Medical Activity of Health Care in Rural Areas of the Rear Areas of the USSR during the Great Patriotic War.

Semenov Mikhail Aleksandrovich PhD in History Scientific Associate, Institute of History of Siberian Branch of the Russian Academy of Sciences 630090, Russia, Novosibirskaya oblast', g. Novosibirsk, ul. Nikolaeva, 8 pihterek@yandex.ru Other publications by this author

Most of the population of the USSR in the 1940s were rural residents. Thus, in the RSFSR in 1941, out of 111.4 million people, 72.4 million lived in rural areas ^{[1, p. 32]}. Without studying the activities of health care institutions to preserve the life and health of villagers, it is impossible to form any complete picture of the conditions in which economic, socio-demographic processes took place, etc., it becomes impossible to create a full-fledged historical picture of village life during the war, which determines the relevance of the study.

The history of rural health care during the war years, in one form or another, has been reflected in studies devoted to the study of health care ^{[2, 3, 4, 5]}. It is particularly worth noting the articles devoted to the development of healthcare in weakly urbanized territories ^{[6, 7, 8]}. Certain aspects of medical work in rural areas were raised when studying the development of the social sphere^{[9, 10]}, the history of the peasantry^{[11, 12]}, demography ^[13]. These works provide valuable data on the activities of doctors in rural areas, and make important generalizations about the development of rural health care within the borders of individual regions and economic districts. However, the researchers devoted most of their attention to the state of rural healthcare: the development of the medical network, staffing, material supply of healthcare institutions, as well as sanitary and anti-epidemic activities of health authorities. The therapeutic activity, which forms the basis of medical work, in fact went beyond the scope of research interests.

In this regard, the purpose of this article is to analyze the main indicators of medical activity of medical institutions in rural areas of the rear areas of the USSR during the Great Patriotic War.

The source base for the study was, first of all, materials extracted from the "Annual Statistical Reports on the network, activities and personnel" (Form 90) of the Union republics stored in the Russian State Archive of Economics (RGAE). This type of reports was created as the main source of information about the state of health care in the field. The consolidated union and republican reports were based on reports prepared by individual regions, and in them, in the end, the information provided by each medical institution of the country was summarized. This feature ensures the high relevance of the information contained in them. However, in cases when some institutions or regions did not provide the required data on any of the indicators, this made it impossible to obtain final figures in summary reports.

The form of the reports itself has changed many times. The form in force in 1940 was considered unnecessarily complicated and radically simplified. In 1941-1942, the information collected in the report, by and large, was limited to data characterizing the state of the medical network and personnel. In the extreme conditions of the war years, these data were not enough to organize effective management, and in 1943 the form of the statistical report was expanded again. However, even in 1943-1945, simplified forms of the 1941 model were used for the newly liberated territories, where the issue of medical statistics was far from a priority. This led to the appearance of several consolidated reports on the territories of individual republics and the USSR as a whole: on the territories that reported on the form 90 of the 1943 sample, and on the territories that reported on the form 90 of the 1941 sample.

Another factor that makes it difficult to work with these materials is characteristic of all statistics of the war years: this is a change in the circle of reporting territories related to the course of military operations.  In this article, attention is focused primarily on the rear republics that escaped the direct influence of the war. However, when working with the data provided for the USSR and the RSFSR, it must be borne in mind that the territories for which statistics were collected in 1940-1945 are not comparable for the USSR during the entire period, and for the RSFSR – comparable only in reports for 1940 and 1945.

The methodology of the article is based primarily on the historical-comparative method. The use of homogeneous statistical data made it possible to correctly compare the processes that took place in different republics or at different times.  Statistical methods were also used for direct analysis of numerical data.

All the main types of medical institutions operated in the village. Medical activity was carried out in medical inpatient (treating the patient during his stay in the hospital: hospital, maternity hospital, etc.) and outpatient polyclinic (not involving hospitalization) institutions.

An impressive network of medical institutions operated in the USSR for the medical care of rural residents. So, in 1940, 179.9 thousand hospital beds were deployed in the village, and in 1944 – 173.0 thousand ^{[14, l. 8, 15-17.]} Numerous outpatient clinics, paramedic and obstetric stations operated. In 1945, there were more than 4,000 sanitary and epidemiological institutions in rural areas alone ^{[15, l. 9.]}.

The situation with the staffing of rural health care underwent significant changes during the war: a powerful flow of evacuated medical workers made it possible to significantly strengthen the rural medical personnel of the rear areas in the first war years. Thus, in 1943, in the areas of the USSR that were not occupied, the number of doctors in rural areas amounted to 131% of the number of doctors in the same territory in 1940 ^{[16, l. 21a–22.]} However, the liberation of previously occupied areas of the USSR led to the need to staff health facilities in them and the reverse outflow of medical workers from the rear regions.

It is worth noting that, despite the high absolute indicators, the degree of provision of medical care, taking into account the number of rural residents, was low. Thus, in the RSFSR, there were 1.6 hospital beds per 1,000 rural residents in 1940; in 1942 – 1.7; in 1943 – 1.9 hospital beds, while for urban residents this figure was respectively 8.2; 8.8; 9.7 hospital beds per 1,000 urban population ^{[17, L. 7.]} Thus, the average number of beds per citizen was 4-5 times more.

Nevertheless, active work was carried out in the countryside to cure the rural population. Table No. 1 shows data on the number of patients served by rural medical inpatient institutions on the territory of the Soviet Union and the rear Union republics.

Table 1.

Number of patients served by rural medical inpatient institutions, 1940-1945, (thousand people)

* Data are given for a disparate territory. In 1941 on the territory of 47 regions of the RSFSR, Central Asian and Transcaucasian republics; in 1942 on the territory of 43 regions of the RSFSR, Central Asian and Transcaucasian republics, Karelo-Finnish SSR; in 1943 on the territory of 47 regions of the RSFSR, Central Asian and Transcaucasian republics, Karelo-Finnish SSR; in 1944 on the territory of 47 regions of the RSFSR, Central Asian and Transcaucasian republics; in 1945 – without data on Moldova, the Baltic republics, the western regions of the Ukrainian SSR and the BSSR.

** Data are given for a disparate territory. In 1941 - for 47 oblasts; in 1942 - for 43 oblasts; in 1943 – for 47 oblasts; in 1944 – without data for 5 oblasts liberated in 1944.

Compiled by: ^{[15, l. 13ob.-14, 15.; 18, l. 2.2vol.; 19, l. 1ob.-2.; 20, l. 3-3ob.; 21, l. 2-3.; 22, l. 3-3ob.; 23, l. 3-3ob.; 24, L. 3-3ob.; 25, L. 3-3ob.; 26, L. 3-3ob.; 27, L. 3-3ob.; 28, L. 2.; 29, L. 2, 11, 19, 27, 35, 43, 52, 60, 68.; 30, l . 3, 13, 23, 33, 43, 53, 62, 73, 83, 93.; 31, L. 1ob.-2, 3.; 32, L. 1ob.-2, 3, 25ob.-26, 27, 37ob.-38, 39, 49ob.-50, 51, 61ob.-62, 63, 73ob.-74, 75, 86ob.-87, 88, 98ob.-99, 100, 110ob.-111, 112.; 33, L. 13ob.-14, 15.; 34, L. 13ob.– 14, 15, 25–25ob., 26, 69ob.-70, 71, 81ob.-82, 83, 93ob.-94, 95, 105ob.-106, 107, 141ob.-142, 143, 153ob.-154, 155, 165ob.-166, 167, 177ob.-178, 179.; 35, L. 1ob.-2, 3, 62ob.-63, 64, 74ob.-75, 76.; 36, L. 1ob.-2, 3, 13ob.-14, 15, 61ob.-62, 63, 73ob.-74, 75, 85ob.-86, 87, 97ob.-98, 99.]}

As can be seen from the table, in all the rear republics, except the RSFSR, in 1941 there was a fairly significant increase in the number of patients admitted to medical inpatient institutions of the village. Thus, in the Armenian SSR, their number increased from 18.0 thousand people in 1940 to 20.0 in 1941, in the Kyrgyz SSR from 42.5 to 48.0 thousand people, etc.^{[24, l. 3-3ob.; 26, l. 3-3ob.; 29, l. 43.60.]} This fact indicates an increased need rural population needs medical care related to the deterioration of living conditions, the spread of infectious diseases.

However, in the future, there is a general trend to reduce the medical and inpatient care provided to the rural population.  In 1945, the number of admitted patients was less than the 1940 level in eight of the nine rear republics. The continuous growth in the number of patients in medical inpatient institutions was demonstrated only by the Turkmen SSR, in which their number increased from 1940 to 1945 from 3.6 thousand people to 8.0 thousand people ^{[27, l. 3-3ob.; 36, l. 97ob.-98, 99.]}

It is not possible to explain the decrease in the number of medical and inpatient care provided by improving the health of the population during the war years. A certain role in the amount of medical and inpatient care apparently played a general decrease in the rural population. The village served as an important source of mobilization, many villagers moved to the cities. According to the decrease in the number of people, the number of requests for medical care also decreased.

Thus, in the Uzbek SSR, where the mobilization of the rural population in 1941-1942 was carried out on a limited scale, and the influx of evacuated citizens was quite significant, by 1942 the number of patients in medical inpatient facilities increased to 150.0 thousand people compared to 130.4 thousand people in 1940^{[20, l. 3-3ob.; 30 By the end of the war, against the background of increasing mobilization measures, re-evacuation of citizens, the number of patients decreased to 118.8 thousand people [35, L. 62ob.-63, 64.]}

On the territory of the RSFSR, the number of rural population decreased from January 1, 1941 to January 1, 1942 due to the occupation of part of the territory of the republic, the mass mobilization of rural residents into the army from 71544.2 thousand people to 56588.3 thousand people, i.e. by almost 21% ^{[37, p. 11.]}, which is comparable with a decrease in the number of patients in medical inpatient institutions in 1941 relative to 1940. (by 26%). By the end of the war, the rural population of the RSFSR was 52537.3 thousand people, or 73.4% of the rural population in 1940 ^{[37, p. 11.]}, and the number of patients admitted to rural medical inpatient institutions in 1945 was 80.2% of the level of 1940. At the same time, if we calculate on the basis of the above data the number of patients admitted to rural medical inpatient institutions per 1000 people of the rural population, then this figure will be 40.8 people in 1940, 38.1 people in 1941, and 44.5 people in 1945. Thus, in the RSFSR, while the absolute number of patients hospitalized in rural medical inpatient institutions decreased by 19.8% during the war period, the relative level of assistance provided to the rural population increased by 9.2% over the same period. The reason for this quasi-increase was a sharp decline in the rural population.

It is worth noting that urban medical institutions played an important role in maintaining the health of rural residents. In some cases, rural residents sought help from city hospitals. For example, in the Turkmen SSR, the number of rural residents hospitalized in urban medical inpatient institutions in 1940 was 20.4 thousand people, in 1943 - 24.0 thousand people, in 1944 – 18.5 thousand people, in 1945 – 19.4 thousand people ^{[27, l. 3-3ob.; 32, l. 110ob..-111, 112.; 34, l. 177ob.-178, 179.; 36, l. 97ob.-98, 99.]}, which several times exceeded the number of patients served by rural medical inpatient institutions proper. The reason for this was primarily the poor development of the rural medical network in the republic, which caused the need to seek help in the city. The situation in the Transcaucasian republics was relatively similar. For example, in the Georgian SSR in 1943, 31.2 thousand people of rural patients were hospitalized in urban medical inpatient institutions compared to 44.3 thousand patients admitted to rural medical inpatient institutions, in the Armenian SSR – 7.7 thousand people compared to 15.0 thousand people, in the Azerbaijani SSR – 18.7 thousand people and 31.0 thousand people. accordingly ^{[32, L. 49ob.-50, 51, 61ob.-62, 63, 98ob.-99, 100.]}. The small size of the republics, led to the fact that it was easier for a person to get to the city and get, as a rule, better medical care in the city.

In other republics, the importance of urban health institutions in providing medical care to the rural population was lower, but, nevertheless, they also played a significant role. So in 1944, in 67 regions of the RSFSR, urban medical inpatient institutions provided assistance to 655.6 thousand rural residents (with 2235.9 thousand patients in rural medical inpatient institutions proper) [Calculated according to: 34, L. 13ob.- 14, 15, 25-25ob., 26.], in the Kazakh SSR urban hospitals received 39.4 thousand people of the rural population (with 163.4 thousand patients in rural medical inpatient institutions) ^{[34, l. 81ob.- 82.]}. On average, in the incomparable territory of the USSR in 1943-1945, the number of rural population in urban medical inpatient institutions was 29-38% of the number of rural residents admitted to rural medical institutions.-inpatient facilities [Calculated by: 15, l. 13ob.-14, 15.; 31, l. 1ob.-2, 3.; 33, l. 13ob.-14, 15.].

The qualitative side of treatment is evidenced by such an indicator as the number of days spent by the patient in a medical inpatient facility before discharge. Data on the dynamics of this indicator are shown in Table 2.

Table 2.

The number of days before the discharge of the patient in rural medical inpatient institutions, (days)

* The data is calculated for a disparate territory. In 1941 on the territory of 47 regions of the RSFSR, Central Asian and Transcaucasian republics; in 1942 on the territory of 43 regions of the RSFSR, Central Asian and Transcaucasian republics, Karelo-Finnish SSR; in 1943 on the territory of 47 regions of the RSFSR, Central Asian and Transcaucasian republics, Karelo-Finnish SSR; in 1944 on the territory of 47 regions of the RSFSR, Central Asian and Transcaucasian republics; in 1945 – without data on Moldova, the Baltic republics, the western regions of the Ukrainian SSR and the BSSR.

** The data is calculated for a disparate territory. In 1941 - for 47 oblasts; in 1942 - for 43 oblasts; in 1943 – for 47 oblasts; in 1944 – without data for 5 oblasts liberated in 1944.

Calculated by: ^{[15, l. 13ob.-14, 15.; 18, l. 2.2vol.; 19, l. 1ob.-2.; 20, l. 3-3ob.; 21, l. 2-3.; 22, l. 3-3ob.; 23, l. 3-3ob.; 24, L. 3-3ob.; 25, L. 3-3ob.; 26, L. 3-3ob.; 27, L. 3-3ob.; 28, L. 2.; 29, L. 2, 11, 19, 27, 35, 43, 52, 60, 68.; 30, l . 3, 13, 23, 33, 43, 53, 62, 73, 83, 93.; 31, L. 1ob.-2, 3.; 32, L. 1ob.-2, 3, 25ob.-26, 27, 37ob.-38, 39, 49ob.-50, 51, 61ob.-62, 63, 73ob.-74, 75, 86ob.-87, 88, 98ob.-99, 100, 110ob.-111, 112.; 33, L. 13ob.-14, 15.; 34, L. 13ob.– 14, 15, 25–25ob., 26, 69ob.-70, 71, 81ob.-82, 83, 93ob.-94, 95, 105ob.-106, 107, 141ob.-142, 143, 153ob.-154, 155, 165ob.-166, 167, 177ob.-178, 179.; 35, L. 1ob.-2, 3, 62ob.-63, 64, 74ob.-75, 76.; 36, L. 1ob.-2, 3, 13ob.-14, 15, 61ob.-62, 63, 73ob.-74, 75, 85ob.-86, 87, 97ob.-98, 99.]}

As can be seen from the data given in the table, the general trend is an increase in the number of days before the patient is discharged from a rural medical hospital. If in 1940, on average in the USSR, the patient was in a rural hospital for 9.27 days, then in 1945 it was already 11.81. The growth during the war years was 2.54 days or 27.4% of the length of stay in 1940. The reasons for such dynamics are complex and include both positive (termination of early discharge of patients, the emergence of new highly effective drugs) and negative (deterioration of the material and drug supply of hospitals, which caused an increase in the duration of treatment) factors. But, apparently, one of the most important reasons for the increase in the length of stay of patients in medical inpatient institutions was the change in the structure of patients, in particular, the increase in the number of infectious patients requiring long periods of treatment and quarantine. For example, if in the RSFSR in 1941 there were 6.2% of the total number of infectious patients, then in 1942 – 10.8%, in 1943 – 8.4%, in 1944 – 9.7%, in 1945 - 8.0%. In the Kazakh SSR , respectively 1,2%, 2,7%, 5,4%,8,7% and 3.5% of infectious patients from the total number of patients [Calculated by: 29, L. 2ob., 19ob.; 30, L. 13ob., 33ob.; 32, L. 3, 39.; 34, L. 15, 26, 83.; 35, L. 3, 76.].

Another feature of the indicators given in Table 2 was a certain alignment of the republics according to the length of stay of patients. If in 1940 in the Tajik, Azerbaijani, Uzbek SSR the duration of the patient's stay was in the range from 7 to 8 days, in the Kyrgyz, Armenian, Georgian SSR from 8 to 9 days, in the RSFSR and Turkmen SSR from 9 to 10 days, and in the Kazakh SSR – over 11 days, then in 1945 out of 9 of the same republics, 6 had the duration of the patient's stay before discharge in the area from 11 to 12 days, and only the Kazakh, Kyrgyz and Armenian SSR had a duration of treatment beyond these limits.

Another explanation for the increase in the duration of treatment of patients during the war could be a deterioration in the quality of treatment, delaying the time of cure. However, this assumption is refuted by data on another indicator characterizing the quality of treatment – mortality, that is, the ratio of the number of deceased patients to their total number. Unfortunately, lethality has been recorded in statistical reports only since 1943. Data on its movement are given in Table 3.

Table 3.

Mortality in rural medical inpatient institutions of the Republics of the USSR in 1943-1945, (in %)

* The data is calculated for a disparate territory. In 1943, on the territory of 47 regions of the RSFSR, Central Asian and Transcaucasian republics, Karelo-Finnish SSR; in 1944, on the territory of 47 regions of the RSFSR, Central Asian and Transcaucasian republics; in 1945 – without data on Moldova, the Baltic republics, the western regions of the USSR and the BSSR.

** The data is calculated for a disparate territory. In 1943 – for 47 oblasts; in 1944 – without data for 5 oblasts liberated in 1944.

Calculated by: ^{[15, l. 15.; 31, l. 3.; 32, l. 3, 27, 39, 51, 63, 75, 88, 100, 112.; 33, L. 15.; 34, l. 15, 26, 71, 83, 95, 107, 143, 155, 167, 179.; 35, L. 3, 64, 76.; 36, L. 3, 15, 63, 75, 87, 99.]}.

From the table it can be seen that in 1943-1945 there is a fairly significant decrease in mortality. A decrease in the number of deaths means an increased quality of treatment. On average in the USSR, as well as in the largest of the republics – the RSFSR, it decreases by about a third in two years. There is also a continuous reduction in mortality in the Turkmen, Georgian and Azerbaijani SSR. In the Armenian SSR, despite a slight increase in mortality in 1944, by the end of the war, it is also possible to reduce the mortality rate relative to the values of 1943.

A more complicated situation has developed in most Central Asian republics: in the Tajik SSR, on the contrary, the mortality rate in these years is increasing. In the Kazakh and Kyrgyz SSR, the mortality rate after takeoff in 1944 begins to decline, but even by the end of the war it is above the values of 1943. In the Uzbek SSR, the opposite situation develops: in 1944, the mortality rate sharply decreases, but in 1945 its growth begins again. Apparently, the reason for these deviations is the unstable situation in the region with the spread of infectious diseases, primarily typhus.

In general, if in 1943 the mortality rate was below 2% only in one (Armenian) Union Republic, then in 1945 it was already in four, including the RSFSR.

Outpatient polyclinic institutions, that is, institutions that do not involve hospitalization of the patient, were active in preserving the health and curing diseases of the rural population.

Data on the number of visits to rural outpatient clinics are shown in Table 4.

Table 4.

Number of visits to rural outpatient clinics in 1940, 1943-1945, (thousand visits)

* The data is calculated for a disparate territory. In 1943, on the territory of 47 regions of the RSFSR, Central Asian and Transcaucasian republics, Karelo-Finnish SSR; in 1944, on the territory of 47 regions of the RSFSR, Central Asian and Transcaucasian republics; in 1945 – without data on Moldova, the Baltic republics, the western regions of the USSR and the BSSR.

** The data is calculated for a disparate territory. In 1943 – for 47 regions; in 1944 – without data for 5 regions liberated in 1944.

Compiled by: ^{[15, L. 15ob.-16.; 18, L. 4-4ob., 5ob.-6.; 19, L. 3-3ob.,4ob.-4a.; 20, L. 4A-4Aob., 5ob.-6.; 21, L. 4-4ob., 5ob.-6; 22, L. 5-5ob., 6ob.-7.; 23, L. 5-5ob., 6ob.-7.; 24, L. 5-5ob., 6ob.-7.; 25, L. 5-5ob., 6ob.-7.; 26, L. 5-5ob., 6ob.-7.; 27, L. 5-5ob., 6ob.-7.; 31, L. 3ob.-4.; 32, L. 3ob.-4, 27ob.-28, 39ob.-40, 51ob.-52, 63ob.-64, 76ob.-77, 88ob.-89, 100ob.-101, 112ob.-113.; 33, l. 15ob.-16.; 34, l. 15ob.-16, 27ob.-28, 71ob.-72, 83ob.-84, 95ob.-96, 107ob.-108, 143ob.-144, 155ob.-156, 167ob.-168, 179ob.-180.; 35, l. 3ob.-4, 64ob.-65, 76ob.-77.; 36, l. 3ob.-4, 15ob.-16, 63ob.-64, 75ob.-76, 87ob.-88, 99ob.-100.]}.

When analyzing data, the changing range of reporting institutions should be taken into account. Thus, the active growth in the number of visits to the USSR in 1943-1945 was caused primarily by this factor. For example, in 1945, the number of visits to rural outpatient clinics in the Soviet Union increased by 15.4 million visits, or by 27% compared to the results of the previous year. However, the basis of this growth was the fact that for the first time provided information on the number of visits to rural outpatient clinics in 1945. The Ukrainian and Byelorussian SSR reported 12275,9 thousand and 1174,0 thousand visits to rural outpatient clinics, respectively ^{[35, l. 28ob.-29, 40ob.-41.]}. Similar reasons for the dynamics of the number of visits in 1943-1945 and in the largest Union Republic - the RSFSR, which first reported on its entire territory only in 1945. It is worth noting, however, that in the RSFSR there was still some increase in the number of outpatient care provided to the population. If we compare the data for a comparable territory, in 1940 and 1945 it is clear that the number of visits increased during the war period by 2,170.3 thousand visits, or 5% of the level of 1940. Of all the rear republics, the steady growth of outpatient care to the rural population was characteristic only of the Georgian and Azerbaijani SSR. In the Central Asian republics, a different trend is visible: in 1943, all of them showed a serious increase in outpatient care compared to the level of 1940, but in 1944-1945, the number of visits began to decline rapidly and fell below pre-war indicators or to comparable values (Kazakh SSR). The exception is the Turkmen SSR, where, with a similar trend in the dynamics of the number of visits to outpatient clinics, the growth was most pronounced (more than twice the level of 1940), and the decline in 1943-1945 was relatively slow, which allowed even in 1945 to significantly exceed the level of pre-war years. The reason for such dynamics in the republics of Central Asia was the outflow of evacuated doctors who had previously arrived here, which in itself reduced the availability of medical care. In addition, local health authorities sought primarily to staff the network of inpatient medical institutions with the remaining doctors, and outpatient clinics acted as a "donor" at the same time. Thus, the outflow of doctors from the region hit them with double force.

It is worth noting that the level of outpatient and outpatient care, as well as medical and inpatient care, also depended on the change in the number of the rural population itself. Thus, taking into account the previously cited data on the rural population of the RSFSR, it can be calculated that a modest five percent increase in the absolute number of visits to rural outpatient clinics in 1940 - 1945, when converted into relative indicators, becomes an increase in visits to outpatient clinics per 1,000 people of the rural population in 1940 – 1945 in 43.1%, i.e.E. almost one and a half times.

As well as in the case of medical and inpatient care, rural residents often used the services of urban outpatient clinics. Unfortunately, data on the number of such patients is fragmentary. For example, in the Kazakh SSR, their number was in 1940 – 30.9%, in 1943 – 7.4%, in 1944 – 24.0%, in 1945 – 26.1% of the number of visits in the rural outpatient network proper Calculated according to: ^{[21, l. 4-4ob., 5ob.-6.; 32, l. 39ob.-40.; 34, l. 83ob.-84.; 35, l. 76ob.-77.]}.

As can be seen from the above materials, the implementation of therapeutic activities had a large territorial specificity. Thus, the republics of Central Asia were more dependent on evacuation and re-evacuation processes, which greatly changed the number of medical workers in the region, and, accordingly, the possibilities of local healthcare. The Republics of Transcaucasia and the Turkmen SSR largely focused on using the resources of urban settlements to help rural residents.

In quantitative terms, the absolute values of medical care provided to the rural population have decreased. This is especially true of medical inpatient institutions. In outpatient care, the decline was less noticeable, and in the largest republic, the RSFSR, there was even a slight increase in the number of visits by the rural population to outpatient clinics.

If we consider the relative indicators, then, taking into account the sharp decline in the rural population, we can talk about a quasi-increase in the amount of medical care provided to the population: relatively modest in terms of inpatient care (9.2% in the RSFSR for five war years) and quite serious for outpatient care (43.1% in the RSFSR for five war years).

At the same time, based on a comparison of qualitative indicators (lethality, the number of days before the discharge of the patient), it can be concluded that, in general, the qualitative level of treatment of patients has increased during the war years.

Thus, during the war years, active and quite successful activities were carried out in the countryside to preserve people's health, which allowed thousands of human lives to be saved.