On first thought it seems strange that the Soviet Union should have created so thorough and far-reaching a system of child welfare. On second thought, however, one can see at least two good reasons why it would do this. First, there is the paradoxical sentimentalism of the Russian people. On the one hand, they are extraordinarily brutal in their treatment of their own. The world has had its fill of the horrors of premeditated starvation of huge groups, of “purges” which seem incomprehensible to us, of cold-hearted, bestial brutality and of total indifference to the sanctity of human liberty and life. But there seems to be another side to the Russian character. They are astonishingly soft-hearted and sentimental about anything and everything that has to do with children. Not that this tells the whole story. I have a strong suspicion that the Soviet Government is keenly alive to the necessity of a high birthrate and the equal necessity of strong and vigorous childhood. Man power for future war material is also a necessity.
During this trip I heard a story which illustrates this strange dual temperament. It concerned an official in high authority in the old Cheka, which was the secret police organization that preceded the famous OGPU. This official had a particular passion for interviewing suspects who had already been made prisoners. His technique consisted of summoning these prisoners, one by one, to his office and listening, with apparent sympathy, to all they had to say. When they were dismissed and started for the door leading out of his office, he would pick up a revolver, which had lain concealed under some papers on his desk, and, quite calmly, shoot them in the back. After a morning spent in that edifying occupation, he would wander over to the near-by day nursery, which he had founded, and spend a refreshing half-hour playing gaily and solicitously with the children there. They told me about him at the day nursery, but only about this side of his life. And there is no reason to suppose that, being Russian, he could see or feel anything incongruous about this startling combination of tastes.
Now the Soviet Union is certainly feeling the full effect of the demand for child welfare that always arises in any nation that is frantically preparing for war. It is just another example of the grisly connection between the need for life and preparation for wholesale death. For its first ten years, before the policy of fostering the world revolution was officially soft-pedalled, the Soviet Union was morally certain that the Capitalistic powers would invade her at any moment. Today, with the ascendancy of Fascist powers in Germany and Italy and the emerging Fascism that has always been latent in Japan, war seems even more imminent than it did in Trotzky’s time from the Red Russian point of view. I am far from being an international political expert but I do know that you could not talk to any Intourist guide for ten minutes without hearing something about the Red Army and impending war and, from sickening experience, I know it is no accident that, in 1934, the two groups of Russians who looked really well fed were the soldiers and the children.
It was exciting for me who had spent twenty-three years fighting and intriguing to keep a huge municipality interested in babies, compromising here and there and gaining a little as the years went by, to see a whole nation straining every nerve to give babies and little children the best available, even if it was not altogether the best possible. But there was disappointment too in seeing the inefficiency and the primitive arrangements that, except in the cream of the day nurseries and hospitals, were all too often balking well-intentioned efforts in the Soviet Union. After all, the revolution left little enough of the middle-class Russian medical faculty. Red medicine was woefully short-handed, and, in building up a new generation of doctors, the Communist government had to work far too rapidly to get first-class results in either plant or personnel. It was very hard to find out much about those early, hastily organized medical colleges. But any well-trained doctor is perfectly aware that it takes years and years to build up an institution capable of affording a good medical education and that training ill-prepared young people in a hurry is always a mistake, even in a well-organized and well-staffed medical school. It is probably fair to say that, for some time, a young Russian man or woman could call himself or herself a doctor and be considered fit for practice on the basis of an amount of medical training that, in the United States, would be considered hardly sufficient for a hospital orderly. Nowadays, however, the standard is being raised. No doubt the present standard of medical training would be acceptable in almost every country.
Besides, the profession of medicine was, in those days, competing for the best young blood. Other kinds of technicians—engineers for instance—received much higher salaries than doctors and were likely to attract the more ambitious and possibly more intelligent class of young men. One result of this that naturally pleased me, of course, was that since so many of the better class of young men were crowded into engineering, the bright young women flocked to medicine. Already in 1928, according to the figures issued by the state, half of the doctors in the Soviet Union were women. The proportion continued to rise until, when we were there, it was quoted at a little over three-quarters for women. Since doctors’ salaries have recently been put in the same class as engineers’ salaries, the proportions between the sexes in medicine will probably revert to a more even basis. But in view of the impression I often encounter, among people who know Russians well, that the gray mare is usually the better horse, that may not necessarily be a good thing for Russian medicine. From my own experience I can offer tribute to the high-minded selfless ambition and professional alertness of women who are now doctors in Russia.
In acquainting myself with Russian medical standards, I naturally used American standards for comparison. Again and again I have been told that this is a great mistake and that the only fair thing to do is to make a comparison with what Russia had before the revolution. But I do not know much about what Russia had before the revolution and I do know what a reasonable attention to the dictates of modern medical discoveries calls for in a modern hospital, whether in America or in the Andaman Islands.
I think it was the swarms of flies in the hospitals and day nurseries that bothered me the most. They did not seem to bother the doctors or the patients or the children. But it was summer and fairly hot and the best screening that offered, when there was any at all, was rather decrepit and often torn mosquito-netting. It was not a matter of being far from home, unable to understand alien methods; in Helsingfors, for example, only overnight from the Soviet border, there were hospitals that, I could see at a glance, compared most favorably with the best I have ever seen in any city in the United States. So I must go on record here as feeling that the best managed and the best equipped hospital that I saw in Russia—and I saw most of the best hospitals west of the Urals—would be considered third-rate in the United States. Even the nurses, although probably willing enough, appeared barely better than the average ward maid in discipline and training. But you could not convey this impression to any of the modern Russians. One and all, from director down to the least important nurse, they were convinced that the Soviet Union had the finest hospitals, the best doctors and the most widely distributed medical service in the whole world. It was that way with everything. They are all trained to believe that only the Russian brand of Communism can produce any good and there is no point in trying to convince them that the capitalistic world ever so much as heard of a free clinic or a children’s playground. I soon learned that no one there had the slightest desire to hear of anything being done elsewhere. If I ventured to suggest that we had ambulances (which they seemed to think they had invented) or that our hospitals offered something that they had not yet heard of, a curious mental blankness would come over their faces; it was as though a screen had been pulled down in front of them. They knew nothing of the outside world and they did not want to know anything about it.
Still, that attitude has produced some fine achievements and some excellent work; they have the spirit of pioneers. There is no reason to believe that they will stop until their system of state medicine and child welfare really is as extensiv
e and as efficient as they think it is now. In fact, if they have, by this time, caught up with their theories, they may well now have the best nation-wide system of child care in the world. But there is a big “if.”
I always mistrust people who make broad generalizations about other countries. But I am fairly sure that I made out one significant Russian trait in my contacts with Soviet medical and welfare workers. They seemed to me practically incapable of distinguishing between the honest intention to do something and actually having done it. The idea was just as good as the fulfillment and less trouble. Everywhere we went, for instance, in child clinics and maternity wards there were posters tacked up on the walls, cleverly illustrating the idea that children should get plenty of spinach and orange juice. So they should, and this was extremely well done propaganda. But, unhappily, green vegetables and citrus fruits were practically unobtainable in the whole northern half of European Russia. If you asked: “But where do you get the oranges and spinach?” they would answer: “They are indeed difficult to get,” and go on to talk about something else.
Yet no one but me seemed disturbed by the unbridgeable gap between theory and performance. In Moscow I saw the most intelligent educational exhibit of infant hygiene that I have ever encountered. The whole story was there in pictures, models and charts, from conception to school age, covering diet, exercise, mental development, prenatal care, even birth control and abortion. In many other places I saw highly intelligent and effective displays teaching the best birth-control methods. Yet birth control equipment was practically impossible for the mass of the population to procure.
Nevertheless, there was always a counterbalancing, sanguine point of view to cheer you up when these absurdities had depressed you. Those clinics and day nurseries were often astoundingly primitive, but at least they were there, where they had never been before, battering away at superstition and ignorance. In a certain day nursery outside of Kharkov, that has always stayed in my mind as the dirtiest nursery I ever saw, all the little children had to eat was corn on the cob. But that was better than nothing and the state was supplying it free and, if some baby grew sick, there was a sort of doctor in the village, certainly far better than the oldtime herb doctor. Anyone who had been through all I had in the early struggles for saving babies, could hardly be discouraged by the sight of primitive conditions. And, as the least thing you can do for little children is always helpful, so these children were thriving on what was probably the first attempt at adequate care Russian children, as a whole, had ever had. The striking thing in the Soviet Union from the point of view of the child-welfare worker is that, however scrawny and stunted the middle-aged people may look, the youngsters are husky and plump; they look well-nourished and sturdy. And evidently quite smart. Almost universally, children under two years of age could dress and undress themselves with ease. I have seen that demonstrated, at the word of command, many times. In the better nurseries they wore aprons with symbols such as animals or flowers and these same symbols appeared on their mugs and face-cloths. The children could pick out their mugs and cloths at once even as our children do. They told me they had invented this idea and who am I to know better with the pictures of our well-equipped day nurseries in my mind?
The children, however, were dismayingly solemn. That used to worry me an unconscionable amount. It still worries me as I think back to it. If this was just “company manners,” then Russian children are the most easily trained of any in the world. I must have seen thousands of Soviet infants and children and, when they were not engaged dutifully in some kind of organized play, they just sat and looked at you like so many little Buddhas. They even had an exact moment when they all sat on their little chamber pots and, to judge by the rest of the system, I could only suppose that their bowel movements were regulated in true Soviet fashion. They never smiled. They never fought. Elsewhere in the world I have yet to see a sizable collection of two- or three-year-olds that will not at some time, in some way, start some sort of disagreement or row, whether there is a visiting foreigner there or not. I found myself actually itching to do something that would startle them out of their abnormal, stolid passivity. For they did not even cry. After you have seen thousands of babies and never even heard a whimper, there has to be a question. “Don’t they ever cry?” I asked. “It isn’t normal.” “No, no,” said our guide, rather pleased than not by the inquiry. “Why should a Soviet baby cry? There is nothing to cry about.”
That strange placidity seemed to hold good throughout childhood. I bought and brought home several delightful pictures of Soviet children grinning broadly, even laughing, or looking as though they were laughing. But throughout the length of European Russia, from Leningrad to Tiflis, I never saw any laughing children. That sort of thing depresses you just as Leningrad depresses you. In Rostov, way down south not far from the Black Sea, there was a certain amount of movement and gaiety on the streets, a sense of well-being and of having time to be cheerful. But in Leningrad the broad squares and wide streets that the Russian Emperors built to glorify themselves were lined with shuffling, stooping, gray-faced people all apparently walking nowhere in particular, glum, discouraged and pretty sordidly clothed. It seemed to me like a city of ghosts. Throughout Russia there were no generalizations that would hold good. The gray discouragement of Leningrad was, to a degree, offset by the semblance of crowded gaiety of Moscow. The tired, filthy and often diseased condition of the vast storms of people in the little towns along the Volga had its antithesis in the picturesque, astrakhan-capped brigands of the Caucasus. Everything is true about Soviet Russia and, equally nothing is true about Soviet Russia. So I well understand the widely varying stories that can come out of that astonishing land. We were, perhaps, fortunate as we were not on any conducted tour. Just the two of us with our guide who was an ex-Red-Army man and a most delightful companion. He spoke English perfectly, he was young and gay and, above all, constantly solicitous about his “two ladies.” Once outside of Moscow and Leningrad where the path is set for all tourists, we were free to go and to see anything we chose. In all we traveled about 6,000 miles. We had gay days and happy ones; we had experiences which still make me shudder. Bedbugs and cockroaches are not desirable bedfellows. But it was a colorful experience.
One thing that depressed me was the rapid turnover in responsible posts, if the medical and child-welfare end of the government is any example. Before we left America and while we were in London, I was well supplied with letters to the heads of the Health Departments of all the Soviets. Some of these came from an eminent Soviet diplomat. By the time we reached the various Soviets, not one of these men could be found. The office was always there but when I asked for the official to whom my letter was addressed, I met a simply evasive reply. “Doctor So-and-so has gone.” “No, we do not know where he is.” “We will take care of you.” I can only surmise that they had all been dismissed from their jobs in the space of two or three weeks and departed to that realm where “purged” Russians lose their names if not their lives. Maybe I landed in the middle of one of the “purges.” I do not know; I only know that it did rather alarm me.
I should have been far more puzzled by the discrepancy between the calibre of Soviet sanitation and the healthiness of Soviet children if I had not acquired so profound a respect for the congenital resistance to bacteria of the modern generation of Russians. Ernest’s acceptance of that unspeakable meal was nothing unusual. They are evidently immune to practically anything, even a joke. I can only suppose that the non-resistant strains died out during the revolution and the privations that followed and in the succeeding “terrors” of various kinds. We seldom saw elderly people, and few enough that were middle-aged. The streets, theatres and trains were full of people below thirty-five. In fact, Russia is generally populated by a post-war generation, all bred and fed on early hardships. Today, babies are fed solid and horrible food at an age that would frighten an American pediatrician, and they flourish on this diet. Babies can be born and spend their firs
t few weeks in a hospital swarming with flies and yet bid defiance to intestinal diseases. Families and their children can live in insanitary conditions and on a diet that would mean pestilence in this country. And all of them have a stoicism to pain that makes me marvel.
There are two incidents that I remember about this reaction to pain. They could be duplicated all over Russia. One day I was talking to a doctor and asked about his wife. He said she had gone to a dentist to have an impacted wisdom tooth pulled. “I hope the doctor has some anaesthetic,” I said. “Certainly not,” he replied. “Why should she have an anaesthetic? It will not hurt her at all.” On another occasion I was watching one of those famous (and then not prohibited) abortions. The surroundings were simple; only a few elementary instruments were used and aseptic precautions were startlingly lacking, but the technique was very good indeed. There was no anaesthetic either. No doctor who has had any experience with gynaecology need be told that a thorough curettage can cause almost unbearable pain. Yet that woman lay there on the table without contracting a muscle of her face and without any signs of distress whatsoever. Toward the end she reached out and squeezed her nurse’s hand a little and smiled. She had been completely stolid and immobile throughout. Once again I had to marvel at something I could not believe. “Good Lord,” I said, “how can she keep from screaming?” “Why should she scream?” asked the guide at my elbow. “She has confidence in her doctor.” The idea that confidence in the doctor was a substitute for ether was new to me. So was the fact, as evidenced in Soviet statistics about the results of free public abortions, that to perform curettage under startlingly insanitary conditions does not necessarily lead to a high death rate—if the patients are Russians. The average, as they gave it to me, was one death in every 25,000 operations and the ratio of sepsis somewhere around .03 percent. The only way I could account for it was that the Communist Party had outlawed sepsis along with private ownership of the means of production.
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