Semashko, Nikolai Alexandrovich

(1874–1949)

 

 

Semashko, Nikolai Alexandrovich (1874–1949)—prominent Soviet statesman. Member of the Bolshevik Party since 1893. Took an active part in the revolution of 1905–07. Was arrested in 1907 by the Swiss authorities; on his release from prison he moved to Paris, where he was secretary of the Bureau Abroad of the Central Committee of the Bolshevik Party.

 

N. A. Semashko and his role in medicine

Nikolai Alexandrovich Semashko (1874–1949) made a huge contribution to the development of not only Soviet, but also world medicine.

Semashko’s career did not begin with brilliant success: he graduated from Kazan University, after which he worked for 3 years as a zemstvo doctor in the Oryol province, and then in Nizhny Novgorod. The revolution in February 1905 ended for him with arrest, imprisonment for 10 months, and then 10-year emigration to France, Switzerland and Serbia. In the summer of 1917, at the age of 43, he returned to Moscow with a group of other emigrants. He took part in the medical arrangement of the country from the moment the idea of ​​creating a state health care system arose: first he headed the medical department of the Moscow Council, and later became the first People's Commissar of Health of the RSFSR. He managed the People’s Commissariat of Health for 11 years, in the most difficult years for the country, when the bloody Civil War was fought, epidemics raged in the Union.

He took part in the development of anti-epidemic programs, seriously stated the need to create a program for maternal and child health and the need to develop Soviet medicine by improving and expanding the network of research institutes. Under him, the sanitary-resort business began to develop intensively, the system of higher medical education was transformed.

N. A. Semashko made a huge contribution to the development of hygiene in the USSR, opening in 1922 the department of social hygiene at the medical faculty of Moscow State University. He himself was the head of this department for 27 years.

In the years 1927-1936. the first edition of the Big Medical Encyclopedia was created and released, the initiator of which was N. A. Semashko. From 1926 to 1936 he led the children's commission of the All-Russian Central Executive Committee.

He put especially much effort into studying the sanitary and hygienic situation after the war.

N. A. Semashko became one of the founders and one of the first academicians and members of the Presidium of the Academy of Medical Sciences of the USSR. He was the director of the Academy of Pedagogical Sciences from 1945 to 1949. Since 1945 he was the academician of the Academy of Pedagogical Sciences of the RSFSR. He also became the founder of the Institute of Organization of Health Care and the History of Medicine of the Academy of Medical Sciences of the USSR, after its creation he directed it from 1947 to 1949. This institute long afterwards bore his name; later it was renamed the National Research Institute of Public Health of the RAMS.

Semashko managed to leave his mark in the development of physical culture and sports, as he became the first chairman of the organization in charge of this field of medicine, and also headed the board of the All-Union Hygienic Society (1940–1949).

All his life he wrote scientific works and works, which number more than 250. All of them were devoted to theoretical, organizational and practical issues of hygiene and public health in general, which earned him an immortal memory among the people.

 

 

Dr. N. A. Semashko

The Commissar of Health

written by Anna J. Haines

 

TO THE leaders who are making history in the Russia of today, institutions, ideas, and people in collective masses constitute the interesting and determining factor in life, but to Americans, a greater value always seems inherent in the individual. If Nikolai Alexandrovich Semashko had accomplished in any other country what he has done in Russia, he would probably be a well-known figure in the medical circles of the world. The initiation and growth of the Commissariat of Health from nothing to its present enormous size is a monument to Dr. Semashko’s mental energy and tact in handling men.

Before the Revolution there had been no central health organization although several different departments like the army and the railroads, were doing unrelated health work. In general, doctors, like other professional men in Russia, were not sympathetic to the workers’ revolution, which deprived them of their property and private practice, and offered them in exchange hard work and low salaries as state officials. Out of this disaffected personnel and unorganized material setting Dr. Semashko has created an integrated Department of Health with a loyal group of men and women carrying out its complicated details over a wider area than that which any other state controls. He has been able to do this because everyone recognizes the sincerity of his interest in the health of Russian people, whether they be Slav or Semite, Communist or Cossack, peasant or professor. He is everywhere recognized as a party man of old standing, but in his appointments and his support of efficient fellow-workers he seems never to question anyone else’s politics. Therein is probably the secret of his having gained the respect and loyalty of so many of the medical profession in Russia to whom the theory of Communism is still abhorrent.

Dr. Semashko was born in the Orlov Gubernia in 1874. Growing up in the country he laid the foundation for a rugged good health which many radical leaders of Russia have lacked. Another characteristic which one senses on meeting him, and which was probably developed in his early years close to primitive conditions, is a quiet self-reliance, a practical ability to take care of himself and of others in any emergency, and this also is not a characteristic of all Russians. It is told of him that he showed very early much sympathy for the peasants and an intolerance for the way in which they were treated by the landowners. Once when he was quite a little boy he doubled his fists and started to fight a local official who had sent a young peasant, a friend of his, to jail because he had outraced the official’s horse on the road. And yet this sympathy with the peasants’ joys and sorrows never became sentimental. Perhaps from his very closeness to them he learned their weaknesses as well as their strength—their very human devotion to people rather than to ideas or ideals, and that selfish individuality bred by generations of wrestling single-handed with nature which makes them so uncomprehending of the meaning of socialism. Semashko never became a Populist, although many educated people of his generation, inspired by Tolstoi, gave themselves to this movement.

The nearby schools gave him his early education—a rather formal and bookish education under strict, almost military, discipline. During the last years of his course at the gymnasium (a school which corresponded to our high school and junior college years combined) he sought mental stimulus outside of the state supervised curriculum. With a number of other eager young students he organized a club for the study of political and social questions. Although their attitude was not very radical the young men took themselves seriously, and since those were the days of suppression of free thought and speech their professors also took them seriously. When the existence of the club was finally discovered most of the members were expelled from the school with a document prohibiting their entrance to any university, but Semashko was luckier than his fellows. He was an excellent student and had stood at the head of his class for several years, so that he escaped to the medical school of the University of Moscow with only a severe reprimand.

Coming to Moscow in 1893 he found a great many other students full of the same dissatisfaction with current political and social conditions as himself. This more mature group of young people was not content with a passive study of problems, but carried on a campaign of active propaganda. Reading clubs were organized and libraries of illegal books circulated among the intelligentsia, and much radical literature secretly distributed among the workers. Nikolai’s father had died while he was still at school and his university education was obtained by his own efforts, this necessity to work making it all the more difficult for him to find time to participate in the activities of radical circles. By his third year, however, he was already well known, and after some slight clash between the students and the police he was imprisoned for some months, together with several other leaders. The regimen was severe—small dark cells, no exercise, no reading matter, but finally they prevailed on the warden to give them one book. On unwrapping it they found it to be the Bible, in French. However, the Bible is more interesting than many would believe, and besides, Semashko became a very good French student during the next three months. At the end of that time he was exiled to his old home in the Orlov Gubernia, to be under police surveillance for a year and a half, and permanently expelled from the Moscow University.

While in the country he read omnivorously in science, history, philosophy and political economy, and also conducted a Sunday-school for workers on the railroad. These Sunday-schools were very popular and a legal means of educating illiterate adults, their political, social or religious significance depending largely on the personality of the teacher. By this time Semashko was teaching Marxian Socialism in his school. It is significant that he chose railway workers, and not his old friends the peasants, for pupils.

In 1897 his exile was over and he immediately entered Kazan University in order to complete his medical course. Again throwing his energy into radical channels we find him organizing secret political clubs among the city workers. In these activities he met and became the friend of Rykov, the present prime minister of Russia. Also he met an enthusiastic young woman student burning with zeal for social service, who became his wife. In those early days she helped him with his clubs and with the underground distribution of literature, until in 1901, during a sympathetic strike of the students on behalf of some poorly paid factory workers, Semashko was imprisoned as one of the leaders of the demonstration. After several months’ imprisonment he was released, but was refused permission to enter the city of Kazan or any other center of commerce. Owing to this prohibition he settled in the suburbs of the city and with considerable difficulty finished his medical studies and took his final examinations.

His first independent medical practice was in the Samara Gubernia, but in 1904 he moved to Nizni-Novgorod where he immediately became active in underground political work. The next year he was arrested again, and imprisoned for about a year. Having now the reputation of being a dangerous radical he knew that he would be so watched that further activities would be almost impossible, and on his release from prison he left Russia to join the group of emigrant Russians in Geneva.

Plekhanov, his mother’s brother, was there the leader of the Menshevik Socialists and as such distinctly cold toward his Bolshevik nephew. But there also he met and became the personal friend as well as the co-worker of Lenin. Pamphlets and journals were prepared here for distribution in Russia and other countries; party policies were fought over and adopted in semi-secret all-night sessions. It was a frugal, feverish life, exceedingly intellectual and unpractical, but very satisfying to the eager spirits of the participants.

In a few years the split in the Socialist Party was so serious that the Bolshevik group under Lenin’s leadership moved to Paris and the Semashko family joined them there, settling in the suburbs where their home and their children provided happy recreation for the serious idealists who were the parents’ friends. Dr. Semashko supported himself by his medical practice, but found time to be secretary of the Foreign Bureau of the Central Committee of his party and to devote much energy to the founding of a school for workers in Paris, and to speak publicly for social insurance, and for the eight-hour day. By 1913 the group of agitators were under such suspicion from the French government that it was necessary to find another home, and this time Dr. Semashko left the central cities of Europe for the Balkans where he worked as a doctor more or less obscurely until the March Revolution in Russia.

As soon as possible he tried to reenter Russia, but found that the Kerensky government was not especially hospitable to such a well-known Bolshevik as himself. He was detained at the frontier for several months, but finally entered Moscow in September and resumed both his medical and his political activities. He became a councilman for the Zamoskovresky ward, took part in the October Revolution and immediately afterwards was made head of the Moscow City Health Department.

This was an unorganized jumble of private hospitals without funds on which to operate, a few wretchedly equipped public hospitals and a dwindling staff of disgusted doctors, feldshers and nurses. While he was trying to bring some cohesion and plan of work to this mass of material the whole Soviet government moved down to Moscow from Petrograd, and almost immediately Lenin asked his old friend Semashko to draft a scheme for a Department of Health on a nation-wide scale.

To one who had been thinking in collective terms for so many years the paper plan for such a department was not difficult. The really great accomplishment has been to vitalize the plan. Socialized medicine has never been and cannot be a source of revenue to the state; on the other hand, like a public school system, it is tremendously expensive, and from the beginning even some of the Communists could see it only in that light. Semashko had Lenin and several others behind him in the fight for the recognition of the People’s Commissariat for the Protection of Health, but after it was created there remained the problem of making it work. Here Dr. Semashko was more alone, for the majority of people with whom he had to deal belonged to the aristocraticminded, old medical profession among whom Lenin’s approval was not a conspicuous help. The health conditions in Russia at that time, though exceedingly bad for the country, were perhaps of some assistance to the newly established Commissariat. Epidemics of typhus, cholera and malaria were raging; typhoid fever, smallpox and scarlet fever were increasing. In such a crisis it was easier to appeal to any physician’s loyalty to his profession, and also easy to make everyone appreciate the necessity for state control of the medical situation. By the time the worst years of plague and famine were over and a more constructive policy of prophylactic work brought into consideration, the Commissariat of Health was firmly marching, and the Commissar was granted by all to be a wise general of forces.

From 1922 to the present time have been years of gradual expansion and consolidation. Formerly famous specialists found themselves again at the head of their profession, irrespective of their political beliefs—that is, so long as they gave their scientific activity their whole attention, which the majority wanted to do. Dr. Pavlov is head of the Institute for Preventive Medicine in Leningrad, Dr. Speransky director of the Institute for the protection of Motherhood and Infancy in Moscow, and they with many others have wider opportunities and facilities for research than was possible in their former days of private practice. There are positions open to every doctor in Russia; two women physicians at least who were formerly nuns and who still wear their religious costume are now being employed by the government.

Much of the doctors’ willingness to work when people of other professions have sabotaged, much of the tolerance toward them on the part of a somewhat politically suspicious government is due to the general confidence in Dr. Semashko. Of all the Commissars he is the easiest to approach, the only requirement being that one put into writing one’s reason for seeking an interview with him, and then wait one’s turn in an ante-room decorated with signs “Smoking Not Allowed in the Offices of the Commissariat of Health”, “Do Not Shake Hands; It Is a Waste of Time and May Spread Disease”—slogans which are directed against two of Russia’s favorite habits. The Commissar himself is short, fat and jovial, definite in his questions and answers, showing a close and realistic knowledge of the many details of his department. One comes away from an interview feeling that one has been face to face with one of the real builders of the new Russia.

Extract from speech of Comrade N. A. Semashko, Commissar for Health of the R.S.F.S.R., at a conference of the Workers’ International Russian Relief at Berlin.


THE tasks of the Commissariat for Public Health have been extraordinarily heavy and full of responsibilities, but, in spite of all, we have succeeded in the main in overcoming the plagues and epidemics which had their cause in the famine, although in the Ukraine and in some of the eastern districts dysentery, typhus, cholera and small-pox are again breaking out.

But in every respect the worst consequences of the famine are to be seen in their effect on child life. In the cases of these plagues the organism of children has to put up a much greater power of resistance to enable it to recover than is the case with adults.

Russia has always had the sad notoriety of possessing the highest rate of infant mortality in the world. The death-rate in the case of young children is as high as 25 per cent. In consequence of the famine, this rose to 32 per cent. In the course of 1922, thanks to the energetic efforts of the Soviet Government and workers’ and foreign organisations, we were able to reduce it to 20 per cent. Since the war, and especially as a result of the famine, a serious diminution in the population of Soviet Russia has occurred, though this, is not the same in all districts. In Siberia it is much smaller than in European parts, largely due to the fact that in the latter there is a great shortage of food and suitable dwelling places, conditions which afford a fruitful soil for epidemics.

In our work for the public health we have to distinguish between two different categories of diseases—the plagues on the one hand, and social diseases on the other. Among the latter category we find two which have always reacted in a frightful way on public health—consumption and venereal disease. Unfortunately, the limited means at our disposal do not allow the majority of cases of the social diseases to be properly treated in sanatoria, so travelling dispensaries have been formed as the most ready makeshift. These travelling dispensaries do not wait until the sick come to them, but carry help and medical aid right into the factories themselves, seeking in every case to arrange for such a type of employment as will enable the disease to be successfully overcome. The travelling dispensaries, and also all other units of the Commissariat for public health, work in closest touch with the different workers’ organisations.

In addition to the dispensaries, every effort is being made to provide a sufficiency of sanatoria for sufferers, especially for sick children, who are also being housed in forest schools and similar institutions. In order to bring this work to completion, a large-scale campaign has been undertaken. A special propaganda week for the struggle against tuberculosis and prostitution has already been carried through, with special emphasis on the question of additional relief for unemployed women.

A further field of work is mother and child protection. For this purpose advisory centres have been opened in every large town and district, which do not, however, limit their activities to giving advice to mothers and expectant mothers, but carry through practical work in this field. Special homes for mothers with babies, and lying-in homes have been set up in all districts. In proportion to the enormous mass of population, what has. already been achieved only reaches relatively modest proportions.

In this connection one thing especially must be borne in mind. Formerly nothing whatever had been done in Russia in this direction, and the Soviet Government has had to break entirely new ground. To the Soviet Government belongs the credit for these important social innovations.

Child welfare is not by any means limited to babies and young children, but attention is also paid to the welfare of older children and the youth. All these activities find their best support through the planned work of the committees for dealing with the consequences of the famine, on all such committees both working women and youth having representation.

In the case of the youth special attention is paid to physical culture as a basis for proper mental and moral development. Monthly courses are given in every centre at which chosen workers from every factory and large undertaking attend. In this way general instructors in physical culture for the masses are provided. There are also more advanced courses covering a period of three years, which fits special youth instructors to take over educational work of greater responsibility.

In view of our tremendous needs in both a bodily and mental respect, what we have already been able to achieve may appear insignificant, but a good beginning has been made in face of great difficulty. War and famine have enormously increased the number of unprovided children. There are in Russia to-day about two million children for whose care and education nobody is responsible unless this is undertaken by the social organs of the State. Of these two million children about 1,300,000 have already been accomodated in homes. A further point that must be borne in mind, is that the majority of these children, due to the severity of famine conditions and the hardships they have suffered, are not only bodily, but also mentally, often abnormal.

What then, in view of these conditions in our country, can the Workers’ International Russian Relief do to most suitably aid the work of the Health Department of the Soviet Government? One special activity presents itself at once. The Commissariat of Public Health is engaged in the preparation of small travelling dispensaries for service among the rural population. These dispensaries are being prepared abroad for introduction into Russia as complete units of medical aid, fitted up with the most important medicines for fighting plague and social diseases. This is especially a task in which the W.I.R.R. can share by materially supporting the supply of these travelling dispensaries. Anything that can be done to provide the dispensaries, sanatoriums and children’s homes with the necessary material, faced and clothing, will be a material help for Russia of the first importance.

With reference to the change over from pure famine relief work to productive economic relief, the Workers’ International Russian Relief can be of special service with regard to our work in the Crimea. The Crimea is the most healthy region of Russia, to which sick people go when convalescent. The People’s Commissariat of Health yearly sends many thousands of consumptive workers to this region, because in its balmy climate they can find the best relief, and stand the best chance of recovery. Many sanatoriums and dispensaries have been set up in this area for the benefit of the sick workers of Russia, and not only that, but to enable partially recovered workers to remain longer in the Crimea until their health is once again established. We have set up farms, vineyards and similar undertakings in which these workers can be employed with profit to themselves and the Republic,

All comrades must realise that it is in raising the public health, lies the best basis for a sound rebuilding of Russian economic life. The rebuilding of Russia cannot be carried through by a sick nation, by broad masses whose hygiene, physique and sanitary requirements are not well developed. In the great and heavy work of rebuilding Russia, the health standard of the Russian masses is of the very first importance. It is to be hoped that the comrades who are creating and supporting the International Workers’ Relief for Russia may bear these truths continually in mind so that we may go forward to a practical realisation of Socialism based on sound minds in healthy bodies.

 

 

Lenin

Letter to Semashko

October 4, 1910

Dear N. A.,

We must meet as soon as possible to talk about the speediest convocation of a meeting of Bolsheviks (anti-Vperyodists). Yesterday Mark+Lozovsky+Lyova departed with a protest against a factional newspaper. The funny fellows! I am glad that the muddlers are out of it, but we must speedily ascertain the attitude of the remaining people. If possible come out as quickly as you can and take steps for an early meeting.

Yours,
Lenin