improvement [Ibid., l. 32]. However, this measure had even more modest results, since its artificiality raised the question of reviving "campaigning" among water workers instead of carrying out systematic systematic work.

In this regard, the issue of replacing one-time measures to combat social diseases with systematic work in this direction has come up on the agenda. Even by order of the People's Commissariat of Health No. 1600 dated April 19, 1923, sanitary doctors on railway and water transport were given broad powers to visit all transport enterprises and institutions, rolling stock, river and sea vessels at any time with the right to carry out sanitary inspections, take samples for analysis, check compliance with sanitary requirements and regulations. In case of non-compliance with the latter, doctors, through local transport departments, had to seek consideration of such cases in people's courts and military tribunals ^{[13, p. 3-4]}.

The leadership of the People's Commissariat of Health attached an important role to the organization of a unified mass sanitary and educational work, as well as the creation of an extensive network of dispensaries. In circular No. 00301-15/61 dated January 24, 1925, People's Commissar of Health N.A. Semashko wrote, addressing the water workers: "Sanitary and educational work, to which we always attach great importance, is all pieces, fragments of medical examination... The main task of transport medicine is to participate in increasing labor productivity" ^{[14, L. 2]}.

The result of the appeal was the formation of a special commission for a detailed and accurate inspection of all workers of the Moscow-Oka basin water transport under the chairmanship of the head of the Moskvoretsky outpatient clinic, Doctor of Medicine Livshits [Ibid., l. 2 vol.]. At the same time, the leadership of the Moscow-Oka Basin water Department for the execution of circulars No. 184 of February 3, 1925 and No. 206 of 5 On February 1925, instructions were sent to the places: on registration of all patients with venereal diseases, tuberculosis and malaria, with the provision of treatment and "healthy" living conditions; on examination by doctors of all workers and employees in order to identify patients with chronic forms of diseases and study their causes; on the introduction of a modern system for registering cases of morbidity [Ibid., l. 7, 10].

Practical work on the ground was deployed in two directions: sanitary and preventive, with the involvement of the general public, and therapeutic, mainly in the form of medical examinations by medical personnel. Within the framework of the first of them, the employees of the Moscow-Oka water Health department showed the greatest activity. The peak of public activity occurred in the period from January to March 1926, when 20 corners and health boards, 36 public lectures, 17 conversations were organized, and the total number of visits amounted to 4,764 cases ^{[15, L. 5]}. The topics of lectures and talks covered not only the problem of social diseases, but also related issues: "On syphilis", "Sexual issue", "Infectious diseases", "Ways to protect motherhood and infancy", "Abortion and the fight against it", "Alcoholism", "Rules of health preservation". The lectures were of a visual nature, accompanied by a demonstration of "fog maps" and posters [Ibid.].

A lot of therapeutic and preventive work was carried out to combat malaria. In just 10 months of 1925, 2,384 people underwent preventive quinination. The procedure was carried out using the Laveran method, which was advanced for its time, and covered both coastal personnel and crews of cruise ships, which made it possible to prevent the massive spread of the malaria epidemic. Since severe waterlogging after the decline of spring waters was an important source of insect spread and the spread of malaria, insect screens began to be used in residential buildings and office buildings, drainage works and oil cultivation of territories were planned and from time to time, depending on the availability of funds ^{[10, L. 4, 11]}.

With the establishment of appropriate dispensaries in Nizhny Novgorod and Astrakhan, the diagnosis and treatment of tuberculosis and sexually transmitted diseases have improved. In April-June 1926, in the Nizhny Novgorod tuberculosis dispensary of the water health department, 21 patients were taken for medical examination, and 11 people were put on observation ^{[16, L. 7]}. There was a decrease in the number of new cases of morbidity: in 1927, 950 new cases of tuberculosis were detected, in 1928 – 897 ^{[17, l. 29d]}. At the same time, the small number of staff at the Nizhny Novgorod dispensary (2 doctors, 3 nurses and 2 nurses), the lack of permanent inpatient beds and the difficulties of clinical examination and treatment forced the dispensary to resort to the help of other medical institutions. So, in 1928, 90 people were sent to the Barbashina Polyana resort in Samara, 52 people were sent to the Zaton hospital named after the Paris Commune of the Nizhny Novgorod province, to the Zholninsky sanatorium and resort treatment in other places – 17 people each. accordingly [Ibid., l. 29g]. In 1931, the number of inspections amounted to 5,575 people, including 1,517 on steamships ^{[18, l. 12]}.

In Astrakhan, the tuberculosis dispensary also carried out a lot of work: the number of visits amounted to 4,553 people, 801 cases of tuberculosis in adults were detected, as well as 117 cases of tuberculosis among children, 162 people were sent to sanatoriums and resorts, and 123 people to rest homes. [Ibid., l. 38ob.]. Such results became possible due to close interaction with peripheral health centers № 32, 33, 34, 36, 39, 40, with the corresponding offices of a special outpatient clinic – therapeutic, surgical, nervous diseases, venereological, children's, as well as with almost all educational institutions [Ibid.].

The diagnosis and treatment of sexually transmitted diseases have improved. During the navigation period, the work on the survey of water workers was transferred to ships. Plans for such work provided for surveys of passenger ship crews at least twice a navigation, and employees of buffets of local and transit steamships – monthly ^{[19, L. 4]}. The venereological dispensary in Nizhny Novgorod increased the number of patients from 100 in 1927-1928 to 440 in 1929. In July-September 1926, 798 people were examined. for the detection of skin and venereal diseases, which were detected in 153 cases ^{[20, l. 1]}. And in 1929, the total number of visits amounted to 24,500 cases. Syphilis was diagnosed in 196 people, clap in 219, and other skin diseases in 149 ^{[19, l. 16]}. The Astrakhan Venereological Dispensary demonstrated outstanding activity in carrying out cultural and educational work - in 1929, with its participation, 140 lectures were organized at enterprises and other places of the greatest concentration of insured water transport workers. The dispensary actively joined the socialist competition [Ibid., l. 19].

Alcoholism in transport became another social disease that manifested itself with particular severity by the mid-1920s. In the order of the Head of the Department of Inland Waterways of the Volga basin No. 238 dated September 10, 1926 It was noted: "Recently, the Department has received a number of investigations establishing cases of drunkenness of employees of Watering holes in the performance of official duties" ^{[21, p. 15]}. Since the reaction of the leadership to such cases was, as a rule, warnings about responsibility for the repeated commission of such acts in the form of dismissal and trial, the harmful phenomenon could not be eradicated. Based on the joint circular of the People's Commissariats of Railways and Justice No. AHP-5 dated December 2, 1927. "On taking measures to combat hooliganism on inland Waterways", an order was prepared by the head of the Department of Inland Waterways of the Volga Basin No. 6 dated January 6, 1928, introducing the possibility of forced detention and temporary isolation of ship crews and passengers who were intoxicated and posed a danger to other people. Hooligans were ordered to be placed in separate rooms on the ship before arriving at the settlement, followed by the transfer of the rowdies to the OGPU authorities for criminal prosecution ^{[22, p. 5-6]}. However, the situation changed only by the early 1930s. with the introduction of a more stringent joint order of the People's Commissariats of Railways and Labor No. 1989 dated January 1, 1931, adopted instead of the previous order No. 1331 dated February 8, 1930 and charged the heads of departments with suspending employees from official duties under the influence of alcohol with withholding the earnings of the perpetrator during the suspension ^{[23, p. 1-2]}.

As the situation with the mass incidence of social diseases stabilized, the problem of the quality of medical care came to the fore. As early as September 22, 1923, at a meeting of the Transport Sub-Department under the Nizhny Novgorod Provincial Committee of the Russian Communist Party (b), it was noted that the medical network of water transport institutions could not provide for all patients. The latter were forced to seek help from institutions of local health authorities, where they were charged a large fee, but the quality of care varied greatly ^{[24, pp. 38-38]}. A way out of this situation was found in administrative regulation and redistribution of financial resources: the water department proposed to the Nizhny Novgorod Provincial Health Department to reduce the fee by including only the cost of maintenance and treatment of the patient [Ibid.]. Similar incidents occurred throughout the study period. It was only by 1927 that gradually the complaints of rivermen about the system of organizing medical care were replaced by claims against specific doctors. The bulletins of the Volga Transport Department of the OGPU are full of such information. Thus, in Bulletin No. 1 of January 2, 1927, in relation to the Kazan district, it was noted that the medical business in it was satisfactorily delivered, but cases of discontent of rivermen in the number of 100 people were recorded in the backwaters of Krasny Volgar and Spasskoye. medical staff due to the fact that local doctors refused to receive patients outside of working hours and treated their patients negligently ^{[25, L. 7]}. Similar cases occurred in Nizhny Novgorod, Astrakhan and other places ^{[25, l. 6, 14; 26, l. 5-6]}. Party and departmental control helped to establish the true state of affairs in healthcare and transport.

The final transition from public to state dominance in overcoming social diseases in the water transport of the Volga basin was completed by the end of 1932. On IV The Congress of Doctors of the Volga River, held on December 15-18, 1932 with the participation of more than 100 specialists, set a course for centralized registration of patients with social diseases, which became possible only with an increase in state funding and mass training of specialist doctors. The network of venereological institutions formed by this time, consisting of two dispensaries (Nizhny Novgorod and Astrakhan) and 14 venereological points, was recognized as "fully deployed", and the tuberculosis organization, although having shortcomings, was successfully functioning ^{[7, p. 24]}. All this predetermined the curtailment of the last spontaneous public actions and the transition to systematic work to eradicate social diseases.

Thus, in the 1920s, the Department of Health of the waterways of the Volga basin, despite the acute shortage of material and human resources, the difficult conditions of the post-war period, did considerable work to localize and eradicate the most widespread social diseases – malaria, tuberculosis, venereal diseases, and also took an active part in the fight against drunkenness and alcoholism on water transport. The activity of the water health department to overcome social diseases has passed through two stages in its development – public and state. The conditional boundary between them is the mid-1920s, when the failure of attempts to solve the most complex social issues by public organizations became apparent. State support made it possible to carry out some types of anti-tuberculosis and other measures, but could not help to keep public attention on these issues. Only the full-fledged participation of government agencies, institutions and organizations of a social and medical nature was able to reverse the situation of mass spread of social diseases. The final transition to this system coincided with the reorientation of the country to the planned development of the economy in general and the healthcare sector in particular.

7. The Central Archive of the Nizhny Novgorod region (TSANO). F. R-1246. Op. 2. d. 722. 78 l.

8. The situation of medical and sanitary affairs on the waterways of the Volga basin // Bulletin of the Management of inland waterways of the Volga basin. 1923. No. 15-16. pp. 9-10.

9. TSANO. F. R-1980. Op. 1. d. 120. 183 l.

10.TSANO. F. R-1980. Op. 1. d. 45. 85 l.

11. TSANO. F. R-1246. Op. 2. D. 164. 61 l.

12. TSANO. F. R-1246. Op. 1. D. 369. 11 l .

13. On the rights of medical and sanitary supervision authorities in transport // Bulletin of the Management of inland waterways of the Volga basin. 1923. No. 9-10. pp. 3-4.

14. TSANO. F. R-1980. Op. 1. D. 70. 10 l.

15. TSANO. F. R-1980. Op. 1. D. 76. 37 l.

16. TSANO. F. R-1980. Op. 1. D. 83. 65 l.

17. TSANO. F. R-1246. Op. 2. d. 416. 46 l.

18. TSANO. F. R-1246. Op. 2. d. 692. 27 l.

19. TSANO. F. R-1246. Op. 2. D. 625. 36 l .

20. TSANO. F. R-1980. Op. 1. D. 84. 51 l.

21. On the inadmissibility of drunkenness in the performance of official duties // Bulletin of the Management of inland waterways of the Volga basin. 1926. No. 35-36. p. 15.

22. Order of the head of the Department of Internal Waterways of the Volga basin No. 6 dated January 6, 1928 // Bulletin of the Management of internal waterways of the Volga basin. 1928. No. 1-2. pp. 4-6.

23. Bulletin of the Management of inland waterways of the Volga basin. 1931. No. 8. pp. 1-2.

24. The State Socio-political Archive of the Nizhny Novgorod region (GOPANO). F. R-1. Op. 1. d. 3393. 102 l.

25. GOPANO. F. R-2. Op. 1. d. 5239. 103 l.

26. GOPANO. F. R-2. Op. 1. d. 5240. 152 l.