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The organization of medical care for the population of Buryatia during existence of the Far East Republic



UDK 614.2 (09) (571.54)

The ORGANIZATION of MEDICAL CARE for the POPULATION of BURYATIA during EXISTENCE of the FAR EAST REPUBLIC

S.D. Batoyev

Children's republican hospital, Ulan-Ude E-mail: drbol@buryatia. ru

THE ORGANIZATION OF MEDICAL CARE FOR THE POPULATION OF BURYATIA DURING THE EXISTENCE OF THE FAR EASTERN REPUBLIC

S.D. Batoev

Children Republic-wide Clinical Hospital, Ulan-Ude

Health workers in the bulk adequately carried out work on laying of fundamentals of effective state health care to the difficult period of existence of the Far East Republic (DVR). The uniform governing body of medical and sanitary business is allocated. Fight for increase in level of sanitary culture of the population, decrease in illiteracy, ignorance began. For the first time the system of delivery care and medical care for children became priority. Certainly, completely free and available the medicine on this interval of time could not be. Health workers and their families starved, did not earn the put salary. The Materialnotekhnichesky base of health care was weak. Loans and various grants of DVR from the Soviet Russia made not less than 14 million rubles during 1921-1922. All this helped to achieve by the end of 1922 of the budgetary balance, having given rise to rise in the national economy and gradual strengthening of material and technical resources of the state health care.

During the hard period of the existence of the Far Eastern Republic the most of medical staff had led the worthy work laying the foundation-stone of the efficient National Health Service. The united body of the medical-sanitary management was established. The struggle for the increasing of the sanitary-cultural level of the population, reducing of the illiteracy and ignorance had begun. For the first time the system of the confinement of children and health care of children had become the priority. Certainly, health care could not be completely free and their families starved and did not get the prescribed salary. The material and technical foundation of the National Health Service was weak. The contributions and different donations, provided by the Soviet Russia to the Far Eastern Republic during the 1921-1922 were not less than 14 million rubles. All these measures had helped to reach the budget balance by the end of 1922 and gave the beginning to the development of the socialist planned economy and the gradual fortification of the material and technical base of the National Health Service.

The Soviet power was established in Transbaikalia on February 16, 1918. The imperialistic states and a counterrevolution began fierce fight against the young state of workers and peasants. Advance of the Red Army for Baikal inevitably would lead to military collision under unprofitable conditions for the Soviet power. Considering these circumstances, the Communist Party and the Soviet government made the decision to refuse immediate Sovietization of Transbaikalia and the Far East and to head for creation here of the intermediate, buffer state - the Far East Republic. Officially the foundation to formation of the buffer state was laid in Verkhneudinsk (nowadays for Ulan-Ude). Opened on March 28, 1920. The constituent congress of workers of Baikal region addressed on April 6 all governments and people of the world with the declaration on formation of the independent democratic Far East Republic. Borders of the new state had to oh -

to vatit the Transbaikal, Amur, Sakhalin and Kamchatka regions and a right-of-way of the Chinese-east Railroad (CER) [1].

The Ministry of national affairs created in DVR was engaged in practical implementation of tasks in the field of national policy, making use of experience of national construction in RSFSR. The constituent assembly of DVR decided to allocate all territory inhabited drill - the Mongolian people, to the special Buryat Mongolsky autonomous region. Its structure included the following aimags: Agin, Barguzin, Horinsky and Chikoysky.

From May 23 to June 3, 1920 in Verkhneudinsk the Buryat Mongolsky national and revolutionary committee (Burnarrevk) as the leading national authority of East Transbaikalia was created. In Verkhneudinsk the organization of the office of the Ministry of Health of DVR led by the Bolshevik Fiodor Nicolae - began

vichy Petrov. Studying documents of RSFSR, DVR and the state archive of the Chita region (Zabaykalsky Krai), we found many official papers and orders signed by F.N. Petrov. He met the February revolution in Irkutsk where he managed sypnotifozny barracks, directed the Bolshevist organization of the working suburb of Irkutsk - Znamenka. In 19201922 F.N. Petrov was a member of Revolutionary Military Council of army, the member of the RCP(b) Central Committee Far East bureau, the vice-chairman of Council of ministers of DVR, the Minister of Health and internal affairs. As the head of the delegation of DVR, F.N. Petrov conducted negotiations with representatives of Japan at the Dayrensky conference on withdrawal of the Japanese troops from the territory of the Far East.

Aiming at creation of the state health care system, the Temporary Business Presidium of the government decided: "All medical and sanitary, veterinary institutions and institutions, and equally bacteriological institutes, the antiplague stations, sanpo-driving, floating hospital and so forth as civil (resettlement, railway, waterways of the message, mountain and so forth), and throughout the Far East Republic turn the military of departments and public private organizations (zemstvoes, the cities, fellow countrymen unions, a sogor, a zemgor, society of the Red Cross, health insurance funds and so forth) into maintaining and submission of the Ministry of Health.

Throughout the territory DVR is entered public and free medical care in all its types (out-patient, stationary, resort and sanatorium, dental, etc.) for all labor groups of the population [2].

The resolution is signed by the chairman A. Krasno-shchekovym. For No. 1 F.N. Petrov is appointed the Minister of Health [3].

The Prime Minister of DVR A. Krasnoshchekov issued order No. 24 of November 29, 1920 [4] by which he approved employees of the Ministry of Health in positions: the doctor of medicine Yu.B. Klein - the manager of medical department; the doctor L.I. Dobrovolsky - the manager of sanitary and epidemiologic department; the doctor P.Ya. Kaplunov - the head of department of medical areas; the doctor A.N. Beck - the head of department of protection of motherhood and an infancy; the doctor G.A. Kohn - the head of department of the State medical examination; the doctor I.I. Golderin - the manager of sanitary and educational department; the pharmacist I.G. Bankevits - the manager of pharmaceutical department; the veterinarian L. Suntsev - the chief of the head Veterinary department; G.E Galferova - the head of department of the general supply; the engineer to A.A. Petya - managers of sanitary department; I.I. Portnyagin - the manager of sanitary and statistical department; I.G. Koloyartseva - the manager of finance department; A.F. Bonch-Osmolevsky - managing affairs of the Ministry of Health.

On December 20, 1920 the government approved the provision on the Ministry of Health in which it was emphasized that "The Ministry of Health is the highest state establishment uniting and leading all medical and sanitary and veterinary business of DVR" [5]. The law "About the right was approved

medical practice in DVR" [6] according to which the doctors and average health workers who gained the diploma at the Russian universities, army medical college and medical assistant's and obstetric schools had the right of universal continuous medical practice and foreign physicians were allowed to practice after passing of check in the special commission where certificates of the established sample were issued it. For the purpose of strengthening of party influence in bodies and healthcare institutions order No. 30 of March 30, 1921 entered institute of political commissioners [7]. Among other things, on politkoma also such duty as creation of libraries at medical institutions lay. We provide the report of one of politkom of September 18, 1921. "Libraries in Verkh-neudinska city hospitals and in an oblzdrava with quantity of 400-500 copies of books in everyone are created, literature for creation of libraries at the Barguzin and Troitskosavsky uyezdzd-rav is received. Trade-union work" returns to normal [8].

In this report it is about medical institutions of the Baikal oblzdrav. Except the Barguzin and Troitskosavsky uyezdzdrav, entered it also Ver-hneudinsky gorzdrav and uyezdzdrav. Worked as Politkomami: in Verkhneudinsky infectious hospital V. Zavrazhnov, in Verkhneudinsky city hospital - Snegirev [9]. In half a year the institute of politkom was abolished as carried out an objective. The organizations of health care in the Buryat Mongolsky autonomous and Pribaykalsky DVR regions were in financial difficulties, nevertheless, the government of DVR allocated in

1921 of means for the equipment in Buryat Mongolsky area of three hospitals, four medical out-patient clinics and ten infirmaries. In general 120 thousand rubles with gold were allocated for needs of health care [10]. About what was situation with medical care of the population living in the territory of the Buryat Mongolsky area of the beginning of 1921 it is possible to judge by the report of the manager of health care of Buryat Mongolsky off-line control (Burmonav-tupr) doctor D.V. Pisarev: "The population of the autonomous region consists of 113627 people. On aimags it is distributed so: in Barguzin - 11958 people, in Chikoyskom

>- 18247 people, in Horinskom - 49957 people and in Agin - 33465 people. Now there are on all area only two doctors and four paramedics" [11].

Since November 1, 1921 at aimags of the Buryat Mongolsky autonomous region local councils of health care were organized [12]. Such council was authorized governing body of medical care of the population. Were its part:

1) all medical personnel of this site;
2) representatives of local public government (2 persons);
3) representatives professional, cooperative and

the cultural organizations - on 1 person;

4) local teachers - on one representative.

For the management of meetings the chairman, the companion of the chairman and the secretary was available.

Council of health care paid much attention

to health education of the people. Here one of documents of that time: "To provide teaching at schools as an obligatory subject, a course of public and personal prevention of infectious diseases, mainly syphilis, gonorrhea, tuberculosis and trachoma; to give lectures and conversations; to release sanbyulleten, articles and brochures" [13]. Much attention was paid to the organization of obstetric care to the population. In 1920 in Verkhneudinsk it was decided to open a maternity shelter [14]. On November 15, 1920 the commission as a part of the manager of medical and sanitary bureau doctor A.V. Segelman managing city hospital of doctor M.V. Tansky, the operator of the Ministry of Health of DVR technician V.G Levitsky and the city mechanic Evgrafov examined the building of the house owner Zaguzin for adaptation it under a maternity shelter and found necessary to repair. The estimate made 515200 rubles.

Thus, the maternity shelter began to function since December, 1920 as office of the hospital which was available in the city on 50 beds. Also as office the shelter day nursery was organized. Entered into staff of city hospital: the manager is a doctor Mikhail Vasilyevich Tansky, the attending physician Aleksandra Afanasyevna Tol-stikhina, two lekpom, the paramedic-midwife Anna Afanasyevna Gorbunova, three nurses, two hospital attendants, the supply manager, a kontorshchik, the disinfector, the cook and her assistant, the laundress and the janitor. The doctor Sara Davydovna Pandre managed a maternity shelter, Olga Pavlovna Karpacheva, Nadezhda Nikolaevna Goldberg, Maria Pavlovna Odintsova worked as midwifes. The state of a shelter day nursery consisted of the manager

>- doctor Vera Iosifovna Rodovskaya, nurse Eudoxia Nikolaevna Solovarova, housekeeper, seven nurses and laundresses.

In 1921 in Pribaykalsky region the city hospital extended up to 80 beds [15]. Also the hospital of society "Economiya" on 25 beds, infectious hospital on 100 beds and the cholera barrack developed at it on 30 beds functioned. There was Verkhneudin-Skye a prison hospital on 50 beds.

In such extensive territory as the Barguzin County were available: city hospital, out-patient clinic and pharmacy in Barguzin, Telyatnikovsky hospital, pharmacy to Gorya-chinske, three medical sites and 13 infirmaries. For comparison: today in the territory of this former county in detail 5 central district hospitals - Barguzin, Kurumkansky, North Baikal, Baun-tovsky, Eravninsky.

Troitskosavsky uyezdzdrav had city hospital, the infectious barrack, pharmacy, out-patient clinic, 3 medical sites, 12 infirmaries and Tamirsky hospital.

In the Verkhneudinsky uyezdzdrav were developed: Petrovsky hospital with out-patient clinic, pharmacy in the village of Hilok, 7 medical sites and 16 infirmaries.

The hospital of the American Red Cross in Verkhneudinsk existed since January, 1920 and in June, 1920 was transferred to the jurisdiction of the city. Here organized local surgical infirmary. This building was built in the 1909-1910th at the expense of the Russian Red Cross. The room was planned according to requirements of modern clinic, equipped with a water supply system,

washing rest rooms and bathrooms. Water arrived from own well by means of the electric pump. In the building the x-ray office and also operational and chemical and bacteriological laboratory were located [16]. The infirmary had 115 beds and had the following offices: surgical - 50 places, department of internal diseases - 30, department of female diseases - 15, skin and venereologic office - 20 places [17]. Treatment was paid and rather expensive.

The severe need in pharmaceutical workers was felt. So, for November 20, 1920 the staff of pharmaceutical public health department of Pribaykalsky region consisted of 7 people. 18 employees, including 2 pharmacists worked at the Top-non Udi regional warehouse. In the city two pharmacies in which 22 persons worked functioned. Pharmacies in Barguzin, Goryachinsk, Troitskosavsk, Hilke, the Petrovsky plant were developed [18].

The order of the Ministry of Health of DVR of October 28, 1921 to a position of the manager of the Baikal Regional public health department approved the doctor Nikolay Mikhaylovich Serkov, the graduate of medical faculty of the Tomsk university of 1906 [19].

At this position he worked more than 2 years. In Buryatia the memory of it remained as about the organizer of the first Baikal kumysolechebnitsa who was opened in

1922 in 6 versts from Verkhneudinsk in the beautifull place Upper Beryozovka [20]. At a kumysolechebnitsa were available: out-patient clinic, chemical bakteriologicheskya laboratory and solyarium.

N.M. Serkov reflected a condition of medical care for the population of Pribaykalsky region from 03.03.1920 for 01.10.1921 in the report [21]. "Upon termination of a congress of the working people of Baikal region and after the organization by the new government of the Ministry of Health - N.M. Serkov writes - the section of health care was on April 22, 1920 perereformirovan in the regional public health department subsequently renamed into regional to which jurisdiction civil medical institutions and institutions within 3 counties - Russians, and 3 aimags - Buryat were transferred. Reduction in the correct system of all medical and sanitary management was made during everything 1920 and the beginnings of 1921".

The Baikal regional public health department as the executive body of the Ministry of Health knowing business of protection of national health among the civilian population of Baikal region had at that time in the maintaining three counties: Verkhneudinsky, Troitskosavs-ky and Barguzin.

Doctor Serkov gives the following network of a sanuchrezh-deniye of the Buryat Mongolsky autonomous region: The 3rd county - it is sensible, 15 medical sites, 41 infirmaries, 3 city hospitals on 50 beds, one Verkhneudin-Skye infectious hospital on 100 beds, 2 infectious barracks on 50 beds, 5 out-patient clinics, 3 disinfection groups, 1 anatomic rest, 1 regional pharmaceutical warehouse, 7 pharmacies, 3 epidemic groups, a maternity shelter on 25 beds, 1 shelter day nursery on 25 beds [22]. In the area 23 doctors, 24 school and 44 company feldshe-worked

ra, 3 dentists, 12 paramedics-midwifes, 7 obstetricians, 14 nurses and 17 pharmacists [23]. These 3 counties occupied the huge territory of the Far East Republic. It is enough to tell that in Soviet period 7 areas Buryat the ASSR and the Chita region were developed in the former Verkhneu-dinsky County.

In 1921 the supply of the population with doctors was very low, in counties - and that is lower. So, in the area 0.9 doctors respectively were the share of 10000 population: in the Barguzin County - 0.7, Troitskosavsk - 0.5 and in Ver-hneudinsky - 0.4. Doctor Serkov explains such situation as follows: "One of the main reasons which are slowing down work of medics besides their numerical insufficiency, is until the very last day the extreme material neediness paralyzing both will, and desire of the most zealous of them. Hunger and need, here two trees of that cross which is born on the shoulders by fighters for national health, following everyone to the Golgotha. On the matter was written much and to repeat the tenth one time and too there are no more than forces".

But the most conscious, standing on a democratic platform doctors continued to work selflessly. The list of doctors who, overcoming difficulties, worked at that time in the city of Verkhneudinsk [24] remained.

GYa was a city health officer. Lyubarsky, the senior doctor of infectious hospital worked as L.S. Reznits-ky, a medical expert was K.N. Terentyev, in city hospital M.V. Tansky and G.V. Bogolyubov worked.

In Verkhneudinsky railway hospital doctors V.V. Natanson, I.I. Alekseev and the dentist E.Z. Soroker, the paramedic S.S. Titov, the midwife A.N. Cherepanova worked.

N.M. Serkov paid to strengthening of material resources of health service of the city much attention. We submitted the following document signed with it: "In view of the fact that the city of Verkhneudinsk is the regional center and, in view of small fitness of the old building of city hospital under a medical institution, the regional public health department excited the petition for transfer of Verkhneudinsky local voyennokhirurgichesky infirmary with chemical and bacteriological laboratory in the order of civil department for the device in it regional hospital that will give the chance to support her with combined forces areas, having kept an expense of the city and county on the maintenance of a little satisfying all, city hospital" [25]. Unfortunately, this petition was not satisfied.

To areas there was a fight against infectious diseases. Its state is completely reflected in the report N.M. Serko-va [26]. "The typhus epidemic which took in 1920 a wide wave Siberia was thrown in Baikal region and extended on all three counties. In time from May 1 to December 31 3605 diseases sypnyaky with 273 mortal outcomes (7.6%) were registered; returnable typhus gave 306 cases with 12 mortal outcomes (4%); the typhoid gave 461 cases with 15 mortal outcomes (3.4%). Incidence of typhus in 1921, having sharply gone down in the cities, continued to rage in counties, especially in Verkhneudinskom, near the Chikoy River and pogra-

nichny district of the Troitskosavsky County. From January 1 to August 1, 1921 on area 2645 cases of a typhus and 230 (8.7%) mortal outcomes were observed; returnable typhus - according to 147 and 18 (4.3%); typhoid

>- 517 and 64 (21.39%)".

The regional public health department took vigorous measures, sending epidemic groups to places. So, in the Barguzin County the group of doctor I.F. Shtessel, in the Troitskosavsky County - the doctor Zeydne-r worked, and in the Verkhneudinsky County the group was headed by the doctor Mla-dov.

We will address the report on activity of the Baikal regional public health department in time from October 1, 1921 to February 1, 1922. "Work of department all the time proceeds in extremely adverse conditions, the main of these reasons is material neediness of health workers" - is emphasized in it.

Medical care drill - Mongolian it was to the people aymzdrava. The last were in the Agin, Horinsky, Barguzin and Chikoysky aimags. In total the foreign population made about 131332 people. D.V. Pisarev worked as the manager of Buryat Mongolsky public health department. The department was located in Chita. The means were provided for the maintenance of a medical and sanitary part of the Buryat Mongolsky Autonomous region on the estimate of People's assembly. If the account estimate on health care in 1921 made 17900 rubles [27], then in the first half of 1922 it increased already up to 46735 rubles [28]. However medical institutions were developed not across all territory of present Buryatia. So, for example, in 1921 in the extensive area Bauntovs-kom there was neither doctor, nor the paramedic, nor a lekpo-m.

the Provision of health care of area improved extremely slowly. Zavoblzdravy N.M. Serkov in the report of December 15, 1921 wrote about this so: "on October 1

1921 is that side with which began and continues business of destruction of what was created in the previous one and a half years in the field of health care till this moment. Till this time medical and sanitary business was centrally, medical institutions and medical institutions existed at the expense of the Ministry of Health of DVR. But once the government stated that cares of expenses on the maintenance of medical and sanitary institutions have to be an area of jurisdiction and attention of municipalities of domicile that the contents and the invitation of medical staff are business of also local government as a picture sharply changed [29]. Verkhneudinsky of mountains-narrevkom - we read further in the report, - accepted medical institutions of the city on the contents, only after the categorical order of the regional emissary and regional management and started first of all staff reduction at discretion. The only maternity shelter in Verkhneudinsk is closed, the room is given for a body. Verkhneudinsky gornarrevky established a payment in infectious hospital on 1 ruble 80 kopeks by gold in day from the person, and Troitskosavsky gornarrevky, having it is available smallpox epidemics, decided to close the infectious barrack. Within 5 months oblzdrav did not receive to -

peyka. Medics and their families literally starve as two months did not earn a salary".

The Verkhneudinsky city hospital was subsidized with town council and was paid. For outpatient appointment 10 rubles, for daily keeping and treatment of the patient - 65 rubles, for daily keeping and treatment of children to 12-year age - 32 rubles 50 kopeks, for maintenance and treatment of children to 12-year age in the infectious barrack - 32 rubles 50 kopeks were raised [30]. However at the same time it is necessary to notice that workers and employees of all institutions and enterprises of the city including the foreign citizens who submitted the relevant documents were exempted from payment. It is also necessary to note that in case of evasion from payment for treatment the last was raised forcibly.

The financial and economic situation in the Far East Republic was difficult. The government of DVR decided to abolish the Ministry of Health. On September 25, 1922 the law on Head department of health care of the Ministry of Internal Affairs was issued [31]. Doctor L.A. Korenevsky was appointed the chief of Head department of health care [32]. In 1922 at a meeting of doctors of the Chita regional hospital the payment for treatment and surgery was defined. Now outpatient appointment cost 50 kopeks, bandagings - from 75 kopeks to 1 ruble 50 kopeks, and out-patient operations - from 80 kopeks to 1 ruble. A phlegm research - 75 kopeks gold, and urine - from 50 kopeks to 1 ruble gold. Daily stationary keeping of the patient was estimated at 1 ruble. The performed operations cost from 2 rubles to 35 rubles, and normally proceeding childbirth was estimated at 3 rubles. On November 14, 1922 in the city of Chita the act of the government of the Far East Republic of addition of the power was published [33].

Thus, the Far East Republic successfully carried out the problem of prevention of military collision of the Soviet Russia with imperialistic powers. Health workers in the bulk adequately carried out work on laying of fundamentals of the state health care to this difficult period. Fight for increase in level of sanitary culture of the population, decrease in illiteracy, ignorance began. Certainly, completely free the medicine on this interval of time could not be. Health workers and their families starved, did not earn the put salary. The material and technical resources of health care were weak. In successful implementation of the program of economic construction planned in DVR full assistance about hundred - had huge value

Rhone of the Soviet Russia. Loans and various grants to the Far East Republic made during 1921-

1922 not less than 14 million rubles. All this helped to achieve by the end of 1922 of the budgetary balance, having given rise to rise in the national economy and gradual strengthening of material and technical resources of the state health care.

Literature

1. History Buryat ASSR. - Ulan-Ude, 1959. - T. 2. - Page 140.
2. GAChO Resolution No. 6 of November 5, 1920 - Chita. - T. 1144. Op. 1, Unit of Hr. 1, L. 3.
3. GAChO. - T. 1144. Op. 1, Unit of Hr. 1, L.7.
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18. GAChO F. River of 1144. - Op. 1, Unit of Hr. 10, L. 23-24.
19. GATO F. 102. - Op. 2, 1899.
20. GAChO F. R 1144. - Op.1, Unit of Hr. 21, L. 210.
21. GAChO F. R 200. - Op.1, Unit of Hr. 3, L. 1-3.
22. GAChO F. R 200. - Op.1. Unit of Hr. 3, L. 1 about.
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27. CGA RSFSR DV F. River of 1468. - Op. 1, 73, L. 61.
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29. GAChO F. R 181. - Op.1, Unit of Hr. 5, L. 20.
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31. GAChO F. P181. - Op. 1, Unit of Hr. 6, L. 67.
32. GAChO F. River 181. - Op. 1, Unit of Hr. 21, L. 21.
33. GAChO F. R 1122. - Op.1, Unit of Hr. 4, L. 17.

Arrived 20.08.2010

Maria Agnes
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